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Preschool Depression: a Diagnostic Reality

  • Child and Adolescent Disorders (TD Benton, Section Editor)
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Abstract

Purpose of Review

We review findings related to predictors, correlates, outcomes, and treatment of preschool depression that have been published in the last 3 years.

Recent Findings

Preschool depression displays a chronic course through late adolescence and is associated with temperamental and personality traits, poorer physical health, and negative parenting practices. Preschool depression predicts deficits into adolescence, including social difficulties and blunted neural response to rewards. Depressed preschoolers can experience suicidal ideation and behaviors and display an accurate understanding of the finality of death. A treatment for preschool depression has now been validated that uses the parent-child relationship to enhance emotion development and reduce depressive symptoms.

Summary

Preschool depression is homotypic with depression that occurs later in life. Future work elucidating mechanisms through which preschool depression develops and informs the sub-groups for which particular treatments may be most effective will have considerable implications for prevention and early intervention.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Spitz RA, Wolf KM. Anaclitic depression. Psychoanal Study Child. 1946;2:313–42.

    CAS  PubMed  Google Scholar 

  2. Rie HE. Depression in childhood: a survey of some pertinent contributions. J Am Acad Child Adolesc Psychiatry. 1966;15:653–85.

    Google Scholar 

  3. Cytryn L, McKnew D. Factors influencing the changing clinical expression of the depressive process in children. Am J Psychiatr. 1974;131:879–81.

    Google Scholar 

  4. Carlson GA, Cantwell DP. Unmasking masked depression in children and adolescents. Am J Psychiatr. 1980;137:445–9.

    CAS  PubMed  Google Scholar 

  5. Kashani JH, Carlson GA. Major depressive disorder in a preschooler. J Am Acad Child Psychiatry. 1985;24:490–4.

    CAS  PubMed  Google Scholar 

  6. Kashani JH, Ray JS. Depressive related symptoms among preschool-age children. Child Psychiatry Hum Dev. 1983;13:233–8.

    CAS  PubMed  Google Scholar 

  7. Luby JL, Heffelfinger AK, Mrakotsky C, Hessler MJ, Brown KM, Hildebrand T. Preschool major depressive disorder: preliminary validation for developmentally modified DSM-IV criteria. J Am Acad Child Adolesc Psychiatry. 2002;41:928–37.

    PubMed  Google Scholar 

  8. • Bufferd SJ, Dougherty LR, Olino TM, Dyson MW, Laptook RS, Carlson GA, et al. Predictors of the onset of depression in young children: a multi-method, multi-informant longitudinal study from ages 3 to 6. J Child Psychol Psychiatry. 2014;55:1279–87. This study is the first to demonstrate frequency at which depressive symptoms in preschoolers are normative or severe.

    PubMed  PubMed Central  Google Scholar 

  9. Fuhrmann P, Equit M, Schmidt K, von Gontard A. Prevalence of depressive symptoms and associated developmental disorders in preschool children: a population-based study. Eur Child Adolesc Psychiatry. 2014;23:219–24.

    PubMed  Google Scholar 

  10. Wichstrøm L, Berg-Nielsen TS. Psychiatric disorders in preschoolers: the structure of DSM-IV symptoms and profiles of comorbidity. Eur Child Adolesc Psychiatry. 2014;23:551–62.

    PubMed  Google Scholar 

  11. Gaffrey MS, Belden AC, Luby JL. The 2-week duration criterion and severity and course of early childhood depression: implications for nosology. J Affect Disord. 2011;133:537–45.

    PubMed  PubMed Central  Google Scholar 

  12. Luby JL, Heffelfinger AK, Mrakotsky C, Brown KM, Hessler MJ, Wallis JM, et al. The clinical picture of depression in preschool children. J Am Acad Child Adolesc Psychiatry. 2003;9.

  13. Luby JL, Belden AC, Pautsch J, Si X, Spitznagel E. The clinical significance of preschool depression: impairment in functioning and clinical markers of the disorder. J Affect Disord. 2009;112:111–9.

    PubMed  Google Scholar 

  14. Luby JL, Heffelfinger A, Mrakotsky C, Brown K, Hessler M, Spitznagel E. Alterations in stress cortisol reactivity in depressed preschoolers relative to psychiatric and no-disorder comparison groups. Arch Gen Psychiatry. 2003;60:1248.

    PubMed  Google Scholar 

  15. Luby JL, Si X, Belden AC, Tandon M, Spitznagel E. Preschool depression: homotypic continuity and course over 24 months. Arch Gen Psychiatry. 2009;66:897–905.

    PubMed  PubMed Central  Google Scholar 

  16. Luby JL, Gaffrey MS, Tillman R, April LM, Belden AC. Trajectories of preschool disorders to full DSM depression at school age and early adolescence: continuity of preschool depression. Am J Psychiatr. 2014;171:768–76.

