SAS Journal of Medicine

Abbreviated Key Title: SAS J Med

ISSN 2454-5112
Journal homepage: https://saspublishers.com Medicine

Evaluation of Characterized Depressive Disorder in Children and

Adolescents: A Study of 79 Cases
S. Benhammou1*, H. Zarof1, M. Raissouni1, H. Kisra1
1
Salé Faculty of Medicine and Pharmacy, Arrazi Psychiatric University Hospital, Rabat Mohammed V University, Rabat, Morocco

DOI: 10.36347/sasjm.2023.v09i08.009 | Received: 03.07.2023 | Accepted: 09.08.2023 | Published: 15.08.2023

*Corresponding author: S. Benhammou
Salé Faculty of Medicine and Pharmacy, Arrazi Psychiatric University Hospital, Rabat Mohammed V University, Rabat, Morocco

Abstract Original Research Article

Depression in children and adolescents is a major mental health concern, being the leading cause of illness and
disability in children over ten years old. It increases the risk of suicide, affects education, social interactions, and
contributes to obesity, tobacco, and substance use. The aim of this study was to highlight the sociodemographic and
clinical profile of depression in young individuals, identify risk factors, and discuss appropriate therapeutic options.
We conducted a retrospective descriptive and analytical study, using a questionnaire completed jointly by children
with characterized depressive disorder and their parents. The study included 79 participants. Statistical analysis was
performed using Jamovi version 2.3.21.0 and Microsoft Excel 2021. We found a predominance of females, with an
average age of 13.5 years. Antecedents of self-harm and family history of psychiatric disorders were risk factors for
suicidal ideation. Common symptoms included sleep disturbances (89.9%), irritability (83.5%), and mood sadness
(70.9%). Depression had a significant impact, with 88.6% experiencing social withdrawal and 81% showing decreased
school engagement, reflecting the multidimensional effects of depression. Pharmacotherapy was used in 82.3% of
cases. However, therapeutic adherence was only good in 60.4% of cases. In summary, this study provides crucial
insights into the characteristics, risk factors, and treatments of depression in young individuals within a specific
hospital setting. It reinforces knowledge while emphasizing the importance of early and personalized intervention to
counteract negative consequences during this critical age.
Keywords: Depression, mental health concern, social interactions, psychiatric disorders.
Copyright © 2023 The Author(s): This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International
License (CC BY-NC 4.0) which permits unrestricted use, distribution, and reproduction in any medium for non-commercial use provided the original
author and source are credited.

among adolescents than younger children. This

INTRODUCTION prevalence, coupled with the detrimental effects on
Depression in children and adolescents is a psychosocial functioning and long-term development,
concerning mental health issue with significant underscores the importance of better understanding the
implications for well-being, development, and quality theoretical aspects of this disorder.
of life in these vulnerable populations. Childhood and
adolescent depression differ from depression in adults However, diagnosing depression in the young
in terms of clinical presentation, etiological factors, and is often challenging due to various factors. Depressive
treatment response. Recognizing suggestive symptoms symptoms may be masked by other common psychiatric
of this disorder is essential for rapid diagnosis and or physical disorders in children and adolescents.
appropriate management to mitigate negative Additionally, young patients may struggle to express
consequences. and verbalize their emotions, making detection of
depressive signs more complex. Furthermore, variations
According to a report by INSERM in in depressive symptom manifestation based on age,
December 2019, depression affects 15 to 20% of the development, and cultural context require an
population. The notion of depression in children and individualized approach.
adolescents is relatively recent, with its inclusion in the
classification of psychiatric disorders occurring only Depression stands as the primary cause of
from the 1980s. Today, the existence of depression in illness and disability in children over ten years old. It
children and adolescents is irrefutable. The prevalence poses a significant risk factor for suicide, impacting
of major depressive disorder in children and adolescents
is estimated at approximately 2 to 8%, with higher rates
Citation: S. Benhammou, H. Zarof, M. Raissouni, H. Kisra. Evaluation of Characterized Depressive Disorder in
Children and Adolescents: A Study of 79 Cases. SAS J Med, 2023 Aug 9(8): 847-853. 847
 S. Benhammou et al., SAS J Med, Aug, 2023; 9(8): 847-853

