Prevalence of Childhood Affective disorders in Turkey: An epidemiological study

The burden of major depressive disorder in the Middle East and North Africa region, 1990-2019

BACKGROUND

Major depressive disorder (MDD) is one of the leading causes of disability. We aimed to report the MDD-attributable prevalence, incidence and years lived with disability (YLDs) in the Middle East and North Africa (MENA) region from 1990 to 2019 by age, sex and socio-demographic index (SDI).

METHODS

Publicly available data on the burden of MDD were retrieved from the Global Burden of Disease (GBD) study 2019 for the 21 countries in MENA. The counts and age-standardised rates (per 100,000) were presented, along with their corresponding 95% uncertainty intervals.

RESULTS

In 2019, MDD had an age-standardised point prevalence of 3322.1 and an incidence rate of 4921.7 per 100,000 population in MENA. Furthermore, there were 4.1 million YLDs in 2019. However, there were no substantial changes in the MDD burden over the period 1990-2019. In 2019, Palestine had the highest burden of MDD. The highest prevalence, incidence and YLDs attributable to MDD were found in the 35-39 age group. In 2019, the YLD rate in MENA was higher than the global rate for almost all age groups. Furthermore, there was a broadly negative association between the YLD rate and SDI.

CONCLUSION

The study highlights the need to prevent the disorder using a multidisciplinary approach and for the provision of cost-effective treatments for those affected, in order to increase their quality of life.

A systematic review and network meta-analysis on comparative efficacy, acceptability, and safety of treatments in acute bipolar mania in youths

BACKGROUND

The evidence of treatment options' efficacy on acute bipolar manic episodes is relatively less in youths than adults. We aimed to compare and rank the drug's efficacy, acceptability, tolerability, and safety for acute mania in children and adolescents.

METHOD

We systematically reviewed the double-blinded, randomized controlled trials (RCTs) comparing drugs or placebo for acute manic episodes of bipolar disorder in children and adolescents using PRISMA guidelines. We searched PubMed/MEDLINE, EMBASE, Web of Science, EBSCO, Scopus, the Cochrane Central Register of Controlled Trials, and https://clinicaltrials.gov from inception until November 20, 2022. Response to treatment was the primary outcome, and random-effects network meta-analyses were conducted (PROSPERO 2022: CRD42022367455).

RESULTS

Of 10,134 citations, we included 15 RCTs, including 2372 patients (47 % female), 15 psychotropic drugs, and the placebo. Risperidone 0.5-2.5 mg/day, aripiprazole 30 mg/day olanzapine, quetiapine 400 mg/day, quetiapine 600 mg/day, asenapine 5 mg/day, asenapine 10 mg, ziprasidone, and aripiprazole 10 mg were found to be effective (in comparison with placebo) in children and adolescents, respectively (τ2 = 0.0072, I2 = 10.2 %). The tolerability of aripiprazole 30 mg/day was lower than risperidone 0.5-2.5 mg/day and olanzapine. Oxcarbazepine had the highest discontinuation due to the adverse effects risk ratio.

LIMITATIONS

Efficacy ranking of the treatments could be performed by evaluating relatively few RCT results, and only monotherapies were considered.

CONCLUSIONS

Efficacy, acceptability, tolerability, and safety are changing with the doses of antipsychotics for children and adolescents with acute bipolar manic episodes. Drug selection and optimum dosage should be carefully adjusted in children and adolescents.

Estimated Prevalence of Depressive Disorders in Children From 2004 to 2019: A Systematic Review and Meta-Analysis

Importance

Depression during childhood (ie, age <13 years) poses a major health burden. Recent changes in environmental and lifestyle factors may increase children's risk of mental health problems. This has been reported for anxiety disorders, but it is unclear whether this occurs for depressive disorders.

Objective

To provide prevalence estimates for the depressive disorders (ie, major depressive disorder [MDD], dysthymia, disruptive mood dysregulation disorder [DMDD], and overall) in children, and whether they have changed over time.

Data Sources

The MEDLINE, PsycINFO, Embase, Scopus, and Web of Science databases were searched using terms related to depressive disorders, children, and prevalence. This was supplemented by a systematic gray literature search.

