Clinical Profile and Psychosocial Correlates of Childhood Depressive Disorder: A Case-Control Study

Introduction: Historically, childhood depression was overlooked due to perceived developmental immaturity. However, modern paradigms recognize it as a complex disorder often presenting with "masked" symptoms that differ from adult manifestations. In India, prevalence rates show an increasing trend, yet research on younger children remains sparse. This study aimed to delineate the clinical features, temperamental traits, and family environmental correlates of childhood depressive episodes in an eastern Indian hospital setting, while quantifying the perceptual gap between children and parents. Methods: This institution-based, case-control study screened 145 children aged 5-12 years, resulting in a final population of 34 cases (diagnosed via the International Classification of Diseases, 10th Revision, Diagnostic Criteria for Research) and 34 age- and sex-matched controls. Assessment tools included the Pediatric Symptom Checklist (PSC), Center for Epidemiological Studies Depression Scale for Children (CES-DC), Draw-a-Person Test (DAP) for evolving personality traits, and the Family Environmental Scale (FES). Statistical analysis data were tabulated in Microsoft Excel (Microsoft Corporation, Redmond, WA) and analyzed using SPSS version 16.0 (SPSS Inc., Chicago, IL). Categorical variables were summarized as frequencies and percentages, while numerical variables were expressed as means and standard deviations (SD). Inferential statistics included the chi-squared (χ2) test for categorical associations. Data were found to be normally distributed via the Shapiro-Wilk test (p = 0.413). Independent t-tests were done to compare numerical means between groups. Pearson’s correlation coefficient (r), Crammer's V, and Cohen’s d were calculated to quantify the magnitude of categorical variables. Results: Depressive episode was diagnosed in 23.44% (n = 34) of children. Most cases were aged 9-12 years (n = 26, 76.5%) with a slight male preponderance (n = 18, 52.29%). Frequent symptoms included sleep disturbances (n = 28, 82.35%), irritability (n = 26, 76.47%), and somatic complaints (n = 22, 64.7%). Environmental stressors such as bullying (χ2 (1, n = 68), 11.691, p = 0.001, V = 0.415) and a lack of close friends (χ2 (1, n = 68), 23.611, p = 0.00, V = 0.589) were significantly more prevalent in cases. FES results indicated that depressed children lived in domestic environments characterized by lower cohesion (p = 0.032) and higher conflict (p = 0.00) and control (p = 0.00). DAP testing revealed significantly higher scores for anxiety (p = 0.00), low self-esteem (p = 0.001), and internalized aggression (p = 0.001) in the case group. Also noted was high discordance in illness perception (88%, n = 30), as parents' severity ratings did not match the child's self-report, with 64.7% (n = 22) of parents underestimating the severity. Conclusion: Children with depression present with varied symptoms, including somatic and behavioral problems. Childhood depression is a multi-dimensional disorder that correlates with the family environment and temperament of the child. The significant parent-child perceptual gap highlights the need for child-centric assessment tools and enhanced parental awareness to ensure early diagnosis and minimize long-term social impairment.