Depression in children and young people: identification and management in primary, community and secondary care (NICE guideline CG28)

Table 1 Child An individual aged 5-11 years Young person An individual aged 12-18 years Typical symptoms of depression Low mood or irritability, loss of interest or enjoyment and increased fatigability for at least 2 weeks, at least half the time and with impairment Other symptoms of depression Poor concentration and attention; reduced self-esteem or self-confidence; ideas of guilt or worthlessness; agitation; ideas or acts of self-harm or suicide (including bleak outlook for future); disturbed sleep (increased or decreased); significant change in appetite (with weight gain/loss) Mild depressive episode At least two typical and two other symptoms for at least 2 weeks Moderate depressive episode At least two typical and three to four other symptoms for at least 2 weeks, usually with significant functional impairment Severe depressive episode All three typical and at least four other symptoms, some of which should be of severe intensity Tier 1 Primary care services, including general practitioners, teachers and voluntary agencies Tiers 2 and 3 2 CAMHS sole practitioners in the community and community paediatricians and CAMHS multidisciplinary specialist outpatient services Tier 4 CAMHS highly specialist outpatient and inpatient services CAMHS, Child and Adolescent Mental Health Services. Previous guidelines Box 1 Resources http://www.nice.org.uk/guidance/cg28/resources/guidance-depression-in-children-and-young-people-identification-and-management-in-primary-community-and-secondary-care-pdf Link to the National Institute for Health and Care Excellence (NICE) full guideline http://www.nice.org.uk/guidance/cg28/ifp/chapter/definitions-of-psychological-treatments Link to public information on guideline Hopkins, et al 2015 3 Summary of the guidance by the Clinical Guidelines Update Committee Key issues that the guideline addresses Risk profiling A child/young person exposed to a single recent undesirable life event should be assessed for symptoms and risk factors for depression with a risk profile documented in their records.