[Complementary treatment methods for depression in children and adolescents]. / Komplementäre Ansätze zur Behandlung von depressiven Störungen bei Kindern und Jugendlichen.

Depressive disorders are among the more common mental illnesses around the world, about 1- 3% of prepubertal children and 6% of postpubertal children and adolescents are affected. They markedly impair psychosocial development and are associated with higher rate of morbidity and mortality throughout life. Many physicians are unsure about which treatment approaches are effective and how the treatment should be planned. A systematic literature search was carried out in electronic databases and study registries and as a manual search. More than 450 studies (mostly randomized controlled trials = RCTs) were identified and summarized in evidence tables. The ensuing recommendations were agreed upon in a consensus conference. The review summarizes the evidence of complementary treatment methods. The evidence for complementary treatment methods (art and music therapy, sleep deprivation, exercise, electroconvulsive therapy, massage, transcranial magnetic stimulation, relaxation, bibliotherapy, computer based therapy, light therapy, omega-3 treatment) is low or there is no evidence due to missing studies or studies of poor quality. For some methods, i. e. light therapy, relaxation and stress reduction and sleep deprivation there is limited indication for effectiveness without sufficient evidence for a practical guidance. There is an urgent need for adequately informative comparative studies on treatment of depression in children and adolescents considering also complementary methods.

The treatment of depressive disorders in children and adolescents.

BACKGROUND: Depressive disorders are among the more common mental illnesses around the world. About 3% of prepubertal children and 6% of postpubertal children and adolescents are affected. Many physicians are unsure about which treatment approaches are effective and how the treatment should be planned. METHOD: A systematic literature search was carried out in electronic databases and study registries and as a manual search. More than 450 studies (mostly randomized controlled trials [RCTs]) were identified and summarized in five evidence tables. The ensuing recommendations were agreed upon in a consensus conference in which 23 organizations were represented. RESULTS: The recommended treatment of first choice for children from age 8 onward and for adolescents is either cognitive behavioral therapy (CBT) (Cohen's d [effect strength]: 0.5-2) or interpersonal psychotherapy (Cohen's d: 0.5-0.6). Fluoxetine is recommended for drug treatment (Cohen's d: 0.3-5.6), either alone or in combination with CBT. The analysis revealed a lower level of evidence for psychodynamic or systemic psychotherapy or for drug treatment with escitalopram, citalopram, or sertraline. For mild or moderate depression, psychotherapy is recommended; for severe depression, combination therapy. Particularly for children, there is a lack of adequately informative comparative studies on these treatment approaches as well as on other, complementary interventions (e.g., art therapy, sleep deprivation, youth welfare services). CONCLUSION: There is adequate evidence to support some recommendations for the treatment of depressive disorders in adolescents, but evidence for children is lacking. There is a pressing need for intervention research in this area for both children and adolescents.

[Agreement of clinical diagnosis, structured interviews, and self-report questionnaires for depression in children and adolescents]. / Übereinstimmung von klinischer Diagnose, strukturierten Interviews und Selbstbeurteilungsfragebögen bei Depression im Kindes- und Jugendalter.

OBJECTIVE: The present study examines the agreement of structured child and parent interviews as well as clinical diagnosis for depressive episodes in children and adolescents. Moreover, it compares the accuracy and optimal cutoff scores of self-report questionnaires with reference to each of these diagnostic assessments. METHOD: 81 children (9-12 years) and 88 adolescents (13-16 years) in psychiatric care and their parents completed the structured diagnostic interview Kinder-DIPS. The children answered the German Children's Depression Inventory (CDI), and the adolescents answered the German Center for Epidemiologic Studies Depression Scale (CES-D). Kappa coefficients quantified the agreement. Receiver operating characteristic (ROC) curves were used to determine optimal cutoff scores, sensitivity, specificity, as well as positive and negative predictive values. RESULTS: The agreement between the child and parent interviews as well as between the interviews and clinical diagnosis was low to moderate. Clinicians diagnosed depressive episodes more frequently than the interviews. Cutoff scores and measures of accuracy varied between the reference standards, with less favorable results for clinical diagnosis. CONCLUSIONS: Clinicians may profit from conducting structured interviews. Strategies for dealing with conflicting information from children and parents should be tested empirically and described in detail.

The Beck depression inventory-II in adolescent mental health patients: cut-off scores for detecting depression and rating severity.

The Beck Depression Inventory-Second Edition (BDI-II) was developed as an indicator of the presence and severity of depression in psychiatric patients from age 13. Its cut-off scores were derived from an adult sample and differentiate four categories of severity but contain no screening cut-off score for classifying patients as depressed vs. nondepressed. We aimed to determine this screening cut-off score and to examine the utility of the severity cut-off scores for adolescents in mental health care. 88 adolescent psychiatric patients (13-16 years, 58% female) completed the German BDI-II. A structured diagnostic interview served as the reference standard for computing receiver operating characteristic (ROC) curves and identified 24 adolescents (27%) as depressed. ROC analysis of depressed vs. nondepressed patients yielded an area under the curve (AUC) value of 0.93. The optimal screening cut-off score according to Youden's Index was ≥23, where sensitivity was 0.88 and specificity was 0.92. The severity cut-off scores yielded satisfying sensitivity (≥0.89) and specificity (≥0.72) for mild and moderate but not for severe depression. Our findings indicate that the BDI-II can be recommended for screening for depressive disorders in adolescent mental health patients. However, the currently used severity cut-off scores may be suboptimal for this population.