Gender and age differences in the symptomatology of child depression

By Nestor Lopez-Duran PhD

I should preface this review by disclosing that Im the corresponding author of this study. I dont usually review my own work at Child-Psych but I think this particular study will be of especial interest to parents, educators, and clinicians.

Last week the Journal of Clinical Psychiatry published one of our studies that examined age and gender differences in the presentation of clinical depression among children and adolescents. The study was part of a large NIMH-funded Program Project on child depression led by my collaborator and recent mentor Maria Kovacs. For those who may not be familiar with Dr. Kovacs work, she is one of the world leaders in child depression research. She has been studying childhood onset depression for several decades and is the creator of the Child Depression Inventory one of the most used child assessment instruments in the world.

During the last decade her team has been following an unusually large sample of children and adolescents diagnosed with clinical depression in Hungary. As part of that study, we recently analyzed and published data that allowed us to closely examine how depression is manifested among these children and adolescents. We were particularly interested in examining whether there were specific differences in the presentation of depression between boys and girls, as well as between younger children (as young as 7 years of age) and adolescents.

The study consisted of 559 children with a DSM-based diagnosis of major depression disorder, including 247 depressed girls and 312 depressed boys ranging in age from 7 to 15 (mean age 11). Depression diagnosis was obtained via a semi-structured clinical interview (the Interview Schedule for Children and Adolescents-Diagnostic Version). The results of this interview was then analyzed by two independent psychiatrists and diagnosis was determined using a consensus procedure. This helped us make sure that all children included in the study had a confirmed diagnosis of depression based on standard DSM-IV criteria. We then examined the individual symptoms endorsed during these interviews and attempted to identify different patterns of symptoms across different age groups as well as between boys and girls.

The results:

Below you can see the unadjusted rates of each symptom (% present) for boys and girls across all ages.

Unadjusted Rates (%) of Depressive Symptoms for Girls and Boys With Major Depressive Disorder

There are a few things worth mentioning. First, depressed mood and irritability were the two most common symptoms among these kids, and anhedonia was relatively less frequent (only between 40 and 50% of the sample showed this symptom). This is not consistent with the DSM-IV criteria that indicates that irritability should replace depressed mood in the diagnostic criteria of depression in children. Our analysis suggests that contrary to the DSM-IV assumption, depressed mood is extremely common among depressed children. In contrast, it is anhedonia that is less common in this population. We were also surprised at how common were thoughts of death in this group, which highlights the need for clinicians and educators to assess for suicidal ideation among depressed kids.

Below you can see the results of the changes in odds ratio for age and sex while adjusting for the intercorrelation between symptoms.

Adjusted Multivariate Odds Ratios (95% CI) of Each Symptom Adjusted for Age and Sex via Alternating Logistic Regression

The column of the left tells you how the odds for each symptom changed per year (the odds of being present). The asterisks indicate which symptom significantly changed per year. In sum, depressed mood, hypersomnia, psychomotor retardation, fatigue, and thoughts of death, and suicidal ideation significantly increased from middle childhood to adolescence, while psychomotor agitation significantly decreased per year.

The column on the right tells us how the odds for each symptoms changed by the sex of the child. Specifically,  anhedonia, insomnia, hypersomnia, and somatic complaints were more likely to be seen in females, while psychomotor agitation was more likely to be seen in males.

In sum, this study provides an overview of the symptom presentation of depression among depressed children and adolescents. The study is compelling in that it presents an examination of symptoms among a very large sample of depressed kids. In fact, this is the largest research sample of children with a diagnosis of major depression ever examined for this purpose. The study suggests that, contrary to previous reports, depressed mood is extremely common in this population. The analysis also suggested that the presentation of depression becomes more neurovegetative with age and among females. Neurovegetative symptoms include those that reflect whole-body processes, such as sleep and motor functioning, so clinicians should be particularly attentive to these symptoms. Finally, thoughts of death and suicidal ideation were very common, also highlighting the need for more careful screening of suicidality among depressed children.]

The reference:

Ildikó Baji, Nestor L. Lopez-Duran, Maria Kovacs, Charles J. George, László Mayer, Krisztina Kapornai, Enikő Kiss, Julia Gádoros, & Ágnes Vetró (2009). Age and Sex Analyses of Somatic Complaints and Symptom Presentation of Childhood Depression in a Hungarian Clinical Sample J Clin Psychiatry