Depression And Problems In Peer Relations

In this we will examine the problems of depression and peer relations. In isolating these as separate categories we confront many of the same problems that we found in examining anxiety disorders. For example, children and adolescents who meet the criteria for a diagnosis of depression are often also given other diagnoses. Similarly, the social withdrawal that one might associate with internalizing problems is part of a more general concern with deficits in peer relations and social skills. Such social deficits are characteristic of youngsters with a number of different disorders. Thus, the designation of these problems as distinct entities is not without controversy. Nonetheless, examining depression and peer relations makes sense in terms of how the research and treatment literature are organized.

Until recently depression in children and adolescents had not received a great deal of attention. However, interest has clearly increased. This can probably he traced to a number of influences. Promising developments in the identification and treatment of mood disorders in adults have played a role.
In addition, improvements in diagnostic practices have facilitated the application of diagnostic criteria to children and adolescents. The emergence of a number of measures of depression has also allowed researchers to examine the phenomenon in clinic and normal populations of youngsters. Furthermore, the new perspective of developmental psycho-pathology focused additional attention on depression in young people.
In everyday usage the term depression refers to the experience of a pervasive unhappy mood. This subjective experience of sadness, or dysphoria, is also a central feature of the clinical definition of depression. Descriptions of youngsters viewed as depressed suggest that they exhibit a number of other problems as well. Loss of the experience of pleasure, social withdrawal, lowered self-esteem, inability to concentrate, poor schoolwork, alterations of biological functions (sleeping, eating, elimination), and somatic complaints are often noted.

In community surveys, prevalence rates for major depression in youngsters vary between 2 and 5 percent, (e.g., Anderson et al. 1987; Kashani et al., 1987). In clinical populations estimate typically fall between 10 and 20 percent (e.g., Alessi and Magen, 1988; Puig-Antich and Gittelman, 1982). Gender and age are clearly relevant to estimates of the prevalence of depression in young people.
The picture regarding gender ratios in young children is somewhat unclear. Usually no gender differences are reported for children ages six to twelve (e.g., Angold and Rutter, 1992; Fleming, Offord, and Boyie, 1989). When differences are reported, depression is more prevalent in boys than in girls during this age period (e.g., Anderson et al., 1987). Yet among adolescents depression is far more common among girls and begins to approach the 2:1 female to male ratio usually reported for adults.
The data for adolescents also suggest a greater prevalence of depression than exists for younger children (e.g. Angold and Rutter, 1992; Cohen, Cohen, Kasen et al., 1993; Lewinsohn et al., 1993; Whicaker et al., 1990). The magnitude of the problem in adolescent populations is indicated by find-•rigs of lifetime prevalence rates among the general population as high as 20 to 30 percent for diagnosable depressive disorders (e.g, Compas, Ey, and Grant, 1993; Lewinsohn et al., 1993). This would mean that about I out of 4 youngsters in the general population experience a depressive disorder sometime during childhood or adolescence.
Estimates of the prevalence of depression vary considerably (Kazdin, 1990; Reynolds and Johnston, 1994). In addition, to variations related to gender and age, there are other developmental considerations which complicate getting accurate estimates. The difficulty of administering similar tests to youngsters of different ages is one consideration. Also, widely employed assessment tools, such as interviews, require that the youngster think in terms of psychological constructs and effectively communicate what is remembered. Such processes clearly depend on developmental level.

Defining Depression
Also important to variations in reported rates of depression are the different criteria that are employed to define depression. A study by Carlson and Cantwell (1980) illustrates this point. A sample of 210 children was selected at random from over 1,000 children between the ages of seven and seventeen seen at the UCLA Neuropsychiatric Institute. Three different criteria were employed to define depression. At intake the presence of depressive symptoms among the presenting problems was noted and this served as one criterion. The youngsters were also administered a version of the Children's Depression Inventory, a second criterion. Finally, separate interviews with 102 of the youngsters and their parents were conducted to assess the presence of affective disorder, according to DSM criteria. The use of the presence of depressive symptoms at intake as a criterion for diagnosing a depressive disorder led to the largest number of children being diagnosed; the depression inventory) led to fewer, and DSM diagnosis led to the least. However, it is also clear that the results were not simply a matter of using more or less stringent criteria. Rather, there appear to be some differences in definition. For example, not all children designated as depressed by the depression inventory were so designated using the depressive symptom criterion as would be expected if the former were just a less stringent definition. Similarly, not all DSM Affective Disorder children were designated as depressed using the criterion of depression inventory score.
These and other findings indicate that different groups of youngsters may or may not be designated as depressed according to what methods were employed for testing (Kaslow and Racusin, 1990). Such variations, may be due to differences in method employed (e.g. depression inventory vs. DSM diagnostic criteria) or use of different informants. As we have mentioned previously, different informants are likely to give quite different views of children's emotional and behavioral problems (Kazdin, 1994; Tarullo at al., 1995b)
This is illustrated in a study by Kazdin (1989b). DSM diagnoses of 231 consecutive child admissions to an inpatient psychiatric facility were made based on direct interviews with the children and their parents. This method of diagnosing depression was compared to criteria based on exceeding a cut off scores on the Children's Depression Inventory (CDI). Both the children and parents completed the CDI. In addition, children and/or their parents completed a number of other measures to assess attributes reported to be associated with depression. Consistent with the findings of Carlson and Cantwell described above, different groups of children appeared to be designated as depressed depending on the criteria employed. In addition, characteristics associated with depression varied depending on the method used to designate the presence of depression. Some of these results are illustrated in Table 1.

Table 1

Defining depression as a high self-report score on the CDI indicated that depressed children were more hopeless; had lower self-esteem, made more internal (as opposed to external) attributions regarding negative events; and, based on a locus of control (IE) scale, were more likely to believe that control was due to external factors rather than themselves. Depressed and non depressed children defined by the other two criteria (parent CDI and DSM) did not differ from each other on these characteristics. Employing the parent CDI criterion, children with high depression scores appear to be more problematic across a wide range of symptoms (as measured by the Child Behavior Checklist-CBCL) than those with very low depression scores. Depression as designated by the other two criteria did not appear to be associated with this wide range of problems. Thus, conclusions regarding correlates of depression may be affected by the criterion and informant employed to designate youngsters as depressed.

Behavior Disorders of Childhood. Rita Wicks-Nelson & Allen C. Israel

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