1. Depression in children
Dr.Ksh. Chourjit Singh
Prof. of Pediatrics
Regional Institute of Medical Sciences, Imphal
National Chairperson, Growth & Development Chapter, IAP
National Executive Board Member
Advisor HIV/AIDS in Children Task Force, Manipur State.
Past President, East Zone, IAP
President, NNF, Manipur State Branch

2. Introduction
Depression in school-age children and adolescents remain a long-overlooked Health problem
As prevalent as in adults
Common cold of mental illness – Clinical Depression
Specially in childhood – is a major health problem

3. Severity of Problem 5% children at any given time
1% of Pre-school children
2% of school-age children
5% of adolescents are affected
25-50% of all children & adolescents in Psychiatric treatment are for depression & its related problems
More common in boys than girls – 5:1 school-age children
Adolescent girls than boys - 2:1

4. Severity of Problem ….
Untreated Depression can be taken as important cause of suicide in adolescents, even adults

5. Why depression in young ?
A) Risk factors
Children referred to mental health providers for school problems
Children with medical problems
Asthma
Diabetes
Epilepsy
Many chronic childhood diseases

6. Why depression in young ? …….
Law and order problems
Frequent bandh/ strikes
Frequent school closures
Ethnic group clashes
Insecure feelings
Conflict environment
Watching television a lot i.e. more than 6 hours a day

7. Risk factors ….. Rural vrs Urban children Sexually harassed children
Children with family history of depression
Genetically potential
What is happening in an individual child’s life

8. B) Why depression runs in families
Genetics
Even if a child never contacts with depressed parents, child may also likely to be depressed
Marital difficulties
Broken family/ marital problems
Divorce plus depression in parents
Parenting problems
Hard to be good parent when depressed
Parenting problems whether from parents or from child

9. C) Can experience depression at any age – Presentation?
Shortly after birth & very young
Failure to thrive
Disrupted attachments to others
Developmental delays
Social withdrawal
Separation anxiety
Sleeping and eating problems

10. C) Chance of depression at any age…
Between 6-12 years of age
Fatigue
Sadness
Inability to feel pleasure
Irritability & Insomnia
Lack of self esteem
Stomach ache and headache

11. C) Chance of depression at any age…
Hallucinations
Agitation & extreme fears
Weight changes
Difficulty with school work
Apathy
Lack of Motivation
Social withdrawal

12. C) Chance of depression at any age…
Adolescent
Over-sleeping
Socially isolated
Acting out in self destructive ways
Sense of hopelessness
Despairing thoughts
Weight changes

13. Future of depressed school-age children
If untreated in time – affects the children
School performance and learning
Social interaction and development of normal peer relationships
Self-esteem and life skill acquisition
Parent-child relationship & sense of bonding

14. Future of depressed school-age children….
Lack of trust – can lead to Substance abuse
Disruptive behaviour
Violence and Aggression
Legal troubles and even suicide
Depression thinking can become part of a child’s developing personality, leaving long-term effects in place for the rest of the child’s life.

15. Behavioural changes – What?
Professional attention decreases
Classroom disruption
Expulsion from school
School failure
Injury to themselves or others
Symptoms ADHD
Truancy
Delinquency

16. Stress in students leading to depression
Parental pressure to perform and to stand out among other children
If not come up to expectations
Frustration
Physical stress
Aggression
Undesirable complexes

17. Stress in students leading to depression…
Under-Performers
Negative traits
Shyness
Unfriendliness
Jealousy
World to loner

18. Over-scheduling a student’s life
Non-availability of time for extra-curricular activities after school
No proper place for ventilation & breathing space
Unwanted learning like music, painting or outstanding in sports
Too many crammed schedule & unmindful of the children’s choice
Unadjusted school systems and tremendous amount of homework – spending their evenings, weekends and vacations

19. Over-scheduling a student’s life…
Loss of interest in studies
Under-perform due to excess academic pressure
Students often carry enormous amount of anxiety and negative personal traits & massive attention problems
Non-effortless learning
Physio-Psychological transition of students
Mainly affected elementary to Junior High School

20. Diagnostic Points Transient depression or sadness
Impairment in child’s ability to function
Two types
Dysthymic disorder
Major depressions
Dysthymic disorder – less severe but lasts longer
Chronic depression/Irritability > 1 year

21. Diagnostic Points …. Onset about 7 years of age
2-6 symptoms within 5 years
Leads to major depression/ Double depression
Untreated Dysthymic disorder will experience Remission within 6 years
Prevalence of depression increases with age – 5 percent of all teens

22. What can be done Diagnostic evaluation – success to treatment
All disorders be discovered and addressed
Medication
Mood stabilisers
Anti-anxiety
Anti-depressants
Stimulants

23. What can be done… Individual therapy
Often beneficial for patients & specially help with issues
Family conflicts
Self-esteem
Relaxation strategies
Mood and anger control
Better communication

24. School environment Interaction School Counsellor Principal
Psychologist
Teachers and Parents
Psycho-educational treatment
Speech and occupational therapy

25. School environment… Counselling Curriculum modification
Resource classes
Behavioural modification system
Self-contained classrooms

26. Home/ Parental environment
Family and Home modification\
Homely life environment

27. Family therapy Defining Family members role and responsibility
Better communication & behavioural Reward systems

28. Let children learn to pace themselves.
Don’t overload your child with too many after-school activities and responsibilities.
Let children learn to pace themselves.
Don’t enrol them in every class along and don’t expect them to be first in everything.

29. Thank you