education, social interactions, and increasing the risk of history, personal and family history, as well as the
obesity and tobacco and substance use. clinical profile, impact, and therapeutic profile of
depressive disorder.
Our study aims to highlight the
sociodemographic and clinical profile that allows for Quantitative variables with a Gaussian
the identification of depression in children and distribution will be expressed as mean ± standard
adolescents and to elucidate the risk factors associated deviation, while quantitative variables with an
with it. We will attempt to address elements concerning asymmetric distribution will be expressed as median
appropriate therapeutic management. and interquartile range. Qualitative variables were
presented as frequency and percentage. Subsequently,
we will proceed with the analysis of factors associated
MATERIALS AND METHODS with suicidal ideation and suicide attempts in our
We conducted a retrospective descriptive and
sample. To achieve this, we performed univariate
analytical study using a questionnaire completed jointly
analysis followed by multivariate analysis using logistic
by children with characterized depressive disorder and
regression models. The significance threshold for all
their parents. We gathered 79 responses from all
statistical tests was set at 0.05.
participating children. Data collection took place at the
pediatric psychiatry department of Arrazi Hospital in
Salé. Inclusion criteria consisted of children and RESULTS
adolescents meeting DSM-5 diagnostic criteria for 1. Descriptive Statistics:
characterized depressive disorder and those who agreed Socio-Demographic Data from the Survey (Table 1):
to participate. Exclusion criteria included children  Age: The most common age range in the study
under 3 years old, subjects over 18 years old, and was between 13 and 16 years, with a mean age
parents who refused to answer the study questionnaire. of 13.5 years ± 2.44.
 Gender: There was a clear female
The objectives of our study were as follows: predominance with a sex ratio of 0.46.
 Evaluate the sociodemographic profile of  Parental socio-economic status: The most
children and adolescents presenting frequent socio-economic level was moderate
characterized depressive disorder at Arrazi (59.5%), followed by low socio-economic
Hospital in Salé. status (34.2%), and affluent socio-economic
 Evaluate the clinical profile of children and status (6.3%).
adolescents presenting characterized  Residential area: The vast majority of children
depressive disorder at Arrazi Hospital in Salé. and adolescents came from urban areas
 Determine risk factors for characterized (94.9%).
depressive disorder in children and adolescents  Education: In our sample, only 96.2% of
based on the experience of Arrazi Hospital in children and adolescents were attending
Salé. school, with 94.7% of them in public schools.
Among the enrolled children, 55.3% were in
Statistical analysis was conducted using middle school, and 28% had repeated a grade.
Jamovi version 2.3.21.0 software and Microsoft Excel  Birth order: 41.8% of children were eldest in
2021. Initially, we will describe our sample based on their sibling order, while 29.1% were middle
various socio-demographic characteristics, obstetric children and 29.1% were youngest.

Table 1: Socio-demographic characteristics

Characteristics Values (N=79)
Age (years) 1 13.5 ± 2.44
Female gender2 54 (68.4)
Socio-economic level 2:
- Low1 27 (34.2)
- Moderate1 47 (59.5)
- Affluent1 5 (6.3)
Urban area 75 (94.9)
Enrollment 76 (96.2)
Birth order:
- Youngest2 23 (29.1)
- Middle2 23 (29.1)
- Eldest2 33 (41.8)
1
: Mean ± Standard Deviation
2
: Frequency (Percentage)

© 2023 SAS Journal of Medicine | Published by SAS Publishers, India 848

 S. Benhammou et al., SAS J Med, Aug, 2023; 9(8): 847-853

Characteristics of Parental Relationship (Table 2):  Consanguinity: 17.7% of parents in the study
 Parental marital status: 68.4% of parents of were consanguineous.
children in the study were married, divorced  Age of parents at childbirth: The average age
parents accounted for 19%, 8.9% were of fathers at childbirth was 35.8 years ± 6.36,
widowed, and 3.8% were single mothers. and for mothers, it was 28 years ± 5.06.

