Inside the young mind: A closer view of childhood depression

Children are first-timers in a world of heartbreaks. What are challenges if not opportunities to remind oneself to be kinder to ourselves and others?

Utter disinterest. Inconsolable misery. Dreary, colourless days, and even tougher nights. Up until very recently, it was believed that only adults could experience such intense emotions (or the lack thereof), and that children didn’t have the emotional or cognitive maturity to feel intense sadness. However, with an expanding corpus of studies we now know that in fact, adolescents and even very young children, can get depression. While experiencing sadness is fairly common, and a crucial aspect of learning how to regulate emotions, some children develop a persistent sense of sadness and that’s when it is a matter of concern.

While experiencing sadness is fairly common, and a crucial aspect of learning how to regulate emotions, some children develop a persistent sense of sadness and that’s when it is a matter of concern.(Shutterstock)

“I really used to love painting, you know; and I’d paint every single day, and now, I just…don’t paint anymore.” This is what a 13-year-old told us in her first therapy session. She said she felt “broken” inside. Her mother, who sat beside her, looked concerned — she had dismissed this behaviour as laziness before she brought her daughter for therapy. Another client, all of 15, raised the issue of how depression affects one’s perception of the world. “You know how people say that happiness finds a way to get to you, I think sadness and negativity somehow find a way to reach me.”

When we enter into a dialogue with children who have been battling depression, we realise how it affects them in the most unkind of ways: hopelessness and a sense of worthlessness are frequent, they experience social withdrawal and isolation, their sleep and appetite witness major fluctuations, and often deep sadness creeps up on them even in seemingly happy moments.

Because depression was originally conceived and conceptualised as an exclusively adult problem, there exists a clear gap in the knowledge of measuring depression in children and adolescents, and in approaching its treatment.

In addition, we learn how depression in children could also result in considerable impairment in cognitive, social, and emotional functions which, in turn, affects their development, academic performance, and relationships with friends and family. It also puts them at risk of engaging in behaviours like substance abuse and/or self-harm, as a means to cope with their emotional anguish.

It is crucial to understand why children get depressed. How and why does a child feel such fierce unhappiness that it eventually leads to shutdown? Childhood, which is supposed to be a relatively carefree period, harbours certain contexts and situations that give rise to depressive symptoms. While depression cannot always be explained by a simple cause-and-effect pattern, it is important to understand that for children, there might be some triggers or stressors that set off the problem, which are also critical to understand. Now, it’s true that genetics, imbalances in brain chemicals (neurotransmitters), and physical, chronic health issues can impact a child’s emotional well-being, but it is crucial to also look out for more subtle, seemingly commonplace stressors that snowball into big stressors in a child’s life.

In recent times, the newspapers have been replete with reports of deaths by suicides of IIT, NEET aspirants and even students studying in institutions where not enough is being done to address caste and class-based bullying. The problem is not endemic to students in high-pressure situations. On Wednesday, 33 states in the United States sued Meta platforms for manipulative features that are designed to lower the self-esteem of children.

Certainly, what seems like an increasing diagnosis of childhood depression can also be attributed to increased awareness and sensitivity, but it is also relevant to reflect on how changing family dynamics and constellations, death, grief, adverse childhood experiences, the advent of social media (and along with it the associated concerns of peer pressure, social comparison, and cyberbullying), and academic pressure interact with each other to make a child feel what they’re feeling.

A 15-year-old client sits gloomily in a therapy room. She says that she’s studying in one of the best schools in a city like Mumbai, has a family that really loves her and never hears a ‘no’ from her parents. “I have everything, and yet I feel empty, almost like I don’t belong anywhere”. Let’s unpack this emptiness to better understand the group of emotions she is experiencing.

Guilt. She realises that maybe not all of her childhood experiences have been entirely positive. Discomfort. She feels a sense of terror when she realises that others around her might get to know about her diagnosis. Internalised shame. “I don’t know how to express what I’m feeling because I don’t know why I feel the way that I do”.

Suicidal ideation

“Sometimes…I just want to end it all, you know. Just existing shouldn’t be so hard, right?” It is interesting to note that when children have come in with their parents, they have been the ones to initiate grave conversations about the suicidal ideations that emerge from their depressive symptoms.

As adults entrusted with their care, it’s important to recognise and look out for suicidal behaviour in children (suicidal ideation, self-harm, suicide attempts), and whether there are any observable changes in their mood, behaviour, academic performance, energy levels, appetite, and thoughts and discuss them in an age-appropriate and sensitive manner. Although this may seem challenging and even counterintuitive to some, to not discuss these issues when necessary is to miss the opportunity to provide help and support.

Problems like impulsivity and difficulty with delayed gratification (and thus, reduced time for intervention) make it even more important to involve a mental health professional and devise a holistic safety plan as soon as possible.

Coping strategy

The youth are prematurely exposed to content and sometimes even the harsh realities of life — one may even argue that “they’re growing up too fast” — but, this should have been coupled with an equally intensive focus on developing resources for healthier coping mechanisms, and for building resilience. Whether we like it or not, most children these days have been forced into premature introspection, meaningful interactions, understanding life and the people in it, without having developed the required skill of coping with such information which is why distress and agony are no strangers to them. However, what we need to remember is that children are first-timers in the world of disappointments and heartbreaks, and the first step that parents and guardians can take to support them is to not belittle their struggles, and not trivialise their feelings of weakness, vulnerability, or sensitivity.

Children, like all humans, need sufficient autonomy. They need to know what they can do for themselves to offset the stress they are feeling. Listen to them. Acknowledge what they’re feeling. Let’s give children the space to make mistakes and face failures. All they need to know is that when things do go south, they’re not alone. Just as they’re taught other survival skills, children should be taught to navigate the complexities of their emotions.

Based on our conversations with children who have been struggling, they often encounter pain and emotional turmoil that they don’t yet fully understand, and perhaps what they fear most is not what’s happening inside of them, but how those around them might react. After all, aren’t struggles also opportunities to remind yourself to be a little kinder to oneself and to others?

Dr Natasha Kate is the consultant psychiatrist and Suveni Kaul is a psychotherapist at Sanctum Foundation, a Mumbai-based holistic mental health care centre