Retrospective Analysis of Clinical Characteristics and Treatment of Children and Adolescents with Depression

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A total of 635 cases of children and adolescents with depression in a hospital were collected through electronic records from January 2014 to December 2021. They were grouped according to the age of onset, amounting to 115 cases in childhood ( 8 – 12 ), 359 early adolescents ( 13 – 15 ), and 161 cases in late adolescence ( 16 – 18 ). The three groups were compared in terms of general conditions, clinical characteristics, and treatment. Results showed that over the past 8 years, the proportion of hospitalizations in the early adolescence group has been increasing, that in the late adolescence group was lower than that in previous years, and gender (X 2 = 16.66, P < 0.001), psychotic symptoms (X 2 = 6.224, P = 0.045), and disease course (Z = 84.617, P < 0.001) were significantly different. No significant differences were found in drug treatment regimen, suicide, length of hospital stay, or family history among the three groups. There were differences in the general conditions and clinical characteristics of children and adolescents with depression at different onset ages. The number of hospitalized children and adolescents with depression is increasing annually, and the proportion of hospitalizations in the children group was higher than that in previous years. Females are more likely to suffer from the disease and present more psychotic symptoms. The course of the disease in the early adolescence group was shorter than that in the other two groups, and the late adolescence group had more males and fewer psychotic symptoms. depression childhood early adolescence late adolescence antidepressants Figures Figure 1 1 Introduction About 3.1% of the total global burden of disease is attributable to mental and psychological disorders ( 1 ), with depression accounting for the largest share of the burden of mental illness ( 2 ). An epidemiological study in the United States found that the lifetime prevalence of depression in adolescents was 11–14%, and approximately 20% of adolescents experienced severe depression before the age of 18 ( 3 ). A domestic study on the prevalence of mental disorders in children and adolescents aged 6–16 found that the overall prevalence of mental disorders is as high as 17.5%. Attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and major depressive disorder (MDD) are the most common mental disorders in children and adolescents, among which the prevalence of the depressive disorder was 3.0% ( 4 ). In addition, a longitudinal study of adolescents whose parents had a history of mood disorders found that depression was the strongest predictor of suicidal behavior in adolescents and young adults. The study also found that children with depression were almost three times more likely to commit suicide before adolescence than adolescents with depression ( 5 ). Notably, the female gender and suicidal ideation are predictors of suicidal behavior in adolescents ( 6 ). Adolescence (ages 10–19) is a unique formative period with multiple physical, emotional, and psychological factors, and social change is critical for the development and maintenance of social and emotional habits. Promoting mental health and preventing adverse experiences and risk factors that may affect the growth potential are important aspects of the physical and mental health of adolescents and adults. Illness is a complex and multifaceted process influenced by many biological and environmental factors. Numerous studies have confirmed the impact of cognitive, psychosocial, and biological developmental levels on the susceptibility of children and adolescents to MDD. However, it remains difficult to reach a consensus on the psychopathology of depression in children and adolescents, the incidence of depressive symptoms, and other relevant phenomenological differences. Chaaopadhyay et al. conducted a 24-week cognitive-behavioral intervention in 82 adolescents with depression and achieved significant results. It was confirmed that, while the amygdala and anterior cingulate cortex were significantly improved in the resting state, the function of the prefrontal cortex was not ( 7 ). In addition, genetic studies on depression have found that parental emotional mishandling and pregnancy adversity may increase the odds of childhood depression. Burkhouse et al. studied the relationship between the emotional processing of depressed parents and their children in 7–18-year-old children and adolescents. Using functional magnetic resonance imaging, they found abnormalities in the dorsal anterior cingulate cortex of depressed parents and children, especially a negative bias in implicit emotional processing, thus altering this emotional processing may reduce the odds of a depressive episode ( 8 ). Another study investigated the association between maternal depression and children, from pregnancy to adulthood, during family adversity. In this study, approximately 2,200 offspring under the age of 30 were followed and found that the association between maternal and offspring depression appears to be partly attributable to the degree of family adversity in the depressive mother ( 9 ). Thirty years ago, depression was thought to be an adult-only mental illness, with children and adolescents being “immune” to it, considering their low mood or their depressive manifestations as a “normal” part of growing up. Existing research shows that children and adolescents can suffer from depression as well as, and that depression in children and adolescents can lead to a range of adverse outcomes, such as suicide, impaired social functioning, lower educational attainment, and possible later physical and mental illness ( 10 ). Adolescence is a risk factor for depressive episodes with a high recurrence rate and poor functional prognosis. After entering adolescence, people are emotionally vulnerable, easily depressed when they experience setbacks, and have a growing sense of independence from their parents, being more sensitive and prone to depressive symptoms. Compared to children, adolescents have more anhedonia, narcolepsy, and difficulty concentrating, while feelings of worthlessness are more common in children ( 11 , 12 ). Symptoms of depression in children and adolescents differ from those in adults. They show fewer core symptoms of depression and often have more problems with behavior, school, and interpersonal relationships. It is often accompanied by behavioral problems, such as Internet addiction, violent conflict, and self-injury. It seriously affects the quality of life of young people and places a heavy burden on their families and society. In a study of 276 adult patients with relapsing depression, approximately 50% had an onset before the age of 18 years ( 13 ). Individuals with depressive episodes in childhood or adolescence had a higher risk of suicide, with 48% of those with early onset depression attempting suicide compared to 26% of those with adult depression. This highlights the importance of the appropriate and effective management of depression in children and adolescents. However, the current diagnosis of depression in children and adolescents is still based on diagnostic criteria for adults. Therefore, to promote the comprehensive recovery of adolescent depression patients, it is important to study the clinical characteristics of adolescent depression patients. In this study, growth stages were divided into childhood (8–12 years old), early adolescence (13–15 years old), and late adolescence (16–18 years old). The main purpose of this study was to better understand the demographic and clinical characteristics of depression at different onset ages from childhood to late adolescence, to improve family and social awareness of depression in children and adolescents, and to provide clinical evidence for targeted assessments and interventions. 2 Materials And Methods Children and adolescents aged ≤ 18 years who were hospitalized in the Fourth People’s Hospital of Hefei City, China, between January 2014 and December 2021 were selected as research subjects. The inclusion criteria were: ( 1 ) they met the diagnostic criteria for depression according to the International Classification of Diseases and Diagnostic Criteria (ICD-10); ( 2 ) the medical records were complete and reliable, and no study had a lack of data and information. The exclusion criteria included: ( 1 ) schizophrenia, bipolar disorder, intellectual disability, or other mental disorders; ( 2 ) alcohol and drug use; and ( 3 ) neurological diseases or organic brain damage. A total of 635 subjects were included in this study, consisting of 456 females and 179 males, aged 11–18 years (15.33 ± 1.71) years old. Data on the general condition and clinical characteristics of inpatients were collected from the electronic records of the hospital. ( 1 ) The general situation investigation included sex, age, family history of mental disorders, physical diseases. ( 2 ) The collection of clinical characteristic data included diagnosis, treatment, whether it was accompanied by suicidal behavior or psychotic symptoms, and suicide assessment. The “suicidal behavior” was clearly identified in the medical record, with the suicide method described in detail. ( 3 ) The treatment situation was according to the medical record and doctor’s order data. The medication regimen was collected on the day of discharge according to data entry and drug treatment regimens were divided into antidepressants alone, antidepressants + antipsychotics, antidepressants + antipsychotics + mood stabilizers, and antidepressants + mood stabilizers. The data was gathered and proofread by multiple people. Based on the age of onset, the cases were divided into children group ( 8 – 12 ), early adolescence group ( 13 – 15 ) and late adolescence group ( 16 – 18 ). SPSS 26.0 was used for data processing and analysis. The measurement data conforming to the normal distribution are expressed as (x ± s), and the measurement data of the skewed distribution are expressed as medians and quartiles. The chi-square test was used to compare differences between groups, and the Bonferroni method was used for multiple comparisons. P < 0.05 (two-tailed) indicated that the difference was statistically significant. 