Understanding Childhood Depression
Total disinterest. Unconsolable misery. Gloomy, colorless days, and even tougher nights. Until very recently, it was believed that only adults could experience such intense emotions (or the absence thereof), and that children didn’t have the emotional or cognitive maturity to feel intense sadness. However, with a growing body of research we now know that in reality, teenagers and even very young children, can suffer from depression. While experiencing sadness is quite typical, and a crucial element of learning how to manage emotions, some children develop a persistent feeling of sadness and that’s when it becomes a matter of concern.
While experiencing sadness is quite typical, and a crucial element of learning how to manage emotions, some children develop a persistent feeling of sadness and that’s when it becomes a matter of concern.
“I really used to love painting, you know; and I’d paint every single day, and now, I just…don’t paint anymore.” This is what a 13-year-old shared with us in her initial therapy session. She said she felt “broken” inside. Her mother, who sat beside her, appeared worried — she had dismissed this behavior as laziness before she brought her daughter for therapy.
Another client, at the age of 15, brought up the issue of how depression impacts one’s perception of the world. “You know how people say that happiness finds a way to reach you, I think sadness and negativity somehow find a way to reach me.” When we engage in a conversation with children who have been struggling with depression, we realize how it affects them in the most unkind ways: a frequent sense of hopelessness and worthlessness, social withdrawal and isolation, major fluctuations in sleep and appetite, and often profound sadness creeping up on them even in seemingly happy moments.
Because depression was initially understood and conceptualized as an exclusively adult problem, there is a clear gap in knowledge when it comes to measuring depression in children and adolescents, and in approaching its treatment. Additionally, we learn how depression in children can also result in significant impairment in cognitive, social, and emotional functions which, in turn, affects their development, academic performance, and relationships with friends and family. It also puts them at risk of engaging in behaviors like substance abuse and/or self-harm, as a means to cope with their emotional distress.
Understanding why children become depressed is crucial. How and why does a child feel such intense unhappiness that it eventually leads to a shutdown? Childhood, which is supposed to be a relatively carefree period, contains certain contexts and situations that give rise to depressive symptoms. While depression cannot always be explained by a simple cause-and-effect pattern, it is important to understand that for children, there might be some triggers or stressors that ignite the problem, and these triggers are also critical to understanding.
Now, it’s true that genetics, imbalances in brain chemicals (neurotransmitters), and physical, chronic health issues can impact a child’s emotional well-being, but it is crucial to also pay attention to more subtle, seemingly ordinary stressors that escalate into major stressors in a child’s life. Recently, newspapers have been filled with reports of suicides by IIT, NEET aspirants, and even students studying in institutions where not enough is being done to address caste and class-based bullying. The problem is not limited to students in high-pressure situations. Just yesterday, 33 states in the United States sued Meta platforms for manipulative features that are designed to lower the self-esteem of children.
Certainly, the increasing diagnosis of childhood depression can also be attributed to heightened awareness and sensitivity, but it is also important to reflect on how changing family dynamics and configurations, death, grief, adverse childhood experiences, the rise of social media (and with it the associated concerns of peer pressure, social comparison, and cyberbullying), and academic pressure interact with each other to evoke the emotions children are experiencing.
A gloomy 15-year-old client sits in a therapy room. She says that she’s studying in one of the top schools in a city like Mumbai, has a family that really loves her and never hears a ‘no’ from her parents. “I have everything, and yet I feel empty, almost like I don’t belong anywhere.” Let’s unpack this emptiness to gain a better understanding of the range of emotions she is experiencing. Guilt. She realizes that maybe not all of her childhood experiences have been entirely positive. Discomfort. She feels a sense of terror when she realizes that others around her might discover her diagnosis. Internalized shame. “I don’t know how to express what I’m feeling because I don’t know why I feel the way that I do.” Suicidal thoughts. “Sometimes…I just want to end it all, you know. Just existing shouldn’t be so hard, right?” It is interesting to note that when children have come in with their parents, they have been the ones to initiate serious discussions about the suicidal thoughts that arise from their depressive symptoms.
As adults entrusted with their care, it’s important to recognize and be vigilant for suicidal behavior in children (suicidal thoughts, self-harm, suicide attempts), and whether there are any noticeable changes in their mood, behavior, academic performance, energy levels, appetite, and thoughts and discuss them in an age-appropriate and sensitive way. Although this may seem challenging and even counterintuitive to some, failing to discuss these issues when necessary means missing the opportunity to provide help and support. Problems like impulsivity and difficulty with delayed gratification (and thus, reduced time for intervention) make it even more important to involve a mental health professional and devise a comprehensive safety plan as soon as possible.
Coping strategy: The youth are exposed to content and sometimes even the harsh realities of life prematurely — one could argue that “they’re growing up too fast” — but this should have been accompanied by an equally focused effort on developing resources for healthier coping mechanisms and building resilience. Whether we like it or not, most children these days have been thrust into premature introspection, meaningful interactions, and understanding life and the people in it, without having developed the necessary skill of coping with such information, which is why distress and agony are familiar to them. However, what we need to remember is that children are experiencing disappointments and heartbreaks for the first time, and the first step that parents and guardians can take to support them is to not belittle their struggles, and not trivialize their feelings of weakness, vulnerability, or sensitivity. Children, like all humans, need a sufficient sense of autonomy. They need to know what they can do for themselves to alleviate the stress they are feeling. Listen to them. Acknowledge what they’re feeling. Let’s give children the space to make mistakes and face failures. All they need to know is that when things don’t go well, they’re not alone. Just as they’re taught other survival skills, children should be taught how to navigate the complexities of their emotions. Based on our conversations with struggling children, they often encounter pain and emotional turmoil that they don’t yet fully understand, and perhaps what they fear most is not what’s happening inside of them, but how those around them might react. After all, aren’t struggles also opportunities to remind yourself to be a little kinder to yourself and to others?
Dr. Natasha Kate is the attending psychiatrist and Suveni Kaul is a therapist at Sanctum Foundation, a Mumbai-based holistic mental health care center.
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