Childhood Depressive Symptoms: Comparison of Diverse Medical Diagnoses

Childhood depression is a serious problem and has long term implications including increased risk for suicide and comorbid conditions. In addition, depressed children are at greater risk for social difficulties, non-compliance to medical regime, and academic difficulties. Children undergoing a medical illness are at increased risk for developing depression, however, there have been few recent studies looking at emotional distress for this population. With thousands of children hospitalized every day, assessing for depressive symptoms is important in order to provide proper referrals and treatment recommendations following discharge. The purpose of the current study was to increase understanding of pediatric depression through analysis of the symptoms children report across various medical conditions. This study included 54 children who were hospitalized for a medical condition at the Loma Linda Children’s Hospital. The Children’s Depression Inventory (CDI) was used to assess for depressive symptomatology. Contrary to what was expected, the hospitalized children report significantly fewer symptoms related to negative mood, ineffectiveness, negative self-esteem, and total score on the CDI compared with the normative sample. Age and length of hospitalization did not significantly predict depressive symptoms. Males reported greater level of depressive symptoms related to feeling ineffective compared with females. With regards to medical conditions, children with a chronic condition reported significantly greater number of depressive symptoms related to negative self- esteem compared with children in the non-chronic group. Those children who experienced a traumatic event, reported significantly less symptoms of depression related to negative mood, anhedonia, negative self-esteem, and total depression score compared to the non-trauma group. The exploratory phase of this analysis looked at depressive symptoms across various medical diagnoses, which included tumor, orthopedic injury, congenital conditions, neurological conditions, and “other” diagnoses which included patients hospitalized due to self-inflicted injury. Results demonstrated that patients in the tumor group had significantly greater number of symptoms related to negative self-esteem then patients in the orthopedic injury group as well as the “other” group. Reasons for why children under stressful situations are not reporting depressive symptoms as anticipated should be explored in future studies

Development and Validation of A Process Focused Measure of Childhood Depression

The purpose of this research was to develop a measure of childhood depression and test its psychometric properties with depressed and non-depressed children. First, an overview of our current understanding of childhood depression and the measures used in assessment is reviewed. Following, the problems with our diagnostic classification are presented, providing justification for the development of a new measure for childhood depression. A bottom-up approach is used in this study to develop a theory driven measure for identifying depression in children which focuses on the process. Thus, varying from the primarily symptom based assessment tools that are currently used in psychology. Gestalt theory is explored to understand the depressive process and items were comprised which are less face valid and present scenarios that may describe how a depressed child functions in his or her environment. The newly created measure, Depression Process Scale- Children (DPS-C), was administered to depressed and nondepressed children. For comparative analysis and validation, additional measures were also administered which include the Children’s Depression Inventory-2 (CDI-2) and the Behavioral Assessment System for Children- Second Edition (BASC-2). An exploratory factor analysis was conducted, revealing three factors with thirteen items for the DPS-C. Next, the validity of the new measure was investigated by determining the scales convergence with the CDI-2 and parent report of the BASC-2. Correlational analysis revealed strong positive correlations between the DPS-C and specific subscales of the BASC-2 (Depression and Withdrawal). The DPS-C did not have strong correlations with the CDI 2 and other subscales of the BASC-2, revealing the convergent and discriminant validity of the measure. Logistic regression analysis revealed the DPS-C total score, Scale 1 and Scale 3 were significant predictors of depression. Additionally, the DPS-C remained a significant predictor of depression after accounting for the variance explained by the CDI 2. Findings suggest the DPS-C is likely tapping into a unique aspect of depression not accounted for by symptom-based measures. Overall, this study demonstrated that a theory driven measure of childhood depression is able to differentiate between depressed and non-depressed children as well as increase the understanding of depression in children beyond DSM symptomatology

My Brain Hurts: A Focus on Somatosensory Complaints in Traumatic Brain Injury Patients Assessed by Neurobehavioral Symptom Inventory

