This guideline covers the identification and treatment of depression in children (5 to 11 years) and young people (12 to 18 years) in primary, community and secondary care. Depression is a broad diagnosis that can include different symptoms in different people. However, depressed mood or loss of pleasure in most activities, are key signs of depression. Depressive symptoms are frequently accompanied by symptoms of anxiety, but may also occur on their own.
The International Statistical Classification of Diseases (ICD‑10) uses an agreed list of 10 depressive symptoms, and divides depression into 4 categories: not depressed (fewer than 4 symptoms), mild depression (4 symptoms), moderate depression (5 to 6 symptoms), and severe depression (7 or more symptoms, with or without psychotic symptoms). For a diagnosis of depression, symptoms should be present for at least 2 weeks and every symptom should be present for most of the day.
For the purposes of this guideline, the management of depression has been divided into the following categories as defined by the ICD‑10:
moderate and severe depression
severe depression with psychotic symptoms.
However, it is unlikely that the severity of depression can be understood in a single symptom count or visit. A child or young person may present initially with psychosomatic symptoms, and may need to be seen on more than one occasion with parents/carers and without, if appropriate, in order to gain trust. Therefore, beyond single symptom count, family context, previous history, and the degree of associated impairment are all important in helping to assess the severity of depression. Because of this, it is important to assess how the child or young person functions in different settings (for example, at school, with peers and with family), as well as asking about specific symptoms of depression.
Children and young people's mental health services are NHS priorities for care quality and outcomes improvement within the NHS Long Term Plan. As part of the plan, services will be expanded and will receive more funding. This includes the expansion of community-based mental health services to meet the needs of more children and young people and the improvement of mental health support for children and young people in school and colleges.
Remember that child maltreatment:
can present anywhere, such as emergency departments and primary care or on home visits.
Be aware of or suspect abuse as a contributory factor to or cause of the symptoms or signs of depression in children. Abuse may also coexist with depression. See the NICE guideline on child maltreatment for clinical features that may be associated with maltreatment.