How does depression manifest itself in children and adolescents?​

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Slight depressive moods to severe depressive disorders are among the most common mental illnesses in children and adolescents. About 1% of preschool children and about 2% of primary school children are affected. Around 3-10% of all young people between the ages of 12 and 17 are currently suffering from depression. In children and adolescents, it often happens that depression is accompanied by other mental illnesses, such as anxiety disorders, eating disorders and ADHD.

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symptoms​

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Depression in adolescents is sometimes not recognized immediately. There are several reasons for that:

• Differentiating normal development in adolescence from depression is difficult because transient mood swings, irritability, and other depressive symptoms are part of puberty.

• Other behaviors predominate (e.g. increased irritability or frequent arguing) so that parents, teachers and doctors overlook the depression.

• The individual cases sometimes differ significantly in appearance depending on the developmental age.

• For fear of stigmatization, families and young people often seek help late.

 

Depending on age, there are peculiarities in the symptoms of depression. 

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Under 1-3 years:

• seems sad

• expressionless face

• increased irritability

• self-stimulating behavior eg body rocking, excessive thumb sucking

• indifference

• reluctance to play

• Gaming behavior with reduced creativity and endurance 

• disturbed eating behavior

• sleep disorders

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Preschool age (3-6 years):

• sad face

• decreased gestures and facial expressions

• easily irritated, mood unstable

• lack of ability to rejoice

• decreased interest in exercise

• introspective or aggressive behavior

• Changed eating habits with weight loss or gain

• Sleep disturbances, eg difficulty falling asleep or staying asleep, nightmares

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school age:

• verbal reports of sadness

• School performance disorders

• Fear that parents are not paying enough attention

• suicidal thoughts

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Puberty and adolescence:

• Depressive symptoms according to diagnostic criteria

• decreased self-confidence

• Anxiety, difficulty concentrating, indifference

• performance disruptions

• time-of-day-dependent fluctuations in well-being

• psychosomatic complaints (e.g. headaches)

• suicidal acts

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The diagnosis should always be made by a doctor or psychotherapist (pediatrician, child and adolescent psychiatrist/psychotherapist). The same diagnostic criteria apply as for adults, but the typical symptoms cannot yet be found in younger children. 

Some of the symptoms of depression are part of normal adolescent development: being irritable or withdrawn, bored or brooding, feeling dissatisfied with yourself and the world. When diagnosing, it is therefore essential to take into account the age-related peculiarities. To ensure a reliable diagnosis, the environment, such as parents, teachers, educators and other caregivers, is always included in the assessment.

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causes​

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The causes of depression are both biological and psychosocial. First of all, there is a predisposition that can be genetic or can be acquired through traumatic experiences in early childhood, for example. This predisposition leads to increased vulnerability, i.e. the risk of developing depression. Triggers of the disease can then z. B. Stress from school, conflicts with friends and family. Due to the predisposition, however, one can also slip into a depression without external reasons.

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Viewed against this background, the corona pandemic and above all the closures of schools, day groups and leisure activities as well as the contact restrictions generally have a negative impact on the psychological well-being of children and young people. In the COPSY study, 70% of the children and young people surveyed stated that they were under stress. 82.8% said they had fewer social contacts than before the pandemic. With the appropriate vulnerability, the corona crisis can therefore promote the development of depression - in children, young people and, of course, parents.

 

There are also other risk factors for families:

• fear for their own health

• Family burdens (e.g. financial worries, parental exhaustion)

• unexpected quarantine

• Social media influences

• Homeschooling stress.

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It can therefore be assumed that the consequences of the corona crisis, which are already visible today, will continue to intensify in the coming months. Homeschooling, contact restrictions and the loss of important support services have left their mark. Adolescents whose resources before the corona pandemic were sufficient to deal with the stresses of life can now develop depressive symptoms and be diagnosed with depression.

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treatment options

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Treatment usually takes place on an outpatient basis in the practices of registered child and adolescent psychotherapists and child and adolescent psychiatrists. The treatment includes:

• age- and development-appropriate information for the child/adolescent and the parents about the disease,

• Psychotherapy with the involvement of family and other reference persons,

• in severe cases, drug treatment is given in addition to psychotherapy,

• interventions in the family.

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suicidality​

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Although childhood suicides are very rare, they are among the most common causes of death in adolescence. Suicidal thoughts are a symptom of depression: In adolescents with depression, there is a up to 20-fold increased risk of suicidal behavior (suicide attempt/completed suicide).

Boys are three times more likely to die from suicide than girls, while girls and young women are the main risk group for suicide attempts. In addition to mental illness, a previous suicide attempt, experiences with this topic among friends and family, and negative life events are further risk factors for suicidal tendencies. Suicidality should always be taken seriously and addressed.

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contact points​

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Getting help is the first and often the most difficult step. With support, however, you or your child will soon feel better.

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are the first points of contact

• Paediatricians

• general practitioners

• Child and adolescent psychotherapists

• school social workers

• Counseling teachers

• Advice centers on site, such as the Red Cross, Caritas or Diakonie

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See more details under ourhelp button.