MAJOR DEPRESSIVE DISORDERS IN PAEDIATRIC SURGICAL PATIENTS: AN OVERVIEW OF THE NIGERIAN ADOLESCENTS

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O.A. Afolabi¹, K.I. Egbuchulem²

1. Department of Psychiatry, University College Hospital, Ibadan, Oyo State.
2. Division of Paediatric Surgery, Department of Surgery, University College Hospital, Ibadan, Oyo State.

Abstract

Introduction: Less than three decades ago, depression was seen as a predominantly adult disorder as children were considered too developmentally immature to experience depressive disorders, and adolescent low mood was considered as part of ‘normal’ teenage mood swings. Major depressive disorder in children and adolescents is a serious psychiatric illness especially in paediatric surgical patients. This may be due to their altered metabolic rate and heighten metabolic response to trauma which has significant implications for the psychological development of the child, yet it remains under-recognized and undertreated. The well-being of the care givers is also not left out as the care givers are inundated with the task of sourcing and providing finance for hospital care., in addition to the stress of providing care for the patient. This may result in loss of man hour, sleeplessness, and physical exhaustion associated with caring for these ill children which can ultimately significantly increase the risk of them having depressive episode.

The aim of this commentary is to highlight the fact that paediatric surgical patients are not exempt to having a major depressive disorder and the care givers should also be evaluated during hospital admission of their wards.

Methodology: This is a commentary on depressive disorders among Nigerian paediatric surgical patients. Related publications on children and adolescents presenting to hospital were searched using the domain – Depression in Nigerian adolescent, Paediatric surgery patients on PubMed, Google Scholar, and MEDLINE to appraise this review.

Conclusion: Mood disorders, especially depression in children and adolescents have been studied increasingly over the last two decades and surgical conditions worsen the outlook, culminating in increased knowledge about the presentation, and treatment. Despite this, it is still often missed or misdiagnosed because it sometimes presents with uncharacteristic symptoms. Prevalence of depressiion among paediatric surgical patient were found to be between 46-82% in this review among Nigerian patients.

Keywords: Depressive disorders, Paediatrics, Surgical adolescents, Nigeria.

Introduction

The Convention on the Rights of the Child (CRC), defined a child as “every human being below the age of eighteen years, or below the legally defined age limit for the country, whereas the World Health Organization defines adolescence as beginning at age 10 years and continuing through age 19 years¹. Major depression is an episodic, recurring disorder characterized by persistent and pervasive sadness or unhappiness, loss of enjoyment of everyday activities, irritability, and associated symptoms such as negative thinking, lack of energy, difficulty concentrating, and appetite and sleep disturbances.²

Less than three decades ago, depression was seen as a predominantly adult disorder as children were considered too developmentally immature to experience depressive disorders, and adolescent low mood was considered as part of ‘normal’ teenage mood swings.³ Few would now doubt the reality of child and adolescent depressive disorders, or that youth depression is associated with a range of adverse outcomes including social and educational impairments as well as both physical and mental health problems later in life. Major depressive disorder in children and adolescents is a serious psychiatric illness especially in paediatric surgical patients. This many be due to their altered metabolic rate and heighten metabolic response to trauma which has significant ramifications for the psychological development of the child, yet it remains under-recognized and undertreated.⁴

The well being of the care givers are also not left out as the care givers are inundated with sourcing and providing finance for hospital care, to …….. to the stress of providing care for the patients. This may result in the loss of man hour, sleeplessness, and physical exhaustion associated with caring for these ill children which can ultimately significanly increase the risk of them being a depressive episode which was corroborated by Aggo and Okafor⁵ where they found the prevalence of preoperative depression to be 49% among parents of children undergoing anaesthesia and surgical operations at University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria.

As debates continue regarding the validity of psychiatric diagnoses in children and adolescents, paediatric patients with surgical conditions are also not exempt. Longitudinal research, however, has continually demonstrated that most adult disorders have their origins in childhood, and most childhood disorders have consequences that persist to adulthood.⁶ For example, a subset of untreated and neglected hydrocoele can persist till adulthood with associated morbidity. Dienye et al.,⁷ found a 62% depression rate among men presenting with giant hydrocoele in a rural clinic in Nigeria.

A cross-sectional study by Nkporbu et al.,⁸ on the pattern of depressive illness among school age children presenting at the university of Port Harcourt Teaching Hospital showed a higher prevalence of depression in children aged 15 – 19 (82 %) while 10 – 14 was 46 %. However, there is evolving evidence to suggest MDD can even exist in preschoolers.9 Additionally, MDD that emerges in children aged 5-12 years can be severe and lead to poorer outcomes compared with later onset MDD⁹.