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Our child has been medically ill. She is having behavioral problems at school and home and is angry all the time. What can we do?

Children and adolescents who have a chronic or severe acute medical illness are vulnerable to a variety of emotional problems, including depression and anxiety. In both children and adolescents, behavioral problems may be the only apparent evidence for a mood or anxiety disorder. After the initial diagnosis, there may be adjustment difficulties with features of depression and behavioral problems. A lot of fears surface when a person is ill, and, particularly for adolescents, the illness may isolate them from their friends because they feel different. Chronically ill children tend to have reduced socialization with their peers, which in turn can also precipitate or worsen depression. There may be developmental delays across several areas of functioning as a result of the illness, so it is important to seek a mental health evaluation as soon as possible, in an effort to minimize these delays. Therapy can be very useful to address issues of self-esteem and loss of personal control. Group therapy in particular is often very useful for the medically ill, both for adolescents and adults.

Why is depression more common in women?

Depression is twice as prevalent in women as in men. This difference, however, does not occur until midpuberty. Childhood depression is more common in boys. Many theories can explain this difference. One hypothesis as to the higher frequency of depression in women is that hormonal changes occur across the life span. Hormonal and other biologic factors have not adequately explained the differences, however. It has also been postulated that women may be more likely to report their depressive symptoms, but scientific evidence has not supported this, as studies have demonstrated that men and women are equally likely to report their depressive symptoms.

The symptom profile for men and women tends to be similar, except that women are more apt to report anxious symptoms and physical complaints. In terms of comorbid conditions, women are more likely to experience concurrent anxiety, and men have behavioral and substance abuse disorders.

Social factors have appeared to have a larger role in the cause of differences between men and women than biologic factors. For example, more females than males are victims of childhood sexual abuse. Women who have experienced physical or sexual abuse in childhood are at higher risk for developing depression than women who have not been abused. In addition, research has shown that girls experience a higher number of stressful events than boys. Gender roles also may contribute, as some aspects of the feminine role may be more associated with depression. Adolescent girls who are preoccupied with their appearance are vulnerable to depression, and gender inequality in marital relationships also promotes increased rates of depression in women. Females tend to have a more negative self-view than males. Such cognitive thought patterns can increase the likelihood for depression.

What are the postpartum blues? Does that mean that I am depressed or will become depressed?

Pregnancy is a time of both physical and emotional changes. It is often expected that women should be happy during their pregnancy, but, in fact, because of physical and psychological changes, an increased susceptibility for the onset of a depressive episode exists. Both the pregnancy and the postpartum period are often when a first episode of depression occurs. During the postpartum period an emotional state called the "blues" commonly occurs. Hormone levels have dropped precipitously. Sleep deprivation occurs, and new psychological factors are at play in response to the woman having a new role as a mother. The blues occur in 50% to 85% of all women postpartum and are characterized by symptoms of depressed mood, tearfulness, mood swings, irritability, and anxiety. These symptoms tend to be self-limited, beginning a few days postpartum and lasting a couple of weeks. If symptoms persist beyond 2 weeks and/or significantly impair functioning, there is a greater likelihood that a major depressive episode is present or will develop.

The postpartum period can be a high-risk time for a depressive episode in susceptible women. For similar reasons that the blues occur, so too can depression develop. Depression occurs in approximately 10% to 15% of all postpartum women, which approximates the occurrence in the general population. Thus, although hormonal factors are believed to be contributory, they are not strictly causative. Factors associated with an increased risk for postpartum depression are past history of depression, a family history of depression, limited social support and interpersonal conflicts, and negative life events. Most women have the onset of symptoms within 6 weeks postpartum. The presence of depression does not signify poor parenting. What is important is to seek treatment right away because untreated depression in the mother can have deleterious effects on the baby's development.

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