World Mental Health Day 2019: Let's Talk About Childhood Depression

Can children experience clinical depression? How can you, as a parent, find out and deal with it? Let’s hear from a globally acclaimed psychotherapist and award-winning author, Dr. Deborah Serani.

By Dr Meghna Singhal

World Mental Health Day 2019: Let's Talk About Childhood Depression

As a young girl, Deborah descended into a debilitating depression. She attempted suicide when she was 19. Recovery from this major depressive episode required her to take medical leave from college. She fought back thanks to psychotherapy.
Ever since, Dr Serani directed her focus to the field of psychology- wanting to help others who struggled with depression like she did. Now in practice for 30 years in New York, Dr. Serani uses her personal experiences with depression to educate people. She is a sought-after depression, trauma and postpartum expert, working with children, adolescents and adults.
Her first book Living with Depression won the 2011 Silver Medal Book of the Year Award. Her second book Depression and Your Child won the 2013 Gold Medal Book the Year Award. Her third book Depression in Later Life: An Essential Guide won the 2016 Gold Book Medal of the Year Award. Her next is a children’s book titled Sometimes when I’m Sad and is slated to be released in 2020.
With mental health emerging as a primary contributor to overall health, more so today than ever before, we reached out to Dr Serani to help parents understand how they can build sound mental health very early in a child’s life. Dr. Serani was clinical in her responses. Here are excerpts from an enriching conversation.
Thank you Dr. Serani for agreeing to be interviewed by us!
Really delighted to be invited. Thank you so much!

Q. A majority of your writing and therapeutic work focuses on childhood depression. How common is childhood depression the world over?
The World Health Organization reports that approximately 15% of the world’s children struggle with a diagnosable mental illness. When it comes to depression, a 2015 Global Burden of Disease Study indicated about 4.5% of adolescents aged 15-19 years experience a depressive disorder, but the rate of depression at younger ages was not as easily measured. Where I live in the United States, research suggests 1% of babies, 4 percent of preschool-aged children, 5 percent of school-aged children, and 11 percent of adolescents meet the criteria a depressive disorder.

Q. From what age onward can depression be reliably diagnosed in children?
I’d say a reliable diagnosis can occur as early as 6 months. But it’s vital that such an evaluation be performed by a paediatric mental health specialist.

Q. Often, parents are caught between sadness and ‘blues’ versus depression in their child. The fine line is tricky, isn’t it?
It’s important to understand that sadness is part of the human experience, even for children. So, seeing a child cry, be sad or upset is to be expected. Especially if the child has lost a toy, scraped a knee, been disciplined, experienced a slight from a friend, etc. But when it comes to mental health, time and duration are aspects with which parents need to be mindful. The amount of ‘time’ a child feels such things (most of the day as opposed to just a moment or two) and the ‘duration’ of sad feelings (for more than a few days in a row) raises concern. When sadness doesn’t fade or go away, or irritability persists for days at a time, isolation or withdrawal from others, or physical aches and pains are reported for more than two weeks, a depressive disorder may be occurring.

Q. The image that comes to mind when we talk about childhood depression is that of a silent or crying child. Does childhood depression also express itself in acting out behaviour or anger outbursts?
Paediatric depression varies widely in its symptoms. Younger children (babies, toddlers and pre-schoolers) don’t have the language ability to express their sadness, so studies report more internalizing kinds of behaviours. Symptoms like withdrawal, hiding from others, feeling tired, aches and pains, slow eye gaze, slow response style, sleeping a lot, increased or decreased appetite and more recognizable ones like tearfulness and irritability are commonly reported. Older school children and teens can also internalize their depression with similar symptoms, but they are more prone to experience poor self-esteem, feelings of guilt, difficulty in concentration and other academic and social difficulties. To make diagnosis trickier, some children can act out, appearing more angry than sad, more oppositional than withdrawn. These kinds of externalizing behaviours of depression also include engaging in self-harm, alcohol or drug use to reduce feelings of despair and helplessness.

Q. Can childhood depression be caused by bad parenting?
Depends on what you mean by bad parenting. No parent is perfect. That being said, serious neglect, physical, emotional or sexual abuse by a parent can definitely cause depression. However, many good parents have children who develop depression. Sometimes, a traumatic event or an unforeseen moment sets into motion the genetic predisposition for a child to develop depression.

Q. Another myth about childhood depression is that it can be fixed by just cheering up the child or getting the child to play sports or engage in hobbies. Does that work?
It’s true that many parents – and even some professionals like teachers, educators, and doctors - believe that you can snap a child out of depression with encouragement or even tough love. But the truth is that depression is a medical illness. It isn’t about being weak, lazy, or needing a push. We’d never tell a child with cancer to just get over it, or cheer the cancer away with positivity. Paediatric depression is a serious, but treatable disorder.