3 Results 3.1 Demographic and clinical characteristics of the study population A total of 635 participants were included, including 115 in the childhood group (18.1%), 359 (56.5%) in the early adolescence group, and 161 (25.4%) in the late adolescence group. Basic demographic information and clinical characteristics of the patients are shown in Table 1 . Among them, 28.2% were men, and 71.8% were women. The mean age at admission was 15.33 ± 1.71 years. There were 494 (77.8%) patients with first onset, 159 (25.0%) patients with psychotic symptoms, with an average age of onset of 14.21 ± 1.87 years, and an average disease duration of 14.54 ± 13.57 months. The Hamilton Depressing Rating Scale (HAMD) and Hamilton Anxiety Rating Scale (HAMA) total scores at admission were 21.42 ± 9.15 and 12.54 ± 6.45, respectively. As time progressed (Fig. 1), the number of hospitalizations for depressive disorder increased yearly, the proportion of hospitalizations in the child group increased compared with previous years, and the proportion of hospitalizations in the late adolescence group tended to decline. Table 1 Demographic and clinical characteristics of the study population. Demographic variables N(%) Male 179(28.2) Age at admission (M, SD) 15.33(1.71) Clinical characteristics Days of hospitalization (M, SD) 36.74(23.02) First onset 494(77.8) Age of onset, years (M, SD) 14.21(1.87) 8 ≤ age<13 115(18.1) 13 ≤ age ≤ 15 15<age ≤ 18 359(56.5) 161(25.4) Duration of illness, months (M, SD) 14.54(13.57) Major depression with psychotic symptoms 159(25.0%) HAMA total at admission(M, SD) 12.54(6.45) HAMD total at admission(M, SD) 21.42(9.15) Depressing Rating Scale ; HAMA,Hamilton Anxiety Rating Scale 3.2 Comparison of general data and distribution of hospitalizations There were no significant differences in hospitalization time, family history of mental disorders, suicidal behavior, or HAMD 24 total score among the three groups (all P > 0.05), while significant differences were found in sex and course of disease among (all P < 0.05) (Table 2 ). Among them, women in the childhood group and men in the late adolescence group had a higher incidence, and the disease duration in the early adolescence group was shorter than that in the other two groups. In terms of clinical characteristics, there were statistically significant differences in psychotic symptoms among the three groups, among which the children were more likely to have psychotic symptoms. During the eight years, there were differences in the proportion of hospitalizations in different age groups in different years (X 2 = 29.736, P < 0.01). Table 2 Comparison of differences in general conditions and clinical characteristics of patients with different types of patients. children n = 115 n(%) early adolescence n = 359 n(%) late adolescence n = 161 n(%) Z/ χ2/F P Gender Male 16(13.9) 105(29.2) 58(36.0) 16.660 <0.001** Female 99(86.1) 254(70.8) 103(64) Family history of mental illness positive 7(6.1) 19(5.3) 8(5.0) 0.172 0.918 Negative 108(93.9) 340(94.7) 153(95.0) Psychotic symptoms With 38(33.0) 89(24.8) 32(19.9) 6.224 0.045** without 77(67) 270(75.2) 129(80.1) Sleep disorder With 54(47.0) 189(52.6) 93(57.8) 3.168 0.205 without 61(53) 170(47.4) 68(42.2) Suicide yes 19(16.5) 77(21.4) 23(14.3) 4.199 0.123 No 96(83.5) 282(78.6) 138(85.7) Days of hospitalization (m, sd) 36.39(21.99) 36.51(23.16) 37.49(23.53) 0.117 0.890 HAMD 24 (m, sd) 22.59(8.06) 21.09(9.29) 21.25(9.58) 1.202 0.301 Duration of ilness 15.00(12.00, 36.00) 12.00(6.00, 24.00) 6.00(2.50, 12.00) 84.617 <0.001** HAMD, The Hamilton Depressing Rating Scale; statistic values were expressed by Pearson’s χ2 tests. *P < 0.05; **P < 0.01. 3.3 Types of medicines on discharge The discharge prescriptions of different antidepressants and discharge regimens of the 635 patients were included in the statistical analysis. Of these, 156 patients were on monotherapy and 479 were on combination therapy. The top five antidepressants were sertraline in 399 cases (52.2%), duloxetine in 114 cases (18.0%), mirtazapine in 95 cases (12.4%), escitalopram in 51 cases (8.0%), and venlafaxine in 50 cases (7.9%)( Table 3 ). Comparing the frequency of commonly used antidepressants and treatment regimens in patients of different age groups, it was found that among the top five antidepressants, there was no significant difference in the frequency of antidepressant use in hospitalized patients of different ages (all P > 0.05; X2 = 8.082, P = 0.425) ( Table 4 ). There were no significant differences in depressive drugs, antidepressant drug + antipsychotic drug combination, antidepressant drug + antipsychotic drug + emotion stabilizer combination, and other treatments (all P > 0.05) (Table 5 ). Table 3 Analysis of the use frequency and the dosage of commonly used Antidepressants. N(%) Dosage(mg/d) Dosage range(mg/d) Escitalopram 51(8.0%) 15 ± 4.58 5.00–20.00 Fluvoxamine 18(2.8%) 176.39 ± 17.05 20.00-120.00 Fluoxetine 26(4.1%) 43.08 ± 15.69 20.00–60.00 paroxetine 12(1.9%) 35 ± 13.14 10.00–60.00 Sertraline 399(62.8%) 119.76 ± 49.47 25.00-120.00 Mirtazone 95(15.0%) 18.95 ± 11.93 7.50–60.00 Venlafaxine 50(7.9%) 175.98 ± 48.98 75.00-225.00 Duloxetine 114(18.0%) 55.58 ± 17.05 20.00-120.00 Table 4 Comparison of Antidepressant Drugs in Children, Early Adolescents, and Late Adolescents Sertraline Duloxetine Mirtazone Venlafaxine Escitalopram χ2 P children (n = 115) 90(78.3) 17(14.8) 14(12.2) 7(6.1) 9(7.8) 8.082 0.425 early adolescence (n = 359) 227(63.2) 68(18.9) 54(15.0) 30(8.4) 27(7.5) late adolescence (n = 161) 82(51.0) 29(18.0) 24(15.0) 13(8.1) 15(9.3) statistic values were expressed by Pearson’s χ2 tests. *P < 0.05; **P < 0.01. Table 5 Comparison of the treatment of depression in childhood, early adolescents and late adolescents. medical treatement χ2 P A B C D children (n = 115) 30 58 21 6 10.024 0.124 early adolescence (n = 359) 80 160 70 49 late adolescence (n = 161) 46 61 32 22 A ：Antidepressants；B Antidepressants + Antipsychotics；C ：Antidepressant + Antipsychotic + Mood Stabilizer treatment；D： Antidepressant + Mood Stabilizer treatment.Data were expressed by N (%) or mean ± standard deviation; statistic values were expressed by Pearson’s χ2 tests. *P < 0.05; **P < 0.01. 4 Discussion Reviewing the demographics, clinical characteristics, and drug treatment plans for children and adolescents with depression in different age groups from 2014 to 2021, results showed that women in the children group had more symptoms and psychotic symptoms, and the disease duration in the early adolescence group was shorter than that in the other two groups. In the late adolescence group, males had more morbidities and fewer psychotic symptoms. As time progressed, the number of hospitalizations for depressive disorder increased yearly, the proportion of hospitalizations in the child group increased compared with previous years, and the proportion of hospitalizations in the late adolescence group tended to decline. There were no statistically significant differences in the frequency of antidepressant use or treatment regimens among the three groups. Our study found that regarding depression, gender differences appeared in childhood and later adolescence. It was more common in female patients than in the other two groups of children, while male patients were more common in the late adolescence group. Regarding gender differences, the results of a 1998 study showed that gender differences in depression appeared in early adolescence (around 12–13 years old) and mid-adolescence. Angold et al. used the Children’s Depression Inventory (CDI) to evaluate depressive symptoms. The results showed that gender differences in depressive symptoms in children and adolescents aged 9–16 years in the UK appeared at 13 years of age. Previously, there was no statistically significant difference in the detection rate of depressive symptoms between boys and girls. In addition, another study showed that, in the general population, the incidence of depression in boys during childhood did not differ by sex and was even slightly higher than that of girls ( 14 ). Female predominance in depression is thought to appear at 13–15 years of age ( 15 ). However, this differs from our findings. The age of onset in women in this study was more commonly 8–12 years. A meta-analysis of nearly a decade of studies on adolescent depression found that negative life events in early female adolescents can increase the risk of depression, most likely by increasing the individual’s sensitivity to and amplifying stress, and other pathways increase adolescents’ susceptibility to depression ( 16 ). Furthermore, some theorists believe that physiological changes during puberty increase the risk of depression in girls ( 17 ). The exact timing of depression may indicate which physiological changes may increase the risk of depression in girls. Social changes, such as school transitions, improved living standards, and changes in parental divorce rates may be responsible for gender differences in depression key turning points. In conclusion, although gender differences in depression symptoms in adolescence have not yet been unified, research generally supports the phenomenon of “female dominance” in depression symptoms in adolescence and considers that gender differences in sex hormone levels in adolescence are the main reasons. Boys with depression in the late adolescence group are more common, probably because boys in this age group are more lively and naughty than girls, so they are generally more criticized and punished in school than girls; further, their psychological pressure is also higher than that of girls, thus being prone to show more anxiety and worry, hence, they are at a higher risk of developing depressive symptoms than girls. Depression can be divided into two subtypes: depression with and without psychotic symptoms. Depression with psychotic symptoms refers to meeting the diagnostic criteria for depression, and is accompanied by hallucinations, delusions, depressive stupor, and other symptoms. Our study found that 25.0% (159 cases) of depressive children and adolescents had psychotic symptoms. Ryan et al. found that the prevalence of psychotic features in outpatients with major depressive disorder was 18% ( 18 ), while Haley et al. showed a prevalence of 45% in a sample of hospitalized adolescent patients ( 19 ). Some studies have shown that the proportion of depression with psychotic symptoms in patients with depression is 15–19% ( 20 ), which may be related to differences in the study population, ethnicity, assessment of psychotic symptoms, and diagnostic criteria. In terms of associated psychiatric symptoms, the age of onset is younger and more common in childhood, consistent with previous studies ( 21 ). A study of 129 depressed adolescents found that individuals with psychotic symptoms were more likely to have a history of childhood trauma, especially severe sexual abuse ( 22 ). Previous studies have also shown that patients with adverse childhood events have an earlier age of onset than patients without ( 23 ), indicating that adverse childhood life events