Depression in Children and Adolescence
Depression, anxiety and behavioral disorders are among the leading causes of illness and deaths among young children and adolescents. Suicide is also another leading cause of death among 10-19-year old. The consequences of failing to address children’s mental health conditions can be fatal and can extend to adulthood, impairing both their physical and mental health. Depression is a common and serious medical illness that negatively affects how one feels, thinks and acts. It’s a common mental disorder that causes persistent feelings of sadness and lack of interest or pleasure in previously rewarding or enjoyable activities. Depression does not only affect adults, children and teenagers can get depressed as well. A report, titled, The State of the World’s Children 2021, On My Mind-Promoting, Protecting and Caring for Children’s Mental Health, Zimbabwe was listed as one of the leading five countries out of 21, whose young children suffer from depression. When a child is depressed it is called Major Depressive Disorder (MDD). According to WHO (2021) globally, one in seven, 7-19-year-olds experiences a mental disorder accounting for 13% of the global burden of disease in this age group. In children, depression can lead to a variety of emotional and physical problems and can decrease their ability to function well at school and at home. Depression is diagnosed when a child experiences a severe or intense stress that lasts more than two weeks.
Causes of depression in children and adolescence
There is no single cause of depression in children and teens but experts believe that in this digital age it is virtually impossible to stop children from finding out about upsetting news and events that can be traumatic and stressful to them. The social environment can tremendously affect them. Children may get exposed to technological devices younger than ever. This can greatly affect their mental status and their ability to strive in school and the real world. Cyberbullying has been linked to teen depression. Cyberbullying refers to electronic communication and the use of mediums such as phone calls, faxes, text messages, videos, emails, internet messaging and blogs to harass, defame any person and threaten or humiliate individuals. It can cause children and teens to feel increasingly anxious, embarrassed, worried and greatly stressed and more likely to become depressed. In these instances, children depressed can experience psychological, physical and emotional trauma. This, can also reach a point where it exposes them to risk-taking behavior like drug and substance abuse, risky sexual activities, risky driving, and contemplate or complete suicide.
Two thirds of children in Zimbabwe have experienced violent discipline at home and at school and are vulnerable to mental health challenges and over a third of the girls suffer from sexual violence before their 18th birthday, UNICEF Zimbabwe 2022. The home environment can greatly influence a child’s mental health, especially when the family is dysfunctional and experience a family discord, such as divorce of parents, violence, neglect, abuse, poverty, problems at home, parents fighting, death of parent/s and death in the family can be so stressful to these children and make them vulnerable to depression. Children also grieve and go through the stages of grieving as adults do, (Kubler Ross grieving stages), they may become upset and withdrawn. Events such as parents’ separation and parents in the diaspora leaving their children behind, can cause children to get stressed and depressed. Children need love as much as they need food. Love starved children struggle to develop psychologically, physically and socially. When children are loved they develop well. They are able to learn and to thrive, reaching their full potential.
Abuse, neglect and other adverse childhood experiences are the main preventable causes of mental health. The school environment is where children spent most of their time and it can be a source of stress and depression. Children can be psychologically, physically, emotionally and socially abused at school and teachers have a strong impact on how these children see themselves and others. Bullying, harassment, verbal abuse, sexual abuse, stigma and discrimination, exploitation and other forms of humiliation can come at the hands of peers, teachers or even a school authority. Some children also experience school violence associated with gang culture, weapons and fighting. All these abuses are most prevalent in schools and can be a serious cause of depression in children and teenagers.
One’s personality can also be a risk factor for depression. Children with low self-esteem, who are easily overwhelmed by stress, or who are generally pessimistic appear to be more likely to experience depression. Also, as parents and caregivers, we have raised children to have unrealistic expectations and goals. So many parents and caregivers have little or no time with their children. These children are not taught the kind of coping skills they need to survive in hard, stressful and emotionally challenging times. Some adolescents during their developmental stages, can have a period of storm and stress, which takes place between the ages of 11 and 19. This period, is a time of upheaval and difficulty in which adolescents experience emotional and behavioral challenges such as peer pressure, increased conflicts with parents and other authority figures, disruptions in mood and increased participation in risk-taking activities such as drug and substance abuse, which can result in depression.
Physical disorders and disability can depress children as well. Some children face stigma and discrimination, neglect and unfriendly environments at home and at school which can be stressful to them. Also, life experiences and rejection can contribute to depression in children. Children whose parents have depression are at higher risk of being depressed too.
Biochemistry and genetics are other risk factors for depression. Differences in certain chemicals in the brain may contribute to symptoms of depression. Depression can run in families, for example if one twin has depression, the other have a greater chance of having the illness sometime in life.
Signs of depressed children, the signs range from mild to severe-
● Withdrawal from family events and other social gatherings
● Sudden decline in performance at school or underperforming in school.
● Not wanting to do or enjoy doing funny things, feeling sad, hopelessness irritability,
● Stress related physical health symptoms (stomach aches and headaches)
● Showing changes in eating patterns, eating a lot more or less than usual.
• Showing changes in sleep /sleeping a lot or less than normal.
