Depression in children and adolescents. Fact with you cant't discussed.
Depression in numbers
Looking for an answer to the question on depression rates in children and adolescents I got stuck in a statistical corn field. Data is unclear – the problem has not been identified and is underestimated.
Medical terms used in the diagnosis are also problematic. In Poland, one thing is clear – growing numbers of people visit health centres belonging to The National Health Fund (pol. Narodowy Fundusz Zdrowia) to receive treatment on the outpatient basis. You need to wait for help in a private healthcare centre. Mental health hospitals for children and adolescents are overcrowded.
Doctors and therapists cannot keep up with providing help. Hard facts – statistics provided by the polish police. Data provided by the police in 2022 mention 2,031 suicidal attempts by young people, 150 of which resulted in death. In 2020, there were 800 suicidal attempts by young people, so we observed an increase by 150 per cent year over year. Based on my medical practice, I would like to add that not everyone who attempted suicide contacts the police and is included in the statistics. People undergoing a crisis require specialized medical help, and the police intervenes only when the support of a specialist intervention team is necessary or a tragedy happens – somebody took his or her life.
The situation is distressing. No treatment or no action is like burying our heads in the sand.
How does it look like in your country? fast jump to date on WHO webside - date about mental health of young people Mental health of adolescents (who.int) and date about suicide. Suicide (who.int)
Or maybe diagnosing and talking about depression is in fashion, especially among young people?
A trend for saying that you are suffering, asking a specialist for help or wanting „to leave”? It does not make any sense. Young people explore and try to name what they feel and experience. In the ‘internet’ era, there is a lot of information and it is not always coherent with what a specialist can see. Not each case of depression identified by a non-specialist is clinical depression. At the same time, however, if a young person talks about a problem and looks for help, it means that they are ‘calling for help’. It is healthy to name, express, ask for help, when you feel really badly.
I do not reckon we ought to condemn it. We should be happy that young people are so wise, they explore. Using the term ‘depression is in fashion among young people’ we are making a mistake and we are underestimating the problem.
As to fashion, I have recently heard that the works of Zdzisław Beksiński are trending now. Who is Beksinski? Take a look - Youtube Know the Artist: Zdzisław Beksiński.
His works - depict death, dying, suffering, disease. Art – music as well as painting – is often the heart rate of our times. Our reality – on the one hand fast-paced and delightful, giving us a heart attack – mentally and physically – uses up our resources. As I see it, many people find their mental home in these works. They try to order and name the reality, and through art, they experience consolation. It is similar with Banksy, who is admired by a lot of people, whose works express longing for normality and nonviolent communication. And what does reality bring us –a symbolically destroyed painting ‘Girl with balloon’ – loss of hope for normality.
What do young people say when they come for a consultation due to depression?
It might be worthy to ask young people themselves. The experience of work with adolescents suggests that they understand more than adults think, they want to speak out and they suffer. Just like in the aforementioned Beksiński’s art – they experience surreality, death, disease, suffering, war, loss. The artist’s family endured trauma and depression, suicidal attempts, and that is why we can feel these issues in his works – that is why I keep coming back to them. Young people, not equipped with defence mechanisms, experience the world with all their
How do you notice and not overlook the problem? What are the characteristics of youth depression?
Just like every kind of depression, it also comprises a depressive vision of reality – negative view about the past, present, future, and oneself. It leads to hopelessness of being in the present moment, takes away strength and motivation to act. A depressed person is like in a cage – views the reality irrationally – focuses on shadows, does not see the colour of life.
Are there any characteristics specific for child and teen depression? What symptoms should we be alert for?
Depression in children and teens is usually connected with irritability, angry outbursts. Young people often run away from hopelessness by doing their favourite activities – e.g., using
Anhedonia may not develop in the first stage of depression, although as depression develops, the taste for hobbies goes away. Apathy, pain, idleness remain.
What symptoms should we be concerned about?
