The general profile of children and adolescents with major depression referred to the Free State Psychiatric Complex

Abstract

Background. Depression can have far-reaching effects on the functioning and adjustment of young people. Among both children and adolescents depression confers an increased risk for illness, interpersonal and psychosocial difficulties. Objective. The aim of this study was to determine the profile of children (birth - 12 years) and adolescents (13-18 years) with major depression referred to the Child Mental Health Unit at the Free State Psychiatric Complex (FSPC) from 1 January 2004 to 31 December 2004. Method. A total of 904 children and adolescents were referred to the Unit during 2004. From these referrals 100 children and adolescents (11.06%) were diagnosed with major depression and were included in the study. Data analysis. The data were summarised using frequencies and percentages (categorical variables) and means of percentiles (numerical variables). Results. The majority (74%) of the cases were in the adolescent age group and 61% were girls. The main complaints presented by the parents or in the referral letter by the general practitioners were behavioural problems (37%) such as stealing, aggression and attention-seeking behavior, followed by decrease in school performance (25%), suspected depression (21%), suicidal tendencies (17%), and school refusal (8%). Twelve per cent of the group had lost a family member. The main presenting clinical syptoms of major depression in the study group were sleep disturbance (59%), dysphoric (depressed) mood (57%), disturbance in appetite (49%), constant fatigue/loss of energy (43%), inability to enjoy activities that would normally give pleasure (37%), and impaired concentration (36%). Somatic complaints occurred in 42% of the study population. Most of the complaints involved headaches (28%), stomach aches (14%), neck and back pain (8%) and nausea (6%). Thirty-three per cent of the participants with physical complaints were on medication. Behavioural problems present among the children/adolescents induded fighting (26%), disobedience (23%), staying away from school (15%), stealing (13%), telling lies (13%), running away from home (8%), and aggression (4%). Fifty-six per cent (56%) of the participants showed a decline in school perfomance and 4% had enuresis. Conclusion. Of particular interest was the finding that the clinical features in this South African community are consistent with samples studied in First-World countries. These areas or symptoms are sleep disturbance, depressed mood, disturbance in appetite, constant fatigue or loss of energy, inability to enjoy activities that would normally give pleasure, impaired concentration and suicidal thoughts. Other notable clinical features were behaviour problems, substance abuse and somatic complaints. There is no doubt that this research will also encourage other extrapolations of First-World findings such as treatment safety and efficacy of major depression in children and adolescents.