may lead to an earlier onset and the chronicity of depression in patients with depression, obvious social function impairment, and other characteristics. McGee et al. found that healthy children who had hallucinatory experiences before the age of 11 were more likely to develop more severe depression ( 24 ). Further major depressive disorder with psychotic symptoms is associated with more severe symptoms, worse prognosis ( 25 ), greater risk of relapse ( 25 , 26 ), and higher mortality rates ( 27 ). Therefore, childhood and adolescence are critical periods for the prevention of and early intervention for depression. Reasonable intervention can reduce or delay the related health problems caused by depression, whether it is a normal group or a sick child, such as hallucinations, delusions, and other abnormal experiences. Thus, early detection should be desirable. In clinical practice, it is difficult for clinicians to collect mental symptoms of sick children because patients with psychotic symptoms are often reluctant to mention their abnormal perception and thinking due to embarrassment, which requires clinicians and the use of flexible and proficient communication skills to define whether an affected child has psychotic symptoms. Compared with the childhood and late adolescence groups, the early adolescence group had a shorter course of disease, and the proportion of hospitalizations increased yearly. On the one hand, this may be due to people paying more attention to children aged 13–15 than other age groups, probably being the main reason for family members and patients seeking medical treatment as soon as possible. On the other hand, it may be due to the fact that early adolescents are in a critical period of physical and mental development. During the process of aging, their body structure changes significantly, while their psychological and physiological development is not mature, living through a contradiction between naivety and maturity, dependence and independence. At this psychologically sensitive and fragile stage, it is easy to take a one-sided and extreme view of problems, to be unable to properly handle complex interpersonal relationships and stressful events, and often be accompanied by some physical discomfort symptoms; the physical condition becomes worse, and it is easier for individuals to cast their eyes on themselves, while ignoring other aspects. The mentality is further deteriorated, resulting in the accumulation of bad emotions, eventually developing into a depressive disorder. Previous research has found an association between peer bullying and depression ( 28 ). The mechanism may be that peer bullying as a chronic stressor leads to hypervigilance, followed by learned helplessness, and finally, depression ( 29 ). In addition, study pressure is an important factor related to depression. The mechanism may be that under external pressure, the individual’s hypothalamic-pituitary-adrenal axis neuroendocrine system is disorderly regulated, and a large amount of stress hormones are released, resulting in damage to the brain regions related to emotion ( 30 ). This may be an important factor in the occurrence of depression among children and adolescents. This study showed that there were no statistical differences in the choice of antidepressant drugs and treatment options among the three groups of patients. Internationally, most treatment guidelines for children and adolescents recommend psychological intervention for mild depressive episodes, treatment and a combination of psychotherapy and antidepressant medication for moderate-to-severe depressive episodes ( 31 ). In the United States, only two antidepressants have been approved for child and adolescent use: fluoxetine is approved for the use in children with MDD, and both fluoxetine and escitalopram are approved for use in adolescents (FDA, accessed 2021a). In this study, the top five antidepressants used for children and adolescents were sertraline, duloxetine, mirtazapine, escitalopram, and desvenlafaxine. As a new antidepressant, sertraline can effectively inhibit the reuptake of serotonin in the central nervous system and regulate norepinephrine. It is used in the clinical treatment of various patients with depression and obsessive-compulsive disorder. Especially children and adolescents, patients can gradually see the effect after using the drug for approximately 3 to 4 weeks, and their condition improves significantly until it returns to the normal state. Previous studies on the effectiveness of antidepressants have shown that sertraline can effectively reduce negative emotions in patients with depression, improve psychosomatic health status, and improve quality of life ( 32 ). Escitalopram belongs to the SSRI class and is the active S-isomer of citalopram. The selectivity and inhibition of 5-HT reuptake were better than those of citalopram, with stronger pharmacological effects and fewer adverse reactions. Numerous studies have confirmed that escitalopram has a higher remission rate than placebo in the treatment of adolescent depression ( 33 – 35 ). However, studies have found that duloxetine and desvenlafaxine are not superior to placebo in acute-phase clinical trials on children and adolescents with depression ( 36 – 38 ). Therefore, the therapeutic effects of duloxetine and desvenlafaxine on depression in children and adolescents require further research and evaluation. In addition, this study found differences in the clinical characteristics of children and adolescents in the three stages, but there were no differences in drug treatment plans. A follow-up should be based on the patient’s sex, age, family history, disease course, symptom characteristics, disease severity, comorbidities, and physical diseases status, in choosing antidepressant drugs. 5 Conclusions No significant differences were found in family history, suicidal behavior, and course of depression among children and adolescents of different ages. However, this study has certain limitations. First, the selected sample size was quite small and limited to the Fourth People’s Hospital of Hefei City. Second, the depression level of the selected patients represents the score of the initial admission evaluation of the previous inpatients, which may fluctuate due to the recent experience of the patients, and insufficiently reflect their long-term depression level. Third, when comparing “children,” “early adolescents” and “late teens,” we used only age to differentiate the three samples, describing the degree of difference between the three samples rather than a developmental trend. Addressing the heavy burden of adolescent depression has major public health implications. Depression, which often lasts into adulthood, can also cause or exacerbate physical and/or other mental health problems. Our study found that the number of hospitalizations in children and adolescents with depression has increased annually, and the proportion of hospitalizations in the children group has increased compared with previous years. The course of the disease in the early adolescence group was shorter than that in the other two groups, and the late adolescence group contained more males and fewer psychotic symptoms. It is necessary to further study the clinical characteristics of children and adolescents with depression at different ages to screen, identify, and prevent early depression in adolescents. Declarations Ethics approval and consent to participate All stages of research were conducted following the Declaration of Helsinki and the Ethical Statements of the Ethics Committee of the Hefei Fourth People’s Hospital. This study was approved by the Medical Ethics Committee of the Hefei Fourth People’s Hospital. (Ethical code: IRB-HFSY-YJ-LW-ZH (2022004), and the informed consent was waived by the Hefei Fourth People’s Hospital Medical Ethics Committee. Consent for publication Not applicable. Availability of data and materials The datasets generated and/or analyzed during the current study are not publicly available due reason why data are not public but are available from the corresponding author on reasonable request. Additionally, any further permission from the hospital is required to access the medical records of patients Competing interest All authors declare no conflict of interest. Author Contributions Xiaolu Jiang, Hongyu Zheng, Rong Yang, Shuo Wang data collection, Xiaolu Jiang conceptualization and draft writing. Hui Zhong provided financial support. The authors approved the final version for publication. Funding This work was supported by the National Key Research and Development Program of China (No. 2018YFC1314300), the National Natural Science Foundation of China (No. 32071020) and Hefei Key Specialties (No. Hwk2019yb0022) Acknowledgments We would like to thank the support of Hefei Fourth People’s Hospital. 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Psychotic depression in hospitalized patients: Longitudinal outcomes of psychotic vs. nonpsychotic depression among inpatients. J Psychiatr Res. 2020;129:73-9. Holshausen K, Bowie CR, Harkness KL. The Relation of Childhood Maltreatment to Psychotic Symptoms in Adolescents and Young Adults With Depression. J Clin Child Adolesc Psychol. 2016;45(3):241-7. Desmond DM, MacLachlan M. Coping strategies as predictors of psychosocial adaptation in a sample of elderly veterans with acquired lower limb amputations. Soc Sci Med. 2006;62(1):208-16. McGee R, Williams S, Poulton R. Hallucinations in nonpsychotic children. J Am Acad Child Adolesc Psychiatry. 2000;39(1):12-3. Jaaskelainen E, Juola T, Korpela H, Lehtiniemi H, Nietola M, Korkeila J, et al. Epidemiology of psychotic depression - systematic review and meta-analysis. Psychol Med. 2018;48(6):905-18. Johnson J, Horwath E, Weissman MM. The validity of major depression with psychotic features based on a community study. Arch Gen Psychiatry. 1991;48(12):1075-81. Vythilingam M, Chen J, Bremner JD, Mazure CM, Maciejewski PK, Nelson JC. Psychotic depression and mortality. Am J Psychiatry. 2003;160(3):574-6. Maj M, Stein DJ, Parker G, Zimmerman M, Fava GA, De Hert M, et al. The clinical characterization of the adult patient with depression aimed at personalization of management. World Psychiatry. 2020;19(3):269-93. Arseneault L. The long-term impact of bullying victimization on mental health. World Psychiatry. 2017;16(1):27-8. Widiger TA, Oltmanns JR. Neuroticism is a fundamental domain of personality with enormous public health implications. World Psychiatry. 2017;16(2):144-5. Malhi GS, Bassett D, Boyce P, Bryant R, Fitzgerald PB, Fritz K, et al. Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders. Aust N Z J Psychiatry. 