Study Selection

Studies were required to provide population prevalence estimates of depressive disorder diagnoses (according to an established taxonomy and standardized interviews) for children younger than 13 years, information about participants' year of birth, and be published in English.

Data Extraction and Synthesis

Data extraction was compliant with the Meta-Analysis of Observational Studies in Epidemiology guidelines. A total of 12 985 nonduplicate records were retrieved, and 154 full texts were reviewed. Data were analyzed from 2004 (the upper limit of a previous review) to May 27, 2023. Multiple proportional random-effects meta-analytic and mixed-effects meta-regression models were fit.

Main Outcomes and Measures

Pooled prevalence rates of depressive disorders, prevalence rate differences between males vs females and high-income countries (HICs) vs low-and middle-income countries (LMICs), and moderating effects of time or birth cohort.

Results

A total of 41 studies were found to meet the inclusion criteria. Pooled prevalence estimates were obtained for 1.07% (95% CI, 0.62%-1.63%) for depressive disorders overall, 0.71% (95% CI, 0.48%-0.99%) for MDD, 0.30% (95% CI, 0.08%-0.62%) for dysthymia, and 1.60% (95% CI, 0.28%-3.90%) for DMDD. The meta-regressions found no significant evidence of an association with birth cohort, and prevalence rates did not differ significantly between males and females or between HICs and LMICs. There was a low risk of bias overall, except for DMDD, which was hindered by a lack of studies.

Conclusions and Relevance

In this systematic review and meta-analysis, depression in children was uncommon and did not increase substantially between 2004 and 2019. Future epidemiologic studies using standardized interviews will be necessary to determine whether this trend will continue into and beyond the COVID-19 pandemic.

VEGF, IGF-1 and FGF-2 Serum Levels in Children and Adolescents with Autism Spectrum Disorder with and without Bipolar Disorder

PURPOSE

To investigate serum levels of VEGF, IGF-1 and FGF-2, and relationships with several clinical characteristics in children and adolescents with autism spectrum disorder (ASD) with and without bipolar disorder (BD).

METHOD

40 subjects with ASD + BD as study group, and 40 subjects with ASD as control group were included. Serum levels of VEGF, IGF-1, and FGF-2 were measured using commercial enzyme-linked immunosorbent assay kits.

RESULTS

The study group was significantly higher than the control group in terms of ASD severity, self-harming behavior and sleep disturbance. Serum VEGF and FGF-2 levels were significantly higher in the ASD + BD group than in the control group. There was no significant difference in serum IGF-1 levels between the two groups. There was no correlation between VEGF, IGF-1 and FGF-2 serum levels and ASD severity in the study group. However there was a negative correlation between VEGF levels and age at first diagnosis of BD, and a positive correlation between IGF-1 levels and the number of bipolar episodes in the study group.

CONCLUSION

Growth factors like VEGF and FGF-2 may be potential biomarkers of bipolar disorder in young subjects with ASD. Given the difficulty of clinical management of BD in young subjects with ASD, potential biomarkers would help clinicians in the diagnosis and follow up of BD in this special population. Further research is needed whether VEGF and FGF-2 can be potential biomarkers in the clinical management of young subjects with ASD and BD.

The diagnosis of bipolar disorder in children and adolescents: Past, present and future

AIMS

This article examines the ongoing debate concerning the diagnosis of bipolar disorder in children and adolescents. This contentious issue has generated robust discussion over the past two decades without consensus, and as such the true prevalence of so-called paediatric bipolar disorder (PBD) remains unknown. In this article we offer a solution to break this deadlock.

METHODS

Recent meta-analyses and additional literature concerning the definition and prevalence of PBD was critically reviewed with a view to understanding the perspectives of those developing the taxonomy of PBD, and those engaged in research and clinical practice.

RESULTS

A key finding is the lack of iteration and meaningful communication between the various groups interested in PBD that stems from deep-seated problems within our classificatory systems. This undermines our research efforts and complicates clinical practice. These problems make the already difficult diagnosis of bipolar disorder in adults even more challenging to transpose to younger populations, and additional complexities arise when parsing clinical phenomenology from normative developmental changes in youth. Therefore, in those manifesting bipolar symptoms post-puberty, we argue for the use of adolescent bipolar disorder to describe bipolar symptoms whereas in pre-pubertal children, we propose a reconceptualisation that allows symptomatic treatment to be advanced whilst requiring critical review of these symptoms over time.