    PubMed  Google Scholar 

  17. Luby JL, Belden AC, Spitznagel E. Risk factors for preschool depression: the mediating role of early stressful life events. J Child Psychol Psychiatry. 2006. https://doi.org/10.1111/j.1469-7610.2006.01672.x.

    Google Scholar 

  18. Egger HL, Erkanli A, Keeler G, Potts E, Walter BK, Angold A. Test-retest reliability of the preschool age psychiatric assessment (PAPA). J Am Acad Child Adolesc Psychiatry. 2006;45:538–49.

    PubMed  Google Scholar 

  19. Lavigne JV, LeBailly SA, Hopkins J, Gouze KR, Binns HJ. The prevalence of ADHD, ODD, depression, and anxiety in a community sample of 4-year-olds. J Clin Child Adolesc Psychol. 2009;38:315–28.

    PubMed  Google Scholar 

  20. Bufferd SJ, Dougherty LR, Carlson GA, Klein DN. Parent-reported mental health in preschoolers: findings using a diagnostic interview. Compr Psychiatry. 2011;52:359–69.

    PubMed  Google Scholar 

  21. Finsaas MC, Bufferd SJ, Dougherty LR, Carlson GA, Klein DN. Preschool psychiatric disorders: homotypic and heterotypic continuity through middle childhood and early adolescence. Psychol Med. 2018;48:2159–68.

    PubMed  PubMed Central  Google Scholar 

  22. Wichstrøm L, Berg-Nielsen TS, Angold A, Egger HL, Solheim E, Sveen TH. Prevalence of psychiatric disorders in preschoolers: psychiatric disorders in preschoolers. J Child Psychol Psychiatry. 2012;53:695–705.

    PubMed  Google Scholar 

  23. Bufferd SJ, Dougherty LR, Olino TM. Mapping the frequency and severity of depressive behaviors in preschool-aged children. Child Psychiatry Hum Dev. 2017;48:934–43.

    PubMed  PubMed Central  Google Scholar 

  24. Gaffrey MS, TIllman R, Barch DM, Luby JL. Continuity and stability of preschool depression from childhood through adolescence and following the onset of puberty. Compr Psychiatry. in press.

  25. Luby JL, Belden AC, Jackson JJ, Lessov-Schlaggar CN, Harms MP, Tillman R, et al. Early childhood depression and alterations in the trajectory of gray matter maturation in middle childhood and early adolescence. JAMA Psychiatry. 2016;73:31–8.

    PubMed  PubMed Central  Google Scholar 

  26. Marrus N, Belden A, Nishino T, Handler T, Ratnanather JT, Miller M, et al. Ventromedial prefrontal cortex thinning in preschool-onset depression. J Affect Disord. 2015;180:79–86.

    PubMed  PubMed Central  Google Scholar 

  27. Suzuki H, Botteron KN, Luby JL, Belden AC, Gaffrey MS, Babb CM, et al. Structural-functional correlations between hippocampal volume and cortico-limbic emotional responses in depressed children. Cogn Affect Behav Neurosci. 2013;13:135–51.

    PubMed  PubMed Central  Google Scholar 

  28. Barch D, Pagliaccio D, Belden A, Harms MP, Gaffrey M, Sylvester CM, et al. Effect of hippocampal and amygdala connectivity on the relationship between preschool poverty and school-age depression. Am J Psychiatr. 2016;173:625–34.

    PubMed  Google Scholar 

  29. Gaffrey MS, Barch DM, Singer J, Shenoy R, Luby JL. Disrupted amygdala reactivity in depressed 4- to 6-year-old children. J Am Acad Child Adolesc Psychiatry. 2013;52:737–46.

    PubMed  PubMed Central  Google Scholar 

  30. Gaffrey MS, Luby JL, Repovš G, Belden AC, Botteron KN, Luking KR, et al. Subgenual cingulate connectivity in children with a history of preschool-depression. NeuroReport. 2010;21:1182–8.

    PubMed  PubMed Central  Google Scholar 

  31. Gaffrey MS, Luby JL, Botteron K, Repovš G, Barch DM. Default mode network connectivity in children with a history of preschool onset depression: default mode network connectivity in preschool depression. J Child Psychol Psychiatry. 2012;53:964–72.

    PubMed  PubMed Central  Google Scholar 

  32. Luking KR, Repovs G, Belden AC, Gaffrey MS, Botteron KN, Luby JL, et al. Functional connectivity of the amygdala in early-childhood-onset depression. J Am Acad Child Adolesc Psychiatry. 2011;50:1027–1041.e3.

