Depression is often thought of as a health issue in adults only. Firstly, let us understand that depression is an equally prevalent issue in children also, especially adolescents. As is in the case of many other health issues, families can help and support children through their tough times here as well. If let to worsen depression can have long lasting repercussions on children and adults.

It is only natural for anyone to feel sad occasionally. Children are no different either. Get your child to sit down and talk it out with you, no matter how small or big the feeling might be. You never know if a small sadness can grow into something bigger in the long run. So, make it a point to keep yourself free for a while everyday to discuss their day, thoughts, ideas and feelings with them.

More about Depression in Children and Youth

• Understanding Depression
  • Clinical/ Major Depression
  • Persistent Depressive Disorder
  • Bipolar Depression
  • Children having Suicidal Thoughts and/or Ideation
• Causes of Depression
  • Biological
  • Genetics
  • Psychological or Behavioral
  • Social/ Environmental
• Impacts of Depression on Children
• Triggers for Suicidal Thoughts
• Risk Factors for Suicide
• Ways to Help
  • Get Professional Support As Soon As Possible
  • Build Self-Esteem in Children
  • Replace Negative Thoughts with Positive Ones
  • A Few More General Guidelines
  • Specific Guidelines for Children Having Suicidal Thoughts or Tendencies

Understanding Depression

Clinical/ Major Depression

If five or more of the below symptoms are observed nearly every day for at least 2 weeks, it is called clinical/ major depression:

• Irritable mood, crying, fighting or throwing tantrums often.
• Less interest in activities that they used to enjoy – could be in hobbies, interests, studies, friends or even loved ones.
• Noticeable gain or loss of weight – due to mood changes that cause lack or increase of appetite in children.
• Lack of sleep or oversleeping – might be having disturbed sleep, might have difficulty falling asleep or waking up. They might not feel rested enough.
• Psychomotor retardation – sluggishness, slowed/ quiet speech, reduced movement, lack of eye-contact, impaired cognitive functions, etc. Impaired cognitive functions could lead to slowness in completing class/ home work. It could further lead to bad grades or performance at school.
• Psychomotor agitation – restlessness, agitation, fidgeting, etc.
• Lack of energy – fatigue or slouching posture. Parents might often mistake this for laziness or avoidance of responsibilities. This could further worsen the negative thoughts and feelings that the child is having.
• Feelings of hopelessness, worthlessness, inappropriate feelings of guilt – might not celebrate their achievements like other children do, might be self-critical and unhappy about themselves. Some children might lie about their own skills or success to feel better about themselves. Further, they might even be envious of other children’s achievements or skills. Due to their negative expectations, they might not want to try out a lot of things. Moreover they might also blame themselves for anything that goes wrong and feel that they deserve to be punished.
• Recurrent thoughts about death and sometimes suicide – feel that others will be better off without them or that their life is not worth living. There might be too many negative thoughts going in through their brains. Such children need immediate medical support.

Persistent Depressive Disorder

If a child is constantly depressed for at least two years and has any of the below two symptoms, the child might be going through persistent depressive disorder:

• Loss of appetite or overeating
• Lack of sleep or oversleeping
• Constant fatigue or low energy levels
• Low self-esteem
• Difficulty in making decisions or concentrating
• Feelings of hopelessness.

Ideally no child would have to go through this stage if they get the right kind of attention and care at the right time.

Bipolar Depression

Yet another type of depression is bipolar depression wherein the child experiences persistent elevated or irritable mood for at least one week. At least three of the below symptoms might also be present:

• Very high and unhealthy self-esteem
• Reduced sleep requirements
• Too talkative and high energy levels
• Lack of concentration, restlessness and easily distracted
• Experience racing thoughts or ideas
• Increase in goal-oriented activity
• High involvement in risky pleasurable behavior

Adolescents experiencing bipolar depression might also indulge in substance and drug abuse, etc. This could further make their health and situation worse.

Children having Suicidal Thoughts and/or Ideation

In addition to the symptoms stated above, children who have suicidal thoughts or ideas might talk or joke about death/ suicide or about killing themselves. Also, they might start to write stories or poems about death, watch or read about morbid themes. Although unhappily, they might start giving away their favorite possessions. Further, they could even seek out ways to kill themselves.

