Depression in Children
Depression Awareness and Suicide Prevention Campaign
Depression in children facts
- Depression is a condition that is more severe than normal sadness and can significantly interfere with a child's ability to function.
- Depression affects about 2% of preschool and school-age children.
- Depression in children does not have one specific cause but rather a number of biological, psychological, and environmental risk factors that are part of its development.
- General symptoms of depression, regardless of age, include having a depressed or irritable mood or loss of interest or pleasure for at least two weeks and having at least five clinical signs and symptoms.
- Suicide is the third leading cause of death in young people 10-24 years of age.
- To diagnose depression, a health care professional will likely perform or refer for a thorough medical assessment and physical examination and ask standard mental health questions.
- Treatment for childhood depression may include addressing any medical conditions that caused or worsened the condition. It can also involve lifestyle adjustments, psychotherapy, and, for moderate to severe depression, medication.
- Interpersonal therapy (ITP) and cognitive behavioral therapy (CBT) are the major approaches commonly used to treat childhood depression.
- About 60% of children who take antidepressant medication improve. It may take up to six weeks of treatment with medication at its effective dose to start improving.
- Childhood depression is a risk factor for developing a number of other mental health symptoms and disorders.
- Prevention of childhood depression seeks to reduce risk factors and strengthen protective factors using approaches that are appropriate for the child's developmental level.
- It is advisable for family members and friends to seek mental health assessment and treatment for the depressed child.
Symptoms of depression also include:
• feelings of worthlessness,
• loss of energy,
• loss of appetite,
• lack of interest in daily activities,
• sleep problems,
• thoughts of suicide.
What is childhood depression?
Clinically significant depression is being severe enough to interfere with one's ability to function. It is quite common at every age, affecting more than 16% of children in the United States at some time in their lives and thought to be increasing in children and adolescents, both in this country and elsewhere. Other statistics about depression include its tendency to occur at a rate of about 2% prior to the teenage years and at approximately 5%-8% when both adolescents and children younger than adolescence are considered. It is a leading cause of health impairment (morbidity) and death (mortality). About 3,000 adolescents and young adults die by suicide each year in the United States, making it the third leading cause of death in people 10-24 years of age.
What are the types of depression in children?
Children may suffer from the episodes of moderate to severe depression associated with major depressive disorder, or more chronic, mild to moderate low mood of dysthymia. Depression may also be part of other mood disorders like bipolar disorder, as a result of psychosis (for example, having symptoms of delusions or hallucinations), as part of a medical condition like hypothyroidism, or the result of exposure to certain medications such as cold medications or drug abuse, like cocaine withdrawal.
What are causes and risk factors for depression in children?
Depressive disorders in children does not have one specific cause. Rather, people with these conditions tend to have a number of biological, psychological, and environmental contributors to its development. Biological factors are associated with chemical imbalances in the brain, namely serotonin in the brain.
Psychological contributors to depression include low self-esteem, negative social skills, negative body image, being excessively self-critical, and often feeling helpless when dealing with negative events. Children who suffer from conduct disorder, attention deficit hyperactivity disorder (ADHD), clinical anxiety, or who have cognitive or learning problems, as well as trouble engaging in social activities, also have more risk of developing depression.
Other contributors to this condition include poverty and financial difficulties in general, exposure to violence, social isolation, parental conflict, divorce, and other causes of disruptions to family life. Children who have limited physical activity, poor school performance, or lose a relationship are at higher risk for developing depression, as well.
Depression often results in the sufferer being unable to perform daily activities, such as getting out of bed or getting dressed, performing well at school, or playing with peers. General symptoms of a major depressive episode, regardless of age, include having a depressed mood or irritability or difficulty experiencing pleasure for at least two weeks and having at least five of the following signs and symptoms:
- Feeling sad or blue and/or irritable or seeming that way as observed by others (for examples, tearfulness or otherwise looking persistently sad, or angry)
- Significant appetite changes, with or without significant weight loss, failing to gain weight appropriately or gaining excessive weight
- Change in sleep pattern: trouble sleeping or sleeping too much
- Physical agitation or retardation (for example, restlessness or feeling slowed down)
- Fatigue or low energy/loss of energy
- Difficulty concentrating
- Feeling worthless, excessively guilty, or tend to self-blame
- Thoughts of death or suicide
Children with depression may also experience the classic symptoms but may exhibit other symptoms as well, including
- impaired performance of schoolwork,
- persistent boredom,
- quickness to anger,
- frequent physical complaints, like headaches and stomach-aches,
- more risk-taking behaviours and/or showing less concern for their own safety.
