Characteristics Associated with Depression Severity in 270 Juveniles in a Major Depressive Episode

Giulia Serra; Maria Elena Iannoni; Monia Trasolini; Gino Maglio; Camilla Frattini; Maria Pia Casini; Ross J Baldessarini; Stefano Vicari

doi:10.3390/brainsci11040440

Characteristics Associated with Depression Severity in 270 Juveniles in a Major Depressive Episode

Brain Sci. 2021 Mar 29;11(4):440. doi: 10.3390/brainsci11040440.

Authors

Giulia Serra^{1

2}, Maria Elena Iannoni¹, Monia Trasolini¹, Gino Maglio¹, Camilla Frattini^{1

3}, Maria Pia Casini^{1

4}, Ross J Baldessarini^{2

5}, Stefano Vicari^{1

6}

Affiliations

¹ Child Neuropsychiatry Unit, Department of Neuroscience, I.R.C.C.S. Children Hospital Bambino Gesù, 00165 Rome, Italy.
² International Consortium for Mood & Psychotic Disorders Research, Mailman Research Center, McLean Hospital, Belmont, MA 02478, USA.
³ Department of Clinical and Dynamic Psychology, Medicine and Psychology Faculty, Sapienza University of Rome, 00185 Rome, Italy.
⁴ Psychiatric Emergency in adolescence Departmental Unit Umberto I General Hospital, 00161 Rome, Italy.
⁵ Department of Psychiatry, Harvard Medical School, Boston, MA 02478, USA.
⁶ Child Neuropsychiatry, Catholic University, 00168 Rome, Italy.

Abstract

Introduction: Severe depression is prevalent in young persons and can lead to disability and elevated suicidal risk. Objectives: To identify clinical and demographic factors associated with the severity of depression in juveniles diagnosed with a major mood disorder, as a contribution to improving clinical treatment and reducing risk of suicide. Methods: We analyzed factors associated with depression severity in 270 juveniles (aged 6-18 years) in a major depressive episode, evaluated and treated at the Bambino Gesù Children's Hospital of Rome. Depressive symptoms were rated with the revised Children's Depression Rating Scale (CDRS-R) and manic symptoms with the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS) Mania Rating Scale (K-SADS-MRS). Bivariate comparisons were followed by multivariable linear regression modeling. Results: Depression severity was greater among females than males (55.0 vs. 47.2), with the diagnosis of a major depressive disorder (MDD) vs. bipolar disorder (BD; 53.8 vs. 49.3), and tended to increase with age (slope = 1.14). Some symptoms typical of mania were associated with greater depression severity, including mood lability, hallucinations, delusions, and irritability, whereas less likely symptoms were hyperactivity, pressured speech, grandiosity, high energy, and distractibility. Factors independently and significantly associated with greater depression severity in multivariable linear regression modeling were: MDD vs. BD diagnosis, female sex, higher anxiety ratings, mood lability, and irritability. Conclusions: Severe depression was significantly associated with female sex, the presence of some manic or psychotic symptoms, and with apparent unipolar MDD. Manic/psychotic symptoms should be assessed carefully when evaluating a juvenile depressive episode and considered in treatment planning in an effort to balance risks of antidepressants and the potential value of mood-stabilizing and antimanic agents to decrease the severity of acute episodes and reduce suicidal risk.

Keywords: adolescent; bipolar; child; depression; mania; mixed; severity; suicidal.