This quality standard covers the diagnosis and management of depression in children and young people aged between 5 and 17 years (that is, up to their 18th birthday). For more information please see the topic overview.
Depression is a broad and heterogeneous diagnostic grouping, central to which is depressed mood and loss of pleasure in most activities. Depressive symptoms are frequently accompanied by symptoms of anxiety, but may also occur on their own. The ICD‑10 Classification of Mental and Behavioural Disorders (World Health Organization 1992) uses an agreed list of 10 depressive symptoms to divide the common form of major depressive episode into 4 groups. Symptoms should be present for at least 2 weeks and every symptom should be present for most of the day. The 4 groups are:
not depressed (fewer than 4 symptoms)
mild depression (4 symptoms)
moderate depression (5–6 symptoms)
severe depression (7 or more symptoms, with or without psychotic symptoms).
Depression is most often not confined to only 1 family member. Parental depression is a strong risk factor for the child or young person's depression, and the child or young person's experience of depression is best helped by their parents or carers. Parents and carers have an important role to play in supporting the child or young person with depression and should be engaged at all stages of assessment, diagnosis and treatment.
NICE quality standards are a concise set of prioritised statements designed to drive measureable quality improvements within a particular area of health or care. They are derived from high‑quality guidance, such as that from NICE or other sources accredited by NICE. This quality standard, in conjunction with the guidance on which it is based, should contribute to the improvements outlined in the following outcomes framework published by the Department of Health:
Table 1 shows the outcomes, overarching indicators and improvement areas from the frameworks that the quality standard could contribute to achieving.
Table 1 NHS Outcomes Framework 2013–14
Overarching indicators and improvement areas
4 Ensuring that people have a positive experience of care
Improving children and young people's experience of healthcare
4.8 An indicator is under development
The quality standard for depression in children and young people specifies that services should be commissioned from and coordinated across all relevant agencies encompassing the whole care pathway for depression in children and young people. A person‑centred, integrated approach to providing services is fundamental to delivering high‑quality care to children and young people with depression.
The Health and Social Care Act 2012 sets out a clear expectation that the care system should consider NICE quality standards in planning and delivering services, as part of a general duty to secure continuous improvement in quality. Commissioners and providers of health and social care should refer to the library of NICE quality standards when designing high‑quality services. Other quality standards that should also be considered when choosing, commissioning or providing a high‑quality service for children and young people with depression are listed in related NICE quality standards.
The quality standard should be read in the context of national and local guidelines on training and competencies. All healthcare professionals and social care practitioners involved in assessing, caring for and treating children and young people with depression should have sufficient and appropriate training and competencies to deliver the actions and interventions described in the quality standard.
Quality standards recognise the important role families and carers have in supporting children and young people with depression. If appropriate, healthcare professionals and social care practitioners should ensure that family members and carers are involved in the decision‑making process about investigations, treatment and care.