A Rough Patch, or Something More?

Depression in Youth

Dr. Natalie Brei

We all have periods when stress, misfortune, or the “downs” of day-to-day life get the better of us. We feel sad, tired, lonely, or dejected. Working through these periods can build resiliency and increase our faith in God and ourselves. But what if the negative mood - sadness, loneliness, irritability, anger - characterizes most of one’s weeks or months? What if you suspect there might be more than the typical “ups and downs” or hormonal changes in your child? 

Depression can hit children of almost every age. Risk varies according to family history, life events, support, environmental situation, and the unique history and temperament of the child. A history of trauma or abuse can significantly raise risk. Additionally, some children are more melancholic, more withdrawn or reserved, more irritable, or quieter in nature. However, if you are noticing a difference from what is the norm for your particular child, further investigation might be necessary. And whether or not you can pinpoint a reason (a big change, a breakup, school stress, a move, hormones, etc.), how DO you investigate? 

Reading the Signs

A quick internet search can give you the basics about what depression in children looks like, though it varies from child to child. Depression is characterized by a period of two weeks or more in which one of these two main things is present most of the day, nearly every day:

1. Feeling down, depressed, or hopeless mood (**this can be irritability in children)

OR

1. Loss of interest or pleasure in daily life and previously enjoyed activities

If you can answer “yes” to “is this the case more often than not?”, your child may be depressed.

Additionally, depression includes several of the following during that same period:

• Feelings of worthlessness or guilt

• Loss or appetite or unusual weight gain

• Feeling very tired or fatigued

• Difficulty concentrating or distractibility

• Slowing of thought or physical activity (noticeable to others)

• Thoughts of death or suicidal thoughts

*A special note when considering children is that depression can manifest as a persistent irritability rather than obvious sadness. We’re not just talking about irritability with siblings, but more of an underlying irritability with most people and things that isn’t typical of your child’s temperament. 

The following may be helpful to consider:

Activity Level: Your child might be busy with commitments (depression doesn’t have to mean sitting around doing nothing but looking sad). However - is he engaging in activities he enjoys during free time? Often, withdrawal from family, friends, or activities is a first sign of depression.

Thoughts and Feelings: Statements about feeling guilty or worthless, sad, hopeless, irritable/angry, or numb are cause for concern.

Suicidal Ideation: If your child begins to express thoughts about death, from “I wonder what it would be like if I never woke up” to “I wish I were dead,” this is cause for immediate follow-up. How parents respond is important - try to talk to your child in a way that helps him or her open up. See below for some tips on this.

How do I talk to my child if I think he/she is depressed?

Active listening - put aside the “fix-it” mentality and just listen. One approach is to repeat what you hear your child saying. If you hear an emotion come out, say, “Sounds like you feel ... (xxx).” If you want more explanation, say, “Tell me more about that.” Children often talk more if you talk less.

Monitor your Reactions - (This one’s HARD!) -  Especially if a child mentions thinking about suicide or death, try not to have a big reaction. Instead, tell them you’re seriously concerned. Emphasize your love for your child, and let him know his safety is priority. This is a time when talking to a professional right away would be a next-step recommendation. If you have immediate concerns about safety - don’t be afraid to ask your child about this! - it’s time to take them to the E.R. or a professional who can help. It is important to follow through on your words that you are serious about safety. 

Don’t Discount Them - In this moment of talking with your child, try not to minimize what she says, even if you believe she is looking at things the wrong way or with a bad attitude. Your child might blame you for some of her mood, saying you yell or don’t listen or don’t care. Instead of fighting back, realize that this is her perception right now, nod, and revert to the, “Sounds like you feel...” You can talk more later when you’ve processed her words.

What Can We Do Right Now?

If you think your child is indeed dealing with depression, but you have caught it early, these are some suggestions to prevent the situation from worsening.

Increase social support and combat loneliness. Social support includes time with friends, family, and activities that get your child around others. *Note that it will be important to speak with your child’s teacher, coach, or other adults who see your child in other settings. The adult may be able to give you valuable information about peer interactions, especially bullying.

Build up family time and any one-on-one time you can snag with your child so he or she gets the message - even if there is no talking and even if it doesn’t end well - that you care.

Turning outward, toward others and toward God or other spiritual figures, is a great way to help a child who has been ruminating - thinking almost obsessively - about his or her sadness or current plight. Volunteering or assisting a younger child with a project can build a child’s sense of purpose. Having a time reserved for prayer, talking about blessings, or discussing thankfulness can also assist with this turn away from rumination over negative things.

Sleep, exercise, and a proper diet can’t be emphasized enough. Each of these is an essential part of a healthy mood. If these areas seem upside-down, start with small changes to develop better habits. 

Dealing with the unhelpful thoughts - while this is usually a technique taught in therapy, it can be useful just to help your child notice when negative thoughts - for example, “Nobody loves me” - come out, and to gently teach your child to question whether the statement is actually true. 

“Behavioral activation” - intentionally planning pleasant activities into the schedule to increase opportunities for positive reinforcement and a resulting improvement in mood. For example, parents can help a child incorporate a walk, one-on-one time, music, drawing, games, and social activities into the calendar every day and then adhere to the plan.

When to seek more help

What if you’ve tried everything you can think of and the situation fails to improve? Or what if you sense that your child hesitates to open up to you? Don’t put pressure on yourself as a parent to “fix” everything. Often, children hide feelings from parents to avoid feeling like they are burdening or worrying parents. Seeking outside help is important in these cases, and it ideally comes from a professional rather than one of your child’s peers or relatives. If your child resists the idea of talking with a mental health professional, is there a trusted adult, such as a priest, deacon or other religious, a spiritual director, a school guidance counselor or other mentor who shares your family values? 

Most primary care doctors, with whom your child has already established a relationship, are trained to screen for depression and offer suggestions or refer to appropriate resources. You can also talk to your child’s doctor about whether medication is needed. For clinical depression, a combination of therapy and medication predicts the best outcomes.

The important thing is to get them talking. If you encourage your child to start to discuss these feelings with someone who can help, this may eventually lead to more openness to formal counseling if things do not improve.