CONCLUSION

Significant changes in our current taxonomy are necessary and to be clinically meaningful, these revisions to our diagnoses need to be developmentally-informed.

Prevalence of affective disorders in Chinese school-attending children and adolescents aged 6-16 based on a national survey by MINI-Kid

BACKGROUND

Major depressive disorder (MDD), dysthymia disorder (DD) and bipolar disorder (BD) are the most prevalent affective disorders. A nationwide epidemiological investigation of MDD, DD and BP in school-attending children and adolescents was carried out, taking the effect of age, gender and comorbidity into consideration.

METHODS

A two-stage nationwide epidemiological study of point prevalence was conducted. Using a multistage cluster stratified random sampling strategy. The sample distribution was described, and the point prevalence of affective disorders was estimated. Chi-squared tests were used to compare disease prevalence based on sex and age. Comorbid ratios for MDD, DD and BP were calculated.

RESULTS

The total number of cases in Stage 1 was 72,107 (aged 6-16 years). The point prevalence of MDD, DD and BP were 2.004 % (95 % CI: 1.902 to 2.106), 0.352 % (95 % CI: 0.309 to 0.395) and 0.856 % (95 % CI: 0.788 to 0.923), respectively. The total prevalence of affective disorder was 3.212 % (95 % CI: 3.079 to 3.338). The total prevalence of affective disorders between sexes (female: 3.834 % versus male: 2.587 %, χ² = 90.155, p < 0.001) was consistent with the gender difference in MDD, DD and MD. The total prevalence of affective disorders in adolescents was higher than that in children (adolescents: 5.024 % versus children: 1.863 %, χ² = 566.841, p < 0.001).

CONCLUSIONS

Our study is the first nationwide survey on the prevalence of affective disorders among school-attending children and adolescents aged 6-16 in China. Our results also highlighted the importance of addressing comorbidities in future studies of affective disorders.

Relationship of herpesvirus (HSV1, EBV, CMV, HHV6) seropositivity with depressive disorder and its clinical aspects: The first study in children

Infections can lead to the onset of mood disorders in adults, partly through inflammatory mechanisms. However pediatric data are lacking. The aim of this study is to evaluate the relationship between depressive disorder and seropositivity of herpes virus infections in children. The sample group consisted of patients diagnosed with depressive disorder according to DSM-5 diagnostic criteria and healthy volunteers, being between 11 and 18 years with clinically normal mental capacity. All children completed DSM-5-Level-2 Depression Scale, DSM-5-Level-2 Irritability Scale, DSM-5-Level-2 Sleep Scale, DSM-5-Level-2 Somatic Symptoms Scale. The levels of anti-HSV1-IgG, anti-CMV-IgG, anti-EBNA, and anti-HHV6-IgG were examined in all participants. Patients with an antibody value above the cut-off values specified in the test kits were evaluated as seropositive. The mean age was 15.54 ± 1.57 years in the depression group (DG), 14.87 ± 1.76 years in the healthy control group (CG). There were 4 boys (11.2%), 32 girls (88.8%) in the DG, 9 boys (21.9%) and 32 girls (78.04%) in the CG. There was no statistically significant difference between the groups in terms of the presence of seropositivity of HSV1, CMV, EBV, and HHV6. HHV6 antibody levels were significantly higher in the DG (p = 0.000). A significant positive correlation was found between HHV6 antibodies and DSM-5 level-2 somatic symptoms scale score. HHV6 antibody levels were found to be significantly higher in patients with existing suicidal ideation in the DG (n = 13) compared to those without existing suicidal ideation in the DG (p = 0.043). HHV6 persistent infections may be responsible for somatic symptoms and etiology of suicidal ideation in childhood depressive disorder.