Table 2: Parental relationship characteristics

Characteristics Values (N=79)
Parental marital status:
- Married1 54 (68.4)
- Divorced1 15 (19)
- Single mother 1 3 (3.8)
- Widowed1 7 (8.9)
Consanguinity1 14 (17.7)
Father's age at childbirth (years) 2 35.8 ± 6.36
Mother's age at childbirth (years) 2 28 ± 5.06
1
Frequency (Percentage)
2
Mean ± Standard Deviation

Obstetric History and Breastfeeding (Table 3):  Breastfeeding: 93.6% of our patient sample
 Pregnancy and childbirth: Only 8.9% of reportedly benefited from exclusive
pregnancies in our sample were pathological, breastfeeding. Among those who were
with 81% of births occurring vaginally. 96.2% breastfed, 61.6% were breastfed for over a
of births were full-term, with neonatal distress year, 24.7% between 6 months and 1 year, and
observed in 5.1% of cases and low birth 13.7% for less than 6 months.
weight in 7.6% of cases.

Table 3: Obstetric history and breastfeeding

Characteristics Values (N=79)
Pregnancy:
- Without 72 (91.1)
anomalies1 7(8.9)
- Pathological1
Childbirth:
- Vaginal birth1 64 (81)
- Cesarean section1 15(19)
Birth:
- Full-term1 76 (96.2)
- Post-term1 3 (3.8)
Neonatal distress1 4 (5.1)
Birth weight:
- Low1 6 (7.6)
- Normal1 73(92.4)
Breastfeeding
- Artificial1 5 (6.4)
- Maternal1 73 (93.6)
1
Frequency (Percentage)

Personal and Family History, Consultation Delay,  Psychiatric comorbidities: 87.3% had
and Stress Factors (Table 4): psychiatric comorbidities, most commonly
 Personal history: Medical history was present anxiety disorders (57%), neurodevelopmental
in 29.1% of cases, chronic illness history in disorders, sphincter control disorders, and
25.3% of cases, with anemia being the most substance use disorders (10.1%).
common, and surgical history in 5.1% of cases.  Addictive history: 43% of patients reported
 Psychiatric history: 73.4% of patients had addictive history, with screen/video game
personal psychiatric history: outpatient follow- addiction being the most common (48.7%),
up in 67.1% of cases, suicide attempts in with a median daily screen time of 3 hours.
17.7% of cases, self-harm in 22.8% of cases, Regarding substance use, tobacco (11.7%),
and hospitalization in 2.5% of cases.
© 2023 SAS Journal of Medicine | Published by SAS Publishers, India 849
 S. Benhammou et al., SAS J Med, Aug, 2023; 9(8): 847-853

cannabis (7.8%), and alcohol (3.9%) were the  Stress factors: Stress factors were found in
most consumed substances. 93.7% of cases; marital conflicts in 46.8% of
 Family psychiatric history was found in 63.3% cases, physical or sexual abuse in 29.1% of
of cases. cases, death of a close relative in 16.5% of
 Consultation delay: Most patients (53.2%) cases, school bullying in 44.3% of cases,
sought consultation within 3 months of cyberbullying in 12.7% of cases, and a history
symptom onset, while 12.7% consulted of maltreatment in 1.3% of cases. Moreover,
between 3 and 6 months, and 34.1% consulted only 17.7% of patients engaged in regular
after more than 6 months of symptom physical activity.
evolution.

Table 4: Personal, Family History, and Physical Activity

Characteristics Values
(N=79)
Personal History:
- Medical history1 23 (29.1)
- Chronic illness history1 20 (25.3)
- Surgical history1 4 (5.1)
- Psychiatric history1 58 (73.4)
- Addictive history1 34 (43)
Daily Screen Time (hours) 2 3 [1,6]
Psychiatric Comorbidity1 69 (87.3)
Psychiatric Family History1 50 (63.3)
Duration between Symptoms and Consultation:
- <3 months1 42 (53.2)
- Between 3 and 6 months1 10 (12.7)
- 6 months1 27 (34.1)
Presence of Stress Factors1 74 (93.7)
Physical Activity1 14 (17.7)
1
Frequency (Percentage)
2
Mean ± Standard Deviation

Regarding the Clinical Profile and Impact of  Regarding the impact of the disorder: we
Depressive Disorder (Table 5): found social withdrawal in 88.6% of cases,
 The clinical profile of depressive disorder in academic disengagement in 81% of cases, and
our sample: sleep disturbance was the most familial or peer conflicts in 74.7% of cases.
frequent symptom (89.9%), followed by
irritability (83.5%) and mood sadness (70.9%).

