Major depression is the most prevalent mental health problem currently worldwide, to the point that its expansion is beginning to be considered to be reaching epidemic proportions.
When we think about this disorder we usually imagine an adult person, with a series of symptoms known to everyone: sadness, loss of the ability to enjoy, recurrent crying, etc. But does depression only occur at this stage of life? Can it also occur at previous times? Can children develop mood disorders?
In this article we will address the issue of childhood depression with special emphasis on the symptoms that allow it to be differentiated from that which occurs in adults.
What is childhood depression?
Childhood depression presents multiple differences with respect to that of adults, although they tend to reduce as the years go by and the stage of adolescence approaches. It is, therefore, a health problem whose expression depends on the evolutionary period. Furthermore, it is important to keep in mind that many children lack the precise words with which to reveal their inner world which can make diagnosis difficult and even condition the data on its prevalence.
For example, sadness is an emotion that is present in children who suffer from depression. Despite this, the difficulties in managing it generate symptoms different from those expected for adults, as we will point out in the corresponding section. And this requires coping strategies that the child still has to acquire as his psychological and neurological development progresses.
Studies carried out on this issue show a prevalence for depression in childhood of between 0.3% and 7.8% (depending on the evaluation method); and a duration of 7-9 months (similar to that of adults).
Symptoms
In what follows we will deal with the particularities of childhood depression. All of them should alert us to the possible existence of a mood disorder, which requires a specific therapeutic approach.
1. Difficulty saying positive things about themselves
Children with depression They often express themselves negatively about themselves, and even make surprisingly harsh statements about their self-worth suggesting a damaged underlying self-esteem.
They may indicate that they do not want to play with peers of the same age because they do not know how to “do things right,” or for fear of being rejected or treated badly. In this way, they usually prefer to stay away from symbolic play activities between peers, which are necessary for healthy social development.
When they describe themselves they frequently refer to undesirable aspects, in which they reproduce a pattern of pessimism about the future and eventual guilt for events to which they did not contribute. These biases in the attribution of responsibility, or even in expectations regarding the future, usually deal with the stressful events that are associated with their emotional state: conflicts between parents, school rejection and even violence in the domestic environment (all of them risk factors). important risks).
The loss of confidence usually generalizes to more and more areas of the child’s daily life, as time progresses and effective therapeutic solutions are not adopted for your case. In the end, it negatively conditions his performance in the areas in which he participates, such as academics. Negative results would “confirm” to the child the beliefs he harbors about himself, entering a cycle that is harmful to his mental health and self-image.
2. Predominance of organic aspects
Children suffering from a depressive disorder They often show obvious complaints of physical problems, which lead to numerous visits to the pediatrician and make it difficult for them to attend school normally. The most common are headache (located in the forehead, temples and neck), abdominal discomfort (including diarrhea or constipation), persistent fatigue and nausea. The face would tend to adopt a sad expression, and significantly reduce eye contact.
3. Irritability
One of the best-known characteristics of childhood depression is that it usually presents with irritability, which is much more easily identifiable by parents than the emotions that could underlie it. In these cases, it is very important to consider that Parents are good informants of their children’s behavior, but they tend to be somewhat more imprecise at the moment in which its internal nuances are investigated. This is why sometimes the reason for the initial consultation and the problem to be treated are somewhat different.
This circumstance, together with the fact that the child does not describe himself using the term “sad” (as he uses qualifiers such as “grumpy” or “angry”), can delay identification and intervention. In some cases, a diagnosis is even made that does not adhere to the reality of the situation (oppositional defiant disorder, to cite an example). It is therefore necessary for the specialist to have precise knowledge about the clinical particularities of depression in children.
4. Vegetative and cognitive symptoms
Depression can be accompanied (in both children and adults) by a series of symptoms that compromise functions such as cognition, sleep, appetite and motor skills. Particular expressions have been observed depending on the child’s developmental stage, although it is considered that as time passes they become more similar to those of adults (so in adolescence they are comparable in many ways, but not in all).
In the first years of life they are common insomnia (sleep), weight loss (or cessation of expected gain for age) and motor agitation; while as the years go by, it is more common for hypersomnia, increased appetite and generalized psychomotor slowing to appear. At school, significant difficulty is evident in maintaining focus of attention (vigilance) and concentrating on tasks.
The presence of anhedonia suggests a severe depressive state in children. This is a significant difficulty in experiencing pleasure with what was previously reinforcing, including recreational and social activities.
Thus, they may feel apathetic/disinterested in exploring the environment, progressively distancing themselves and giving in to harmful inactivity. It is at this moment that It becomes evident that the child is suffering from a situation other than “behavioral problems” since it is a common symptom in adults with depression (and therefore much more recognizable to the family).
