While we have accepted that stress is a part of adult life since long ago, stress in childhood is usually mentioned when it is necessary to point out difficult experiences children are exposed to, e.g. in a crisis. Adults often think that experiences children are exposed to are not so important. However, in the course of their growth, children and youth are exposed to various stressors: injuries, difficult separations, losses, disturbing events in the family and at school and other things.
The truth is that depression does not affect only adults, but children and adolescents, too. Depression is a disease as are diabetes, or high blood pressure. It is believed to be the disease of the future. World Health Organisation estimates that it will soon become the second public health issue in the world.
Depression affects the growth and development, academic achievement, relationships
About 3-5% of children and adolescents had a depression episode in their history. The condition affects the growth and development, academic achievement, relationships in the family and with peers.
Various factors participate in the genesis of depression. They may be categorised into biological, factors originating in the personality, and environmental factors,
It has been noted that the incidence of depression is higher in some families. It is assumed that genes make the person react to stressful situations with the symptoms of depression. Furthermore, research has shown concrete changes at the level of the activity of certain neurotransmitters – chemical substances which enable brain cells to communicate. Diminished activity in certain neurotransmitters in some parts of the brain has been noted and proved. That is why medications have been developed for the treatment of depression aiming at the diminished activity of these neurotransmitters, having an effect upon symptoms.
Personality factors are the tendency of a person to a negative cognitive style, resulting with hopelessness and depression in situations of failure, interpersonal losses or rejection. Consequently, some authors define depression as a consequence of the combination of negative experience and a negative interpretation of events.
Environmental factors for the occurrence of depression symptoms include harmful events in the environment, like neglect and abuse, stressful events, like a loss, parental divorce, family dysfunction implying the existence of significant and frequent conflicts among family members, domestic abuse, witnessing domestic abuse, chronic diseases, addiction.
Differences in depression between adults and children/adolescents
Clinical interview is the first step in the evaluation if some child/adolescent suffering from depression. It is important to talk with the parent/carer and the child/adolescent separately.
Depression in children/adolescents is very similar to depression in adults, only with some specific characteristics. There are differences in the scope, severity and effect of symptoms. The child/adolescent will be depressed or irritable most of the day, with significant difficulties in functioning in the family, school and with peers, but will be able to enjoy some activities, unlike adults who suffer from depression.
Symptoms like depressive mood with a subjective feeling of sadness or emptiness and others’ perception that somebody is sad or tearful, loss of interest or pleasure in all or almost all activities, increase or decrease of body weight, with the accompanying increase or decrease of appetite, insomnia or sleeping too long, psychomotor speed or slowing perceived by others, but also a subjective feeling of restlessness or slowing, fatigue and energy loss, concentration difficulties, difficulties in decision making, feeling of worthlessness, of guilt, of hopelessness, low self-esteem, thoughts of death, suicidal ideas without plans or suicidal plans and attempts, indicate depression.
Adolescence – a period of big changes
Adolescence is considered a period of higher incidence of depression because it is a period of big changes, maturation, crisis. It is the time when the adolescent is not a child any more, but not an adult either, the time of searching for one’s own identity and independence as well as adjustment to physiological and physical changes. It is also the time of frequent misunderstandings between adolescents and parents which aggravates the circumstances for both the adolescents searching for their own path and for the parents who cope with their own midlife crisis. The period of quest for identity is accompanied with separation from parents, often followed with the feeling of loss, which requires acting on the feelings in order to grow and acquire personal autonomy. Adolescents can often feel lonely. Transient changes of mood, mild depression and anxiety can be considered normal phenomena in the course of their personal development.
Psychosocial and pharmacological therapies are administered in the treatment of depression in children and adolescents. Depending on the severity of symptoms, a combination of various psychosocial therapies, like psycho education, psychotherapy and medication are often administered in the treatment. In cases of suicidality it is necessary to consider child/adolescent safety and hospitalisation.
Finally, it is important to mention that behind the seemingly various behaviour changes, academic failure, difficulties in peer relationships, eating disorders, we must not forget that they may implicate depression in the child/adolescent.
Written by: Dr. Renata Zdenković, psychiatrist