Depression in children

Depression in children Dr.Ksh. Chourjit Singh Prof. of Pediatrics Regional Institute of Medical Sciences, Imphal National Chairperson, Growth & Development Chapter, IAP National Executive Board Member Advisor HIV/AIDS in Children Task Force, Manipur State. Past President, East Zone, IAP President, NNF, Manipur State Branch

Introduction • Depression in school-age children and adolescents remain a long-overlooked Health problem • As prevalent as in adults • Common cold of mental illness – Clinical Depression • Specially in childhood – is a major health problem

Severity of Problem • 5% children at any given time • 1% of Pre-school children • 2% of school-age children • 5% of adolescents are affected • 25-50% of all children & adolescents in Psychiatric treatment are for depression & its related problems • More common in boys than girls – 5:1 school-age children • Adolescent girls than boys - 2:1

Severity of Problem …. Untreated Depression can be taken as important cause of suicide in adolescents, even adults

Why depression in young ? A) Risk factors • Children referred to mental health providers for school problems • Children with medical problems • Asthma • Diabetes • Epilepsy • Many chronic childhood diseases

Why depression in young ? ……. • Law and order problems • Frequent bandh/ strikes • Frequent school closures • Ethnic group clashes • Insecure feelings • Conflict environment • Watching television a lot i.e. more than 6 hours a day

Risk factors ….. • Rural vrs Urban children • Sexually harassed children • Children with family history of depression • Genetically potential • What is happening in an individual child’s life

B) Why depression runs in families • Genetics • Even if a child never contacts with depressed parents, child may also likely to be depressed • Marital difficulties • Broken family/ marital problems • Divorce plus depression in parents • Parenting problems • Hard to be good parent when depressed • Parenting problems whether from parents or from child

C) Can experience depression at any age – Presentation? • Shortly after birth & very young • Failure to thrive • Disrupted attachments to others • Developmental delays • Social withdrawal • Separation anxiety • Sleeping and eating problems

C) Chance of depression at any age… • Between 6-12 years of age • Fatigue • Sadness • Inability to feel pleasure • Irritability & Insomnia • Lack of self esteem • Stomach ache and headache

C) Chance of depression at any age… • Hallucinations • Agitation & extreme fears • Weight changes • Difficulty with school work • Apathy • Lack of Motivation • Social withdrawal

C) Chance of depression at any age… • Adolescent • Over-sleeping • Socially isolated • Acting out in self destructive ways • Sense of hopelessness • Despairing thoughts • Weight changes

Future of depressed school-age children • If untreated in time – affects the children • School performance and learning • Social interaction and development of normal peer relationships • Self-esteem and life skill acquisition • Parent-child relationship & sense of bonding

Future of depressed school-age children…. • Lack of trust – can lead to Substance abuse • Disruptive behaviour • Violence and Aggression • Legal troubles and even suicide Depression thinking can become part of a child’s developing personality, leaving long-term effects in place for the rest of the child’s life.

Behavioural changes – What? • Professional attention decreases • Classroom disruption • Expulsion from school • School failure • Injury to themselves or others • Symptoms ADHD • Truancy • Delinquency

Stress in students leading to depression • Parental pressure to perform and to stand out among other children • If not come up to expectations • Frustration • Physical stress • Aggression • Undesirable complexes

Stress in students leading to depression… Under-Performers • Negative traits • Shyness • Unfriendliness • Jealousy • World to loner

Over-scheduling a student’s life • Non-availability of time for extra-curricular activities after school • No proper place for ventilation & breathing space • Unwanted learning like music, painting or outstanding in sports • Too many crammed schedule & unmindful of the children’s choice • Unadjusted school systems and tremendous amount of homework – spending their evenings, weekends and vacations

Over-scheduling a student’s life… • Loss of interest in studies • Under-perform due to excess academic pressure Students often carry enormous amount of anxiety and negative personal traits & massive attention problems • Non-effortless learning • Physio-Psychological transition of students • Mainly affected elementary to Junior High School

Diagnostic Points • Transient depression or sadness • Impairment in child’s ability to function • Two types • Dysthymic disorder • Major depressions • Dysthymic disorder – less severe but lasts longer • Chronic depression/Irritability > 1 year

Diagnostic Points …. • Onset about 7 years of age • 2-6 symptoms within 5 years • Leads to major depression/ Double depression • Untreated Dysthymic disorder will experience Remission within 6 years • Prevalence of depression increases with age – 5 percent of all teens

What can be done • Diagnostic evaluation – success to treatment • All disorders be discovered and addressed • Medication • Mood stabilisers • Anti-anxiety • Anti-depressants • Stimulants

What can be done…Individual therapy • Often beneficial for patients & specially help with issues • Family conflicts • Self-esteem • Relaxation strategies • Mood and anger control • Better communication

School environment • Interaction • School Counsellor • Principal • Psychologist • Teachers and Parents • Psycho-educational treatment • Speech and occupational therapy

School environment… • Counselling • Curriculum modification • Resource classes • Behavioural modification system • Self-contained classrooms

Home/ Parental environment • Family and Home modification\ • Homely life environment

Family therapy • Defining Family members role and responsibility • Better communication & behavioural Reward systems

Don’t overload your child with too many after-school activities and responsibilities. Let children learn to pace themselves. Don’t enrol them in every class along and don’t expect them to be first in everything.

Thank you

Depression in children