Besides, adolescents may tend to indulge in substance or drug abuse to overcome such feelings. This only worsens the situation. In spite of their thoughts they will still have the urge to live if the cause of stress or pain is relieved. Nevertheless they might be too busy seeing only the negatives instead of the positives in life. Some love and support would really help them at such times.

Please avoid self-diagnosis and treatment in such cases. If you notice any of the above symptoms, please take your child to a general practitioner, family doctor, psychologist or psychiatrist for check-up.

Causes of Depression

Biological

The chemicals in the brain called neurotransmitters could be held responsible to an extent for depression. Imbalances in brain’s chemical levels are known to cause depression and other mood disorders. Multiple chemicals might be involved. Further, the kind and degree of imbalance differs from person to person. Likewise, depression could also be due to some parts of the brain having issues. These parts are known to help with mood regulation. Also, physical illness, trauma and side effects of some medications could increase the likelihood of depression. Some of these might affect our brain chemicals or vulnerable brain regions and consequently lead to depression.

Genetics

Children with parents who have had depression have a higher chance of inheriting it. Although it is in their genes, environmental factors could also play a big role in alleviating or worsening the risk.

Psychological or Behavioral

Negative thoughts trigger negative emotions. This consequently triggers more irrational thoughts and the vicious cycle goes on and on. This is known as the depressive spiral. Therefore, when negative thinking becomes a recurrent thing, it increases the risk of having mood disorders like depression. The people around you and your friends might also play a huge role in impacting your thinking habits.

Social/ Environmental

• issues in the family (parents who constantly fight, are divorced, or are unemployed, financially weak )
• bulling (including cyber bullying)
• bad performance at school (in studies or some other area)
• change of schools
• traumas (resulting from sexual abuse, physical abuse, health issues, etc.)
• feeling left out and lonely
• relationship issues (girlfriend/ boyfriend)
• unhappiness about the way they look, body, etc.

Impact of Depression on Children

• Issues at school tend to be the most common. It could manifest as bad performance at studies or not being able to get along with peers and teachers.
• There have been cases of children running away from their homes because of depression.
• Low self-esteem, low assertiveness and low self-confidence, etc.
• Eating disorders are quite common too. These can hence result in loss or gain of weight.
• Substance and drug abuse is something that adolescents might indulge in as a result. It further worsens the issue.
• Children might get addicted to internet and/or games to snap out of their unhelpful thoughts. On the contrary, these are only temporary solutions and will not help in the long run.
• In some children, the tendency to hurt self or self-mutilate tends to be high. Hence, seek immediate help if you sense any such tendencies in your child.
• Besides, some children might indulge in reckless behavior, violence and have thoughts of suicide, etc.

Triggers for Suicidal Thoughts

• Situational – Pain due to unmet needs
• Relational – To instill feeling of guilt
• Emotional – Feelings of hopelessness
• Mental – Start seeing logic in ending life

All of these are essentially due to exaggerated or unhelpful automated negative thoughts. Automated negative thoughts are like reflexive thoughts. They take shape from the beliefs that we hold about ourselves, others, things, the world, or our experiences. This can be changed by challenging the underlying beliefs. It might need extra support and help.

Risk Factors for Suicide

• psychological disorders,
• death of a dear one,
• issues at school,
• break up of a relationship,
• health issues,
• dealing with gender issues,
• history of suicide or depression in the family,
• previous suicide attempts or depression, etc.

Ways to Help

Get Professional Support As Soon As Possible

Most of the times it will be difficult for parents or caretakers to understand if a child is going through depression. If you see a child being overly sad/ disturbed for a couple of days at a stretch and their performance at school, behavior at home/ with friends change, contact a healthcare provider for help. Seek immediate help if the child is having suicidal thoughts or showing such behavior.

Doctors might do necessary check-ups to rule out any physical problems. Several physical ailments have symptoms similar to that of depression. It is also common for such children to have other related health issues like anxiety, ADHD (attention deficit hyperactivity disorder), eating disorders, etc. So, the doctor might assess your child for these conditions also to ensure that they get the right diagnosis and treatment.

Read on to know how to nip depression in the bud, before it even starts taking root.