Q. In your book Depression and Your Child, you have suggested some strategies for parents to help their child diagnosed with depression. Could you kindly elaborate?
There are three things parents can do:

  1. Learn the signs and symptoms of depression in children. Remember that depression presents differently in younger children than it does in older children
  2. Encourage a healthy home life with eating wholesome foods, keeping a good sleeping schedule, exercising regularly, and having a structured but not too stressful lifestyle
  3. Create open lines of communication, so that your child can come to you to express difficult feelings or thoughts. Help her feel connected and loved – and understood

Q. What are some things parents should NOT say or do when their child is experiencing depression?
Don’t
trivialize the disease. “This too shall pass.” “Just try harder to be happy.” “Maybe you should go for a walk.” “Just think happier thoughts.” “But you don’t look depressed.” “Play with your toys and you’ll feel better.”
Don’t expect depression recovery to happen quickly. “Is your therapist really helping you?” “You seem to feel the same as you did a month ago” “This behaviour of yours has got to change.”
Don’t shame your child. “Why are you sleeping all day?” “Can’t you turn that frown upside down?” “You’re too grumpy to be around.

Q. You have talked about experiencing depression as a child. How much has that influenced your practice today?
My experiences growing up as a depressed child and young adult helps to hone my clinical skills. I understand the textures of depression and how they can be missed or mistaken by others. I also understand the personal experience of living with this chronic disorder – how others stigmatize mental illness. It offers me a unique perspective as a psychologist, that’s for sure.

Q. How does stigma against mental disorders in children make seeking professional help difficult? How can we break this stigma?
Most children don’t want to feel singled out and viewed as ‘crazy’, ‘odd’ or ‘weird’. Regrettably, those kinds of adjectives are used to describe anyone with a mental illness. When this happens, children will mask their depression and avoid talking or seeking help. So, we need to take the shame out of experiencing a mental illness. This starts with messages at home, at school, and in the community, making it known that physical health and mental health are both necessary for well-being. Adults need to be role models for mental health, making sure to embrace psychotherapy, medication, and avoiding devaluing others with phrases like ‘Wacko’, ‘Schizo’ or ‘Psycho’. Public campaigns, educating others how mental illnesses are grounded in neuroscience and neurobiology can help minimize stigma. So can disclosures from high profile individual and celebrities about their struggles and successes with mental health treatment.

Q. Depression is associated with a high suicide risk. How could parents know if their child is feeling suicidal?
Be mindful of your child’s thoughts and feelings’ states. Does sadness and irritability come and go? Or is it rather pronounced and chronic? Listen to how your child speaks. Look for statements that reflect helplessness - “I’m no good at anything,” or “I’m such a burden to everyone.” Hopelessness, “Everyone would be better without me,” or “I feel so useless.” Look for statements of despair or sadness - “I just can’t stand feeling like this anymore," or "I'm afraid to go on like this." Also be on the lookout for sudden use of alcohol or drugs, cigarette smoking or other kinds of reckless behaviours. These are red flags. Sometimes, children don’t share their negative thoughts or show suicidality outwardly. Instead, they begin giving items away, asking others to take care of things for them, make sure projects in school are done, that their room is clean. Putting things in order, so to speak. Seeking immediate medical attention is vital to assess suicidal tendencies. And while some children might be angry at their parents for taking them to a doctor or a mental health professional, they’ll thank you for the intervention when their depression and suicidal thinking reduces.

Q. There are games that are 'promoting' suicide as an adventure for kids today. Considering such games are here to say given the advancements in technology, who should the onus be on to prevent suicides from such games?
Public education campaigns must address the trends of games like Blue Whale, MoMo and other life-threatening dares by reminding children that real life has no reset button. So many children have grown up with online games, video games, and Internet experiences that mistakenly imply the world has reboots, resets or do-overs. Parents need to monitor their child’s online and telephone interactions, and communities must do more to raise awareness of depression and suicide warning signs.

In a Nutshell

  • Childhood depression is a serious mental health condition that parents need to be aware of; it can be diagnosed as early as 6 months of age
  • When sadness doesn’t fade or go away, or irritability persists for days at a time, isolation or withdrawal from others, or physical aches and pains are reported for more than two weeks, a depressive disorder may be occurring
  • Childhood depression cannot be fixed by just cheering up the child. Shaming the child or trivialising the disorder will only worsen the situation and make it more difficult for the child to seek help
  • To know if your child is feeling suicidal, listen to statements that reflect worthlessness, helplessness, and hopelessness. Also be on the lookout for sudden use of alcohol or drugs, cigarette smoking or other kinds of reckless behaviours

What you can do right away

  • Educate yourself about the symptoms of childhood depression
  • Encourage a healthy home life with eating wholesome foods, keeping a good sleeping schedule, exercising regularly, and having a structured but not too stressful lifestyle
  • Spend a few minutes of connection time with your child every day, following his lead in playing/talking/whatever he wants to do, so that your child comes to you when he wants to express his difficult feelings and thoughts

About Dr. Deborah Serani

  • A licensed psychotherapist in practice for 30 years in New York
  • Specialises in depression, anxiety, trauma, and postpartum disorders
  • Senior professor at Adelphi University, teaching graduate courses in psychological diagnosis, psychodynamic treatment, and multicultural diversity
  • Serves as a Disaster Mental Health Specialist for the American Red Cross and for the veterans organisation Give an Hour
  • TEDx speaker and writes for Psychology Today. She has worked as a technical advisor for the NBC television show Law & Order: Special Victims Unit

About the author:
Interviewed by Meghna Singhal, PhD on 1st October 2019.
Dr. Singhal is a clinical psychologist with a doctorate degree from NIMHANS (Bangalore) and holds a post-doctorate in parenting from the University of Queensland (Australia). She is Head of the Content Solutions Zone at ParentCircle.

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