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This book is about depression in children and teenagers during their school years, from five to eighteen. It is written primarily for parents, but we hope that teachers, social workers, health visitors and family doctors will also find it useful.
Why do parents need to know about possible depression in their children? All children get sad and miserable from time to time. Sometimes it is difficult to know if such normal unhappiness needs special attention. We aim to help parents in this situation.
Like a plant, depression grows because a particular seed (perhaps psychological, such as a loss, or perhaps physical, such as a viral infection) has been planted in soil that is good for growth. The child’s genes or inherited characteristics, the child’s personality and the child’s early experiences can be seen together as the soil in which the seed is planted. Just as both seed and soil are necessary for plant growth (you won’ t get much plant unless you have both of these), so when we look at depression we need to look at both the seeds – the stresses or triggering events – and the nature of the child at the time these events occur. It would be meaningless to say that one or the other is the cause: both are necessary.
We thought there was something wrong because he was unhappy – he’s normally a very happy cheery boy, outgoing, wants to be with friends, playing with friends. But he didn’t want to see his friends, even on weekends, for example, when he was able to, he didn’t want to. And just looking down and, you know we talk quite often, but there would be lots of tears and that was not like him at all. So, we realized that something was very, very different.
In the previous chapter we discussed some of the things all parents can do to help build children’s resilience and help reduce their chances of developing depression. But there are also some specific stresses that are known to be associated with depression in children and teenagers. When children suffer from depression, it is always important to think of the events that might have triggered the problem. In some children, the stress that has brought on the problem will be obvious; in others it will be far from clear. In this chapter, we focus on six of the most common stresses experienced by children and young people (experiences of loss; parental conflict and separation; academic pressure; bullying and online abuse; gender identity issues; and physical ill health), and discuss what parents can do to help children who face such difficulties.
If you think it is likely that your child or teenager is indeed suffering from depression, you will first want to try to work out why. Often parents are concerned that this is their fault, or that they are somehow to blame for their child’s depression. Or you may be worried that something has happened in your child’s life to cause the depression which they haven’t told you about.
In the United Kingdom, all those involved with supporting the physical and mental health of children and young people are expected to take into consideration the guidelines produced by the National Institute for Health and Care Excellence (NICE). NICE’s most recent recommendations on the treatment of depression in children were published in 2019, and it includes a lot of helpful advice, mostly based on good research evidence.
Although this is a book primarily for parents, we think it right to point out that there is a great deal that governments could do to make it easier for parents and teachers to help children avoid emotional problems. The policy measures we list below would help parents, teachers and children themselves reduce the frequency of clinical depression in the young. Perhaps some parents might use their influence and their votes to bring about changes in these directions.
This chapter summarises some of what we know about depression: how common it is in young people, where it comes from and what are the things that research suggests may increase or decrease the likelihood of a young person developing depression. We also explain what we know about the most likely outcomes for those who do experience depression.
It is at least possible that you have picked this book up because you are wondering if your own child or teenager, or one whom you know, is suffering from depression. Is there any clear-cut indication which will tell you whether what you are noticing is just normal behaviour or a sign of clinical depression? Unfortunately, the answer may not be straightforward and we shall not pretend that it is.
Has your daughter lost her sparkle? Has everyday life become a trial for your son? This book, written by two experts in child and adolescent mental health, describes how to recognise depression and what causes it; and provides guidance on how parents can support their child, including up-to-date advice on seeking professional help. It gives advice on how to tell the difference between normal responses to stress and symptoms that are more concerning. It covers topical issues such as academic pressure, social media, getting a grip on screen time and cyber-bullying. You will also be given information about the different treatment options provided by child and adolescent mental health services, as well as practical advice and information about the support you can give at home.
UK Biobank is a well-characterised cohort of over 500 000 participants including genetics, environmental data and imaging. An online mental health questionnaire was designed for UK Biobank participants to expand its potential.
Describe the development, implementation and results of this questionnaire.
An expert working group designed the questionnaire, using established measures where possible, and consulting a patient group. Operational criteria were agreed for defining likely disorder and risk states, including lifetime depression, mania/hypomania, generalised anxiety disorder, unusual experiences and self-harm, and current post-traumatic stress and hazardous/harmful alcohol use.
A total of 157 366 completed online questionnaires were available by August 2017. Participants were aged 45–82 (53% were ≥65 years) and 57% women. Comparison of self-reported diagnosed mental disorder with a contemporary study shows a similar prevalence, despite respondents being of higher average socioeconomic status. Lifetime depression was a common finding, with 24% (37 434) of participants meeting criteria and current hazardous/harmful alcohol use criteria were met by 21% (32 602), whereas other criteria were met by less than 8% of the participants. There was extensive comorbidity among the syndromes. Mental disorders were associated with a high neuroticism score, adverse life events and long-term illness; addiction and bipolar affective disorder in particular were associated with measures of deprivation.
The UK Biobank questionnaire represents a very large mental health survey in itself, and the results presented here show high face validity, although caution is needed because of selection bias. Built into UK Biobank, these data intersect with other health data to offer unparalleled potential for crosscutting biomedical research involving mental health.
UK Biobank is a well-characterised cohort of over 500 000 participants that offers unique opportunities to investigate multiple diseases and risk factors.
An online mental health questionnaire completed by UK Biobank participants was expected to expand the potential for research into mental disorders.
An expert working group designed the questionnaire, using established measures where possible, and consulting with a patient group regarding acceptability. Case definitions were defined using operational criteria for lifetime depression, mania, anxiety disorder, psychotic-like experiences and self-harm, as well as current post-traumatic stress and alcohol use disorders.
157 366 completed online questionnaires were available by August 2017. Comparison of self-reported diagnosed mental disorder with a contemporary study shows a similar prevalence, despite respondents being of higher average socioeconomic status than the general population across a range of indicators. Thirty-five per cent (55 750) of participants had at least one defined syndrome, of which lifetime depression was the most common at 24% (37 434). There was extensive comorbidity among the syndromes. Mental disorders were associated with high neuroticism score, adverse life events and long-term illness; addiction and bipolar affective disorder in particular were associated with measures of deprivation.
The questionnaire represents a very large mental health survey in itself, and the results presented here show high face validity, although caution is needed owing to selection bias. Built into UK Biobank, these data intersect with other health data to offer unparalleled potential for crosscutting biomedical research involving mental health.
Declaration of interest
G.B. received grants from the National Institute for Health Research during the study; and support from Illumina Ltd. and the European Commission outside the submitted work. B.C. received grants from the Scottish Executive Chief Scientist Office and from The Dr Mortimer and Theresa Sackler Foundation during the study. C.S. received grants from the Medical Research Council and Wellcome Trust during the study, and is the Chief Scientist for UK Biobank. M.H. received grants from the Innovative Medicines Initiative via the RADAR-CNS programme and personal fees as an expert witness outside the submitted work.