Feature: More Children Presenting with Depression

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Depression affects more people than any other mental disorder and is one of the world’s leading causes of disability. It is a common mental disorder, characterised by sadness, loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep or appetite, feelings of tiredness and poor concentration.????

It can affect anyone and impacts an estimated 350 million people worldwide.?? However, one worrying sub-population has developed.

Across the globe, more children than ever before, and at an earlier age, are presenting in clinics and doctors’ offices with signs of depression.?? Although local statistics still need to be gathered, anecdotal evidence is pointing to the age bracket of nine to 15 years old as the age range of concern.??

In a recent interview, Chairman of the National Mental Health Commission, Rev. Dr. Marcus Lashley pointed out that this disturbing trend meant that as a community we need to determine what is happening in the psyche of the children and in their external environment.?? The condition results from a complex interaction of social, psychological and biological factors and it can, in turn, lead to additional stress and dysfunction and could worsen the affected person’s life situation and the depression itself.

The trained Clinical Psychologist noted that he often told parents who argued, fought and used abusive language in the presence of children, that they were being abusive parents and their actions could result in a depressed child.

"It’s a hard thing for them to hear but it is true because when home becomes unsafe for a child, then that is very dangerous because home is one of the few places that is consistent and safe.

So, when we talk to children who appear to be depressed, that is one of the things that we look at first.?? With whom are they living and what is happening in the relationship between the adults present? Is there someone who is possibly physically or psychologically molesting them and how are they coping?" Rev. Dr. Lashley said.??

He explained that as children went through the various stages of change they might also become despondent.?? Bullying is also a mental health issue as children who are targeted could become depressed as a result of teasing and by feeling unsafe.

"Children have a lot of body image issues – am I too fat, am I too tall, are my feet too big, are children laughing at my lips because they are too thick, are they laughing at my walk??? All of these issues, along with other chemical changes that occur as they move from one state to another, in terms of childhood to adulthood," he said.

Dr. Lashley outlined that the level of depression may be determined using certain tests, however, no one knows you, better than you do.??

"We now have some great tests to determine if someone truly is depressed or just going through the blues – and it’s important to make that distinction. For the individual, it is good to note the changes that are taking place in you…?? So that when you see that there is a change taking place, when you are not doing the things that you would normally do, or you are not enjoying the things that normally would give you pleasure… Of course we all have the days when we just don’t want to go over to our in-laws house and have dinner.??

That’s not what I am talking about.?? We are talking about these feelings over a prolonged period and if, for at least two weeks, we notice that this is happening and there is no change or things are getting worse, then it is essential to begin to get help, especially with children," he stressed.

He emphasised that this was where the parent/child relationship was critical.?? "The parent, by observation can get a sense of what is wrong.?? And, once you begin to pick up those symptoms, for example, not being engaged with other children as before, complaints about body pains – what we call somatisation where they are picking up in the body what is going on in the mind – shying away from certain places.?? The child no longer wants to go to that location because it may be again an environmental issue, or someone in that space [for example] – I don’t want to go to grandma’s house anymore.?? Then you have to begin to monitor those changes, and having seen the changes, go for an assessment to determine what is happening and then move to the next phase of actual treatment," Dr. Lashley recommended.

Depression amongst children is also fuelling debate as to what treatments could be applied, what medications could be prescribed and at what age.

"That has become extremely controversial and several books are now being written on this topic because what we do know is that the pharmaceutical intervention can work for some people. What we also know is that this approach works better in certain types of depression and it works better with certain age groups and categories…

"In terms of children we know that medication does work for some specific cases.

Persons who are a little older and who are having not just a single episode but recurring episodes of going up and down, highs and lows, where there is bipolar disorder, then medication also does work fairly well.?? However, what we do know from research is that a combination of medication and psychotherapy seems to be the best model forward," he shared.

While speaking at a recent symposium on Childhood Depression hosted by the Psychiatric Hospital, Health Minister, Donville Inniss, told the guidance counsellors from a number of secondary schools that since depressive disorder often started at a young age, that targeted strategies and interventions should be developed to help the youth.??
"The main way to successfully reverse the trends is by employing strategic interventions that are directed at children and adolescents with the clear objectives to first, prevent depression and other mental conditions and secondly to implement a comprehensive system of screening and early diagnosis, and thirdly to provide holistic management and care in an environment that is free from stigma and prejudice associated with mental illness," Mr. Inniss opined.??

He emphasised the need for psychiatrists, psychologists, social workers, occupational therapists, guidance counselors, teachers and other workers in the community, to design protocols for identifying individuals who were at risk for depression, particularly children, and to give a first line level of care, whether it be in the school, the workplace, the church or the clinical setting.
Research confirms that relationships play a significant role in a person’s quality of life and may impact how an individual deals with stress or depressive episodes.??

Minister Inniss called upon members of society to work together to create a safe environment for the youth, stating:?? "Every day, I see the effects of depression on families. As a parent, with one child in primary school and one in secondary school, I know the importance of having the right skills mix at our schools to identify and help where we as parents can sometimes fail. As Minister of Health, the task is to find sustainable solutions to our healthcare challenges.?? As a human being, I say let us recommit today to wrestling the scourge of childhood depression to the ground. Our children deserve all the help and guidance they can get. We ought to leave a better and more productive society than we may have inherited."
World Mental Health Day was celebrated on Wednesday, October 10 under the theme Depression: A Global Crisis and was selected to reflect the magnitude of the problem, to raise awareness of the conditions that impact on the lives of the millions affected worldwide and to advocate for addressing it on an international, regional and national level.

It is predicted that by 2020, depression will become the second most prevalent disease to affect all people throughout the world, with heart disease taking the first place.?? ??

lisa.bayley@barbados.gov.bb

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