After years of controversy about whether or not it is possible for preadolescent children to experience depression, professionals have finally agreed that some young children do indeed suffer from this problem. Moreover, they exhibit symptoms that are strikingly similar (although not identical) to those of adolescents and adults with depression, dispelling the myth that depression is “masked” in the juvenile population (Milling, 2001). Research in the area of childhood depression has increased dramatically in the last 20 years, but substantial questions about its nature, causes, and treatment remain. Although relatively rare, childhood depression is a very complex disorder, as reflected in the extent to which its presentation is influenced by developmental factors, the degree to which it is associated with other disorders, and the negative and long-lasting impact it has on all areas of psychosocial functioning (Geller, Zimerman, Williams, Bolhofner, & Craney, 2001). As Kazdin and Marciano (1998) note, “Depression, from our perspective, consists of a pervasive disorder that encompasses diverse characteristics and domains of functioning well beyond mood-related symptoms” (p. 212). Although the functioning of children who experience depression can be significantly impaired in many different areas, a majority of these children do not come to the attention of mental health professionals (Wu et al., 1999). Moreover, for those who do receive mental health services, few treatments have been empirically validated for effectiveness, safety, and practicality (Kaslow & Thompson, 1998).
One of the most difficult problems in the area of childhood depression is definitional. The term “depression” can describe a wide variety of manifestations. It is often used to denote either a single symptom (i.e., depressed mood or sad affect), or a cluster of symptoms (behaviors and emotions, including depressed mood) that reflect several clinically significant disorders described in the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSMIV; American Psychiatric Association [APA], 1994; Compas, 1997). Clearly, how depression is defined influences our interpretation of the epidemiological research, as well as our understanding of the nature, etiology, and course of this disorder. Thus this chapter begins with a discussion of issues related to the definition and classification of childhood depression. Its comorbidity with other disorders, as well as its prevalence, developmental course, associated features, and etiology, are then reviewed. Finally, issues related to its assessment and treatment are discussed.