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Child Psychiatrist /Adult Psychiatrist

Duration of Daily Depressive Behaviors Among Preschoolers Linked to Impairment

Keypoint: Duration of depressive symptoms in preschool-aged children is positively correlated with daily impairment and distress.

Daily Depressive Behaviors

Study results published in The Journal of Child Psychology and Psychiatry found that among preschool-aged children, episodes of tantrums, sadness, tearfulness, and irritability needed to last an average total of more than 30 to 38 minutes per day to be considered psychometrically severe. Longer durations of these depressive behaviors were significantly correlated with increased daily impairment.

Although depressive moods and behaviors (ie, sadness, irritability, and tearfulness) are developmentally normative for children, the length of time that children exhibit these behaviors may be a risk factor for depression and other clinically significant difficulties. However, it remains unclear what duration of time is considered “normative” for these episodes.

To assess the daily duration of depressive mood behaviors, researchers recruited the parents and primary caregivers (N=900) of 3- to 5-year-old children at 2 sites in Maryland and California through flyer advertisements at local establishments and on social media. Participants completed a daily online diary for 14 days in which they described the duration of their child’s depressive moods and behaviors and how their mood affected the impairment and/or distress of the child and family. The diary items were adapted from the Early Childhood Inventory (ECI) and the impairment and distress items were adapted from the ECI and Preschool Age Psychiatric assessment (PAPA).

On average, the children were 4.25 (SD, 0.79) years of age, attended 21.49 (SD, 16.88) hours of childcare per week, 48.0% were girls, and 62.8% were White. Most parents or guardians were married (87.8%), earned more than $100,000 annually (43.9%), and graduated college (78.3%).

Although the original confirmatory factor analysis model did not fit the data, including the covariance between low energy or fatigue and change in activity level resulted in a well-fit model (c2, 77.23; P <.001).

The researchers stratified the daily duration of behaviors and moods into 4 percentile categories: below the 50th percentile, between the 50th and 80th percentile, between the 81st and 95th percentile, and above the 95th percentile. The following cumulative durations of depressive behaviors/moods were considered psychometrically severe (either between the 81st and 95th percentile or above the 95th percentile):

  • Tantrums: 30 minutes or greater

  • Sadness: 32 minutes or greater

  • Tearfulness: 35 minutes or greater

  • Irritability: 38 minutes or greater

  • Low interest or pleasure: 48 minutes or greater

  • Low energy or fatigue: 59 minutes or greater

  • Change in activity level: 101 minutes or greater

The researchers observed significant correlations between depressive behavior duration and average daily impairment (r, 0.243; P <.001), all depressive behaviors and average daily impairment (r, 0.182; P <.001), and all depressive behaviors and overall distress for parent and child (r, 0.200; P <.001).

A longer duration of depressive behaviors was also positively correlated with the child’s age (r, 0.122; P <.001) and negatively correlated with parental education (r, -0.181; P <.001), family income (r, -0.209; P <.001), and parental marital status (r, -0.172; P <.001). Parents of a Black (P =.038), multiracial (P <.001), or Hispanic (P =.009) child reported significantly longer duration of depressive behaviors than parents of a White child.

Study authors concluded, “To our knowledge, this is the first study to delineate specific duration ranges for behaviors related to depression in preschool-aged children. These data can assist child practitioners in differentiating normative patterns from less normative mood problems to determine which children may be at risk.”

Study limitations include the potential overlap between moods and behaviors, a lack of data on guilt, and possibly inaccurate estimates given the only once-daily behavior reporting.

Note: This article originally appeared on Psychiatry Advisor

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