Characteristics Associated with Depression Severity in 270 Juveniles in a Major Depressive Episode

Abstract

Introduction: Severe depression is prevalent in young persons and can lead to disability and elevated suicidal risk. Objectives: To identify clinical and demographic factors associated with the severity of depression in juveniles diagnosed with a major mood disorder, as a contribution to improving clinical treatment and reducing risk of suicide. Methods: We analyzed factors associated with depression severity in 270 juveniles (aged 6–18 years) in a major depressive episode, evaluated and treated at the Bambino Gesù Children’s Hospital of Rome. Depressive symptoms were rated with the revised Children’s Depression Rating Scale (CDRS-R) and manic symptoms with the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS) Mania Rating Scale (K-SADS-MRS). Bivariate comparisons were followed by multivariable linear regression modeling. Results: Depression severity was greater among females than males (55.0 vs. 47.2), with the diagnosis of a major depressive disorder (MDD) vs. bipolar disorder (BD; 53.8 vs. 49.3), and tended to increase with age (slope = 1.14). Some symptoms typical of mania were associated with greater depression severity, including mood lability, hallucinations, delusions, and irritability, whereas less likely symptoms were hyperactivity, pressured speech, grandiosity, high energy, and distractibility. Factors independently and significantly associated with greater depression severity in multivariable linear regression modeling were: MDD vs. BD diagnosis, female sex, higher anxiety ratings, mood lability, and irritability. Conclusions: Severe depression was significantly associated with female sex, the presence of some manic or psychotic symptoms, and with apparent unipolar MDD. Manic/psychotic symptoms should be assessed carefully when evaluating a juvenile depressive episode and considered in treatment planning in an effort to balance risks of antidepressants and the potential value of mood-stabilizing and antimanic agents to decrease the severity of acute episodes and reduce suicidal risk.

Correlates of suicidality in young people with depressive disorders: A systematic review

“…Depression severity and recurrence were positively associated with suicidality. These findings are congruent with a large body of existing literature (Avenevoli et al, 2015;Handley et al, 2018;Hetrick et al, 2012;Serra et al, 2021;Stewart et al, 2019;Xu et al, 2018), though it must be noted that several included studies (Gulec et al, 2010;Hart et al, 2001;Rudd et al, 1996;Seo et al, 2015;Zhang et al, 2016) failed to find statistically associations between these aspects and suicidality. In young people, it is likely that associations between depression severity and suicidality are influenced by psychological factors such as resilience, emotion regulation, and hopelessness (Bilgiç et al, 2017;Bridge et al, 2006;Tamás et al, 2007;Teismann et al, 2018) and psychosocial factors such as social support and negative life events (Esposito and Clum, 2003;Kerr et al, 2006;Siegmann et al, 2018).…”

Childhood Clinical Features Preceding the Onset of Bipolar Versus Major Depressive Disorders During Adolescence

“…Indeed, there is a high rate (20%-45%) of change of diagnosis from MDD to BD among of juveniles initially meeting diagnostic criteria for MDD, based on emergence of hypo manic, manic, or mixed states, sometimes during treatment with an antidepressant or other moodelevating medicine (Baldessarini et al, 2013;Faedda et al, 2015). Also, severe major depressive episodes during juvenile ages are fre quently characterized by the presence of subthreshold manic or mixed symptoms such as mood lability, severe irritability, and racing thoughts both in subjects nominally diagnosed with either BD or MDD (Serra et al, 2021). Indeed, most cases of juvenile mood disorders, including those in our sample, appear to be distributed on a spectrum and longitudinal observation sufficient to allow differential diagnosis between single episode or recurrent depression versus fully expressed bipolar disorder at the moment is not available.…”

Factors behind a remarkable increase in adolescent psychiatric inpatient treatment between 1980 and 2010 – a nationwide register study

“…There is no evidence that depressive disorders, more common among females, would have increased in prevalence in the adolescent population. However, depressive symptoms may be more severe in females, therefore, possibly increasing the need for inpatient care [47]. Externalizing symptoms and disorders, more common among boys, may also trigger child welfare interventions instead of psychiatric interventions.…”