Reliability and Validity of the Bipolar Prodrome Symptom Interview and Scale-Full Prospective in Its Turkish Translation

Editors' Note: The Editors would like to address issues related to the acceptance of this manuscript. The original manuscript referenced the study tool as the Bipolar Prodrome Symptom Interview Scale-Prospective (BPSS-P). After the manuscript's initial acceptance, the authors requested a revision of the tool name to Bipolar Prodrome Symptom Interview Scale-Full Perspective (BPSS-FP). When this request was made, the original acceptance was rescinded, and the authors were asked to formally revise and resubmit the manuscript with an explanation for the change. This revision and subsequent review led to the final acceptance of the manuscript. The authors have assured us that the tool used in the manuscript was the BPSS-FP (version 5) as opposed to abbreviated forms of this tool that are also used in research (e.g., Bipolar Prodrome Symptom Scale-Abbreviated Screen for Patients (BPSS-AS-P). Background: No scale exists to assess patients at-risk for bipolar disorder (BD) in Turkey. We aimed to assess the psychometric properties of the Turkish version of the Bipolar Prodrome Symptom Interview and Scale-Full Prospective (BPSS-FP). Method: Psychiatric service users aged 11-18 years old were interviewed using the BPSS-FP translated into Turkish and the Kiddie Schedule for Affective Disorders and Schizophrenia. Youth with major depressive disorder (MDD, n = 63), bipolar-spectrum disorder (n = 47), and healthy controls (n = 122) were included. Cronbach's alpha was calculated to assess internal consistency. The Young Mania Rating Scale (YMRS) and Children's Depression Rating Scale-Revised (CDRS-R) were administered to test convergent/discriminant validity. Discriminant validity was further tested using one-way ANOVA and "receiver operating characteristic" (ROC) curves. Inter-rater reliability was tested using correlation coefficients. Findings: Across 232 youth, Cronbach's alpha values were 0.932 for the BPSS-FP total score, 0.878 for the Mania Symptom Index, 0.887 for the Depression Symptom Index, and 0.797 for the General Symptom Index. Correlation coefficients for inter-rater reliability were high for the Mania Symptom Index (r = 0.989), Depression Symptom Index (r = 0.973), and General Symptom Index (r = 0.981). There were high correlations between the BPSS-FP Mania Symptom Index subscore and YMRS (r = 0.732), and the BPSS-FP Depression Symptom Index subscore and CDRS-R (r = 0.754), whereas cross-polarity correlations were non-significant. ROC analysis cut-off value was ≥21 for the BPSS-FP Mania Symptom Index between patients with BD and MDD (specificity = 85.7%, sensitivity = 78.7%). Conclusion: The Turkish version of the BPSS-FP has good psychometric properties and can be used in research. Longitudinal studies are needed to confirm the predictive value of the BPSS-FP.

Lifetime depressive and current social anxiety are associated with problematic internet use in adolescents with ADHD: a cross-sectional study

AIM

To evaluate the relationships between problematic internet use (PIU) and psychiatric comorbid disorders and internet use habits in a clinical sample of adolescents with attention-deficit/hyperactivity disorder (ADHD).

METHOD

This cross-sectional study included 95 adolescents with ADHD. Problematic behaviors and symptoms related to internet use were evaluated via Young's Internet Addiction Scale (YIAS), and subjects with a YIAS score of ≥50 were categorized as PIU while those with a score of <50 were defined as normal internet use (NIU). The two groups were compared with respect to demographics and psychometric tests. While psychiatric disorders were examined by a semistructured instrument, self-report and parent-report scales were used to assess other individual and clinical characteristics of participants.

RESULTS

33.7% (n = 32) of the participants were determined to have PIU. There was no gender (p = .058) or age (p = .426) difference between the PIU and NIU groups. Current presence of social phobia (p = .035) and history of major depressive disorder (p = .006) were more frequent in the PIU group than the NIU group. Multivariable regression analysis revealed that PIU was independently associated with online gaming (OR: 2.375, 95% CI: 1.532-3.681), e-mail use (OR: 1.864, 95% CI: 1.170-2.971), social networking (OR: 1.834, 95% CI: 1.156-2.910), and Social Phobia Scale for Children and Adolescents (SPSCA) score (OR: 1.058, 95% CI: 1.020-1.098).

