Prevalence of depressive disorders in children with specifi c learning disabilities
Mona P. Gajre, Himali Meshram, Neelkamal Soares, Chedda Nidhi, Afreddy Anagha
Background: Learning disabled children are at risk for behavioral disorders, including depression. In India, diagnosis and interventions for learning disorders are limited. The purpose of this study was to examine the prevalence of depression and its severity in school-aged children with specific learning disability (SLD) compared to non-learning disabled peers. Methods: In a tertiary care pediatric neurodevelopmental center in Mumbai, we identified 200 children consecutively over 12 months referred for low academic performance, by screening of clinical records, academic history, vision-hearing tests, who additionally underwent psychoeducational battery and cognitive testing at the center, and were determined to have average intelligence but meeting criteria for SLD. The controls were 100 siblings of the cases who were screened for SLD by curriculum-based tests. We assessed depression using Hamilton rating scale for depression (HDRS for 8-12 years) and beck depression inventory II (BDI for 13-14 years). In addition, parental history of prescription medications for mental health needs was also noted. We performed multivariate logistic regression to study the association between SLD and depression. All activities were approved by the Institutional Review Board. Results: The mean (standard deviation [SD]) age of children with SLD was 11.9 (1.6) years and of non-SLD children was 11.2 (1.2) years. In SLD group the M: F ratio was 1.5:1 and in the non-SLD it was 0.8:1. A significantly higher proportion of children with SLD reported that their academic and extracurricular activities were reduced compared to children without SLD (6% vs. 0%, P < 0.01). Although, a higher proportion of children with SLD reported depression compared with children without SLD (16% vs. 11%, P = 0.29), the difference was not statistically significant. About 15% of the SLD cases had mild and 1% had moderate depression. About 11% of non-SLD children had mild depression as per the HDRS (7-17 indicates mild) and BDI II (10-16 is mild) cut-offs. None of the children had severe depression. In the multivariate model, depression was more likely in older children (aged 13-14 years vs. 10-12 years; odds ratio [OR]: 5.2, 95% confidence intervals [CI]: 2.4-11.1), in children from upper middle socio-economic status (SES) (OR: 6.7, 95% CI: 1.3-34.0), and in those whose parents had mental health concerns (OR: 5.3, 95% CI: 1.8-16.1). Conclusions: In an Indian tertiary center cohort, children with SLD do not have significantly higher proportion of depression than their non-disabled siblings. However, older children, and those with higher SES, and co-existent parental psychopathology are significantly associated with risk of depression.