Mood disorders in children and adolescents: An epidemiologic perspective

Epidemiologic studies show that major depression is comparatively rare amon g children, but common among adolescents with up to a 25% lifetime prevalen ce by the end of adolescence. Mania is much less common, with no more than a 2% lifetime prevalence by the end of adolescence. Developmental studies t hat include assessments of both hormonal changes and social changes through the pubertal transition ai e needed to investigate joint biological and en vironmental influences an the emergence of the gender difference in depress ion in puberty. Although subthreshold mood disorder symptoms are common, co ntroversy exists about their clinical significance. This controversy is mad e more complex by methodologic uncertainties regarding inconsistent symptom reports obtained from patients, teachers, and children and by the pervasiv e existence of comorbidity Retrospective reports about age of onset in adul t studies suggest that at least 50% of youngsters with major depression and 9a% of those with mania continue to have adult recurrences. These recurren ces are mediated by adverse role transitions, such as truncated educational attainment and teenage childbearing that typically occur before the time o f initial treatment Aggressive entrench and early treatment aimed at preven ting the occurrence of adverse role effects might help decrease the persist ence of child and adolescent mood disorders. Long-term follow-up studies ar e needed to resolve current uncertainties regarding nosology, methodology, and long-term treatment effects. Innovative epidemiologic research designs aimed at more quickly providing provisional information are also needed to advance understanding of long-term developmental processes. (C) 2001 Societ y of Biological Psychiatry