Child Psychology

Child Psychology and Childhood Depression

Last Updated Oct 5, 2008 00:40 PM

Studies of Childhood Depression

A review of the literature was conducted to identify empirical studies of psychosocial and pharmacological treatments of children with depression. This review was conducted in two stages. First, systematic computerized literature searchers were conducted on PsycINFO and Medline databases, with keywords depression and major depression. The resulting list of references was reduced to include only those studies that: (1) were identified in the electronic database by one or more of the following study descriptors: treatment outcome study, clinical trial, controlled clinical trial, or randomized controlled trial; (2) included subjects between the ages of 6 and 12 as the primary treatment target population, although studies that included younger children and adolescents were not excluded; (3) were published between 1985 and 1999; and (4) were published in the English language. Second, reference lists obtained from review articles and book chapters were searched to ensure that all of the relevant studies had been identified. This search strategy resulted in 28 potential studies. This list was further reduced by excluding studies for the following reasons: depression was a secondary comorbid diagnosis (e.g., mentally retarded children, socially anxious children, medically ill children; n = 4); the study focus was other than treatment outcome (e.g., effects of extended evaluation on symptoms of depression, factors related to correspondence to teacher and child ratings, information processing in recovered depressed children; n = 4); or subjects were not randomly assigned to treatment conditions (n = 1). This process identified 19 peer-reviewed controlled studies of children with either depression or depressive symptoms. These studies are presented and described in table 2.

Perhaps the most striking conclusion that can be drawn from the current review of empirical studies of childhood depression is the relative paucity of well-controlled outcome studies with this population. Psychosocial and pharmacological interventions are the two primary treatment modalities that have been studied. The psychosocial interventions investigated include individual and group cognitive behavior therapy, self-control training, and problem-solving and social skills training. The pharmacological interventions include tricyclic antidepressants (imipramine, nortriptyline), selective serotonin reuptake inhibitors (fluoxetine), and phenethylamine monoamine reuptake inhibitors (venlafaxine).

Generally, it can be concluded that both cognitive behavior therapy and self-control therapy are efficacious treatments for children with symptoms of depression. However, with few exceptions, the inclusion criteria for psychosocial treatments were based on depressive symptoms rather than a diagnosis of depression, and treatments usually occurred in school settings with an average of 12 sessions. Few of these studies reported followup data. In the few studies reporting longitudinal data, treatment gains were maintained at followup.

Research addressing the efficacy of tricyclic antidepressants for the treatment of childhood depression failed to find superiority for its use over placebo. Thus, there is no evidence to suggest that tricyclic antidepressants should be used in the treatment of children with depression. However, studies investigating the effectiveness of selective serotonin reuptake inhibitors are promising. One recent double-blind, placebo-controlled study of fluoxetine for childhood depression reported significant treatment effects relative to placebo. A second new generation antidepressant venlafaxine (a phenethylamine monoamine reuptake inhibitor) has not been found beneficial for this population. Well designed studies regarding the safety, efficacy, and long-term use of antidepressant medication need to be conducted before strong statements can be made regarding their overall efficacy in the treatment of childhood depression.

References
Studies of Childhood Depression

Stark, K. D., Reynolds, W. M., & Kaslow, N. J. (1987). A comparison of the relative efficacy of self-control therapy and a behavioral problem-solving therapy for depression in children. Journal of Abnormal Child Psychology, 15, 91-113.

Stark, K. D., Rouse, L. W., & Livingston, R. (1991). Treatment of depression during childhood and adolescence: Cognitive-behavioral procedures for the individual and family. In P. C. Kendall (Ed.), Child and Adolescent Therapy: Cognitive-Behavioral Procedures (pp. 165-206). New York: The Guilford Press.

Vostanis, P., Feehan, C., & Grattan, E. (1998). Two-year outcome of children treated for depression. European Child and Adolescent Psychiatry, 7, 12-18.

Vostanis, P., Feehan, C., Grattan, E., & Bickerton, W. L. (1996). A randomised controlled out-patient trial of cognitive-behavioural treatment for children and adolescents with depression: 9-month follow-up. Journal of Affective Disorders, 40, 105-116.

Vostanis, P., Feehan, C., Grattan, E., & Bickerton, W.-L. (1996). Treatment for children and adolescents with depression: Lessons from a controlled trial. Clinical Child Psychology and Psychiatry, 1, 199-212.

Weisz, J. R., Thurber, C. A., Sweeney, L., Proffitt, V. D., & LeGagnoux, G. L. (1997). Brief treatment of mild-to-moderate child depression using primary and secondary control enhancement training. Journal of Consulting and Clinical Psychology, 65, 703-707.

Wood, A., Harrington, R., & Moore, A. (1996). Controlled trial of a brief cognitive-behavioural intervention in adolescent patients with depressive disorders. Journal of Child Psychology and Psychiatry and Allied Disciplines, 37, 737-746.

See also Child Psychology 555 1 - 2