PURPOSE: Somatosensory symptoms are common complaints from patients following a Traumatic Brain Injury (TBI), but are not specific to TBI diagnosis. This study investigated the prevalence of somatosensory symptoms in TBI patients, evaluated if symptoms severity was associated with TBI severity, and assessed the relationship of somatosensory complaints to psychological complaints commonly associated with depression and Post Traumatic Stress Disorder (PTSD). METHODS: Somatic symptoms following traumatic brain injury (TBI) were assessed using 7 of the 22 items from the Neurobehavioral Symptom Inventory (NSI) which included headache, nausea, vision problems/blurriness, body numbness/tingling, taste/smell changes, light sensitivity, and noise sensitivity. RESULTS: Prior to treatment, 90.8% of patients endorsed clinically-elevated pre-treatment somatosensory symptoms. The presence of clinically-elevated somatosensory symptoms decreased after treatment to 77.6%. This demonstrated a high prevalence at admission of somatosensory complaints in patients with TBI which remained high even after completion of TBI treatment. Patients with a history of LOC greater than 30 minutes were three times less likely to endorse clinically-elevated somatosensory complaints when assessed prior to starting treatment as compared to those with no history of TBI. A similar association was found when evaluated clinically-elevated somatosensory complaints assessed after treatment. This study also demonstrated patients with clinically-elevated somatosensory symptoms at admission were more likely to have and clinically-elevated depressive symptoms post-treatment. Similar significance was found assessing clinically-elevated somatosensory symptoms as admission and PTSD symptoms. CONCLUSION: Somatosensory symptoms are highly prevalent in TBI patients, but do not appear to correlate to TBI severity. Additionally, there is a strong association between somatosensory symptoms and psychological symptoms. The presence of both somatosensory and psychological symptoms before starting TBI treatment may be considered a strong indicator that somatosensory complaints will persist following completion of a TBI treatment program. Patients that endorse a high degree of psychological symptoms may benefit from targeted behavioral health therapies instead of traditional TBI treatment strategies. Special focus on somatosensory symptoms assessed by NSI may help guide clinical decision-making when treating TBI patients

Disparities in mental health symptoms recovery across race/ethnicity and education level following mild traumatic brain injury.

PURPOSE: The purpose of this study was to investigate the relationship between race/ethnicity and post-concussive mental health (i.e., depressive, post-traumatic stress disorder [PTSD]) and neurobehavioral symptoms among service members, and whether this association differed by education level. METHODS: The study sample consisted of 524 patients from a multidisciplinary US military outpatient treatment facility for post-concussive symptoms. Poisson regression with robust error variance was utilized to investigate outcome (i.e., clinically-elevated depressive [Patient Health Questionnaire-8 ≥15], PTSD [PTSD Checklist, DSM 5 ≥38] and neurobehavioral [Neurobehavioral Symptom Inventory >75th percentile] symptoms at admission and last follow-up in this cohort study. Modification by education level (low [no college degree] vs. high [associates degree or higher]) was additionally evaluated. RESULTS: The relationship between race/ethnicity and mental health/neurobehavioral symptoms varied by education level (p-interaction: depressive symptoms = 0.002, PTSD symptoms = 0.035, neurobehavioral symptoms = 0.040). Specifically, non-Whites were at a significantly higher prevalence for clinically-elevated depressive symptoms post-treatment than Whites, but only among those with higher education level (PR = 2.22, CI = 1.37-3.59). A similar trend was demonstrated for PTSD and neurobehavioral symptoms. CONCLUSION: Military healthcare may need to increase depression-focused treatment options that are acceptable for racial/ethnic minority patients, particularly those with higher education, while they are recovering from comorbid traumatic brain injury

Presenting symptoms as prognostic measures of mental health recovery among service members with concussion

BackgroundComorbid mental illness may negatively impact recovery from concussion. This study evaluated whether the level of symptom clusters at clinic intake contribute to poor mental health recovery in concussed patients during treatment, which may in turn serve as a target intervention.ObjectiveThe objective of this study is to examine the association between the level of initial symptoms and mental health symptoms among service members with concussion.MethodsData were obtained from 483 active duty service members treated in interdisciplinary treatment programs for traumatic brain injury, all of which were concussions. Pre-treatment symptom clusters included self-reported hyperarousal, dissociation/depression, cognitive dysfunction/headache and neurological symptoms. The outcomes, clinically-relevant decreases in depressive symptoms (assessed by the 8-item Patient Health Questionnaire, PHQ-8) and PTSD symptoms (assessed by the PTSD Checklist for DSM-5, PCL-5), were defined as a decrease in PHQ-8 > 5 and PCL-5 > 7, respectively. Poisson regression with robust error variance was used to evaluate the relationship between the level of each symptom cluster and clinically-relevant decrease in outcomes.ResultsParticipants with higher (vs. lower) levels of pre-treatment hyperarousal and dissociation/depression symptom cluster were less likely to improve in depressive and PTSD symptoms during treatment. The level of cognitive/headache and neurological symptom clusters were not significantly associated with any symptom changes.ConclusionThese findings support the need for individualized treatment for symptoms identified and treated after determining concussion history, with particular attention to high levels of hyperarousal and dissociation/depression prior to treatment