A change in a young person’s behaviour should be of concern. A tendency for social isolation, both from family and peers, if a young person did not have it earlier. High irritability and angry outbursts are significant – they stem from the need to reduce stimuli, vent their emotions, the need for control. My child is not the same person any more, parents say.
What about symptoms of depression in children?
Younger children will present physical complaints – the so-called somatizations and continuously being worried about their health or their relatives’ health. Fear of losing their loved ones. A child will have a trouble to name the problem – he or she will not say ‘I have depression’. A child will show emotions through the body – stomach-ache, headache, nausea, impaired biological patterns – changes in appetite, sleep. It may lead to impaired weight gain and growth – impairment of growth and impaired mental development – a paediatrician may notice these symptoms.
What are depression risk factors in a young person?
In the assessment of depression risk, loss is the key term. Loss may be defined as destabilization of secure base. Secure base – a safe, stable family place, financial safety, a safe place to study, a safe peer environment, environment adjusted to my neurodevelopmental needs and potentially to physical dysfunctions. If the pillars of security fail, we are faced with risk factors.
Are we now dealing with phenomena which are conducive to depression among young people?
We cannot ignore the effect of Covid-19 pandemic on young people’s psychological condition. Isolation and the message that contact with others is potentially threatening and the world is a dangerous place experienced by children and adolescents cannot be ignored. The required sterility was not a normal situation – it was a necessity.
What about other risk factors?
From the point of view of system therapy and genogram, depression, as seen by a psychologist, might be passed down through generations. More specifically – depressive vision of the world gets passed down. When might that happen? Untreated mental issues in the family, for sure – a depressed caregiver, may contribute to depression in a young person. A young person unknowingly adopts the vision of the world present by people around them – he or she is like a blank slate where reality makes its notes – parents and close ones write the most.
War loss is not of less importance. War, meaning destabilisation of family ties – domestic violence, as well as war meaning military conflict – war in the east. Young people experiencing war – every aspect of their world falls apart. Trauma affects both those experiencing the world personally, but also those observing somebody’s world falling to pieces. The trauma of War World II has been present in generational transmission until now. I would hate the history of generational transmission of trauma to come full circle. Looking at it from psychological and psychiatric perspective, we know and are able to do more – we have the space to learn a lesson from history. In a nutshell, the current young generation may experience more losses – that is why I think their situation is more difficult.
When we talk about depression, another aspect is often brought up – teenage rebellion.
Adolescence – inseparably connected with rebellion – hormonal storm destabilises the world. Teenage rebellion means contradicting everything you have heard at home and heading towards what the world offers. Developmental aims – creating your own quality – your own vision of the world and yourself.
What is the difference between teenage rebellion and depression in children and adolescents? Is it possible to confuse one with the other?
Yes, you might have doubts. Irritability is characteristic for depression in children and adolescents – teenage rebellion is also associated with it.
I believe that the most important feature is life destabilization, accompanied by mood and psychomotor drive disorders, as well as biological markers of depression in a young person. In both we can see changes in the brain’s function. In teenage rebellion, we recognize hormonal fluctuations and reorganization – that is instability – changes from good to bad. Depression means a deficit of neurotransmitters and an atomic bomb of stress hormones. In depression, the situation is bad for most of the time – functioning, mood, psychomotor drive, sleep, appetite, concentration – gradually worsen. These two processes may obviously overlap. It is a simplification, although it outlines the situation. Finally, if a young person asks for a consultation with a psychologist or we have doubts, it is worth to listen to him or her, not to overlook an increasingly growing problem.
Is there a group of young people at a higher risk of developing depression?
I believe that every person described as “the different one”, “the troubled one”, “the one who does everything slowly”, “the one who has less and can’t show off”. Being a teenager comprises a tendency to compare and compete. Every group might reject people from these groups, rather than include them. Hate is still widespread. Young people judge themselves – hurt themselves a lot.