CONCLUSION

PIU may be common among adolescents with ADHD. The severity of social phobia and particular online activities (playing online games, e-mailing, social networking) may be associated with a higher risk of PIU in adolescents with ADHD.

'Pediatric Bipolar Disorder' rates are still lower than claimed: a re-examination of eight epidemiological surveys used by an updated meta-analysis

Background

‘Pediatric bipolar disorder’ (PBD) is a controversial diagnosis with varying rates of clinical diagnosis. A highly cited meta-analysis (Van Meter et al. 2011) of a dozen epidemiological surveys suggested a global community prevalence of PBD of 1.8%. This was updated to 3.9% with eight additional surveys (Van Meter et al. 2019a). In terms of the Cochrane Handbook for Systematic Reviews of Interventions, the heterogenous community surveys were arguably unsuitable for statistical meta-analysis and warranted a narrative analysis. A narrative analysis (Parry et al. 2018) of the original 12 surveys concluded rates of PBD were substantially lower than 1.8% and led to a nine-article debate on the validity, arguable overdiagnosis and iatrogenic aspects of the PBD diagnosis (e.g. Carlson and Dubicka Child Adolesc Mental Health 21:86–87, 2019). This article extends the narrative analysis to include the eight newer community surveys.

Methods

A narrative analysis of the methodologies and the prevalence rates reported by the epidemiological surveys.

Results

Across all twenty surveys there was significant variation in methodologies and reported prevalence rates. Of the eight newer surveys, five (two Brazilian, one English, one Turkish, one United States) provided information of pre-adolescent prevalence rates of bipolar spectrum disorder. These pre-adolescent rates were zero or close to zero. Rates of adolescent hypomania and mania were higher, but follow-up data in two studies suggested hypomania might sometimes achieve prolonged remission or not lead to adult bipolar disorder.

Limitations

Methods in the original surveys vary and criteria used for various bipolar diagnoses were not always fully described. This limitation applies to a narrative analysis but also to a statistical meta-analysis.

Conclusion

Bipolar disorder is very rare in childhood and rare in adolescence. PBD as a diagnostic construct fails to correlate with adult bipolar disorder and the term should be abandoned. Hypomanic syndromes in adolescence may not always progress to adult bipolar disorder. Early diagnosis of bipolar disorder is important, but over-diagnosis risks adverse iatrogenic consequences.

The prevalence, comorbidity and socio-demographic factors of depressive disorder among Iranian children and adolescents: To identify the main predictors of depression

BACKGROUND

Depressive disorders are a major public health problem in developed and developing countries. Recently, several risk factors have been described for depressive disorders in children and adolescents. The aim of the present study was to identify the main risk factors that can affect the incidence of depression in Iranian children and adolescents.

METHODS

A total of 30,546 children and adolescents (between 6 and 18 years of age) participated in a cross-sectional study to identify the predictors of depressive disorders. Depressive disorders were assessed using the Persian version of the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS-PL). In addition, a demographic characteristics questionnaire was completed by parents of the participants. The data was analyzed using the SPSS₂₂ software via performing the descriptive analysis and the multiple logistic regression analysis methods. P-values less than 0.05 were considered statistically significant.

RESULTS

Results showed that a higher age (15-18), being female, and the father's unemployment were associated with an increased odds ratio for depressive disorders. The age of 10-14 (OR = 2.1; 95% CI, 1.57-2.81), the age of 15-18 (OR = 4.44; 95% CI, 3.38-5.83), female gender (OR = 1.44; 95% CI, 1.2-1.73) and the father's unemployment (OR = 1.59; 95% CI, 1.01-2.5) were significant positive predictors, whereas, the mother's job (as a housewife) (OR = 0.66; 95% CI, 0.45-0.96) and a history of psychiatric hospitalization of the father and mother (OR = 0.34; 95% CI, 0.15-0.78 and OR = 0.34; 95% CI, 0.14-0.84) were negative predictors for depressive symptoms.

CONCLUSION

Depressive symptoms are common in children and adolescents and are correlated with age and gender. The assessment of the prevalence of psychiatric disorders, especially the depressive disorders and their comorbidities, may help to prevent mood disorders in children and adolescents.