A systematic review and meta-analysis on the prevalence of depression in children and adolescents after exposure to trauma.

BACKGROUND: Depression is often reported as co-occurring with post-traumatic stress disorder in children and adolescents, but its prevalence within trauma-exposed child and adolescent samples is not well understood. METHODS: Our meta-analyses addressed two questions: I. What is the prevalence of depression (either based on structured interview or cut-off on a self-report measure) in children and adolescents after exposure to trauma? II. Does trauma exposure increase the severity or rates of depression comparative to another comparison group of children and adolescents with milder exposure or no exposure to trauma? RESULTS: Fifty-six studies reported depression prevalence. A random effects meta-analysis suggested that 24.2% [95% CI 20.6-28.0] of children and adolescents exposed to a traumatic event met criteria for depression. Our second meta-analysis across 30 studies found that the effect of trauma exposure (relative to unexposed or less exposed children and adolescents) on depression scores was medium in size (d = 0.51, 95% CI 0.41-0.61). The odds of a diagnosis of depression were 2.6 times greater [95% CI 2.0-3.3] for children and adolescents exposed to trauma as compared to those unexposed or less exposed. Participants exposed to interpersonal violence (IPV) had a higher prevalence and level of depression compared with those exposed to non-IPV trauma. LIMITATIONS: Results should be interpreted with caution due to high levels of heterogeneity. CONCLUSION: Depression in trauma-exposed children and adolescents is a common response to trauma that is not solely reflective of pre-traumatic difficulties. Post-traumatic depression merits serious consideration in trauma-exposed children and adolescents.

Pediatric disaster preparedness in the medical setting: integrating mental health.

INTRODUCTION: The increasing prevalence of disasters worldwide highlights the need for established and universal disaster preparedness plans. The devastating events of September 11 and Hurricane Katrina have spurred the development of some disaster response systems. These systems, however, are predominantly focused on medical needs and largely overlook mental health considerations. Negative outcomes of disasters include physical damage as well as psychological harm. Mental health needs should be considered throughout the entire disaster response process, especially when caring for children, adolescents, and their families. OBJECTIVE: To provide an overview and recommendations for the integration of mental health considerations into pediatric disaster preparedness and response in the medical setting. METHODS: Recommendations were developed by a panel of disaster preparedness and mental health experts during the Childrens Hospital Los Angeles Pediatric Disaster Resource and Training Center: Workshop on Family Reunification in Los Angeles, California, March 31-April 1, 2008. Experts discussed the inclusion of mental health-specific considerations and services at all stages of disaster preparedness and response. Recommendations involve the integration of mental health into triage and tracking, the adoption of a child ambassador model, environment, and developmentally appropriate interventions, education, communication, death notification, and family reunification. CONCLUSIONS: The inclusion of mental health concerns into pediatric disaster preparedness may help prevent further and unnecessary psychological harm to children and adolescent survivors following a disaster.