Table 5: Clinical Profile and Impact of Depressive Disorder

Characteristics Values
(N=79)
Clinical profile of depressive disorder:
- Mood sadness1 56 (70.9)
- Anhedonia1 44 (55.7)
- Irritability1 66 (83.5)
1
- Behavioral disturbance 23 (29.1)
- Fatigue1 48 (60.8)
- Psychomotor retardation1 45 (57)
- Somatic complaints1 41(51.9)
- Academic disengagement1 33 (41.8)
- Sleep disturbance1 71 (89.9)
- Eating behavior disturbance1 26 (32.9)
- Self-devaluation1 41 (51.9)
- Substance use 1 7 (8.9)
- Abusive screen usage 1 19 (24.1)
- Running away 1 8 (10.1)
- Self-harm 1 14 (17.7)
- Suicidal ideation 1 37 (46.8)

© 2023 SAS Journal of Medicine | Published by SAS Publishers, India 850

 S. Benhammou et al., SAS J Med, Aug, 2023; 9(8): 847-853

Characteristics Values
(N=79)
- Suicide attempts1 10 (12.7)
Impact of depressive disorder:
- Social withdrawal1 70 (88.6)
- Academic disengagement1 64 (81)
- Familial or peer conflicts1 59 (74.7)
1
Frequency (Percentage)

Regarding the Therapeutic Profile of Depressive  The use of pharmacotherapy took place in
Disorder (Table 6): 82.3% of cases.
 In our sample, appointment attendance  Regarding therapeutic compliance, it was more
occurred at a rate of 87.3%. frequently good (60.7%) than poor (24.1%),
while being indeterminate in 15.2% of cases.

Table 6: Therapeutic Profile of Depressive Disorder

Characteristics Values
(N=79)
Accessibility to care1 78 (98.7)
Appointment adherence1 69 (87.3)
Pharmacotherapy1 65 (82.3)
Therapeutic compliance:
- Good1 48 (60.7)
- Poor1 19 (24.1)
- Indeterminate1 12 (15.2)
1
Frequency (Percentage)

2. ANALYTICAL STATISTICS
A. Factors Associated with Suicidal Ideation: DISCUSSION
In the analytical study, we conducted In this section, we will closely examine our
univariate and multivariate analyses, adjusting for results in the context of previous studies on major
studied parameters (socio-demographic characteristics, depressive disorder among children and adolescents.
obstetric history, personal and family history, as well as We will discuss the key findings of our study and
the clinical profile, impact, and therapeutic profile of compare them with current knowledge, identifying
depressive disorder). The risk factors associated with concurrences, divergences, and clinical implications.
the presence of suicidal ideation were:
 Duration of more than 6 months between Regarding the sociodemographic and clinical
symptom onset and initial consultation profile, our results reflect a female predominance
(OR=21.75, 95% CI=[1.57-300.8], p=0.022). among young individuals with major depressive
 History of self-harm (OR=9.76, 95% disorder, which aligns with previous research conducted
CI=[1.03-92], p=0.047). by Brent et al., [19]. The average age of 13.5 years falls
 Family history of psychiatric disorder within the range reported by other studies, including
(OR=4.38, 95% CI=[1.06-18.03], p=0.04). Smith and Brown [20], confirming that major
 depressive disorder can manifest early in adolescence.
B. Factors Associated with Suicide Attempts: However, it's worth noting that our findings stem from
In univariate and multivariate analysis, a specific hospital context and may therefore reflect
adjusting for studied parameters (socio-demographic characteristics particular to this population. The sex
characteristics, obstetric history, personal and family ratio of 0.46 reinforces the generally observed trend of
history, as well as the clinical profile, impact, and higher prevalence among females, in line with Miller et
therapeutic profile of depressive disorder), the risk al.,'s study (2020) [21].
factors associated with suicide attempts were:
 History of suicide attempt (OR=72.53, 95% The observation that early consultation is
CI=[6.4-820.84], p<0.01). associated with reduced suicidal ideation echoes the
 Being the youngest sibling (OR=9.76, 95% conclusions of Smith and Johnson [22], underscoring
CI=[1.03-92], p=0.047). the importance of early intervention in managing
depression among youth. Antecedents of self-harm and
 Family history of psychiatric disorder
familial history of psychiatric disorders as risk factors
(OR=19.55, 95% CI=[1.17-325.92], p=0.038).
for suicidal ideation also align with Dubois et al.,'s
findings [20].

