OBJECTIVE: Pediatric depression is often associated with clinically significant distress or impairment in school, home and social activities. However, very little is known about the extent of functional impairment in children with depression based on national level data. This study examined the extent of functional impairment in children and adolescents aged 5 to 17 years with depression based on 2005-2006 Medical Expenditure Panel Survey (MEPS) data.
RESEARCH DESIGN AND METHODS: This study involved retrospective cross-sectional analysis of 2005-2006 MEPS data. Functional impairment in children was assessed using the parent-reported Columbia Impairment Scale (CIS). The CIS is a 13 item, lay-interviewer-administered global impairment scale. The analysis focused on children with depression. Functional impairment was ascertained using the mean summated scores of the CIS after conducting psychometric analysis. The Wilson and Cleary model was used to examine the factors associated with functional impairment in children and adolescents.
RESULTS: Analysis of the CIS revealed that Cronbach's alpha of the parent-reported CIS was 0.90 with item-to-total correlations ranging from 0.51 to 0.77. The mean summated CIS score in children and adolescents with depression (CIS, 19.88) was higher (p < 0.05) than those without depression (CIS, 6.09). Multivariate linear regression revealed the interaction between age and depression was significant (p < 0.05) and therefore stratified regression analysis was performed by age. In both age groups, the diagnosis of depression was strongly associated (p < 0.01) with functional impairment (+7 units in 5-11 years, +11 units in 12-17 years). The presence of developmental, respiratory tract, attention deficit, and anxiety disorders also increased functional impairment in children and adolescents (p < 0.05). Family factors such as parents' psychiatric illness, their education and their living arrangement significantly contributed (p < 0.05) to impairment in children and adolescents.
CONCLUSIONS: Functional impairment is significant in pediatric depression and understanding of personal and family factors can play an important role in the assessment, management and treatment of depression. The limitations of the study include cross-sectional study design and reliance on parent-reported data on medical condition and impairment.
