ABSTRACT
Over recent years, there has been an intense interest in the concept of depression in childhood. The issue is particularly complex because sadness and tears are common parts of all children’s lives and so cannot form any true basis for a diagnosis of a depressive illness. In addition, the term itself has become so much part of common usage that it has begun to lose value as a description of a particular illness process. Even within professional circles the word ‘depression’ is used synonymously to describe three discrete levels (Kazdin 1990):
Depressed mood: a state of profound unhappiness and sense of dejection (dysphoria) that is more than normal sadness. The person cannot see any real bright spots to his or her life, and there is a loss of emotional involvement with either other people or activities. Often it is associated with negative styles of thinking about the young people themselves (giving rise to feelings of failure and guilt) or about the future (giving a sense of hopelessness). Figure 10.1 shows how such thoughts create a wider shift in mood, which then becomes attributed to all aspects of life. The presence of some such feelings is a normal reaction to a distressing event, but they are in proportion to the importance of the event, and the overall intensity is not great. Depressive syndrome: a cluster of symptoms including depressed mood, tearfulness, irritability, loss of appetite, sleep disturbance, poor concentration and loss of energy. Depressive disorder: a psychiatric diagnosis of depression, such as the one given in the Diagnostic and Statistical Manual (DSM-IV) of the American Psychiatric Association (1994), is based on typical symptoms but they must be present for a specific time, and clearly impair the person’s functioning. Persistence and impairment are what distinguishes the disorder from the syndrome.
