Clinical update

Depression in children and young people: recognition and management

New guidance aims to improve how depression in children aged 5-18 is assessed and which are the effective treatments to use

New guidance aims to improve how depression in children aged 5-18 is assessed and which are the effective treatments to use

Picture shows a boy, seated, looking intently at a mobile phone. New guidance aims to improve recognition and management of depression in children aged five to 18 and promote effective treatments.
Picture: iStock

Essential information

Depression is thought to occur in 2% of children and young people in England, according to an NHS Digital mental health survey. Rates of emotional disorders, including depression, are higher in girls, and higher as age increases.

Depression is a broad definition but depressed mood or loss of pleasure in most activities are key signs of depression, according to the National Institute for Health and Care Excellence (NICE).

What’s new?

Identifying and managing depression in children aged between five and 18 is the subject of new guidance published by NICE. Based on a stepped-care model, it aims to improve recognition and assessment of depression, and promote effective treatments for different levels of severity.

The stepped‑care model draws attention to the different needs of children and young people depending on the characteristics of their depression and their personal and social circumstances, and the responses that are required from services.

Signs and symptoms

The NICE guidance uses the World Health Organization’s ICD-10 definition as a guide to depression. This uses ten symptoms of depression:

  1. Persistent sadness or low mood.
  2. Loss of interests or pleasure.
  3. Fatigue or low energy.
  4. Disturbed sleep.
  5. Poor concentration or indecisiveness.
  6. Low self-confidence.
  7. Poor or increased appetite.
  8. Suicidal thoughts or acts.
  9. Agitation or slowing of movements.
  10. Guilt or self-blame.

The number of symptoms present suggests the severity of the depression.

Causes and risk factors

NICE says psychosocial risk factors include age, gender, family discord, bullying, physical, sexual or emotional abuse, co-morbid disorders including drug and alcohol use, and a history of parental depression.

Other factors include a history of single loss events, ethnic and cultural factors, and factors known to be associated with a high risk of depression and other health problems, such as homelessness, refugee status and living in institutional settings. NICE highlights the importance of multiple risk factors.

How you can help your patient

  • Healthcare professionals in primary care, schools and other relevant community settings should be trained to detect symptoms of depression and to assess children and young people who may be at risk of depression. They should be trained in communications skills such as ‘active listening’ and ‘conversational technique’ so that they can deal confidently with acute sadness and distress.
  • Children and their families need good information and must be able to give fully informed consent.
  • Healthcare professionals should take time to develop a supportive and collaborative relationship with the patient and the family or carers.
  • Always ask the patient and parents or carers directly about the child or young person’s alcohol and drug use, any experience of being bullied or abused, self‑harm and ideas about suicide. A young person should be offered the opportunity to discuss these issues initially in private.
  • Digital and group cognitive behavioural therapy, group interpersonal therapy or group non-directive supportive therapy should all be considered for mild depression.

Expert comment

Picture of Gemma Trainor, lecturer in child and adolescent mental health services at King’s College London. New guidance aims to improve recognition and management of depression in children aged five to 18 and promote effective treatments.King’s College London lecturer in child and adolescent mental health services Gemma Trainor

‘Depression in young people makes up a considerable proportion of the workload of a child and adolescent mental health nurse, and the responsibility of conducting risk assessments can cause a lot of anxiety for the sole clinician, who can be making important decisions about the young person’s care.

‘The stepped-approach guidelines are useful for staff and helpful for the young person and their parents, as they may clarify the pathway and prevent confusion around what is the best way forward.

‘It is important to assess and treat children in the least restrictive environment, preferably using a community approach where they can remain at home and in school if it is safe to do so.

‘The watchful waiting advocated by the National Institute for Health and Care Excellence when dealing with mild depression is right, before considering further steps. I would recommend involving the family wherever possible, bearing in mind confidentiality and consent, and explaining clearly to patients when you need to break confidentiality. Often parents feel excluded from discussions and can be fearful about what their child is going through.’

Erin Dean is a health journalist

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