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Symptoms of MDD or mania/bipolar can be more difficult to detect in children and adolescents than adults

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Parents involvement with Anna's health.

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Anna's home situation
Parents blaming each other for her depression

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Environmental variables
Stability in one or more areas of the Four Arenas Of Comfort

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Genetic predisposition
Environmental variables
Influence from the Four Arenas of Comfort

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Medication

Online intervention

Interpersonal/ Family based therapy

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Social Impairment
Lack of concentration
Fatigue
Psychomotor agitation
Significant weight gain
Hypersomnia
Feelings of worthlessness
Lack of concentration
Recurrent thoughts of death

Loss of interest or pleasure
Depressed Mood

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Genetic (Anna's father's speculated predisposition to depression for example)

Environmental (her family situation at home, affecting her performance in all arenas of comfort, as another example)