Children and Depression
According to the National Mental Health Association, "more than 6 million young people suffer from some sort of mental health disorder that severely disrupts his/her ability to function at home, in school, or in their community." Depression is more than a temporary change in mood. Depression is marked by a prolonged sense of hopelessness and a lack of energy and enthusiasm that can last for weeks, months, or (in rare cases) even years at a time. Depression is one of the most common psychological/psychiatric disorders. Depressive disorders can increase the risk for illness and interpersonal and psychosocial difficulties that can remain long after the depressive episode is resolved. In adolescents, there is also an increased risk for substance abuse and suicidal behavior. Despite the seriousness of depression in children, however, it can go unnoticed or untreated, because it is often mistaken or viewed as normal mood swings that can be typical of a particular developmental stage. According to The National Institute of Mental Health, research has indicated depression onset as occurring earlier in life today than in past decades. Depression in young people often co-occurs with other mental disorders, most commonly anxiety, disruptive behavior, substance abuse disorders, and with physical illnesses such as diabetes. In 1997, suicide was the third leading cause of death in 10-24 year-olds. Researchers found that among adolescents who develop major depressive disorder, as many as 7 percent may commit suicide in the young adult years. Therefore, it is imperative for doctors and parents to take all threats of suicide seriously. It is advisable to involve a child psychiatrist or psychologist in the evaluation, diagnosis, and treatment of a child or adolescent in whom depression is suspected.
Symptoms
The following are some of the signs of depression in children:
- Missed school or poor school performance
- Changes in eating and sleeping habits
- Withdrawal from friends and activities once enjoyed
- Persistent sadness and hopelessness
- Problems with authority
- Indecision, lack of concentration or forgetfulness
- Poor self-esteem or guilt
- Overreaction to criticism
- Frequent physical complaints, such as headaches and stomachaches
- Anger and rage
- Lack of enthusiasm, low energy or motivation
- Drug and/or alcohol abuse
- Thoughts of death or suicide
Causes
Although psychiatrists still do not completely understand depression, most believe that it is caused by a combination of biological and environmental factors.
Biopsychosocial examples of the causes of depression might include the following:
- Genetic vulnerability (faulty production, transmission or reception of neurotransmitters and biochemical agents)
- Developmental events (early childhood stressors, learned helplessness, object loss)
- Psychosocial stressors (adult stressors, grieving)
- Physiological stressors (medical conditions, disease, viral infections)
- Personality traits (characteristics that influence reactivity to stress)
Psychosocial examples of the causes might include the following:
- Loss or reduction of reinforcement
- Social skills deficit
- Lack of family cohesion, expressiveness, organization
- Family conflict
- Deficient ability to provide for self-monitoring, self-evaluation and self-reinforcement
- Negative views of self, the world and one's future
- Learned helplessness
- Deficient problem solving skills
Social examples of depression might include the following:
- Separation, divorce of parents or even close relatives
- Death of a loved one; a person or a pet
- A move from one town, or even one neighborhood, to another
- Academic, sports or athletic failure
- An injury or physical illness resulting in hospitalization or restricted activity
- Loss of customary surroundings, family, or close friends
- Embarrassment, shame, guilt or loss of "face"
- Failure to live up to personal expectations
- Repeated physical, emotional or verbal abuse
Diagnosis
If depression is suspected, the diagnosis needs to be made by a health care professional, i.e. a psychiatrist, a psychologist. The correct diagnosis of depression is complicated. There are many diagnostic systems and criteria for depressive syndromes. There are at least four main categories of depression that include the following:
- Major Depression: A severe form of depression that may involve disturbed sleep, appetite, suicidal thinking or self-harming behavior, loss of interest, problems thinking or concentrating, fatigue or loss of energy, restlessness or lethargy, and lowered self-esteem.
- Dysthymia: A less severe form of major depression in which symptoms are less evident and yet may appear chronic and last more than two years.
- Separation anxiety disorder: Depressive symptoms that are clearly associated with a child's separation from those to whom he/she is attached.
- Adjustment disorder with depressed mood: Depressive symptoms that emerge as a reaction to an identifiable psychosocial stressor. The reaction is viewed as maladaptive and the symptoms are considered in excess of what is usually expected.
Again, it should be noted that these examples are not all-inclusive, and diagnosis should only be made by a professional health care provider.
Treatment
Treatment will vary depending on the severity of the depression and the diagnosis. The following are examples of different types of treatment:
- Cognitive: cognitive approaches utilize specific strategies that are designed to alter negative thoughts. The depressed patients are trained to recognize the connection between their thoughts, feelings, and behavior and monitor it. They are also taught to focus on new behaviors outside treatment.
- Behavioral: Behavioral approaches designed to increase pleasant activities include several components such as self-monitoring of activities and mood, reinforcing activities that increase positive feelings and decrease negative feelings.
- Social Skills: social skills training consist of teaching children how to engage in several concrete behaviors with others. Initiating conversations, responding to others, refusing requests, making requests, etc. This approach is designed to increase the child's ability to obtain reinforcements from others.
- Self-control: Self-control approaches are designed to provide the self Ðcontrol strategies including self-monitoring, self-evaluation, and self-reinforcement. Depressive symptoms are considered to be the result of deficits from one or more areas and are reflected in attending to negative events, setting unreasonable self-evaluation criteria for performance, setting unrealistic expectation, providing insufficient reinforcement, and too much self-punishment.
- Interpersonal: Interpersonal approaches focus on relationships social adjustment and mastery of social roles. Treatment usually includes non-judgmental exploration of feelings, elicitation and active questioning on the part of the therapist, reflective listening, development of insight, exploration and discussion of emotionally laden issue and direct advice.
- Medications: The drugs given for depression are not without side effects. Therefore, consensus that competent therapy and counseling interventions may be more effective. Restrict the use of medications with children. Medications should only be given under the care of a health-care provider.
- Psychotherapy is usually the first treatment of choice except in cases where depressive symptoms are so severe that immediate relief is necessary to restore function and to prevent immediate and severe consequences. Medication is usually the second choice after a competent trial of psychotherapy.
Some things that parents and caregivers can do to help the depressed child are:
- Seeking immediate advice and consultation for a crisis intervention specialist or qualified health care provider if any of the symptoms that have been listed are present.
- Seeking advice and consultation as soon as possible from a qualified mental health professional if the symptoms are severe, prolonged, debilitating, unexplained or unusual
- Seeking medical advice if health problems or symptoms are not explained.
- Seeking consultation regarding alcohol abuse.
- Evaluating drug use.
- Learning more about any medication the child is taking.
- Allowing the child space and time, as normal depression is usually temporary, can come and go. However, it should diminish over time.
- Maintain a regular and nutritional diet.
- Maintain a regular sleep cycle.
- Stay involved and avoid extended isolation from positive activities and influences.
- Maintain regular or routine physical activity that is appropriate for any existing medical condition
- Physical activity can help relieve or manage depression
- Spend time with the child, be caring, listen well and be understanding.
- Take time on a regular basis to help the child enjoy pleasurable activities and recreational interests.
It should be noted that the prognosis for treatment of depression children is good. Positive treatment outcomes are primarily dependent on a correct diagnosis, and understanding of the etiology, and implementing an appropriate intervention.
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