2015;49(12):1087-206. Lewis G, Duffy L, Ades A, Amos R, Araya R, Brabyn S, et al. The clinical effectiveness of sertraline in primary care and the role of depression severity and duration (PANDA): a pragmatic, double-blind, placebo-controlled randomised trial. Lancet Psychiatry. 2019;6(11):903-14. Emslie GJ, Ventura D, Korotzer A, Tourkodimitris S. Escitalopram in the treatment of adolescent depression: a randomized placebo-controlled multisite trial. J Am Acad Child Adolesc Psychiatry. 2009;48(7):721-9. Findling RL, Robb A, Bose A. Escitalopram in the Treatment of Adolescent Depression: A Randomized, Double-Blind, Placebo-Controlled Extension Trial. J Child Adol Psychop. 2013;23(7):468-80. Wagner KD, Jonas J, Findling RL, Ventura D, Saikali K. A double-blind, randomized, placebo-controlled trial of escitalopram in the treatment of pediatric depression. J Am Acad Child Psy. 2006;45(3):280-8. Weihs KL, Murphy W, Abbas R, Chiles D, England RD, Ramaker S, et al. Desvenlafaxine Versus Placebo in a Fluoxetine-Referenced Study of Children and Adolescents with Major Depressive Disorder. J Child Adol Psychop. 2018;28(1):36-46. Emslie GJ, Prakash A, Zhang Q, Pangallo BA, Bangs ME, March JS. A Double-Blind Efficacy and Safety Study of Duloxetine Fixed Doses in Children and Adolescents with Major Depressive Disorder. J Child Adol Psychop. 2014;24(4):170-9. Atkinson SD, Prakash A, Zhang Q, Pangallo BA, Bangs ME, Emslie GJ, et al. A Double-Blind Efficacy and Safety Study of Duloxetine Flexible Dosing in Children and Adolescents with Major Depressive Disorder. J Child Adol Psychop. 2014;24(4):180-9. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-2487900","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":171046203,"identity":"ff2cd803-31bc-411d-8c8d-cf7b2b3e6fa6","order_by":0,"name":"Xiaolu Jiang","email":"","orcid":"","institution":"Affiliated Psychological Hospital of Anhui Medical University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Xiaolu","middleName":"","lastName":"Jiang","suffix":""},{"id":171046204,"identity":"51963dde-2f36-42e9-9dc5-2bc779e34877","order_by":1,"name":"Hongyu Zheng","email":"","orcid":"","institution":"Anhui Mental Health Center","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Hongyu","middleName":"","lastName":"Zheng","suffix":""},{"id":171046205,"identity":"3cd0d40c-0336-4727-9058-1f842018dcb1","order_by":2,"name":"Rong Yang","email":"","orcid":"","institution":"Anhui Medical University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Rong","middleName":"","lastName":"Yang","suffix":""},{"id":171046206,"identity":"caf51c34-ebe6-4ece-bb50-4ce34c8f8bee","order_by":3,"name":"Shuo Wang","email":"","orcid":"","institution":"Anhui Medical University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Shuo","middleName":"","lastName":"Wang","suffix":""},{"id":171046207,"identity":"87cbd0a6-e417-44b1-b6ae-22b042a750a0","order_by":4,"name":"Hui zhong","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAwElEQVRIiWNgGAWjYDACCQaGAwk/bJj5mZkPPyBey8OeNHbJdrY0A6K1MD5gO8xvcJ5HQYIoHfKzewwPJPAwSxsf5mEwYKixiSaohXHOGYMDCRZsxmaHeQ88YDiWlttASAuzRA5QCw9PstlhvgQDxobDhLWwgbWwSdRvbuYxkCBKCw9EiwGzATOxWiQk0goOJPYkMEscBgZyAjF+kZ+RvPnjjx//mfn7Dx9+8KHGhrAWVJBAmvJRMApGwSgYBbgAAEoYO+U82bugAAAAAElFTkSuQmCC","orcid":"","institution":"Affiliated Psychological Hospital of Anhui Medical University","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Hui","middleName":"","lastName":"zhong","suffix":""}],"badges":[],"createdAt":"2023-01-17 13:14:31","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-2487900/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-2487900/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":32219279,"identity":"0771a204-637d-4269-937c-097a53de2aab","added_by":"auto","created_at":"2023-01-30 16:19:16","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":70197,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend\u003c/p\u003e","description":"","filename":"300.jpg","url":"https://assets-eu.researchsquare.com/files/rs-2487900/v1/c81883cb86628822bc05ec53.jpg"},{"id":39947440,"identity":"57e5ff74-f312-4590-9d7a-f74e83fb0caf","added_by":"auto","created_at":"2023-07-13 03:59:36","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":358335,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2487900/v1/7d8bd0c7-f2ca-43e1-a98a-3db400afe338.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Retrospective Analysis of Clinical Characteristics and Treatment of Children and Adolescents with Depression","fulltext":[{"header":"1 Introduction","content":"\u003cp\u003eAbout 3.1% of the total global burden of disease is attributable to mental and psychological disorders (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e), with depression accounting for the largest share of the burden of mental illness (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). An epidemiological study in the United States found that the lifetime prevalence of depression in adolescents was 11\u0026ndash;14%, and approximately 20% of adolescents experienced severe depression before the age of 18 (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). A domestic study on the prevalence of mental disorders in children and adolescents aged 6\u0026ndash;16 found that the overall prevalence of mental disorders is as high as 17.5%. Attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and major depressive disorder (MDD) are the most common mental disorders in children and adolescents, among which the prevalence of the depressive disorder was 3.0% (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). In addition, a longitudinal study of adolescents whose parents had a history of mood disorders found that depression was the strongest predictor of suicidal behavior in adolescents and young adults. The study also found that children with depression were almost three times more likely to commit suicide before adolescence than adolescents with depression (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Notably, the female gender and suicidal ideation are predictors of suicidal behavior in adolescents (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAdolescence (ages 10\u0026ndash;19) is a unique formative period with multiple physical, emotional, and psychological factors, and social change is critical for the development and maintenance of social and emotional habits. Promoting mental health and preventing adverse experiences and risk factors that may affect the growth potential are important aspects of the physical and mental health of adolescents and adults. Illness is a complex and multifaceted process influenced by many biological and environmental factors. Numerous studies have confirmed the impact of cognitive, psychosocial, and biological developmental levels on the susceptibility of children and adolescents to MDD. However, it remains difficult to reach a consensus on the psychopathology of depression in children and adolescents, the incidence of depressive symptoms, and other relevant phenomenological differences. Chaaopadhyay et al. conducted a 24-week cognitive-behavioral intervention in 82 adolescents with depression and achieved significant results. It was confirmed that, while the amygdala and anterior cingulate cortex were significantly improved in the resting state, the function of the prefrontal cortex was not (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). In addition, genetic studies on depression have found that parental emotional mishandling and pregnancy adversity may increase the odds of childhood depression. Burkhouse et al. studied the relationship between the emotional processing of depressed parents and their children in 7\u0026ndash;18-year-old children and adolescents. Using functional magnetic resonance imaging, they found abnormalities in the dorsal anterior cingulate cortex of depressed parents and children, especially a negative bias in implicit emotional processing, thus altering this emotional processing may reduce the odds of a depressive episode (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Another study investigated the association between maternal depression and children, from pregnancy to adulthood, during family adversity. In this study, approximately 2,200 offspring under the age of 30 were followed and found that the association between maternal and offspring depression appears to be partly attributable to the degree of family adversity in the depressive mother (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThirty years ago, depression was thought to be an adult-only mental illness, with children and adolescents being \u0026ldquo;immune\u0026rdquo; to it, considering their low mood or their depressive manifestations as a \u0026ldquo;normal\u0026rdquo; part of growing up. Existing research shows that children and adolescents can suffer from depression as well as, and that depression in children and adolescents can lead to a range of adverse outcomes, such as suicide, impaired social functioning, lower educational attainment, and possible later physical and mental illness (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Adolescence is a risk factor for depressive episodes with a high recurrence rate and poor functional prognosis. After entering adolescence, people are emotionally vulnerable, easily depressed when they experience setbacks, and have a growing sense of independence from their parents, being more sensitive and prone to depressive symptoms. Compared to children, adolescents have more anhedonia, narcolepsy, and difficulty concentrating, while feelings of worthlessness are more common in children (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Symptoms of depression in children and adolescents differ from those in adults. They show fewer core symptoms of depression and often have more problems with behavior, school, and interpersonal relationships. It is often accompanied by behavioral problems, such as Internet addiction, violent conflict, and self-injury. It seriously affects the quality of life of young people and places a heavy burden on their families and society. In a study of 276 adult patients with relapsing depression, approximately 50% had an onset before the age of 18 years (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Individuals with depressive episodes in childhood or adolescence had a higher risk of suicide, with 48% of those with early onset depression attempting suicide compared to 26% of those with adult depression. This highlights the importance of the appropriate and effective management of depression in children and adolescents. However, the current diagnosis of depression in children and adolescents is still based on diagnostic criteria for adults. Therefore, to promote the comprehensive recovery of adolescent depression patients, it is important to study the clinical characteristics of adolescent depression patients.