Developmental and psychodynamic aspects of childhood depression

Abstract

Twelve depressed children, ranging in age from seven to seventeen, were studied in terms of clinical presentation, familial and situational circumstances, and psychodynamics factors All children had been fully evaluated as outpatients and subsequently seen in treatment at the Massachusetts Mental Health Center. It was found that the symptomatic picture of depression varied with the developmental level of the child according to the unfolding of cognitive, social, and emotional abilities. Each child had been under severe stress for a considerable period of time and when a precipitant could be found, it appeared to be the last in a long series of frustrations and deprivations.

Relevant familial characteristics were depressed parents, marital disharmony, and social isolation. The fathers were either absent or uninvolved, while the mothers were alternately rejecting and overinvolved, often using the depressed child to fulfill her needs for parenting, company, or emotional support. In contrast, to a small group of nondepressed but equally stressed control children, differences were found in early mother-child relationships, the emotional bonding of the child to the parent, the use of the child to assume a precocious role, and in restriction of peer contact.

Within the depressed group of children two predominant personality types were found-those who felt guilty for not living up to the parental standards and those who believed themsleves unworthy because they had been scapegoated by the parent. In both groups, however, the depressed child felt responsible for the parent and actively sought approval from family members.

Conclusions are that (1) depression in childhood varies in its expression with the development level of the child, (2) depression is different from transient sadness and reflects an ingrained manner of reacting to and processing experience, and (3) adverse environmental circumstances provoke depressive reactions but that the choice of the this type of response among others may result from particular parent-child interactions.