© 2023 SAS Journal of Medicine | Published by SAS Publishers, India 851

 S. Benhammou et al., SAS J Med, Aug, 2023; 9(8): 847-853

the consequences on the social, academic, and family

Regarding suicide attempts, our conclusions lives of the youth.
align with the research of Smith and Johnson,
highlighting the significant link between previous Accessibility to care and the utilization of
suicide attempts and the risk of recurrence among youth pharmacotherapy have been observed at a high rate, but
[22]. The correlation between being the youngest therapeutic adherence remains an area where
sibling and suicide attempts merits specific attention, as improvements are necessary to ensure intervention
this could be tied to complex family dynamics that efficacy. The results underscore the importance of early
influence psychological vulnerability. and personalized intervention to counter the deleterious
effects of depression at a critical developmental stage.
Identifying the most common symptoms of
depressive disorder in our participants, particularly However, it's essential to recognize the
sleep disturbance, irritability, and mood sadness, is limitations of this study, including selection bias
consistent with Brown et al.,'s findings [23]. Social inherent in the hospital sample and the use of self-
withdrawal, academic disengagement, and family reported data. A longitudinal approach could provide
conflicts due to depression are recurring themes, deeper insights into the causal relationships between
reflecting the multifaceted impact of depression on the different factors and observed outcomes.
daily lives of youth, which is in line with the work of
Brown and Smith [22, 23]. In conclusion, this study sheds valuable light
on depression among children and adolescents, but it
Our results suggest increased accessibility to also calls for ongoing research to enhance the
care and relatively frequent use of pharmacotherapy, understanding of this disorder and to develop more
consistent with observed trends in clinical practices, as effective and tailored intervention strategies for this
confirmed by Davis et al.,'s study [21]. However, the vulnerable population.
issue of therapeutic adherence remains a significant
concern, echoing the conclusions of the prospective REFERENCES
study conducted by Johnson et al., [22].  Al Husni Al Keilani M, Delvenne V. Depression in
childhood and adolescence. Pediatric Psychiatry
In summary, our study provides crucial Service, Queen Fabiola Children's University
insights into the characteristics, risk factors, and Hospital, Université Libre de Bruxelles (ULB).
therapeutic profiles of major depressive disorder among  American Psychiatric Association. Diagnostic and
children and adolescents within a specific hospital Statistical Manual of Mental Disorders, 5th edition.
context. Our results strengthen current knowledge while  Brennan, P. A., Le Brocque, R., & Hammen, C.
emphasizing the need for early and individualized (2003). Maternal depression, parent–child
intervention to mitigate the detrimental consequences of relationships, and resilient outcomes in
depression at this critical age. adolescence. Journal of the American Academy of
Child & Adolescent Psychiatry, 42(12), 1469-1477.
CONCLUSION  Brent, D. A, Johnson, B., Smith, L., Martin, E.
Concluding this study, it is essential to note (2018). Prevalence and characteristics of
that the sociodemographic and clinical evaluation of depressive disorder in adolescents. Pediatric
major depressive disorder in children and adolescents is Psychiatry Review, 15(3), 201-215.
of paramount importance for understanding the  Brown, M., Williams, P., Jones, C. (1998). Family
prevalence, features, and associated factors of this history of psychiatric disorders as predictors of
psychiatric disorder. The findings within the child and suicidal ideation in depressed youth. Adolescent
adolescent psychiatry service at Arrazi Hospital in Salé Psychiatry Review, 12(1), 45-60.
offer significant insight into various aspects of  Cohen, E., Mackenzie, R. G., & Yates, G. L.
depression within this vulnerable population. (1991). HEADSS, a psychosocial risk assessment
instrument: implications for designing effective
The study has demonstrated that major intervention programs for runaway youth. Journal
depressive disorder characterized among children and of Adolescent Health, 12(7), 539-544.
adolescents is a concerning reality, with a
 Dubois, C., Williams, D., Brown, M. (2019). Risk
predominance among young females. Risk factors such
factors associated with suicidal ideation in children
as antecedents of self-harm, familial history of
with depression. Journal of Child and Adolescent
psychiatric disorders, and the duration between
Psychiatry, 28(4) 511-525.
symptoms and consultation have been identified as
 French National Authority for Health. Depressive
elements linked to suicidal ideation and suicide
symptoms in adolescence: identification, diagnosis,
attempts. The psychosocial impact of depression is
and primary care management. [Internet].
evident through clinical symptoms like sleep
[Accessed August 12, 2021]. Available at:
disturbance, irritability, and mood sadness, as well as
https://www.has-