\u003c/p\u003e \u003cp\u003eIn this study, growth stages were divided into childhood (8\u0026ndash;12 years old), early adolescence (13\u0026ndash;15 years old), and late adolescence (16\u0026ndash;18 years old). The main purpose of this study was to better understand the demographic and clinical characteristics of depression at different onset ages from childhood to late adolescence, to improve family and social awareness of depression in children and adolescents, and to provide clinical evidence for targeted assessments and interventions.\u003c/p\u003e"},{"header":"2 Materials And Methods","content":"\u003cp\u003eChildren and adolescents aged\u0026thinsp;\u0026le;\u0026thinsp;18 years who were hospitalized in the Fourth People\u0026rsquo;s Hospital of Hefei City, China, between January 2014 and December 2021 were selected as research subjects. The inclusion criteria were: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) they met the diagnostic criteria for depression according to the International Classification of Diseases and Diagnostic Criteria (ICD-10); (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) the medical records were complete and reliable, and no study had a lack of data and information. The exclusion criteria included: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) schizophrenia, bipolar disorder, intellectual disability, or other mental disorders; (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) alcohol and drug use; and (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) neurological diseases or organic brain damage. A total of 635 subjects were included in this study, consisting of 456 females and 179 males, aged 11\u0026ndash;18 years (15.33\u0026thinsp;\u0026plusmn;\u0026thinsp;1.71) years old.\u003c/p\u003e \u003cp\u003eData on the general condition and clinical characteristics of inpatients were collected from the electronic records of the hospital. (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) The general situation investigation included sex, age, family history of mental disorders, physical diseases. (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) The collection of clinical characteristic data included diagnosis, treatment, whether it was accompanied by suicidal behavior or psychotic symptoms, and suicide assessment. The \u0026ldquo;suicidal behavior\u0026rdquo; was clearly identified in the medical record, with the suicide method described in detail. (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) The treatment situation was according to the medical record and doctor\u0026rsquo;s order data. The medication regimen was collected on the day of discharge according to data entry and drug treatment regimens were divided into antidepressants alone, antidepressants\u0026thinsp;+\u0026thinsp;antipsychotics, antidepressants\u0026thinsp;+\u0026thinsp;antipsychotics\u0026thinsp;+\u0026thinsp;mood stabilizers, and antidepressants\u0026thinsp;+\u0026thinsp;mood stabilizers. The data was gathered and proofread by multiple people. Based on the age of onset, the cases were divided into children group (\u003cspan additionalcitationids=\"CR9 CR10 CR11\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e), early adolescence group (\u003cspan additionalcitationids=\"CR14\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e) and late adolescence group (\u003cspan additionalcitationids=\"CR17\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSPSS 26.0 was used for data processing and analysis. The measurement data conforming to the normal distribution are expressed as (x\u0026thinsp;\u0026plusmn;\u0026thinsp;s), and the measurement data of the skewed distribution are expressed as medians and quartiles. The chi-square test was used to compare differences between groups, and the Bonferroni method was used for multiple comparisons. P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 (two-tailed) indicated that the difference was statistically significant.\u003c/p\u003e"},{"header":"3 Results","content":"\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Demographic and clinical characteristics of the study population\u003c/h2\u003e \u003cp\u003eA total of 635 participants were included, including 115 in the childhood group (18.1%), 359 (56.5%) in the early adolescence group, and 161 (25.4%) in the late adolescence group. Basic demographic information and clinical characteristics of the patients are shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Among them, 28.2% were men, and 71.8% were women. The mean age at admission was 15.33\u0026thinsp;\u0026plusmn;\u0026thinsp;1.71 years. There were 494 (77.8%) patients with first onset, 159 (25.0%) patients with psychotic symptoms, with an average age of onset of 14.21\u0026thinsp;\u0026plusmn;\u0026thinsp;1.87 years, and an average disease duration of 14.54\u0026thinsp;\u0026plusmn;\u0026thinsp;13.57 months. The Hamilton Depressing Rating Scale (HAMD) and Hamilton Anxiety Rating Scale (HAMA) total scores at admission were 21.42\u0026thinsp;\u0026plusmn;\u0026thinsp;9.15 and 12.54\u0026thinsp;\u0026plusmn;\u0026thinsp;6.45, respectively. As time progressed (Fig.\u0026nbsp;1), the number of hospitalizations for depressive disorder increased yearly, the proportion of hospitalizations in the child group increased compared with previous years, and the proportion of hospitalizations in the late adolescence group tended to decline.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic and clinical characteristics of the study population.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDemographic variables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN(%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e179(28.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge at admission (M, SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15.33(1.71)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClinical characteristics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDays of hospitalization (M, SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e36.74(23.02)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFirst onset\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e494(77.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge of onset, years (M, SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14.21(1.87)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u0026thinsp;\u0026le;\u0026thinsp;age\u0026lt;13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e115(18.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13\u0026thinsp;\u0026le;\u0026thinsp;age\u0026thinsp;\u0026le;\u0026thinsp;15\u003c/p\u003e \u003cp\u003e15\u0026lt;age\u0026thinsp;\u0026le;\u0026thinsp;18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e359(56.5)\u003c/p\u003e \u003cp\u003e161(25.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuration of illness, months (M, SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14.54(13.57)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMajor depression with psychotic symptoms\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e159(25.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHAMA total at admission(M, SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12.54(6.45)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHAMD total at admission(M, SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e21.42(9.15)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"2\"\u003eDepressing Rating Scale ; HAMA,Hamilton Anxiety Rating Scale\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Comparison of general data and distribution of hospitalizations\u003c/h2\u003e \u003cp\u003eThere were no significant differences in hospitalization time, family history of mental disorders, suicidal behavior, or HAMD\u003csub\u003e24\u003c/sub\u003e total score among the three groups (all P\u0026thinsp;\u0026gt;\u0026thinsp;0.05), while significant differences were found in sex and course of disease among (all P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Among them, women in the childhood group and men in the late adolescence group had a higher incidence, and the disease duration in the early adolescence group was shorter than that in the other two groups. In terms of clinical characteristics, there were statistically significant differences in psychotic symptoms among the three groups, among which the children were more likely to have psychotic symptoms. During the eight years, there were differences in the proportion of hospitalizations in different age groups in different years (X\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;29.736, P\u0026thinsp;\u0026lt;\u0026thinsp;0.01).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of differences in general conditions and clinical characteristics of patients with different types of patients.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003echildren\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;115\u003c/p\u003e \u003cp\u003en(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eearly adolescence\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;359\u003c/p\u003e \u003cp\u003en(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003elate adolescence\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;161\u003c/p\u003e \u003cp\u003en(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eZ/ χ2/F\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16(13.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e105(29.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e58(36.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e16.660\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;0.001**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e99(86.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e254(70.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e103(64)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFamily history of mental illness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003epositive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7(6.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19(5.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8(5.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.172\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.918\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNegative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e108(93.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e340(94.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e153(95.