    PubMed  PubMed Central  Google Scholar 

  33. Belden AC, Irvin K, Hajcak G, Kappenman ES, Kelly D, Karlow S, et al. Neural correlates of reward processing in depressed and healthy preschool-age children. J Am Acad Child Adolesc Psychiatry. 2016;55:1081–9.

    PubMed  PubMed Central  Google Scholar 

  34. Whalen DJ, Gilbert KE, Kelly D, Hajcak G, Kappenman ES, Luby JL, et al. Early childhood onset major depressive disorder is characterized by electrocortical deficits in processing pleasant emotional pictures. J Abnorm Child Psychol. in press.

  35. Gaffrey MS, Barch DM, Bogdan R, Farris K, Petersen SE, Luby JL. Amygdala reward reactivity mediates the association between preschool stress response and depression severity. Biol Psychiatry. 2018;83:128–36.

    PubMed  Google Scholar 

  36. •• Rappaport BI, Kandala S, Luby J, Barch DM. Brain reward system dysfunction in adolescence: current, cumulative, and developmental periods of depression. Am J Psychiatry. under review. This study implicates preschool depression in predicting globally blunted response to rewards across the cortico-striatal network during adolescence.

  37. Hopkins J, Lavigne JV, Gouze KR, LeBailly SA, Bryant FB. Multi-domain models of risk factors for depression and anxiety symptoms in preschoolers: evidence for common and specific factors. J Abnorm Child Psychol. 2013;41:705–22.

    PubMed  Google Scholar 

  38. Reinfjell T, Kårstad SB, Berg-Nielsen TS, Luby JL, Wichstrøm L. Predictors of change in depressive symptoms from preschool to first grade. Dev Psychopathol. 2016;28:1517–30.

    PubMed  Google Scholar 

  39. Nigg JT. Annual research review: on the relations among self-regulation, self-control, executive functioning, effortful control, cognitive control, impulsivity, risk-taking, and inhibition for developmental psychopathology. J Child Psychol Psychiatry. 2017;58:361–83.

    PubMed  Google Scholar 

  40. Hopkins J, Gouze KR, Lavigne JV, Bryant FB. Multidomain risk factors in early childhood and depression symptoms in 6-year-olds: a longitudinal pathway model. Dev Psychopathol. 2019:1–15.

  41. Costa PT, McCrae RR. Professional manual: revised NEO personality inventory (NEO-PI-R) and NEO five-factor inventory (NEO-FFI), vol. 61. Odessa: Psychological Assessment Resources; 1992.

    Google Scholar 

  42. Whalen DJ, Gilbert KE, Jackson JJ, Barch DM, Luby, Joan L. (under review) Using a thin slice approach to assess preschool personality dimensions.

  43. Gilbert KE, Whalen DJ, TIllman R, Barch DM, Luby JL. Observed personality in preschool: associations with current and longitudinal symptoms. J Abnorm Child Psychol. in press. https://doi.org/10.1007/s10802-019-00567-w.

    PubMed  Google Scholar 

  44. Grist CL, McCord DM. Individual differences in preschool children: temperament or personality? Infant Child Dev. 2010; n/a-n/a.

  45. Whalen DJ, Belden AC, Tillman R, Barch DM, Luby JL. Early adversity, psychopathology, and latent class profiles of global physical health from preschool through early adolescence. Psychosom Med. 2016;78:1008–18.

    PubMed  PubMed Central  Google Scholar 

  46. Whalen DJ, Gilbert KE, Barch DM, Luby JL, Belden AC. Variation in common preschool sleep problems as an early predictor for depression and anxiety symptom severity across time. J Child Psychol Psychiatry. 2017;58:151–9.

    PubMed  Google Scholar 

  47. Cerniglia L, Cimino S, Erriu M, Jezek S, Almenara CA, Tambelli R. Trajectories of aggressive and depressive symptoms in male and female overweight children: do they share a common path or do they follow different routes? PLoS One. 2018;13:e0190731.

    PubMed  PubMed Central  Google Scholar 

  48. Santesteban-Echarri O, Ramos-Olazagasti MA, Eisenberg RE, Wei C, Bird HR, Canino G, et al. Parental warmth and psychiatric disorders among Puerto Rican children in two different socio-cultural contexts. J Psychiatr Res. 2017;87:30–6.

    PubMed  Google Scholar 

  49. Tichovolsky MH, Griffith SF, Rolon-Arroyo B, Arnold DH, Harvey EA. A longitudinal study of fathers’ and young children’s depressive symptoms. J Clin Child Adolesc Psychol. 2018;47:S190–204.

    PubMed  Google Scholar 

  50. Belden AC, Gaffrey MS, Luby JL. Relational aggression in children with preschool-onset psychiatric disorders. J Am Acad Child Adolesc Psychiatry. 2012;51:889–901.