• Low energy levels in general /general tiredness, challenges with concentration,
• Not having much confidence, talking about feelings of guilty and worthless,
• Refusal to go to school or uneasiness about attending school.
• panic attacks or too frightened, always wants to cry
• have suicidal thoughts or and self-hurting, for example cutting their skin or taking an overdose etc.
• Complete suicide
How to deal with suspected depressed children
Children expresses themselves in three languages which are play, drawing and spoken language.
Spoken Language: If one thinks that a child is depressed, it is important to talk to the child and try to find out what is troubling him/her and how they are feeling. Encouraging them to talk is very helpful. Whatever is causing the problem, take is seriously, it may not seem like a big deal to the adult but it will be a major problem to the child. If the child does not want to share with you, let him/her know that you care and concerned and if they need you they must feel free to talk to you at any given time. However, encourage them to talk to someone as well, such as a family member, a friend, or someone at school, for instance, the teacher or referring them to a mental health child specialist or a psychologist.
Play language: Children express themselves through play, by simply spending time with them and watching them play one can observe and learns a lot. Stressed and depressed children often play fighting games with their toys or friends. Also, a child can be very aggressive, high temperament and mis-behaving. After observing them play, the children must be offered a chance to explain their behavior.
Drawing / Visual language: Psychologists have long used drawings as a way of gaining insight into a person’s thoughts and feelings. The psychoanalytic approach ,for example, uses children and a person’s drawings as a window into their inner world , looking for clues about their unconscious desires ,emotions and motivations .Thus, the use of drawings in children is based on the assumptions that children project their perceptions, feelings ,conflicts and disturbances into their pictures.
Acknowledge their emotions: Mental health issues particularly when it relates to children and adolescents are still a taboo in many societies, also in Zimbabwe. Children experience emotions just like adults do. Parents, caregivers, counsellors and psychologists can provide an environment where these emotions can be safely expressed. The home can be an environment where all parents, caregivers and children, solve their emotional challenges maturely. Providing a supportive family environment with minimal stress is one way that parents and caregivers can help. Thus, creating a psychologically, socially and emotionally safe environment both at home and at school with a culture of respect and care.
Life is full of challenges and our children are not immune to them. As part of critical life skills children must have sound decisions and problem solving skills and with the help of adults, can help the children to not get overwhelmed by life’s challenges. Children must be taught physical self-care like exercising regularly, sleeping well, eating healthy, having a sense of hope and positive perspectives about life. Also, parents, teachers and other adults can help children and adolescence by instilling these coping strategies including, emotional regulation and looking into situations more positively (being optimistic than being pessimistic). Teachers should discourage and deal with bullying swiftly and involving learners in the discussions about safe and health school environments. Teachers and children can also be trained to recognise early signs of stress and depression and to know when to intervene and where to refer the child for further assistance and care.
Inclusion of mental health wellness in Guidance and Counselling sessions and lessons in school syllabi, timetable and including learner wellness topics in the curriculum as cross cutting topics will improve children’s mental wellness. Also, promoting teacher mental wellness is crucial in schools since they play a critical role in the development and wellbeing of learners. When the teachers are able to recognise their own distressing emotions and know when and where to seek help, will promote a health environment for the children.
Furthermore, our children must be encouraged the development of strong family relationships, bonds and friendships. The ability to form meaningful relationships is a critical part of mental wellness in both adults and children. Our family and friends form a supportive network that helps these children to live and thrive. Life is funny, fuller, less stressful and amazing if we belong.
The Government in support of its partners has rolled out a Special Initiative on Mental Health, thereby recognizing the importance of mental health in both children and adults. It has adopted various legislations and regulations to organize the delivery of mental health care in Zimbabwe including the Mental Health Act, Mental Health Strategy and also the Mental Health and Psychosocial support guidelines, recently developed by the Ministry of Health and Child Care. Zimbabwe produced sensitization material on mental health which is broadcasted on radio and television. The Ministry of Primary and Secondary Education (MOPSE) is rolling out a campaign to promote public debate on mental health of children and adolescence and Guidance and Counselling, through a series of radio talk shows and new content on mental health issues on their MOPSE Toll free number 317. Partners, UNICEF Zimbabwe on children and adolescents’ mental health. can also be accessed on www.unicef.org/zimbabwe.
In addition as parents, teachers and care givers must,
● let the children know that it is normal to be concerned and tell them we are concerned as well.
● tell the children to be encouraged to ask questions if they seem unclear about what has happened.
● be truthful to them about what has happened
● involve the children in their favorite activities
● reassure the children about their safety, love and care
The real scale, nature and damage of depression faced by children and adolescence in Zimbabwe is still unknown. Addressing the mental health issues of children and adolescence will need more research so as to respond effectively. However, interventions might not work instantly because an angry child mighty not listen right away, as the Government, partners, parents, helpers or caregivers, must not give up. Many scholars agree that even though not all children and adolescence will not experience stress and depression, likelihood is greatly increased during difficult times, it’s important for parents and other adults to remember that they have an important role to play in these children’s lives. Increased attention and more investments in parenting programmes are needed as parents and caregivers can provide the much-needed safety and security for children and adolescence to flourish and thrive.
Ass/Educational Psychologist at MOPSE
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