Abstract
With depression being the fourth most common cause of disability, many of us are trying to ‘beat the blues’, get ‘beyond blue’ and come ‘out of the blues’. This book, now in its second edition, provides an excellent base of information to guide our efforts. It is part of the ‘Cambridge Child and Adolescent Psychiatry’ series, which provides comprehensive summaries of other major child psychiatric disorders. The chapters in this book are from a range of experts in the field, the standard is high and the coverage wide.
The book starts with a historical overview that challenges the notion that affective disorders were completely disregarded until the last 20 years. The emergence of the concept of depressive disorder in children and adolescents is traced, with particular attention to the nineteenth and twentieth centuries. This section was written by the late Professor William Parry-Jones for the first edition and printed unchanged in this as a tribute to his memory. It is a fascinating historical account of the attempts to make sense of mood change in children and adolescents.
A chapter on the development of emotional intelligence and emotional control follows. Children understand causes of simple emotions at a very early age. Understanding mixed emotions is a later development with emotionally disturbed children unable to recognize conflicting feelings and describing themselves as ‘all good’ or ‘all bad’ with a subsequent failure to acquire a realistic view of themselves. Ways in which the development of ‘theory of mind’ affects concepts of emotion are explained. The later recognition of the social emotions of guilt, shame and pride and their impact on self-control gives insight into the development of socially responsible behaviour and, where development is maladaptive, the beginning of helplessness and hopelessness as precursors of depression. This is a comprehensive overview of the development of emotional competence and how it may go awry.
Factors contributing to a vulnerability to depression are discussed in a chapter on developmental precursors that pulls together attachment theory, family function, temperament, emotional regulation, cognitive style, developmental tasks of adolescence and their relationship to depression. This is followed by a thorough review of physiological processes including endocrine studies, sleep dysregulation and the impact of puberty, with a reminder of how much research is yet to be done in this area.
Phenomenology and classification, epidemiology, family and genetic aspects, neuro-endocrine changes and life events get the same thorough treatment. The complexity of classifying depression in children and adolescents; the extent of comorbidity and our understanding of this; genetic predisposition and the impact of environmental processes are all discussed in depth and highlight the multifaceted nature of depressive disorder.
Suicidal behaviour in adolescents is discussed with a focus on the factors contributing to this, including environmental factors, internal factors such as the cognitive repertoire of suicidal young people, and the influence of impulsivity, imitation and hopelessness. Management of the suicidal adolescent is not included, either in this chapter or in the sections on management of depression. Possibly because I live in a country with the dubious distinction of having one of the highest youth suicide rates in the world, I would have liked to see a section with an overview of assessment and management of suicide risk in clinical practice, with a discussion of the evidence available to inform current recommended management strategies.
The chapters on pharmacological and psychotherapeutic management of depressive disorder provide a good overview of the literature to date and outline future areas for research. The final chapter on longitudinal research highlights the need for vigorous intervention for the first episode of depression and, given the high rate of recurrence of disorder, the need for maintenance treatment to prevent relapse.
The paperback format with a clear layout, makes this book user-friendly while the breadth and depth of coverage in each chapter are satisfying.
Apart from management of suicide risk, the only other area not covered in depth is prevention of depression. A number of writers have pointed out the logic of targeting depression for prevention programmes and there is an increasing literature in this area with a growing enthusiasm for prevention programmes that needs to be tempered by evidence. An examination of this aspect of depressive disorder would have been interesting. Despite these omissions this is an excellent book. I highly recommend it to professionals working in the area of child and adolescent mental health.