We all feel sad or low, which we frequently label as being ‘depressed’, at some time or the other in our lives. Everyone goes through the blues or through a low mood that is of a passing nature. We may also feel down while trying to cope with loss or disappointments at work or at home. However, mostly in such situations after some time things get back to normal and we get back into our daily routines. These situations are not so extreme and as such don’t require the services of a professional to help deal with it.
• Depression is one of the most common mental health illnesses.
• Its prevalence among children and adolescents is estimated to be 1 per cent (Saddock, Saddock & Ruiz, 2015).
• According to the WHO, depression affects 121 million people worldwide (2011).
How can you identify depression?
By depression, we refer to a mood that goes well beyond just feeling the blues. Depression is a condition which involves recurrent and persistent low moods which last for at least two weeks and interfere with the affected individual’s daily life and activities such as going to school and maintaining relationships with friends and family. Symptoms of depression can include the following:
• Loss of interest in activities.
• Not being able to derive pleasure from activities.
• A sense of helplessness and hopelessness about the future.
• Negative thoughts relating to the self.
• Complaints of tiredness and fatigue.
• Withdrawal from social activities.
• Interference with appetite and sleep patterns.
As individuals working closely with children it is important to understand that the signs and symptoms of depression in children and adolescents are different from those observed in adults. Since children are not competent in expressing emotions verbally, their symptoms can also involve the following:
• An increase in irritability.
• Withdrawing from activities and social interaction.
• Increase in aggression and risk-taking behaviour.
• Deterioration in academic performance.
• General appearance of sadness.
• Increase in somatic complaints like headaches and stomach aches.
• Poor self-esteem.
The general apathy, irritable mood and bleak outlook on life can be difficult and confusing for a person trying to intervene in the situation. However, it is important to treat a depressed child or teen with sensitivity while making a special effort to connect with them every day since depression is the leading cause of teenage suicide in the world, the occurrence of which, according to recent estimates, has quadrupled over the last two decades.
This makes it even more imperative to effectively identify and treat the condition in the light of the fact that it is a treatable illness. It is important to remember that depression is not due to a character weakness or something that can go away if the child ‘pulls’ himself together or goes through some behaviour modification. It is an illness and needs to be treated with medication and therapy. Without treatment, depression can last for weeks, months and even years, significantly impacting different spheres of an individual’s life.
Different Ways in Which Depression Can Affect a Child or Adolescent’s Behaviour:
• Social withdrawal
• Physical complaints
• Increase in irritability and restlessness
• Deterioration in attention and concentration
• Decrease in academic performance
• Increase in risk-taking behaviour
• Drug and alcohol use
What causes depression?
There is no single causative factor that can be exclusively implicated in the causation of depression. Genetic, biological and psychosocial factors all have a strong role to play in the aetiology of the illness, combining in various ways and thus leading to its precipitation.
Biological factors: Biologically, the problem tends to be in the neurotransmitter levels in the brain. In depression certain neurotransmitter levels drop below normal, leading to disruption in daily life activities like sleep and appetite disturbance, low mood and loss of interest. Serotonin is one of the main neurotransmitters implicated in the causation of depressive disorders.
Genetic factors: Depression also has a strong genetic component associated with it and is often seen to run in families. Research has shown that depression occurs in one in every four women in contrast to it being observed in one in every 10 men.
Psychosocial factors: Many psychological and social stressors like trauma, loss of a dear one, difficulties in relationships, life-challenges, etc. can be a trigger for a depressive episode. Repeated stressful experiences tend to compromise the individual’s ability to cope with the situations as they emerge, which is exacerbated if the individual does not have adequate support mechanisms in the environment.
Who is at risk?
Different children cope with difficult situations differently. Some are more resilient than
others and are able to work through some of the most challenging circumstances while others may find the stresses of daily life difficult to handle, yet others may experience significant trauma that can compromise existing abilities to cope causing the onset of a depressive episode.
Red Flags (Beware As These Increase Risk)
• Parent with a history of depression or other psychiatric illness.
• Difficult and challenging family circumstances.
• History of childhood abuse—verbal, physical, or sexual.
• Low sense of self.
• Low peer-group support and other support mechanisms.
• Negative and pessimistic thinking patterns.
• Poor problem-solving and decision-making skills.
• Lack of assertiveness.
Excerpted with permission of Rupa Publications India from Let Him Not Sink: First Steps to Mental Health by Dr Samir Parikh and Ms Kamna Chhibber. Pre-order your copy here.