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Background: Depression can have far-reaching effects on thefunctioning and adjustment of young people. Among bothchildren and adolescents depression confers an increased riskfor illness, interpersonal and psychosocial difficulties. Objective:The aim of this study was to determine the profile ofchildren (birth - 12 years) and adolescents (13 - 18 years) withmajor depression referred to the Child Mental Health Unit at theFree State Psychiatric Complex (FSPC) from 1 January 2004 to31 December 2004. Method: A total of 904 children and adolescents were referredto the Unit during 2004. From these referrals 100 children andadolescents (11.06%) were diagnosed with major depressionand were included in the study. Data analysis: The data were summarised using frequenciesand percentages (categorical variables) and means ofpercentiles (numerical variables). Results: The majority (74%) of the cases were in the adolescentage group and 61% were girls. The main complaints presentedby the parents or in the referral letter by the general practitionerswere behavioural problems (37%) such as stealing, aggressionand attention-seeking behaviour, followed by decrease inschool performance (25%), suspected depression (21%),suicidal tendencies (17%), and school refusal (8%). Twelve percent of the group had lost a family member. The main presentingclinical symptoms of major depression in the study group weresleep disturbance (59%), dysphoric (depressed) mood (57%),disturbance in appetite (49%), constant fatigue/loss of energy(43%), inability to enjoy activities that would normally givepleasure (37%), and impaired concentration (36%). Somaticcomplaints occurred in 42% of the study population.