"Neurodiversity – the key that unlocked my world." - Elisabeth Wiklander - Ted -x.
What about suicidal thoughts and self-inflicted wounds, are they a typical of depression in children and teenagers?
They are common, though they are not present in each case. Not always linked to depression, they might be its part. The most important thing is not to underestimate them. Even if a care taker is worried that they are exaggerated, they should be taken care of. Suicidal thoughts are a sign, that a person is feeling badly enough to want to run away from the reality and him- or herself. Such a person needs help and support.
Self-harm behaviours – self-inflicted wounds are also a signal – a safety-valve institution – they are a sign of high internal pressure – the discomfort connected with being on your own.
How can you help a young person without causing harm?
I like comparing help to a young depressed person to entering a young person’s room. Everybody knows that young people do not like it when you enter their room without knocking. It happens that a young depressed person leaves his or her room, tells us about their low mood and asks a psychologist for help, which is the easiest possible situation. I suggest helping a young person with visiting a specialist without delay.
‘Depression’ may, however, close the door to a young depressed person’s room in various ways.
Mild/moderate depression – will lock the door – isolating a young person from the world and closing him or her in the room. A youngster may escape by undertaking pleasurable pastimes. He or she sometimes stays in bed, and his or her behaviour seems unproductive, does not make sense. It is worth knocking on the door to offer help. A young person must find a key to open himself or herself up for the world. A decision to accept help may take some time, at times a young person feels relieved that somebody is asking him or her “how are you feeling” and makes use of the help unknowingly.
Activities which may help with overcoming depression include pleasant activities, renewing contacts with peers, physical activity, mindfulness, relaxation, faith, new interests, inspiring and supportive adult, aim and direction – agency, effort to improve family relations, change of the situation at school, contacts with peers. It is vital to evaluate factors stimulating depression – a conversation with a child. If you want to know more about how to talk to a depressed child, visit Forum Przeciw Depresji (Forum Against Depression). It is sometimes necessary to include a therapist, at times a therapist and a psychiatrist – pharmacotherapy – in the process of overcoming depression. It is important to be with a young person and react to his or her mental state and evaluate the effectiveness of undertaken actions. If you are not able to do it yourself, leave it to a specialist, who should collect information and adjust actions to an individual and his or her life situation.
When depression is serious, the door to a young person’s room has been somewhat concreted over. A youngster has no energy and skills to open it. He or she separates himself or herself from the world. Depression covers the view from the window, family and acquaintances. It takes away the taste of life. It destabilizes sleep, appetite. Suicidal thoughts and behaviours may occur. A person stops being him- or herself and depression develops. Then you just ‘kick the door down’, actively help with overcoming depression.
You should, however, always start with an attempt to do it as subtly as possible. Remember, though, to inform a young person of your actions. In a state of emergency, action means consultation with a doctor in ER, which may lead to a hospitalization in a psychiatry department.
Hospitalization in a psychiatry department is directed at stabilisation of psychological condition of a person in crisis – to bounce back. It does not solve the problem of depression. You need to remember that enforcement is the last resort and, as much as possible, you should share your plans with a young person and do nothing behind his or her back. Help is effective when a person cooperates and knows why something is being done.
Does overcoming depression last long?
You need to be aware that overcoming depression is a process. It might be time necessary for medications to start working, finding the right therapist, sometimes waiting for a doctor’s appointment, and sometimes making a decision to ask for help and accept the fact that depression affects our family, stabilization of the external situation, proper diagnosis of comorbid disorders.
What is the most important?
The most important is to allow yourself to notice the problem, escape labelling and stereotypes and ask for help. The sooner we react, the greater the chance for avoiding concreting the ‘youngster’s door’ over with depression and then kicking the door down. We increase the chances of smoothly returning to normality. Although it is difficult, it might be beautiful again – ‘the rain must cease someday’. It is worth remembering.
