How Depressive Disorders Vary by Age: A Comprehensive Review

» Common Mental Health Disorders

How Depressive Disorders Vary by Age: A Comprehensive Review

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Introduction

Depressive disorders are a significant mental health concern affecting individuals across all age groups, with varying manifestations and implications at different life stages. ^1 2 

Despite the common perception, clinical depression is not an inevitable part of the aging process, and studies indicate that older adults often report a high quality of life, even in the face of physical ailments. ¹ Yet, the prevalence and impact of depressive symptoms can fluctuate substantially throughout the lifespan, underscoring the need for a nuanced understanding of this complex condition. ³

This comprehensive article delves into the intricate landscape of depressive disorders, exploring their distinct characteristics, risk factors, and manifestations across different age groups – from children and adolescents to young, middle-aged, and older adults. ^1 2 3 By examining the latest research and statistics on depression, we aim to shed light on the unique challenges and considerations associated with managing and treating depressive episodes in various developmental stages.

Understanding Depression in Children and Adolescents

Depression is a significant mental health concern affecting children and adolescents, with varying prevalence and manifestations across different developmental stages. The prevalence of depression more than doubles during the transition from childhood (2-4%) to adolescence (4% to 14%), and at least half of the individuals who develop depression in their lifetimes experience their first depressive episode by age 14, and three-fourths by age 24. ⁴

Prevalence and Symptoms

The point-prevalence of depressive symptoms among children and young adolescents aged 11-14 years is just under 10%, with a 12-month prevalence of almost 3% and a 12-month incidence rate of 4.5%. ⁵ Girls tend to report higher rates of point prevalence, 12-month prevalence, and 12-month incidence compared to boys. ⁵

Common symptoms of depression in children include depressed or irritable mood, diminished interest in activities, fatigue, difficulty concentrating, decreased attention, and difficulty sleeping. ⁶ Some children may not outwardly appear sad but may exhibit troublesome behavior or lack of motivation. ⁶

Common Causes

The exact causes of depression in children and adolescents are not fully understood, but various factors may contribute, including brain chemistry imbalances, hormonal changes, inherited traits, early childhood trauma, and learned patterns of negative thinking. ⁷ Early adolescence may be particularly stressful for girls due to the co-occurrence of multiple stressors, such as body image concerns and increased likelihood of being sexualized or harassed. ⁴

Impact on Academic and Social Life

Depressive symptoms can have a significant impact on academic performance and social functioning. Symptoms like lethargy, lack of concentration, poor memory, and reduced attention span can impair the ability to learn. ⁸ Anxiety and depressive symptoms are linked to lower academic scores, particularly in spelling and math. ⁸

Depression can also lead to social withdrawal, amotivation, and changes in weight and sleep patterns, which can have visible and cognitive consequences, potentially leading to lifelong sequelae. ⁴ It can negatively influence academic progress and encourage underachievement, as students with depression may disengage in the classroom or exhibit avoidance behaviors. ⁹

Treatment and Management

If depression is suspected, a comprehensive evaluation by a healthcare provider or mental health professional is recommended. ⁶ Treatment often involves a combination of psychotherapy, such as cognitive-behavioral therapy or interpersonal therapy. ^7 10

In severe cases, a hospital stay or outpatient treatment program may be necessary to ensure the child’s safety and develop coping strategies. ^7 10 Adjunctive therapies like relaxation techniques, yoga, meditation, and art therapy can be helpful when used in conjunction with primary treatments. ¹⁰

Early intervention and gender-specific approaches are crucial, as depression in children and adolescents can have long-lasting consequences if left untreated. ⁵

Depression in Young Adults

An estimated 5.0 million adolescents aged 12 to 17 in the United States had at least one major depressive episode in 2021, representing 20.1% of the U.S. population aged 12 to 17. ¹¹ The prevalence of major depressive episode was higher among adolescent females (29.2%) compared to males (11.5%). ¹¹ The prevalence was highest among adolescents reporting two or more races (27.2%). ¹¹

Prevalence and Symptoms

In 2021, an estimated 3.7 million adolescents aged 12 to 17 in the United States had at least one major depressive episode with severe impairment in the past year, representing 14.7% of the U.S. population aged 12 to 17. ¹¹ Among adolescents with major depressive episode, an estimated 40.6% received treatment in the past year, while among those with severe impairment, an estimated 44.2% received treatment. ¹¹