Along with anhedonia, there arises a tendency towards social isolation and refusal to participate in shared activities (playing with the reference group, loss of interest in academic matters, rejection of school, etc.). This withdrawal is a phenomenon widely described in childhood depression, and one of the reasons why parents decide to consult with a mental health professional.
Causes
There is no single cause of childhood depression, but rather a myriad of risk factors (biological, psychological and/or social) whose convergence contributes to its final appearance. Next we proceed to detail the most relevant ones, according to the literature.
1. Cognitive style of parents
Some children have a tendency to interpret the daily events of their lives in catastrophic and clearly disproportionate terms. Despite many hypotheses having been formulated to try to explain the phenomenon, there is a fairly broad consensus that it could be result of vicarious learning: the child would acquire the specific style that one of his parents uses in order to interpret adversities, adopting it as his own from now on (because attachment figures act as behavioral models).
The phenomenon has also been described in other disorders, such as those included in the category of clinical anxiety. In any case, studies on the issue indicate that there is a four times greater risk of a child developing depression when either parent suffers from it, in contrast to those who have no family history of any kind. However, a precise understanding of how genetics and learning could contribute, as independent realities, to all of this, has not yet been achieved.
2. Conflicts between care figures
The existence of relational difficulties between parents stimulates a feeling of helplessness in the child The foundations on which their sense of security is built would be threatened, which aligns with the common fears of the age period. Screams and threats can also precipitate other emotions, such as fear, which would decisively establish themselves in their internal experience.
Studies on this issue demonstrate that displays of warmth from attachment figures, and consensual parenting agreements, act as protective variables to reduce the risk of the child developing clinically relevant emotional problems. All this regardless of whether the parents remain united as a couple.
3. Family violence
Experiences of sexual abuse and mistreatment (physical or mental) emerge as very important risk factors for the development of childhood depression. Children who suffer from excessively authoritarian parenting styles, in which force is unilaterally imposed as a mechanism to manage conflict, can show a state of constant hyperactivation (and helplessness) that translates into anxiety and depression. Physical aggression is related to impulsivity in adolescence and adulthood, mediated by the functional relationship between limbic structures (amygdala) and cortical structures (prefrontal cortex).
4. Stressful events
Stressful events, such as parental divorce, moving, or changing schools, may be the cause of depressive disorders during childhood. In this case, the mechanism is very similar to that seen in adults, sadness being the natural result of a process of adaptation to loss. However, this legitimate emotion can progress to depression when it involves the additive effect of small additional losses (reduction of rewarding activities), or a poor availability of emotional support and affection.
5. Social rejection
There is evidence that children with few friends are at greater risk of developing depression, as are those who live in socially impoverished environments. Conflict with other children in their peer group has also been shown to be related to the disorder Likewise, suffering from bullying (persistent experiences of humiliation, punishment or rejection in the academic environment) has been closely associated with childhood and adolescent depression, and even with increased suicidal ideation (which is fortunately uncommon among depressed children). ).
6. Personality traits and other mental or neurodevelopmental disorders
It has been described that high negative affectivity, a stable trait for which an important genetic component has been traced (although its expression can be shaped through individual experience), increases the risk of the infant suffering from depression. It results in an overwhelmingly intense emotional reactivity to adverse stimuli which would enhance its effects on emotional life (separation from parents, moving, etc.).
Finally, it has been described that children who suffer from neurodevelopmental disorders, such as attention deficit disorder with or without hyperactivity (ADHD and ADD), also have a higher probability of suffering from depression. The effect extends to learning problems (such as dyslexia, dyscalculia or dysgraphia), tonic and/or clonic dysphemia (stuttering) and behavioral alterations.
Treatment
Cognitive-behavioral therapy has been shown to be effective z in the child population. The identification, debate and modification of basic negative thoughts is pursued; as well as the progressive and personalized introduction of pleasant activities. Furthermore, in the case of children, the intervention is oriented towards tangible aspects located in the present (immediacy), thereby reducing the degree of abstraction required. The contribution of parents is essential throughout the process.
Interpersonal therapy has also been effective in most studies in which it has been tested. The purpose of this form of intervention is to investigate the most relevant social problems in the child’s environment (both those in which he is involved and those in which he is not directly involved), looking for alternatives aimed at promoting the adaptive resources of the understood family. as a system.
Finally, antidepressants can be used in cases where the child does not respond adequately to psychotherapy. This part of the intervention must be carefully evaluated by a psychiatrist, who will determine the profile of risks and benefits associated with the consumption of these medications in childhood. There are some warnings that they may increase suicidal ideation in people under 25 years of age, but in general it is considered that their therapeutic effects far outweigh their drawbacks.
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PsychologyFor. (2024). Childhood Depression: Symptoms, Causes and Treatment. https://psychologyfor.com/childhood-depression-symptoms-causes-and-treatment/