Mild depressive moods to severe depressive disorders are some of the most common mental illnesses affecting children and adolescents. The condition can start in childhood, it can become chronic and severely inhibit the child’s development. The risk of developing depression is under 2 percent in children of nursery and primary school age, but it increases significantly for adolescents. The condition can generally be treated easily.
Especially in children and adolescents the symptoms of the condition can be very different and complex and there are some aspects specific to age and stage of development. In general the younger the child the more difficult it is to recognise depression.
Depressive symptoms in children and adolescents are often not only a melancholy frame of mind with sadness, lack of interest, hopelessness, brooding or apathy, they may also be masked by physical symptoms or abnormal behaviour. In children, depression is often accompanied by symptoms of aggression, agitation, distractibility and inability to concentrate. Fear of separation and school phobia are other issues common in this age group. In adolescents on the other hand depression often occurs in conjunction with eating disorders, alcohol and drug problems.
In these cases the other more obvious problems are often recognised, whilst the symptoms of depression are overlooked. In addition it is often difficult to judge which phenomena are an expression of “normal” development - particularly in puberty, where mood swings and behavioural changes are also common.
Despite these difficulties it is particularly important to recognise depression early since many sufferers find their situation so hopeless that thoughts of suicide often seem the only way out. Any expression of such thoughts or even masked hints must always be taken seriously. In young people suicide is the second most common cause of death after road accidents.
Still, depression is no reason to give up hope. The earlier it is diagnosed and treatment initiated, the greater the chances of overcoming the condition and avoiding disadvantages for later life.
Signs of depression in childhood and adolescence
During puberty many young people often lose their equilibrium for a brief or extended period of time. This manifests itself in e.g. extreme changes of mood from cloud nine to the depths of despair, irritability, withdrawal, boredom or brooding, dissatisfaction with themselves and the world.
Many of these are also symptoms of depression. The boundaries between normal development and the symptoms of depression are not well defined – and therein lies the difficulty of establishing a definitive diagnosis. This leads to the fact that depression in childhood and adolescence is often not recognised at all or only very late. But: depression is an illness which must be taken seriously.
The symptoms of the illness can be very varied and complex, particularly in children. There are however a few clear signs of depressive conditions in childhood and in adolescence.
Please note that the following symptoms can only be taken as indications of depression and they may not occur all at once; diagnosis can only be made by a doctor. This also applies to the exclusion of physical causes for the depressive symptoms, e.g. thyroid dysfunction.
Risk factors / Protective factors
The reasons for developing depression are varied and not yet fully explained. Experts now assume that it is the interaction of certain biological (genetic), sociocultural and psychological factors which can contribution to developing depression. The significance of these factors is however viewed differently in the various models. All three areas provide starting points to explain, treat and overcome depression.
Some depressive episodes occur without any identifiable external reason, but in others there is a catalyst. Extreme external circumstances can affect the resilience of a child or young person and facilitate development of depression. But of course not everyone who faces dramatic events in their lives will become ill, because there are also many protective factors which help young people in particular to overcome such experiences.
Possible triggers (risk factors):
Protective factors (resilience factors):
Consequences of depression in childhood and adolescence
How severe the effects of depression are in childhood and adolescence depends on the severity, the duration and the age of the person affected. Particularly in the case of adolescents there is a considerably increased risk that the depression could lead to thoughts of suicide or suicide attempts. Suicide is one of the most common causes of death in adolescence.
Depression is often also accompanied by physical symptoms. These include in particular psychosomatic conditions such as headaches and stomach pain with no organic cause, but also weight loss and disturbed sleep.
Anxiety and hyperkinetic disorders (ADHS) often occur in conjunction with depression. Eating disorders and extremely inappropriate behaviour (hooliganism) are often associated with depression.
Disturbed development / Long-term effects
Depression can inhibit age-appropriate development in children and adolescents. Moreover, they have a significantly increased risk, even in adulthood, of again suffering from negative moods or depression.
Depression is often accompanied by suicidal tendencies. Whilst suicide in childhood tends to be rare, suicide rates increase steadily from the age of 15. There is an increased risk in the case of adolescents who have already attempted suicide and also if there have been cases of suicide or attempted suicide among family or friends (models of behaviour). Suicide threats should always be taken seriously.
The treatment plan should always be adapted to the individual living conditions and development stage of the child, i.e. age, school and family circumstances. The parents of affected children must always be involved. Almost all children and adolescents with depression are treated on an outpatient basis. In rare cases treatment in a psychiatric clinic for children and adolescents is necessary, for instance if the child no longer wants to live, announces an intention to kill themselves, deliberately and repeatedly injures themselves or if the safety of the child within the family can no longer be guaranteed around the clock.
Treatment for depression can include the following components:
First point of contact
The first point of contact for parents is generally the paediatrician or GP, who has known the child and the family for some time and can judge any changes. He also knows specialists who can offer further help. These include, e.g. paediatric psychiatrists or psychotherapists specialised in treating children and adolescents. In addition some educational and family advice centres or school psychologists are particularly well qualified in the treatment of children and young people suffering mental illness.
The main treatment approach for depressive conditions in childhood and adolescence is psychotherapeutic measures. These may include various forms of therapy depending on symptoms, usually incorporated into family counselling or some form of family therapy.
The efficacy of ‘cognitive behavioural therapy’ is proven. Cognitive behavioural therapy can consist of: removing stress factors and developing positive activities; supporting and underlining existing abilities and strengths (resources); training social competences; learning problem-solving strategies; recognising and dispersing negative thoughts; building up self-confidence and self-esteem.
In addition, drug treatment for depression may be sensible and necessary, particularly in the case of difficult progressions. Before treatment is initiated, both the child and parents should be fully informed.
Relaxation, body awareness, play therapy; physical activity, fresh air, sunlight
There is very little awareness of self-help offers; they can never replace professional treatment. Self-help offers for relatives provide the opportunity to exchange experiences with other parents or relatives.
Tips for parents and other relatives
www.buendnis-depression.de/depression/kinder-und-jugendliche.php: German Alliance Against Depression; Information page on depression in childhood and adolescence
www.fideo.de: Fighting-Depression-Online by the German Foundation for Help with Depression; Information and moderated forum for young people from the age of 14; also information for relatives
www.nummergegenkummer.de: Working Group Association Child and Youth Line; telephone advice and advice by e-mail for children and young people from professional advisors or young people for other young people; telephone advice for parents
www.bke.de: Various advisory offers by the Federal Conference for Parental Advice for parents and young people, addresses of advice centres, moderated forum, chats
www.youth-life-line.de: Youth-Life-Line within the association AKL (Working Group Life); Online peer advice for young people in crisis situations and in case of suicide risk; the young advisors are supported by specialists
www.u25-deutschland.de: AKL Freiburg and German Caritas Association; Information and online peer advice for young people under 25 in crisis situations and in case of suicide risk
www.nethelp4u.de: Email advice from adolescents for adolescents; Evangelische Jugend Stuttgart (Stuttgart Christian youth association)
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