Definition of Depression

‘Depressive disorders are characterized by sadness, loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep or appetite, feelings of tiredness, and poor concentration’( WHO 2017 ).

Depression, otherwise known as major depressive disorder or clinical depression, is a mental disorder, characterised by persistent feelings of sadness and hopelessness, loss of interest in activities that one normally enjoys, and inability to carry out daily activities.

For the diagnosis of major depressive disorder, the most severe depressive disorder in children and adolescents, the following criteria are used ( DSM-5 2013 ):

A. Five (or more) of the following symptoms should have been present during a 2-week period; at least one of the symptoms should be (1) depressed mood or (2) loss of interest or pleasure.

1. Depressed or irritable mood.
2. Lack of interest and/ or pleasure in all, or almost all, activities.
3. Significant weight loss when not dieting or weight gain, or failure to reach expected weight gain, or decrease or increase in appetite nearly every day.
4. Insomnia or hypersomnia nearly every day.
5. Psychomotor agitation or retardation nearly every day (observable by others).
6. Fatigue or loss of energy nearly every day.
7. Feelings of worthlessness or excessive or inappropriate guilt.
8. Diminished ability to think, lack of concentration, or indecisiveness nearly every day.
9. Recurrent thoughts of death, or suicidal ideation, plan or attempt.

B. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

C. The episode is not attributable to the physiological effects of a substance or to another medical condition ( DSM-5 2013 ).

Depending on the severity of symptoms, major depressive disorder can be categorised into mild, moderate or severe ( DSM-5 2013 )( WHO 2017 ). Dysthymia is also a chronic form of mild depression with similar symptoms to depressive disorder but less intense and persists for a longer period ( WHO 2017 (pdf). Depression can vary from gloom feeling to severe life-threatening illness; severe depression can lead to suicide ( DSM-5 2013 )(WHO 2018). Subclinical depressive symptoms in adolescence are likely to develop into depressive disorder in adulthood ( WHO 2016), Preventing depression (pdf)). Nearly half of the mental health problems in adulthood have their onset during childhood or adolescence (WHO 2018) (pdf).

Prevalence of depression in children and adolescents in the EU

Depression is estimated to affect 2.5% of children and 8.3% of adolescents in the WHO European region while 30% of adolescents are estimated to have subclinical depressive symptoms ( WHO 2016a ) ( WHO 2016b pdf).

Table 1 presents the proportion of children and adolescents reporting feeling 'low' more than once a week in the past six months ( HBSC 2018 ).

Table 1: Proportion of children and adolescents reporting feeling low more than once a week in the EU in 2018 

Factors related to depression in children and adolescents

Genetic factors, changes in hormone levels, certain medical conditions, stress, and grief contribute to depression (WHO 2020 , EuroSafe 2009 ).

There are multiple factors that can determine mental health in childhood and adolescence; and exposure to more risk factors increases the potential impact on mental health. Such factors include peer pressure, increased access to and use of technology, exploration of sexual identity, quality of home life, violence, socioeconomic problems, stigma and discrimination ( Mental Health Europe 2019 ,  WHO 2020 ).

Table 2 lists modifiable factors that are recognised to have an impact on the mental health and depression in children and adolescents.

Table 2: Factors associated with the risk of depression in children and adolescents.

Disease burden related to depression in children and adolescents

According to the Global Burden of Disease study 2019, almost 259 thousand Disability Adjusted Life Years (DALYs) are estimated to be attributed to depressive disorders among children and adolescents (<20 years old) in the EU in 2019 ( GDB 2019 ).

Globally, depression is the fourth leading cause of illness and disability among adolescents aged 15-19 years, and fifteenth for those aged 10-14 years (WHO 2020) .

Mental health problems at young age can also significantly affect the development of social relationships with peers, parents, teachers and romantic partners. Incapability to form sustained interpersonal relationships can have a long-lasting effect on youth’s social and emotional well-being (UN 2014) . Suicide is the second leading cause of death among adolescents in the European region ( WHO 2018 ) and depression is a leading risk factor for suicidal behaviour ( Joint Action on Mental Health and Well-being 2015 ).

View visualisation - DALYS map and data table - 20 years old 

Recommended policies related to the prevention in children and adolescents

The prevention of depression has a wide range of benefits as mental well-being improves educational attainment, reduces school absenteeism and risky behaviours, promotes a healthier lifestyle, and improves social relationships ( Joint Action on Mental Health and Well-being 2015 ).

The prevention of child and adolescent mental health can take place in various domains, including individual factors as well as social and environmental factors. It can be achieved by the support and action of many diverse sectors such as education, environment and urban planning, justice, and social welfare ( CAMHEE 2009 ).

Table 3 describes recommendations for policies and actions for the prevention of depression in children and adolescents.

Table 3: Recommended policies for the prevention of depression and its risk factors in children and adolescents.  

Implemented policies related to the prevention of depression in children and adolescents

Table 4 describes examples of measures and best practices implemented to prevent depression and its risk factors and promote mental health for children and adolescents. 

Table 4: Implemented policies and best practices for the prevention of depression and its risk factors in children and adolescents 

References

Overview of the references to this brief