Build Self-Esteem in Children

• Observe any significant emotional changes in your child and listen to what they have to say without lecturing.
• Acknowledge and validate their concerns and feelings, however little they might seem to you.
• Encourage physical and social activity. Play with them to start with and get them moving. Later on you could get them to go on occasional playdates with close friends.
• Some children might be unhappy about their achievements or even the way they look. Teach them to love themselves just the way they are. Help them feel good about themselves instead of mocking at their looks, complexion, body or abilities.
• Set achievable expectations – Understand that every child is different. They develop and learn at their own pace. Provide them enough love and support in their journey. Do not succumb to peer/ societal pressure or compare with siblings or friends.
• Ensure that they do not blame themselves unnecessarily or for everything that goes wrong in their lives or somebody else’s life.
• Build assertiveness in children – Help them look after their own needs, say “no” to unnecessary demands, and express themselves assertively. Send them for assertiveness training if possible.

Replace Negative Thoughts with Positive Ones

Cognitive Behavioral Therapy (CBT) is what most therapists use to help people going through depression. It is about replacing negative thoughts with positive ones. Essentially most of the mood disorders are due to negative thoughts. We have talked about this therapy in many of our posts earlier also.

Get children to write down in a journal when they have negative thoughts. Ask them to describe the situation, what thoughts they have and how it makes them feel. Now ask them if those thoughts are indeed genuine, if they have cross checked with whoever was involved, etc. In most cases those thoughts would be just assumptions. Help them replace those thoughts with positive ones. Then help them notice their change in feelings. Once they do it with your support a couple of times, they should be able to do it on their own whenever required. Believe me, it works best when these thoughts and feelings are written down.

A Few More General Guidelines 

• Get a pet for your child if they are keen about it. Having and caring for a pet could be highly comforting for some children.
• They can hug themselves tightly with their own arms when they really need a hug. They could do this when you might not be around.
• Ensure that they take good care of themselves. This includes staying clean, eating healthy foods and sleeping well. Also, some foods can cause inflammation and thereby cause mood disorders like depression. Watch what they eat. Include vegetables and fruits in their diet every day. Also ensure that they sleep and rest enough as per their age requirements.
• Enroll the child for some enrichment class that they might be interested in, like art, dance, music, or sports activities. If they do not want to enroll at school, get them to attend classes elsewhere. This can help build their self-confidence and health also.
• Help them frame reaffirmations to grow their confidence. They can tell themselves that they are good, lovable, strong, confident, etc. They could do this every morning after waking up, like a morning prayer or anytime they feel like they need a positive energy boost.
• You could also get them to practice gratitude. Teach them to be thankful for each little thing or person that made them feel good on any day. They can do this exercise every night before sleeping. They will start feeling more thankful for what they have, look at the positive rather than the negative aspects of their lives and be happier. You could start practicing this with your child when they are quite young, maybe at two or three years of age. It would also help them start journaling at a later point in life. Journaling can help maintain emotional health at all ages.

Specific Guidelines for Children having Suicidal Thoughts or Tendencies

• If the child has suicidal thoughts understand that they are badly in need of help. Get the child to a psychologist or psychiatrist immediately.
• Remove any means of self-harm, spend more time with them, check on them often and inform their teacher so they can provide necessary support at school.
• Help them come up with a safety plan for themselves. Also help them list down answers to the following questions:
  • When to use the plan?
  • Ways to calm or relax when negative or suicidal thoughts come in.
  • Phone numbers of doctors/ helplines that they can call up when they need immediate professional assistance.
  • List down their reasons for living, reaffirmations and other positive thoughts that might help during difficult times.
  • Ways to make their environment safe.
  • What else can be done if they are still not feeling safe?
  • Whom to talk to if you are not available immediately for support?

Like we mentioned earlier, if you see a child being overly sad/ disturbed for a couple of days at a stretch and their performance at school, behavior at home/ with friends change, contact a healthcare provider for help. If the child is having suicidal thoughts or showing such behavior, seek help immediately.

Lastly, but most importantly, forget all the social stigmas and remember that your child’s life is the most important. You are the biggest support that your child can ever have. Help them while it is not too late.

Sharing a list of helplines for those who need help in Singapore.