Depression, mood disorder and other depressive mental illness is all too common among adults. With children, most of us tend to associate depression with the teenage years.
But more and more, researchers are finding that depression, and even suicidal thoughts or behavior, may begin much earlier. While signs of serious depression may manifest themselves in the adolescent years, the symptoms of clinical depressive disorder can arise in children as young as three years old.
According to the National Institute of Mental Health, these very young symptoms may be an early manifestation of childhood mood disorder.
Yet, no studies have been done to evaluate the best way to treat such mental health problems in children so young. Increasingly, it seems that we must do so. A recent study revealed that 40 percent of young adults who had attempted suicide first did so before they entered high school.
"Increasingly, the mental health profession has been concerned about recognizing early warning signs of depression in children, since depression can lead to suicidal behavior," says Barbara Long, M.D., Ph.D.
"Parents should be alert to any behavioral changes in behavior, such as a loss of interest in school, withdrawal from family or friends, or lack of signs of joy or pleasure in any activities."
Dr. Long recommends consulting your family physician or pediatrician to rule out a medical cause (such as thyroid) and if recommended, seeking help from a qualified mental health professional.
James Mazza, professor of educational psychology at the University of Washington, says that the implementation of mental health programs may need to start in elementary and middle schools. “Young adults who end up having chronic mental health problems show their struggles early,” he confirms.
The Young Childhood Years
Fortunately, a new psychosocial approach has shown promise in helping preschoolers with depression, starting the intervention and treatment earlier in life.
Joan Luby, M.D., of Washington University and colleagues conducted a preliminary pilot study comparing a novel form of psychotherapy called Parent Child Interaction Therapy-Emotion Development (PCIT-ED).
This therapy helps young children learn to regulate their emotions and function better - a much better approach for very young kids, for whom the traditional cognitive behavioral therapy used with older children might not be a good fit.
Luby's PCIT therapy includes hands-on techniques such as positive play, and aims to strengthen the parent-child relationship as well as coach parents in handling difficult behavior. It is designed to teach parents how to help their children recognize emotions and more effectively regulate them.
In the study, 54 preschoolers (age three to seven) and their parents were randomly assigned to either the PCIT therapy, or a traditional psycho-education program that educated parents in small groups about child emotional and social development, but did not include individual coaching or practice sessions with the parents and their children.
After 12 weeks, depression symptoms in the children declined significantly in both groups, but the PCIT group also showed improvements in their levels of anxiety, hyperactivity, hostility, inattention and other conduct problems.
They also showed better functioning and ability to regulate emotions, compared to the other group, and the parents reported less stress as well.
Such early intervention can also have an impact on developmental disorders like autism, the researchers say, and could potentially head off depression later in life. The WU team plans to move forward with a full-scale randomized trial.
Later Adolescence
James Mazza also conducted a study into children's depression at the University of Washington, focusing on young adults and severe depression that leads to suicidal behavior.
One in nine youths attempt suicide by the time they graduate from high school - a startling number that underscores the need to treat childhood depression early. But new findings from the UW research reveal that a significant portion of kids make their first suicide attempt in middle school, and even elementary school.
Mazza and his colleagues asked 883 young adults age 18 and 19 about their history of depression and suicide attempts. 78 of them, or nearly nine percent, said they had tried to commit suicide at some point.
Their attempts showed a sharp increase at sixth grade, around age 12, and peaked in eighth and ninth grades. For those who had tried multiple attempts, the first was at a significantly younger age (as young as nine) than those who had made a single attempt.
The team also compared the suicide attempt reports with the youths' past depression scores, collected annually as part of their participation in the Raising Healthy Children project at UW.
Depression scores were higher at the times of attempted suicide than before and after, and compared with the kids who had not attempted suicide. Mazza says that such depression scoring can help schools and parents identify when kids are in trouble and need help.
“Adolescence is a time when kids are preparing to be more independent from their parents or guardians, but lack the experience of how to do this,” said Mazza, a school psychologist. He added that youth are fairly good self-reporters of their own mental health.
“We’re likely not giving kids enough credence in assessing their own mental health, and this study shows that we can rely on self-report measures to help identify youth who may be at risk for current mental health concerns, including possible suicidal behavior.”
How to Help
"Although everyone has thoughts about suicide, severe depression can distort our thinking and make us feel that there is no way out of our situation except to end our lives," says Dr. Long.
"If you are worried that someone may be feeling this way because of their comments or behavior, ask him calmly but directly if he is feeling so down that he is thinking of harming himself. You will not 'push him over the edge.'
In fact, it is usually the opposite; people who attempt often say that they did so, because no one cared enough to ask," Long explains.
Just like with the PCIT study, other group programs to prevent childhood depression have proven effective. Sally Merry, M.D., a pediatric psychiatrist at the University of Auckland in New Zealand, led a team that analyzed 53 different studies on prevention of childhood depression in various countries.
The studies covered a total of more than 14,000 participants between the ages of five and 19.
The analysis found that young people who participated in prevention programs were significantly less likely to have a depressive disorder in the following year than those who did not participate.
The programs used were diverse, but most included some components of cognitive behavioral therapy. Others emphasized self-efficacy, stress reduction techniques and methods for handling trauma and maintaining optimism.
“Group-based prevention strategies may offer a means of reaching more individuals than most treatment approaches,” said Mendelson. “Our results were encouraging because depression is so common.
By intervening before the start of a disorder, prevention strategies have the potential to avert a chronic, episodic course of mental illness. Thus, prevention efforts with children and adolescents are particularly critical."