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePsychotic symptoms\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWith\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38(33.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e89(24.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32(19.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e6.224\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.045**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ewithout\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e77(67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e270(75.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e129(80.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSleep disorder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWith\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e54(47.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e189(52.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e93(57.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.168\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.205\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ewithout\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e61(53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e170(47.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e68(42.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSuicide\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eyes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19(16.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e77(21.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23(14.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4.199\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.123\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e96(83.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e282(78.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e138(85.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDays of hospitalization (m, sd)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36.39(21.99)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e36.51(23.16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37.49(23.53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.117\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.890\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHAMD\u003csub\u003e24\u003c/sub\u003e(m, sd)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22.59(8.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21.09(9.29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.25(9.58)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.202\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.301\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuration of ilness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15.00(12.00, 36.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12.00(6.00, 24.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.00(2.50, 12.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e84.617\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;0.001**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eHAMD, The Hamilton Depressing Rating Scale; statistic values were expressed by Pearson\u0026rsquo;s χ2 tests. *P\u0026thinsp;\u0026lt;\u0026thinsp;0.05; **P\u0026thinsp;\u0026lt;\u0026thinsp;0.01.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e3.3 Types of medicines on discharge\u003c/h2\u003e \u003cp\u003eThe discharge prescriptions of different antidepressants and discharge regimens of the 635 patients were included in the statistical analysis. Of these, 156 patients were on monotherapy and 479 were on combination therapy. The top five antidepressants were sertraline in 399 cases (52.2%), duloxetine in 114 cases (18.0%), mirtazapine in 95 cases (12.4%), escitalopram in 51 cases (8.0%), and venlafaxine in 50 cases (7.9%)( Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Comparing the frequency of commonly used antidepressants and treatment regimens in patients of different age groups, it was found that among the top five antidepressants, there was no significant difference in the frequency of antidepressant use in hospitalized patients of different ages (all P\u0026thinsp;\u0026gt;\u0026thinsp;0.05; X2\u0026thinsp;=\u0026thinsp;8.082, P\u0026thinsp;=\u0026thinsp;0.425) ( Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). There were no significant differences in depressive drugs, antidepressant drug\u0026thinsp;+\u0026thinsp;antipsychotic drug combination, antidepressant drug\u0026thinsp;+\u0026thinsp;antipsychotic drug\u0026thinsp;+\u0026thinsp;emotion stabilizer combination, and other treatments (all P\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAnalysis of the use frequency and the dosage of commonly used Antidepressants.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDosage(mg/d)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDosage range(mg/d)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEscitalopram\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e51(8.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e15\u0026thinsp;\u0026plusmn;\u0026thinsp;4.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.00\u0026ndash;20.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFluvoxamine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18(2.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e176.39\u0026thinsp;\u0026plusmn;\u0026thinsp;17.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20.00-120.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFluoxetine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e26(4.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e43.08\u0026thinsp;\u0026plusmn;\u0026thinsp;15.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20.00\u0026ndash;60.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eparoxetine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12(1.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e35\u0026thinsp;\u0026plusmn;\u0026thinsp;13.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10.00\u0026ndash;60.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSertraline\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e399(62.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e119.76\u0026thinsp;\u0026plusmn;\u0026thinsp;49.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e25.00-120.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMirtazone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e95(15.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e18.95\u0026thinsp;\u0026plusmn;\u0026thinsp;11.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7.50\u0026ndash;60.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVenlafaxine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e50(7.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e175.98\u0026thinsp;\u0026plusmn;\u0026thinsp;48.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e75.00-225.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuloxetine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e114(18.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e55.58\u0026thinsp;\u0026plusmn;\u0026thinsp;17.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20.00-120.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of Antidepressant Drugs in Children, Early Adolescents, and Late Adolescents\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSertraline\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDuloxetine\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMirtazone\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eVenlafaxine\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eEscitalopram\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eχ2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003echildren\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;115)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e90(78.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17(14.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14(12.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e7(6.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e9(7.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e8.082\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.425\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eearly adolescence\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;359)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e227(63.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e68(18.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e54(15.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e30(8.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e27(7.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003elate adolescence\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;161)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e82(51.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e29(18.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e24(15.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e13(8.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e15(9.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003estatistic values were expressed by Pearson\u0026rsquo;s χ2 tests. *P\u0026thinsp;\u0026lt;\u0026thinsp;0.05; **P\u0026thinsp;\u0026lt;\u0026thinsp;0.01.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of the treatment of depression in childhood, early adolescents and late adolescents.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003emedical treatement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eχ2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eD\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003echildren\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;115)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e10.024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.124\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eearly adolescence\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;359)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e160\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e49\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003elate adolescence\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;161)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u003cp\u003eA ：Antidepressants；B Antidepressants + Antipsychotics；C ：Antidepressant + Antipsychotic + Mood Stabilizer treatment；D： Antidepressant + Mood Stabilizer treatment.Data were expressed by N (%) or mean \u0026plusmn; standard deviation; statistic values were expressed by Pearson\u0026rsquo;s \u0026nbsp;\u0026chi;2 tests. *P \u0026lt; 0.05; **P \u0026lt; 0.01.