The highest prevalence of having ever been diagnosed with depression by a health care professional was found among young adults (aged 18–24 years). ¹² Data from the National Survey on Drug Use and Health show that during 2015 to 2019, previous-year depression increased most rapidly among adolescents (aged 12–17 years) and young adults (aged 18–25 years). ¹²

Contributing Factors

There is no single cause of depression in young adults, but various factors may contribute, including brain chemistry imbalances, hormonal changes, inherited traits, early childhood trauma, and learned patterns of negative thinking. ^13 7 Life events such as fights with family or friends, changing schools, being bullied, experiencing a relationship break-up, recent death, abuse, or neglect can also contribute to anxiety and depression in young people. ^13 13

Impact on Academic and Professional Life

Depression can significantly impact academic performance and social functioning in young adults. ⁴ Symptoms like lethargy, lack of concentration, poor memory, and reduced attention span can impair the ability to learn, leading to lower academic scores, particularly in subjects like spelling and math. ^8 4

Many young adults described how work functions as an effective antidote to feelings of isolation, powerlessness, or low self-esteem that accompany depression, providing a productive distraction, routine, and a sense of purpose. ¹⁴ However, for others, depression and related issues made the daily stress and pressure of a job hard to manage, leading to absenteeism, presenteeism, and difficulty focusing or multitasking. ^14 15

Treatment and Management

If depression is suspected, a comprehensive evaluation by a healthcare provider or mental health professional is recommended. ^6 7 10 Treatment often involves a combination of psychotherapy, such as cognitive-behavioral therapy or interpersonal therapy. ^7 10

Employers can play a key role in supporting the early identification of depression and improving access to care by including depression screening in health risk appraisals (HRAs) and EAP programs, and ensuring that health plans use validated screening tools like the Patient Health Questionnaire (PHQ-9). ¹⁵ Employers should also encourage primary care clinicians to conduct routine depression screenings and offer collaborative care, a research-based model involving a care manager, primary care provider, and specialty mental health provider. ¹⁵

Depression in Middle-Aged Adults

Prevalence and Symptoms

The percentage of adults who experienced any symptoms of depression that were either mild, moderate, or severe in the past 2 weeks was highest among those aged 18–29 (21.0%) and lowest among those aged 30–44 (16.8%). ¹⁶ The percentage of adults who experienced mild depression symptoms was highest among those aged 18–29 (13.9%), followed by those aged 65 and over (12.0%), and lowest among those aged 45–64 (10.7%) and 30–44 (10.3%). ¹⁶ 

The percentage of adults who experienced moderate depression symptoms was higher among those aged 45–64 (4.5%) compared with those aged 30–44 (3.8%) and those aged 65 and over (3.8%). ¹⁶ The percentage of adults who experienced severe depression symptoms did not vary significantly by age and was 2.7% among those aged 18–29, 2.7% among those aged 30–44, 3.1% among those aged 45–65, and 2.6% among those aged 65 and over. ¹⁶ 

In a study, the prevalence of none or minimal, mild, and moderate to severe depressive symptoms were 77.9%, 14.9%, and 7.2%, respectively. ¹⁷

Common Stressors and Life Events

Stressful life events have been a major focus of psychiatric epidemiology and numerous investigations have found a correlation between the occurrence of stressful life events and the subsequent onset of an episode of major depression. ¹⁸ While independent stressful life events were significantly associated with onsets of depression, when level of threat was controlled, the association was significantly stronger for dependent events. ¹⁸ 

The odds ratio for onset of major depression in the month of a stressful life event was 5.64 in all subjects, 4.52 within dizygotic pairs, and 3.58 within monozygotic pairs. ¹⁸ Stressful life events have a substantial causal relationship with the onset of episodes of major depression.