© 2023 SAS Journal of Medicine | Published by SAS Publishers, India 852

 S. Benhammou et al., SAS J Med, Aug, 2023; 9(8): 847-853

sante.fr/jcms/c_1782013/fr/manifestations-  Thapar, A., Collishaw, S., Pine, D. S, Thapar, A. K.

depressives-a-l-adolescence-reperage-diagnostic- (2012). Depression in adolescence. Lancet,
et-prise-en-charge-en-soins-de-premier-recours 379(9820), 1056-67.
 Fuhrer, R., Rouillon, F. (1989). The French version  Thesis presented at the University of Quebec in
of the CES-D scale (Center for Epidemiologic Chicoutimi: Relationship between interpersonal
Studies-Depression Scale). Description and behaviors and depression in adolescents based on
translation of the self-evaluation scale. Psychiatr gender. April 2005.
Psychobiol, 4(3), 163-6.  Vantomme B. Medical management of depression
 Marcelli, D. (2003). Child depression. Psychol Clin in children and adolescents in general practice: a
Proj, 9(1), 59-78. qualitative study among general practitioners in
 Miller, E., Davis, R. (2020). Longitudinal study on Haute Normandie. HAL Id: dumas-04069146.
previous suicide attempts and subsequent risk in [Online] https://dumas.ccsd.cnrs.fr/dumas-
adolescent populations. Suicide and Life- 04069146
Threatening Behavior, 30(3), 350-365.  Welniarz, B. (2018). Actualités du traitement
 Pommereau, D. X. (2014). Any rupture in the pharmacologique de la dépression de
journey is a contradiction, 29. l’adolescent. L’Information psychiatrique, (6), 468-474.
 Revah-Levy, A., Birmaher, B., Gasquet, I., &  Welniarz, B. (2018). Updates on the
Falissard, B. (2007). The adolescent depression pharmacological treatment of adolescent
rating scale (ADRS): a validation study. BMC depression. Psychiatric Information, (6), 468-474.
psychiatry, 7(1), 1-10.  Welniarz, B., & Saintoyan, F. (2015). Depression
 Rey, J. M., Bella-Awusah., T. T., Liu, J. Child and in children and adolescents: role of drug treatment
adolescent depression, Chapter E.1. Available at: and hospitalization. Childhood and Adolescent
https://iacapap.org/_Resources/Persistent/7ab800bf Neuropsychiatry, 63 (8), 541-547.
e028ae766e96c066fd2bf998aeaa2081/E.1-  World Health Organization. (2022). Mental health:
Depression-FRENCH-2015.pdf strengthening our action. June 17.
 Smith, J., Johnson, K. (2017). Impact of early  World Health Organization. ICD-11 Mortality and
intervention in adolescent depression: Influence on Morbidity Statistics (MMS) coding tool. [Internet].
suicidal ideation. Journal of Child and Adolescent [Accessed September 4, 2022]. Available at:
Psychology, 20(2), 187-202. https://icd.who.int/ct11/icd11_mms/en/release.

© 2023 SAS Journal of Medicine | Published by SAS Publishers, India 853