Examples of risk-taking behaviours in children include unsafe play, like climbing excessively high or running in the street.
Parents of infants and children with depression often report noticing the following behaviour changes in the child:
- Crying more often or more easily
- Increased sensitivity to criticism or other negative experiences
- More irritable mood than usual or compared to others their age and gender, leading to vocal or physical outbursts, defiant, destructive, angry or other acting out behaviours
- Eating patterns, sleeping patterns, or significant increase or decrease in weight change, or the child fails to achieve appropriate gain weight for their age
- Unexplained physical complaints (for examples, headaches or abdominal pain)
- Social withdrawal, in that the youth spends more time alone, away from friends and family
- Developing more "clinginess" and more dependent on certain relationships (This is not as common as social withdrawal.)
- Overly pessimistic, hopeless, helpless, excessively guilty or feeling worthless
- Expressing thoughts about hurting him or herself or engaging in self-injury (like cutting or burning him or herself), reckless or other potentially harmful behaviour
- Young children may act younger than their age or than they had before (regress)
What should parents do if they suspect that their child is depressed?
Family members and friends should seek mental health assessment and treatment for the depressed child. Adult family members may confer with the child's primary care doctor or seek mental health services by contacting one of the resources indicated below. Once the child with depression is receiving treatment, family members can promote good mental health by gently encouraging him or her to have a healthy lifestyle, including encouraging the child to maintain a healthy diet, including adequate water intake, get enough sleep, exercise regularly, remain socially active, and to engage in healthy stress-management activities. Research that analysed the results of several studies (meta-analysis) has found that the positive impact of exercise on mood is even more than assumed due to its being part of a healthy lifestyle. Parents and other loved ones can also be helpful to the depressed child by discouraging him or her from engaging in risky behaviours.
What is the treatment for depression in children?
Treatment options may include alleviating any medical condition that causes or worsens depression. For example, a person who has low levels of thyroid hormone might receive hormone replacement with levothyroxine (Synthroid). Other aspects of treatment may include supportive therapy, like lifestyle and behavioural changes, psychotherapy, complementary treatments, and possibly medication for moderate to severe depression. If symptoms are severe enough that treatment with medication is appropriate, symptoms tend to improve faster and for a longer period when medication is combined with psychotherapy.
What are complications of depression in children?
Depression during childhood puts sufferers at risk for developing a number of other mental health issues. Children with depression are also more likely to have poor academic performance and to engage in alcohol and other drug abuse. As adults, people who had depression during childhood and adolescence are at risk for having trouble maintaining employment, as well as family and other social disruptions during adulthood.
Is it possible to prevent depression in children?
For children, from infancy through the teenage years, strong, healthy parent-child attachment can help protect the child from developing depression. Parental behaviours that tend to foster health attachment with their children involve consistent love and care, as well as attentive responsiveness to the child's needs, including age-appropriate steps toward the child's gradual independence.
Preventing depression in childhood tends to involve addressing risk factors, both specific and nonspecific, strengthening other protective factors, and using an appropriate approach for the child's developmental level. Such programs often use cognitive behavioral and/or interpersonal approaches, as well as family based prevention strategies because research shows that these interventions are the most effective.
Protective factors for adolescent depression include involving supportive adults, strong family and peer relationships, healthy coping skills, and emotional regulation. Children of a depressed parent tend to be more resilient when the child is more able to focus on age-appropriate tasks in their lives and on their relationships, as well as being able to understand their parents' condition. For depressed parents, their children seem to be less likely to develop the disorder when the parent is able to demonstrate a commitment to parenting and to relationships.