However, about one-third of the association between stressful life events and onsets of depression is noncausal, since individuals predisposed to major depression select themselves into high-risk environments. ¹⁸

Impact on Family and Career

Depression in middle-aged adults can have a significant impact on their personal and professional lives. It can strain relationships with family members, lead to decreased productivity and performance at work, and contribute to a decline in overall well-being and quality of life. ¹⁹ 

Over 12 years of follow-up, subjects with depressive symptoms were more likely to reach the primary outcome measure of either persistent difficulty with mobility or difficulty with activities of daily living (ADL) function (45% vs 23%, Cox HR=2.33, 95% CI, 2.06–2.63). ²⁰ 

After adjusting for age, gender, measures of socioeconomic status, comorbid conditions, high body mass index, smoking, exercise, difficulty jogging one mile, and difficulty climbing several flights of stairs, the risk was attenuated, but still statistically significant (Cox HR=1.44, 95% CI 1.25–1.66). ²⁰

Treatment and Management

Effective treatment and management of depression in middle-aged adults often involve a combination of therapies, such as psychotherapy (e.g., cognitive-behavioral therapy, interpersonal therapy) and medication (e.g., antidepressants). ¹⁹ 

Additionally, lifestyle changes, such as regular exercise, stress management techniques, and social support, can play an important role in the recovery process. ¹⁹ Untreated clinical depression can last for weeks, months, or years, and can render people disabled in their work life, family life, and social life. ²¹ Appropriate treatment, however, can help most people with depression. ²¹

Depression in Older Adults

Prevalence and Symptoms

Depression is a common mental health issue among older adults, although its prevalence and symptoms may vary. According to the Centers for Disease Control and Prevention (CDC), estimates for major depression in older adults range from 1% to 5% for those living in the general community, 11.5% for hospitalized older adults, and 13.5% for those requiring home health care. ²²

Depression in late-life can present with an atypical cluster of symptoms, with somatic symptoms being more predominant compared to mood symptoms. ²³ These atypical symptoms can include persistent complaints of pain, headache, fatigue, apathy, agitation, insomnia, weight loss, and low attention, which may overlap with or be confused with other physical illnesses and dementia. ²³

Challenges in Diagnosis

Diagnosing depression in older adults can be challenging due to several factors. There is a common misconception that depression is a normal part of aging, leading to underdiagnosis. ^1 23 Additionally, some individuals may be reluctant to accept a diagnosis of depression due to the stigma associated with mental health conditions. ²³

Another challenge is the overlap between symptoms of depression and early-stage dementia, such as subjective memory loss, psychomotor retardation, and lack of motivation during cognitive tests. ²³ This overlap can lead to misdiagnosis or confusion between the two conditions.

Comorbid Physical Conditions

Older adults often have comorbid physical conditions that can contribute to or exacerbate depressive symptoms. More than two-thirds (72.1%) of older adults with depression have at least one physical illness, with the most common being cardiovascular (48.6%), endocrinological (27.1%), and ophthalmological (26.4%) conditions. ²⁴ However, the presence of physical comorbidities like hypertension or diabetes mellitus does not necessarily influence the manifestations of depression as assessed by the Geriatric Depression Scale (GDS-30). ²⁴

Treatment and Management

Effective treatment and management of depression in older adults often involve a combination of psychotherapy, such as cognitive-behavioral therapy or interpersonal therapy, and medication, like selective serotonin reuptake inhibitors (SSRIs). ^1 22

An interprofessional team approach is vital for improving outcomes and minimizing adverse events associated with severe depression in older adults. ²⁵ Mental health professionals should thoroughly evaluate older patients with depression for the presence of various physical illnesses and consider these illnesses and their treatments when prescribing antidepressants. ²⁴

Conclusion

Depression is a multifaceted condition that manifests differently across various age groups, reflecting the complexities of human development and the unique challenges faced at each stage of life. From childhood and adolescence to young adulthood, middle age, and later years, depressive disorders can have profound impacts on academic performance, social functioning, relationships, professional pursuits, and overall well-being. While the prevalence, symptoms, and contributing factors may vary, the consequences of untreated depression can be far-reaching and long-lasting.

Recognizing the age-specific nuances of depressive disorders is crucial for effective prevention, early intervention, and tailored treatment approaches. By fostering a deeper understanding of this complex mental health issue, we can better support individuals of all ages in their journeys towards recovery and resilience. Collaborative efforts involving healthcare professionals, mental health experts, caregivers, and communities are essential in addressing the multifaceted challenges posed by depression across the lifespan.

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