Childhood Depression: Risk Factors And Why It Is Underdiagnosed.

 

Undiagnosed Childhood Depression

Whilst there are many similarities between childhood depression and adult depression, there are also some important differences. One such difference is children displaying objectively observable symptoms of depression often deny that they are depressed.

Certainly this was true in my case as a child. For example, I would have felt a deep sense of (completely irrational and undeserved) shame had my contemporaries realised how deeply unhappy I was, as if being unhappy was some kind of contemptible personal and moral failing (or, as I would have thought at the time, yet another contemptible personal and moral failing).

childhood_depression

Although each child’s experience of depression differs, there are certain symptoms which frequently present themselves. These include:

– disrupted sleep or a need to sleep too much

– impaired concentration (which may lead to academic underachievement)

– low levels of energy

– mood changes

– increased irritability/anger

– general negative outlook on life

– self-harm

– loss of concern about appearance

– increased irritability

– increased proneness to become angry/enraged

– social withdrawal

– loss of interest in previously enjoyed activities

anhedonia (inability to feel pleasure)

– deterioration in behaviour at school and in academic performance

– physical problems such as headaches and stomach ailments (particularly in younger children who may not otherwise seem depressed; such children – although they will themselves be unaware of this – are described by psychologists of somaticizing their internal feelings of mental distress).

Unfortunately, too, because being depressed increases a child’s vulnerability, and other children quickly sense such vulnerability, a depressed child may become the target of school bullies, significantly exacerbating the depressed child’s problems, particularly as his/her depression may make his/her attempts at social interaction awkward and painful anyway, nevermind having to cope with bullies on top of this.  Again, this was close to my own youthful experience.

And, of course, having social difficulties is psychologically devastating for a child. This is because children have a profound need to feel they are accepted by their peers and that they ‘belong’.

What Factors Put Children At Risk Of Developing Depression?

About 95℅ of adolescents who develop clinical depression have chronic problems such as:

– the experience of significant trauma

– being the victim of abuse within the home

– living in a home in which there is domestic violence

– parental divorce/separation/disharmony

– parental neglect

– parental alcoholism/misuse of drugs

– living in a financially poor household

– living in a single parent household

– being taken into care by the local authority

– being placed in an institution young offenders

– being in constant conflict with parents/primary caregivers

– living with a mentally ill patent

– being a young care / parentified

Comorbidity:

Depressed children are likely to have comorbid (simultaneously occurring) mental health conditions such as alcoholism, drug dependency or ADHD (Attention Deficit And Hyperactivity Disorder).

Prevalence:

Depression amongst children is less prevalent than it is amongst adults, but it still affects:

Approx. 7℅ of adolescent children

Approx. 3 ℅ of pre-pubertal children

 

Why Childhood Depression Is Significantly Underdiagnosed:

Sadly, as in my own case, the fact that a child is suffering from depression often goes unacknowledged. This can make the child’s condition much worse; for example, if one of the depressed child’s symptoms is outbursts of rage and anger, s/he may be blamed and punished for this, serving only to lower the child’s self-esteem further.

Indeed, this could lead the child to turn the anger s/he feels in on herself/himself, resulting in self-harm, suicidal thoughts and/or suicidal behaviour.

Appropriate education of parents, teachers and others who come into frequent contact with children about child mental health issues would increase the likelihood of childhood depression being picked up in its early stages which would, in turn, improve the chances of effective treatment.

Also, it would be helpful if young people themselves were taught more about childhood mental health issues, not least because another reason depression in the young is underdiagnosed is due to the stigma that, even in the 21st century, still attaches itself being diagnosed with a psychiatric illness (as I allude to at the start of this article).

Treatment:

This should focus on the ‘whole child’ so that:

– any other conditions the child has may be addressed eg. excessive drinking, social phobia, inappropriate anger

– problems that exist in the family as a whole may be addressed (children who come from dysfunctional families / stressful family environments have a much higher incidence of depression)

– if the child’s parents have a mental illness (making it more likely the child will suffer from mental health problems) that this, too, is addressed.

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David Hosier BSc Hons; MSc; PGDE(FAHE).

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Copyright 2016 Child Abuse, Trauma and Recovery

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