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  • Page | Last updated: 30 Dec 2021
Prevention of depression in children and adolescents

Depression is estimated to affect 2.5% of children in the WHO European region.

Health Promotion Knowledge Gateway

 

‘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), World Health Organization Depression and Other common Mental Disorders, Global Health Estimates ).

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), Diagnostic and Statistical Manual of Mental Disorders, fifth edition, ISBN 978-0-89042-555-8 ):

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), Diagnostic and Statistical Manual of Mental Disorders, fifth edition, ISBN 978-0-89042-555-8 ).

Depending on the severity of symptoms, major depressive disorder can be categorised into mild, moderate or severe ( DSM-5 (2013), Diagnostic and Statistical Manual of Mental Disorders, fifth edition, ISBN 978-0-89042-555-8 )( WHO (2017), World Health Organization Depression and Other common Mental Disorders, Global Health Estimates ). 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), World Health Organization Depression and Other common Mental Disorders, Global Health Estimates (pdf). Depression can vary from gloom feeling to severe life-threatening illness; severe depression can lead to suicide ( DSM-5 (2013), Diagnostic and Statistical Manual of Mental Disorders, fifth edition, ISBN 978-0-89042-555-8 )(WHO 2018). Subclinical depressive symptoms in adolescence are likely to develop into depressive disorder in adulthood ( WHO (2016) World Health Organisation, Preventing depression in the WHO European Region (pdf)). Nearly half of the mental health problems in adulthood have their onset during childhood or adolescence (WHO 2018) (pdf).

 

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 (2016) World Health Organisation, Preventing depression in the WHO European Region ) ( WHO (2016) World Health Organisation Growing up unequal: gender and socioeconomic differences in young people’s health and well-being 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) Health Behaviour in School-aged children, World Health Organization Collaborative cross-national survey ).

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

 

Genetic factors, changes in hormone levels, certain medical conditions, stress, and grief contribute to depression WHO (2020) World Health Organization, Adolescent mental health factsheet , EuroSafe (2009) European Association for injury Prevention and Safety Promotion, Public Health Actions for a safer Europe, Prevention of depression and suicidal behaviour. ).

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), ‘Mental health and sustainable development goals’ ,  WHO (2020) World Health Organization, Adolescent mental health fact sheet ).

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.

 

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 ( GBD (2019) tool, Global Burden of Disease 2019 study, Global Burden of Disease Results tool ).

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) World Health Organization, Adolescent mental health factsheet .

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 United Nations (2014) Mental Health Matters: Social inclusion of youth with mental health conditions . Suicide is the second leading cause of death among adolescents in the European region ( WHO (2018) World Health Organisation, Adolescent mental health in the European Region ) and depression is a leading risk factor for suicidal behaviour ( Joint Action on Mental Health and Well-being 2015, Depression, Suicide prevention and e-Health, Situation analysis and recommendations for action ).

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

 

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, Depression, Suicide prevention and e-Health, Situation analysis and recommendations for action ).

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) Child and Adolescent Mental Health in Europe: Infrastructures, policy and programmes ).

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.

 

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