Pediatricians on the front line for depression in children and parents

Article Outline

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Two reports in The Journal highlight missed opportunities to diagnose and treat depression in children and the clues from family history or parental attitudes toward their children that bely their own depressive problem. Korczak and Goldstein analyzed data from face-to-face, computer-assisted personal interviews of a cross-sectional US sample of approximately 43 000 non-institutionalized civilian adults to identify those with major depressive disorders (MDD) and compare characteristics of those with childhood, adolescent, or adult onset. Compared with older ages of onset, childhood onset MDD was more severe (ie, greater number and duration of episodes, suicidality, and need for hospitalization). Childhood onset cases also had an increased rate of comorbid psychiatric disorders and were less successful as adults in terms of income and marriage status. Characteristics of adolescent-onset MDD were intermediate between childhood- and adult-onset disease. Strikingly, the mean delay in treatment of childhood-onset MDD was 10 years longer than in adults, and delay was more than 3 years longer in adolescent-onset than in adult-onset MDD.

Even with the authors' delineation of limitations of the study and salient explanations for findings, pediatricians and other providers who care for the well-being and optimal outcomes for children must take the responsibility to recognize symptoms and signs of depression in children in order to obtain the treatment they deserve, without delay. With increasing evidence of the genetic inheritance of MDD, and the finding in this study that two-thirds or more of subjects with childhood- or adolescent-onset MDD had a parent with MDD, there is a clear message to the practitioner for anticipatory guidance and vigilance.

In the study by LaRosa et al, 382 parent-child dyads from pediatric sites across the US had directly administered and parent reported screening tests performed for child development and health ratings, as well as depressive symptom screening performed on the parent. Results of tests performed on children were compared between parents whose depressive screening tests had positive and negative results. Parents screening positive for depression were accurate at detecting their children's developmental problems, but they did not appear to contribute as well as parents screening negative for depression to promoting normal development.

Pediatricians are on the front line, and increasingly are being given an armamentarium, that is validated and implementable, to protect and detect mental health and illness in the families they serve as they would general health and illness.

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