Are increased weight and appetite useful indicators of depression in children and adolescents?

During childhood and adolescence, physiological, psychological, and behavioral processes stronglypromote weight gain and increased appetite while also inhibiting weight loss and decreased appetite. TheDiagnostic and Statistical Manual-IV (DSM-IV) treats both weight-gain/increased-appetite and weightloss/decreased-appetite as symptoms of major depression during these developmental periods, despite thefact that one complements typical development and the other opposes it. To disentangle the developmentalversus pathological correlates of weight and appetite disturbance in younger age groups, thecurrent study examined symptoms of depression in an aggregated sample of 2307 children and adolescents,47.25% of whom met criteria for major depressive disorder. A multigroup, multidimensional itemresponse theory model generated three key results. First, weight loss and decreased appetite loadedstrongly onto a general depression dimension; in contrast, weight gain and increased appetite did not.Instead, weight gain and increased appetite loaded onto a separate dimension that did not correlatestrongly with general depression. Second, inclusion or exclusion of weight gain and increasedappetite affected neither the nature of the general depression dimension nor the fidelity of majordepressive disorder diagnosis. Third, the general depression dimension and the weight-gain/increased-appetite dimension showed different patterns across age and gender. In child and adolescentpopulations, these results call into question the utility of weight gain and increased appetite asindicators of depression. This has serious implications for the diagnostic criteria of depression inchildren and adolescents. These findings inform a revision of the DSM, with implications for thediagnosis of depression in this age group and for research on depression.