    PubMed  Google Scholar 

  51. • Finsaas MC, Kessel EM, Dougherty LR, Bufferd SJ, Danzig AP, Davila J, et al. Early childhood psychopathology prospectively predicts social functioning in early adolescence. J Clin Child Adolesc Psychol. 2018:1–12. This study is one of the first to document the impact of preschool depression on social functioning much later in life, during early adolescence.

  52. Donohue MR, Tillman R, Luby JL. Early socioemotional competence, psychopathology, and latent class profiles of reparative prosocial behaviors from preschool through early adolescence. Dev Psychopathol. in press.

  53. Pfeffer CR, Conte HR, Plutchik R, Jerrett I. Suicidal behavior in latency-age children: an empirical study. J Am Acad Child Psychiatry. 1979;18:679–92.

    CAS  PubMed  Google Scholar 

  54. Whalen DJ, Dixon-Gordon K, Belden AC, Barch D, Luby JL. Correlates and consequences of suicidal cognitions and behaviors in children ages 3 to 7 years. J Am Acad Child Adolesc Psychiatry. 2015;54:926–937.e2.

    PubMed  PubMed Central  Google Scholar 

  55. • Luby JL, Whalen D, Tillman R, Barch DM. Clinical and psychosocial characteristics of young children with suicidal ideation, behaviors, and nonsuicidal self-injurious behaviors. J Am Acad Child Adolesc Psychiatry. 2019;58:117–27. This study is the first to demonstrate that preschool suicidality is associated with a distinct pattern of psychosocial characteristics and risk factors.

    PubMed  Google Scholar 

  56. •• Hennefield L, Whalen DJ, Wood G, Chavarria MC, Luby JL. Changing conceptions of death as a function of depression status, suicidal ideation, and media exposure in early childhood. J Am Acad Child Adolesc Psychiatry. in press. This study dispels ideas that preschoolers who express suicidality do not understand the meaning of their thoughts and behaviors.

  57. •• Luby JL, Barch DM, Whalen D, Tillman R, Freedland KE. A randomized controlled trial of parent-child psychotherapy targeting emotion development for early childhood depression. Am J Psychiatr. 2018. https://doi.org/10.1176/appi.ajp.2018.18030321. This is the validation article for the first empirically supported treatment for preschool depression.

    PubMed  Google Scholar 

  58. Luby JL, Gilbert KE, Whalen DJ, TIllman R, Barch DM. The differential contribution of the components of parent child interaction emotion development for treatment of preschool depression. J Am Acad Child Psychiatry. in press.

  59. Barch DM, Whalen D, Gilbert K, Kelly D, Kappenman ES, Hajcak G, et al. Neural indicators of anhedonia: predictors and mechanisms of treatment change in a randomized clinical trial in early childhood depression. Biol Psychiatry. 2019;85:863–71.

    PubMed  Google Scholar 

  60. Safer DJ, Zito JM. Treatment-emergent adverse events from selective serotonin reuptake inhibitors by age group: children versus adolescents. J Child Adolesc Psychopharmacol. 2006;16:159–69.

    PubMed  Google Scholar 

  61. DeCou CR, Schumann ME. On the iatrogenic risk of assessing suicidality: a meta-analysis. Suicide Life Threat Behav. 2018;48:531–43.

    PubMed  Google Scholar 

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Acknowledgments

Meghan Rose Donohue’s work was supported by NIH Grant T32 MH100019 awarded to Joan Luby and Deanna Barch. Diana Whalen’s work was supported by NIH grant K23 MH118426. Kirsten Gilbert’s work was supported by NIH grant K23 MH115074. Laura Hennefield’s work was supported by NIH training grant F32 HD093273. Deanna Barch’s work was supported by NIH grants MH 090786 and 1R01MH117436. Joan Luby’s work was supported by NIH grant R01 MH064769-06A1.

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Authors and Affiliations

  1. Department of Psychiatry, Washington University School of Medicine, 4444 Forest Park Avenue, Suite 2500, St. Louis, MO, 63110, USA

    Meghan Rose Donohue, Diana J. Whalen, Kirsten E. Gilbert, Laura Hennefield, Deanna M. Barch & Joan Luby

  2. Department of Psychology, Washington University, St. Louis, MO, USA

    Deanna M. Barch

  3. Department of Radiology, Washington University, St. Louis, MO, USA

    Deanna M. Barch

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  1. Meghan Rose Donohue
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  2. Diana J. Whalen
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  4. Laura Hennefield
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  5. Deanna M. Barch
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  6. Joan Luby
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Correspondence to Meghan Rose Donohue.

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Donohue, M.R., Whalen, D.J., Gilbert, K.E. et al. Preschool Depression: a Diagnostic Reality. Curr Psychiatry Rep 21, 128 (2019). https://doi.org/10.1007/s11920-019-1102-4

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