By Mohani Niza
When social work student Adrianna (last name withheld), now 25, was a teenager, she attempted suicide.
After the attempt, in order to get better, Adrianna sought help from her school counsellor who wanted her to see a psychiatrist. However, her parents refused to sign the consent form.
“At the time, they did not believe there was such a thing as depression,” Adrianna said. “Plus. I have always been loud and cheerful. I did not show many signs either.”
She was a bright student, but flunked her high school exams because the depression made her lose interest in school.
“I started to lose interest in everything that I did,” Adrianna said. “I skipped school just to stay at home and sleep.”
Adrianna still suffers from depressive episodes from time to time. “My depression is always there. But as I age, and with years of living with it, I start to handle it better. But there will be times where I have no control over it and might do anything to hurt myself.”
Now that she is an adult, Adrianna has the financial means and freedom to see a professional, but said she wished she had received help earlier. “Maybe I would have understood better about what I was going through and I might not have flunked my SPM,” she said.
It is not uncommon for depressed children to lose interest in school, Matilda Xavier, the director and clinical psychologist at Mentem Psychological Services in Subang Jaya, Malaysia, said.
Matilda said: “Their studies may be affected because they have difficulty focusing, concentrating or making decisions. They have thoughts of worthlessness, and loneliness and often ruminate over these negative thoughts. When the depression is severe, they may feel suicidal. Friendships and family relationships are also affected as they may tend to self-isolate.”
“Sleep may also be affected — either not enough sleep or too much sleep. Some may appear to be more restless or, on the other hand, become slower in their activity level,” Matilda said, adding that losing weight or gaining weight can also happen – the latter because depressed children, like depressed adults, tend to emotionally eat.
Matilda said children can be prone to depression because childhood and adolescence in particular are challenging times. “Adolescents tend to be more sensitive at this stage in their lives because they are going through a lot of physical and psychological change — teenage angst. However, depression is more than just teenage angst. Depressed feelings last longer, for most of the day and affect most areas of their functioning. It is not normal any more.”
“Often children with depression express feeling sad, empty or hopeless – crying even – for some time,” Matilda said. “However, sometimes they don’t appear sad but tend to have an irritable mood most of the time. They are also likely to lose interest or pleasure in most of the activities that they used to enjoy previously.”
When depression gets too bad, some children and adolescents may also fall into substance abuse.
COVID-19 has had an impact on the mental health of children as they had to stay at home and attend classes online. The isolation of being cooped up at home, and being cut off from their social groups, are among the factors causing depression in children.
According to an article published in 2022 in Jama Pediatrics, the Health Resources and Services Administration found that depression and anxiety among children ages 3 to 17 had increased between the years 2016 to 2020. However, there are no such statistics in Malaysia.
Matilda often sees depressed children coming to her practice. She said: “If the depressive symptoms are obvious, then parents may bring their children in for therapy. Sometimes the symptoms may not be obvious to the parents. Children may present with behaviour problems that mask their depression. This would cause the parents to seek out our services. Sometimes school teachers or counsellors would have noticed the child displaying depressive symptoms or the child might have talked to their teacher or counsellor about their depression or suicidal thoughts, so teachers or counsellors then inform the parents and suggest therapy.”
“We have even had situations where children themselves asked their parents to send them for therapy because they are depressed,” she added.
Despite the popularity of medications in the market, Matilda said she does not use them as the first option unless the symptoms in a child are severe or disruptive enough to cause behavioural problems that need to be stabilised. She avoids prescribing medications as the first line of defence precisely because children’s brains are still developing. Instead, her practice uses expressive art therapies for young children, and talk therapy, including cognitive behavioural therapy (CBT) for older children, though sometimes older children may also benefit from art therapy.
“At our practice, we do a thorough assessment to understand the child and their environment and to explore what is contributing and maintaining the depression,” Matilda said. “With all the information we gather from our diagnostic interview, with both the child and their parents, and even from teachers, we come up with a plan to treat the depression. We work with both the child and the parents and if necessary, with the teachers as well.”
It takes a village to raise a child
Matilda believes that the community, especially the family unit and schools, must help to tackle depression in children. “First, family members, teachers, etc have to understand and accept that children can be depressed.”
“Do not brush it away and say things that minimise the children’s distress,” Matilda said. “Take it seriously. Listen to the children without being judgmental or negative. Accept without criticism when a child says he or she is depressed. Acknowledge it and find ways to help the child.”
“Being supportive will help the child recover better.”