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"4 Discussion","content":"\u003cp\u003eReviewing the demographics, clinical characteristics, and drug treatment plans for children and adolescents with depression in different age groups from 2014 to 2021, results showed that women in the children group had more symptoms and psychotic symptoms, and the disease duration in the early adolescence group was shorter than that in the other two groups. In the late adolescence group, males had more morbidities and fewer psychotic symptoms. As time progressed, the number of hospitalizations for depressive disorder increased yearly, the proportion of hospitalizations in the child group increased compared with previous years, and the proportion of hospitalizations in the late adolescence group tended to decline. There were no statistically significant differences in the frequency of antidepressant use or treatment regimens among the three groups.\u003c/p\u003e \u003cp\u003eOur study found that regarding depression, gender differences appeared in childhood and later adolescence. It was more common in female patients than in the other two groups of children, while male patients were more common in the late adolescence group. Regarding gender differences, the results of a 1998 study showed that gender differences in depression appeared in early adolescence (around 12\u0026ndash;13 years old) and mid-adolescence. Angold et al. used the Children\u0026rsquo;s Depression Inventory (CDI) to evaluate depressive symptoms. The results showed that gender differences in depressive symptoms in children and adolescents aged 9\u0026ndash;16 years in the UK appeared at 13 years of age. Previously, there was no statistically significant difference in the detection rate of depressive symptoms between boys and girls. In addition, another study showed that, in the general population, the incidence of depression in boys during childhood did not differ by sex and was even slightly higher than that of girls (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Female predominance in depression is thought to appear at 13\u0026ndash;15 years of age (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). However, this differs from our findings. The age of onset in women in this study was more commonly 8\u0026ndash;12 years. A meta-analysis of nearly a decade of studies on adolescent depression found that negative life events in early female adolescents can increase the risk of depression, most likely by increasing the individual\u0026rsquo;s sensitivity to and amplifying stress, and other pathways increase adolescents\u0026rsquo; susceptibility to depression (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Furthermore, some theorists believe that physiological changes during puberty increase the risk of depression in girls (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). The exact timing of depression may indicate which physiological changes may increase the risk of depression in girls. Social changes, such as school transitions, improved living standards, and changes in parental divorce rates may be responsible for gender differences in depression key turning points. In conclusion, although gender differences in depression symptoms in adolescence have not yet been unified, research generally supports the phenomenon of \u0026ldquo;female dominance\u0026rdquo; in depression symptoms in adolescence and considers that gender differences in sex hormone levels in adolescence are the main reasons. Boys with depression in the late adolescence group are more common, probably because boys in this age group are more lively and naughty than girls, so they are generally more criticized and punished in school than girls; further, their psychological pressure is also higher than that of girls, thus being prone to show more anxiety and worry, hence, they are at a higher risk of developing depressive symptoms than girls.\u003c/p\u003e \u003cp\u003eDepression can be divided into two subtypes: depression with and without psychotic symptoms. Depression with psychotic symptoms refers to meeting the diagnostic criteria for depression, and is accompanied by hallucinations, delusions, depressive stupor, and other symptoms. Our study found that 25.0% (159 cases) of depressive children and adolescents had psychotic symptoms. Ryan et al. found that the prevalence of psychotic features in outpatients with major depressive disorder was 18% (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e), while Haley et al. showed a prevalence of 45% in a sample of hospitalized adolescent patients (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Some studies have shown that the proportion of depression with psychotic symptoms in patients with depression is 15\u0026ndash;19% (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e), which may be related to differences in the study population, ethnicity, assessment of psychotic symptoms, and diagnostic criteria. In terms of associated psychiatric symptoms, the age of onset is younger and more common in childhood, consistent with previous studies (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). A study of 129 depressed adolescents found that individuals with psychotic symptoms were more likely to have a history of childhood trauma, especially severe sexual abuse (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Previous studies have also shown that patients with adverse childhood events have an earlier age of onset than patients without (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e), indicating that adverse childhood life events may lead to an earlier onset and the chronicity of depression in patients with depression, obvious social function impairment, and other characteristics. McGee et al. found that healthy children who had hallucinatory experiences before the age of 11 were more likely to develop more severe depression (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). Further major depressive disorder with psychotic symptoms is associated with more severe symptoms, worse prognosis (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e), greater risk of relapse (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e), and higher mortality rates (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). Therefore, childhood and adolescence are critical periods for the prevention of and early intervention for depression. Reasonable intervention can reduce or delay the related health problems caused by depression, whether it is a normal group or a sick child, such as hallucinations, delusions, and other abnormal experiences. Thus, early detection should be desirable. In clinical practice, it is difficult for clinicians to collect mental symptoms of sick children because patients with psychotic symptoms are often reluctant to mention their abnormal perception and thinking due to embarrassment, which requires clinicians and the use of flexible and proficient communication skills to define whether an affected child has psychotic symptoms.\u003c/p\u003e \u003cp\u003eCompared with the childhood and late adolescence groups, the early adolescence group had a shorter course of disease, and the proportion of hospitalizations increased yearly. On the one hand, this may be due to people paying more attention to children aged 13\u0026ndash;15 than other age groups, probably being the main reason for family members and patients seeking medical treatment as soon as possible. On the other hand, it may be due to the fact that early adolescents are in a critical period of physical and mental development. During the process of aging, their body structure changes significantly, while their psychological and physiological development is not mature, living through a contradiction between naivety and maturity, dependence and independence. At this psychologically sensitive and fragile stage, it is easy to take a one-sided and extreme view of problems, to be unable to properly handle complex interpersonal relationships and stressful events, and often be accompanied by some physical discomfort symptoms; the physical condition becomes worse, and it is easier for individuals to cast their eyes on themselves, while ignoring other aspects. The mentality is further deteriorated, resulting in the accumulation of bad emotions, eventually developing into a depressive disorder. Previous research has found an association between peer bullying and depression (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). The mechanism may be that peer bullying as a chronic stressor leads to hypervigilance, followed by learned helplessness, and finally, depression (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). In addition, study pressure is an important factor related to depression. The mechanism may be that under external pressure, the individual\u0026rsquo;s hypothalamic-pituitary-adrenal axis neuroendocrine system is disorderly regulated, and a large amount of stress hormones are released, resulting in damage to the brain regions related to emotion (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). This may be an important factor in the occurrence of depression among children and adolescents.\u003c/p\u003e \u003cp\u003eThis study showed that there were no statistical differences in the choice of antidepressant drugs and treatment options among the three groups of patients. Internationally, most treatment guidelines for children and adolescents recommend psychological intervention for mild depressive episodes, treatment and a combination of psychotherapy and antidepressant medication for moderate-to-severe depressive episodes (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). In the United States, only two antidepressants have been approved for child and adolescent use: fluoxetine is approved for the use in children with MDD, and both fluoxetine and escitalopram are approved for use in adolescents (FDA, accessed 2021a). In this study, the top five antidepressants used for children and adolescents were sertraline, duloxetine, mirtazapine, escitalopram, and desvenlafaxine. As a new antidepressant, sertraline can effectively inhibit the reuptake of serotonin in the central nervous system and regulate norepinephrine. It is used in the clinical treatment of various patients with depression and obsessive-compulsive disorder. Especially children and adolescents, patients can gradually see the effect after using the drug for approximately 3 to 4 weeks, and their condition improves significantly until it returns to the normal state. Previous studies on the effectiveness of antidepressants have shown that sertraline can effectively reduce negative emotions in patients with depression, improve psychosomatic health status, and improve quality of life (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). Escitalopram belongs to the SSRI class and is the active S-isomer of citalopram. The selectivity and inhibition of 5-HT reuptake were better than those of citalopram, with stronger pharmacological effects and fewer adverse reactions. Numerous studies have confirmed that escitalopram has a higher remission rate than placebo in the treatment of adolescent depression (\u003cspan additionalcitationids=\"CR34\" citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). However, studies have found that duloxetine and desvenlafaxine are not superior to placebo in acute-phase clinical trials on children and adolescents with depression (\u003cspan additionalcitationids=\"CR37\" citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e). Therefore, the therapeutic effects of duloxetine and desvenlafaxine on depression in children and adolescents require further research and evaluation. In addition, this study found differences in the clinical characteristics of children and adolescents in the three stages, but there were no differences in drug treatment plans. A follow-up should be based on the patient\u0026rsquo;s sex, age, family history, disease course, symptom characteristics, disease severity, comorbidities, and physical diseases status, in choosing antidepressant drugs.