Centre de recherche en épidémiologie et santé des populations (CESP), Inserm U1018, Université Paris Saclay, Villejuif, France.
Assistance publique-Hôpitaux de Paris (AP-HP), Paris, France.
Eur Child Adolesc Psychiatry. 2024 Jun;33(6):1847-1862. doi: 10.1007/s00787-023-02270-0. Epub 2023 Aug 30.
After decades of controversy, the concept of childhood depression now seems to be part of standard medical knowledge. Yet the form and content of this nosological entity, like many psychiatric diseases, is continuously shaped by the scientific, clinical, and political communities involved in child psychiatry. In this qualitative study, we explored how the concept of childhood depression is constructed in early twenty-first century child psychiatry. We conducted a series of 18 interviews with practising child psychiatrists, international experts in the field, and interpreted them with thematic analysis informed by discourse analysis. We identified five overarching discourse themes across interviews, relating to the definition of depression, the diagnostic process, the causes of this condition, the therapeutic strategy, and the scientific role of child psychiatry. Most participants agreed that childhood depression was a mental disorder where irritability prevailed, heavily influenced by psychosocial factors, and for which psychotherapy was the ideal treatment. However, subtle points of dissent also surfaced: whether depression is primarily a mood state or psychological suffering, whether categories or dimensions are more suitable to make the diagnosis, and whether there is a genetic predisposition were some of the most controversial topics. Theoretical considerations regarding childhood depression may have significant scientific, moral, and socio-political implications beyond child psychiatry and should be addressed appropriately.
经过几十年的争议，儿童抑郁症的概念现在似乎已成为标准医学知识的一部分。然而，像许多精神疾病一样，这种疾病的形式和内容不断受到儿童精神病学领域涉及的科学界、临床界和政治界的影响。在这项定性研究中，我们探讨了儿童抑郁症的概念是如何在 21 世纪初的儿童精神病学中构建的。我们对从事儿童精神病学的医生、该领域的国际专家进行了一系列 18 次访谈，并通过受话语分析启发的主题分析对访谈进行了解释。我们在访谈中确定了五个总体话语主题，涉及抑郁症的定义、诊断过程、这种疾病的原因、治疗策略以及儿童精神病学的科学作用。大多数参与者都认为，儿童抑郁症是一种以易怒为主的精神障碍，受心理社会因素的严重影响，心理治疗是理想的治疗方法。然而，也出现了一些细微的分歧：抑郁症是主要是一种情绪状态还是心理痛苦，类别还是维度更适合做出诊断，以及是否存在遗传倾向，这些都是一些最具争议的话题。关于儿童抑郁症的理论考虑可能除了儿童精神病学之外，还会对科学、道德和社会政治产生重大影响，应该得到适当的关注。
