Depression: Listen to what your kids don’t say
Depression is the most common mental health issue, not only among adults, but among children and teenagers as well.
In the World Health Organisation (WHO) report, ‘Health for the World's Adolescents’, depression is highlighted as the main cause of illness and disability, for children and adolescents aged 10 to 19, and suicide is the chief cause of death after traffic injuries and HIV/AIDS. This body of research is now recognised, but a couple of decades ago, depression and other mental health disorders in children were almost unknown.
Depression in children has always been a difficult topic to comprehend, both for society, and for healthcare professionals. Children who exhibited signs that are now recognized to be those of depression were thought to have behavioural problems that they would eventually grow out of. There are also several myths around this: that children are too young to be depressed; that real depression occurs only in adulthood; and that the sadness just a phase children will grow out of.
Childhood depression is real
In reality, depression is not a phase and not something that the child grows out of. Childhood depression is real and as a parent, you can empower your child to understand it and care for themselves.
In the first year of my psychiatry residency I met a ten-year old who had been referred to us by the paediatrician for losing interest in his studies. The child was quiet for most parts of the interview. In such cases, we sometimes use a projective test to understand how the child sees themselves. The child is asked to share three of their wishes, and this helps gather otherwise hard-to-access perceptions and associations. This child’s wish was to walk out of the hospital, get hit by the bus, or for something bad to happen to him so that he wouldn't have to go home, go to school or deal with everyday life. He did not want to get out of his bed in the morning; he didn’t see the purpose of living and had been contemplating how to kill himself.
We tried talking to the parents about the severity of the condition and the nature of the illness; the parents couldn’t accept that their son had depression.They believed that medication weren’t necessary and that the problem would be solved by taking him to a temple in their native village for a religious ritual they had been postponing for many years now. They didn’t use the words but their message was clear: this was something that was decided by fate.
There is a biological and genetic basis for depression. Children with a family history of depression are at greater risk of experiencing depression themselves. Depression can occur when a child has a biological vulnerability and also experiences familial or social stress. But among children it looks different from an expression of sadness: the child may appear irritable or report physical complaints. This behavior can be noticed both at home and in school; at home, the child may not show any interest in their hobbies, not want to play with their friends or a pet, not want to talk to their parents or sibling. At school, the child’s work may suffer, the child may skip school often, or display disciplinary problems.
When you have a bruise or a scar, you know that eventually, it will heal and fade. Depression, on the other hand, is not as clear or visible, and there’s no way you can tell when you’ll feel better. This can be a scary thought for an adult; and for a child, it can be overwhelming to have this experience.
Do all children need medication?
A question that often comes up is whether all children with depression need anti-depressants. The simple answer is: not really. A child with mild symptoms and identifiable stressors may recover without medication, and with psychotherapy sessions that equips them with better coping strategies. Moderate and severe cases may require medication.
Unfortunately, only one out of five children with depression seek help and receive it. Untreated childhood depression increases the risk for depression in adulthood.
The WHO predicts that by 2030, more people will be affected by depression than any other health problem. Educating parents about the myths and realities of childhood depression is essential for us to tackle this disturbing statistic.
Communicating with children with depression isn’t always easy. But if a parent notices changes in their child’s behavior that are associated with depression, a good way to begin the conversation would be to let the child know that you have noticed changes and that you are willing to listen to whatever they might have to say. Talking about depression can in itself have a therapeutic benefit and while the child may not open up immediately, they may warm up to it eventually.
Dr Suhas Chandran is a post-graduate resident at the department of psychiatry, Dept. of Psychiatry, JSS Hospital, Mysore.