\u003c/p\u003e"},{"header":"5 Conclusions","content":"\u003cp\u003eNo significant differences were found in family history, suicidal behavior, and course of depression among children and adolescents of different ages. However, this study has certain limitations. First, the selected sample size was quite small and limited to the Fourth People\u0026rsquo;s Hospital of Hefei City. Second, the depression level of the selected patients represents the score of the initial admission evaluation of the previous inpatients, which may fluctuate due to the recent experience of the patients, and insufficiently reflect their long-term depression level. Third, when comparing \u0026ldquo;children,\u0026rdquo; \u0026ldquo;early adolescents\u0026rdquo; and \u0026ldquo;late teens,\u0026rdquo; we used only age to differentiate the three samples, describing the degree of difference between the three samples rather than a developmental trend.\u003c/p\u003e \u003cp\u003eAddressing the heavy burden of adolescent depression has major public health implications. Depression, which often lasts into adulthood, can also cause or exacerbate physical and/or other mental health problems. Our study found that the number of hospitalizations in children and adolescents with depression has increased annually, and the proportion of hospitalizations in the children group has increased compared with previous years. The course of the disease in the early adolescence group was shorter than that in the other two groups, and the late adolescence group contained more males and fewer psychotic symptoms. It is necessary to further study the clinical characteristics of children and adolescents with depression at different ages to screen, identify, and prevent early depression in adolescents.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll stages of research were conducted following the Declaration of Helsinki and the Ethical Statements of the Ethics Committee of the\u0026nbsp;Hefei Fourth People\u0026rsquo;s Hospital. This study was approved by the Medical Ethics Committee of the Hefei Fourth People\u0026rsquo;s Hospital.\u0026nbsp;(Ethical code: IRB-HFSY-YJ-LW-ZH (2022004), and the informed consent was waived by the\u0026nbsp;Hefei Fourth People\u0026rsquo;s Hospital Medical Ethics Committee.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analyzed during the current study are not publicly available due reason why data are not public but are available from the corresponding author on reasonable request. Additionally, any further permission from the hospital is required to access the medical records of patients\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors declare no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eXiaolu\u0026nbsp;Jiang, Hongyu Zheng, Rong Yang, Shuo Wang\u0026nbsp;data collection,\u0026nbsp;Xiaolu Jiang\u0026nbsp;conceptualization and draft writing.\u0026nbsp;Hui Zhong provided financial support.\u0026nbsp;The authors approved the final version for publication.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by the National Key Research and Development Program of China (No. 2018YFC1314300), the National Natural Science Foundation of China (No. 32071020) and Hefei Key Specialties (No. Hwk2019yb0022)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to thank the support of Hefei Fourth People\u0026rsquo;s Hospital.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eDALYs GBD, Collaborators H, Murray CJ, Barber RM, Foreman KJ, Abbasoglu Ozgoren A, et al. Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990-2013: quantifying the epidemiological transition. Lancet. 2015;386(10009):2145-91.\u003c/li\u003e\n\u003cli\u003eDALYs GBD, Collaborators H. Global, regional, and national disability-adjusted life-years (DALYs) for 315 diseases and injuries and healthy life expectancy (HALE), 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388(10053):1603-58.\u003c/li\u003e\n\u003cli\u003eMendelson T, Tandon SD. Prevention of Depression in Childhood and Adolescence. Child Adolesc Psychiatr Clin N Am. 2016;25(2):201-18.\u003c/li\u003e\n\u003cli\u003eLi F, Cui Y, Li Y, Guo L, Ke X, Liu J, et al. Prevalence of mental disorders in school children and adolescents in China: diagnostic data from detailed clinical assessments of 17,524 individuals. 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Aust N Z J Psychiatry. 2015;49(12):1087-206.\u003c/li\u003e\n\u003cli\u003eLewis G, Duffy L, Ades A, Amos R, Araya R, Brabyn S, et al. The clinical effectiveness of sertraline in primary care and the role of depression severity and duration (PANDA): a pragmatic, double-blind, placebo-controlled randomised trial. Lancet Psychiatry. 2019;6(11):903-14.\u003c/li\u003e\n\u003cli\u003eEmslie GJ, Ventura D, Korotzer A, Tourkodimitris S. Escitalopram in the treatment of adolescent depression: a randomized placebo-controlled multisite trial. J Am Acad Child Adolesc Psychiatry. 2009;48(7):721-9.\u003c/li\u003e\n\u003cli\u003eFindling RL, Robb A, Bose A. Escitalopram in the Treatment of Adolescent Depression: A Randomized, Double-Blind, Placebo-Controlled Extension Trial. J Child Adol Psychop. 2013;23(7):468-80.\u003c/li\u003e\n\u003cli\u003eWagner KD, Jonas J, Findling RL, Ventura D, Saikali K. A double-blind, randomized, placebo-controlled trial of escitalopram in the treatment of pediatric depression. J Am Acad Child Psy. 2006;45(3):280-8.\u003c/li\u003e\n\u003cli\u003eWeihs KL, Murphy W, Abbas R, Chiles D, England RD, Ramaker S, et al. Desvenlafaxine Versus Placebo in a Fluoxetine-Referenced Study of Children and Adolescents with Major Depressive Disorder. J Child Adol Psychop. 2018;28(1):36-46.\u003c/li\u003e\n\u003cli\u003eEmslie GJ, Prakash A, Zhang Q, Pangallo BA, Bangs ME, March JS. A Double-Blind Efficacy and Safety Study of Duloxetine Fixed Doses in Children and Adolescents with Major Depressive Disorder. J Child Adol Psychop. 2014;24(4):170-9.\u003c/li\u003e\n\u003cli\u003eAtkinson SD, Prakash A, Zhang Q, Pangallo BA, Bangs ME, Emslie GJ, et al. A Double-Blind Efficacy and Safety Study of Duloxetine Flexible Dosing in Children and Adolescents with Major Depressive Disorder. J Child Adol Psychop. 2014;24(4):180-9.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"depression, childhood, early adolescence, late adolescence, antidepressants","lastPublishedDoi":"10.21203/rs.3.rs-2487900/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2487900/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThe purpose of this study was to analyze the demographics, clinical characteristics, and treatment of depression in children and adolescents in different age groups. A total of 635 cases of children and adolescents with depression in a hospital were collected through electronic records from January 2014 to December 2021. They were grouped according to the age of onset, amounting to 115 cases in childhood (\u003cspan additionalcitationids=\"CR9 CR10 CR11\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e), 359 early adolescents (\u003cspan additionalcitationids=\"CR14\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e), and 161 cases in late adolescence (\u003cspan additionalcitationids=\"CR17\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). The three groups were compared in terms of general conditions, clinical characteristics, and treatment. Results showed that over the past 8 years, the proportion of hospitalizations in the early adolescence group has been increasing, that in the late adolescence group was lower than that in previous years, and gender (X\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;16.66, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), psychotic symptoms (X\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;6.224, P\u0026thinsp;=\u0026thinsp;0.045), and disease course (Z\u0026thinsp;=\u0026thinsp;84.617, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) were significantly different. No significant differences were found in drug treatment regimen, suicide, length of hospital stay, or family history among the three groups. There were differences in the general conditions and clinical characteristics of children and adolescents with depression at different onset ages. The number of hospitalized children and adolescents with depression is increasing annually, and the proportion of hospitalizations in the children group was higher than that in previous years. Females are more likely to suffer from the disease and present more psychotic symptoms. The course of the disease in the early adolescence group was shorter than that in the other two groups, and the late adolescence group had more males and fewer psychotic symptoms.\u003c/p\u003e","manuscriptTitle":"Retrospective Analysis of Clinical Characteristics and Treatment of Children and Adolescents with Depression","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-01-30 16:19:11","doi":"10.21203/rs.3.rs-2487900/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"11982bac-f843-4732-a912-7012e40b8431","owner":[],"postedDate":"January 30th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2023-07-13T03:59:24+00:00","versionOfRecord":[],"versionCreatedAt":"2023-01-30 16:19:11","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-2487900","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2487900","identity":"rs-2487900","version":["v1"]},"buildId":"-HB7Z8yhvgn0wM9Nzuekk","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}