Relationship Seen Between Falls, Depression in Preschoolers


Major Findings: Children aged 2–5 who had a fall serious enough to require medical attention were 5.8 times more likely than other preschoolers to meet diagnostic criteria for depression. In more than half of these children, the first depression symptom occurred only after a major fall.

Data Source: Longitudinal study of 666 children representing a larger community sample of more than 3,000 children of the same age.

Disclosures: Dr. Egger reported no relevant financial conflicts of interest.

LOS ANGELES – Serious falls were strongly associated with childhood depression in a study of preschoolers aged 2–5 years.

A series of longitudinal studies conducted at Duke University has found associations between high-stress events and cumulative stressors in the lives of young children and DSM-IV diagnoses, with serious falls emerging as a uniquely important contributor, Dr. Helen Link Egger said at an international conference on pediatric psychological trauma.

In the current study, a weighted representative sample of 666 preschoolers was statistically reflective of a larger community sample of more than 3,000 children of the same age. The children who suffered a serious fall were 5.8 times more likely than others to meet criteria for childhood depression, Dr. Egger said.

The rate of depression in children who fell was 18%, compared with 3.6% in the other children enrolled in the study.

No association was detected between depression and the age at which children fell.

Because the study captured baseline data, the researchers were able to show that 58% of children who fell during the time period of the study developed their first depressive symptom only after the injury.

The findings do not prove causality, but they do raise numerous questions, said Dr. Egger of the center for developmental epidemiology, department of psychiatry and behavioral sciences, Duke University, Durham, N.C.

Of particular interest is whether maternal depression or household environmental factors may set the stage for some childhood falls, as well as for the depression that some of the same children develop, she said.

Beyond physical safety hazards, children who fall may be “living in a household where nobody is watching out for them,” she suggested. If so, the trauma associated with the fall itself and the resulting trip to the emergency room may not be a causal factor in depression, but rather a reflection of caregiving that is not attentive or deeply attached. Factors significantly more common in children who fell included a recent change in day care (41.2% of children who fell, compared with 13.5% of those who did not); death of a loved one (30.4% of children who fell, 13.7% of those who did not); death of a sibling or peer (4.4% of children who fell, 0.5% of those who did not); and removal from the home because of physical abuse (1.7% of children who fell, 0.1% of those who did not).

Children with any injury requiring medical attention, including falls, were 2.7 times more likely than other preschoolers to meet criteria for separation anxiety disorder, with a quarter of the injured children meeting criteria for that DSM-IV diagnosis. Serious injuries occurred in more than 12% of children studied, with serious falls accounting for almost half.

Falls are a major cause of early childhood injury nationally as well, according to the Centers for Disease Control and Prevention. Between the years 2000 and 2006, more than half of all injuries to infants were falls, and falls accounted for 43% of injuries to children aged 1–4 years.

Dr. Egger noted that links between traumatic events in early childhood and psychological sequelae are likely very complex and might depend on the child's pre-existing emotional, developmental, and behavioral characteristics; parental and socioeconomic risk factors; and the event's direct impact on neurocognition.

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