Treatment of depression in children 'needs improving'
“Children as young as five are now suffering from depression,” says The Daily Telegraph, while the Daily Mail reports on the “worrying rise in the number of children with depression,” saying that almost 80,000 children are now affected.
While these figures are cause for concern, they do not represent a sudden worsening of the problems of childhood depression. The statistics on childhood mental health are actually taken from a 2004 report into child mental health.
The figures were quoted in a press release that accompanied new “quality standards” for the care of depression in children and young people published by the National Institute for Health and Care Excellence (NICE).
NICE publishes these “quality standards” as evidence-based statements designed to improve specific areas of public healthcare.
What are NICE quality standards?
NICE produces guidance for healthcare professionals on the prevention, diagnosis and treatment of disease and ill health. Its guidance is designed to ensure that people receive the best possible quality of care at the best value for money. NICE produces its guidance using transparent methods and based on the best available evidence.
NICE quality standards are a set of brief, prioritised statements designed to lead to improvements in the quality of care. The statements are based on current NICE guidance or from other sources that are accredited by NICE and are “designed to drive measurable quality improvements within a particular area of health or care”.
What do current statistics say on how common depression is in children?
NICE says that nearly 80,000 children and young people in the UK suffer from severe depression, including more than 8,000 children aged under 10 years. These statistics – widely quoted in the media – come from the 2004 publication by the Office for National Statistics (ONS) on the mental health of children and young people in the UK. The figures were based on a survey carried out between March and June 2004, in which 8,000 children and young people aged five to 16 years old living in private households in the UK were interviewed (or their parents, depending on child age).
How common is mental illness in children?
According to the ONS findings, in 2004:
- one in 10 children and young people had a mental health illness
- 4% had an emotional disorder such as anxietyor depression
- 6% had a conduct disorder (a range of disorders associated with aggressive and anti-social behaviours)
- 2% had a hyperkinetic disorder such as attention deficit hyperactivity disorder (ADHD) – hyperkinetic disorders affect both thinking and behaviour
- 1% had a less common disorder, such as autism, tics, eating disorders and selective mutism
- 2% had more than one type of disorder
School absences because of mental illness
School absences due to mental illness (from teacher-completed questionnaires): 17% of those with emotional disorders, 14% of those with conduct disorders, and 11% of those with hyperkinetic disorders had missed more than 16 days of school in the last term.
Social effects for children with mental illness
Almost half of children with emotional disorders, about two thirds of children with conduct disorders, and over 80% of children with hyperkinetic disorders scored in the bottom 25% on a measure of parent-assessment of child’s ability to empathise with others.
Around half of children with one of these three conditions also scored in the lowest 25% on a scale measuring the child’s perceived network of close family and friends.
Seeking help for children with emotional disorders
Around three quarters of parents of children with emotional disorders had sought some sort of advice or help (either professional sources or teachers), around 80% of those with conduct disorders, and nearly all (95%) of parents of children with hyperkinetic disorders.
Substance abuse in childhood
Smoking, drinking, drug use: around 20% of young people aged 11–16 with an emotional disorder or hyperkinetic disorder were smokers or had taken drugs, and almost a third of those with a conduct disorder were smokers or had taken drugs.
Children, self-harm and suicide
Among young people with an emotional disorder, 28% said they had tried to harm or kill themselves, among those with conduct disorders the figure was 21% and among those with a hyperkinetic disorder, 18%.
Because these figures are from 2004, they may not accurately reflect the current state of children’s mental health in this country.
What do the NICE quality standards on childhood depression say?
Confirming the depression diagnosis
Children and young people with suspected depression should have a diagnosis confirmed and noted in their medical records. Diagnosing depression in children and young people can be difficult, and confirming and recording their diagnosis can help them to get access to the right treatment.
Information about depression that is appropriate to the child’s age
NICE says that children and young people need age-appropriate information so they can understand their diagnosis and treatment options. With the right information, the child will then be better able to participate in making decisions about their care with their healthcare professionals and family members.
Preventing suicide and self-harming
NICE wants children and young people referred to Child and Adolescent Mental Health Services (CAMHS) with suspected severe depression and who are believed to be at high risk of suicide to be seen as an emergency, within a maximum of 24 hours of referral.
If a doctor refers children and young people to CAMHS, they should also assess whether the child needs a “safe place” (somewhere that helps to prevent injury or worsening of the mental health symptoms) until CAMHS can do an assessment.
Children and young people with suspected severe depression but not at high risk of suicide should be assessed by CAMHS within a maximum of two weeks of referral.
Health professionals need to record children’s mental health outcomes
NICE says that children and young people receiving treatment for depression should have their health outcomes recorded at the beginning and end of each step in treatment. Monitoring the mood and feelings of children and young people who are receiving treatment for depression will help ensure that the effectiveness of treatment can be assessed, and adjustments made to better help the child.