Depression and other mental health issues are usually thought of as adult problems that don't affect children. However, the National Alliance on Mental Health estimates that 50 percent of lifetime mental illnesses develop by age 14, and 75 percent develop by age 24.1 In addition, recent research shows that mental health-related emergency department visits and suicide attempts among young people have significantly increased during the COVID-19 pandemic.2

Children and adolescents commonly suffer from depression, but the signs and symptoms in young people are often different than they are in adults.3,4 Learn to recognize when a young person is at risk and showing signs of depression.

What is Depression and What Causes It?

Depression in children and adolescents is characterized by more than two weeks of persistent sadness, irritability, or hostility coupled with most of the following warning signs: sleep troubles, appetite changes, physical complaints, negative or hopeless thinking, concentration problems, loss of interest in activities and, most concerning, suicidal thoughts.3-5

There are multiple factors that lead to depression. Studies of twins suggest that both genetics and the environment an individual is raised in play a role. Plus, an individual's thoughts and behaviors can impact the course of depression. For example, people who are pessimistic about the future, themselves, or their surroundings are more at risk for depression. In addition, the function of certain chemicals in the brain, called neurotransmitters (serotonin, norepinephrine, and dopamine), plays a role in determining whether a person is more likely to develop depression.3-5

Factors that Increase the Risk of Depression in Children

It is not always clear why some individuals develop depression and others don't. However, there are risk factors that increase the chance a child or adolescent will develop depression. These include:3-5

  • History of depression in a parent or sibling
  • Family dysfunction, divorce, or conflict with a caregiver
  • Exposure to early adversity (abuse, neglect, the loss of a loved one)
  • Problems at school or fitting in with friends
  • Gender dysphoria and/or identifying as gender nonconforming, lesbian, gay, bisexual, transgender, queer, and/or questioning
  • Negative outlook or poor coping skills
  • Stress from being bullied – on social media or in person
  • Previous bouts of depression
  • History of anxiety disorders, learning disabilities, attention deficit hyperactivity disorder, or significant defiance or conduct problems
  • History of brain injury or low birth weight
  • Chronic medical illness

COVID-19 Pandemic: Adolescent Mental Health Issues Are on the Rise 

Major changes, living through a natural disaster, or experiencing other trauma can lead to depression. Case in point, the COVID-19 pandemic. As the virus spread around the world, in addition to causing illness and death, it disrupted schedules, changed how kids went to school, and upended entire educational systems. It canceled birthday parties, made prom and graduation ceremonies impossible, and turned hugs into health risks.

The long-term impact on children is yet to be realized. In the short-term, the effects are showing up as an increase in mental health issues and suicide attempts among young people.

  • During 2020: Mental health-related emergency department (ED) visits among adolescents ages 12-17 increased 31 percent compared to 2019 data.2
  • Between February 21 and March 20, 2021: Suspected suicide-attempt ED visits were 50.6-percent higher among girls and 3.7-percent higher for boys ages 12-17 compared to   the same period in 2019.2

How to Tell if A Young Person is Depressed

Occasional sadness is a normal part of growing up and living life. Plus, teens are often moody and withdrawn, which is common in adolescence.   

But sometimes it's hard to tell the difference between normal childhood emotions and depression. In addition, depression in young people often presents differently than it does in adults, so parents and caregivers might not recognize the symptoms.3-5 For many adults who have mental health disorders like depression, signs and symptoms were present in childhood, but were often not recognized or addressed.4

If children or adolescents are sad, irritable, hostile, or no longer enjoy things for more than two weeks, then it can be a sign they are suffering from depression.3-5

Emotional changes 

Be alert for emotional changes, such as:3-6

  • Feelings of sadness, which can include crying spells for no apparent reason
  • Frustration or feelings of anger, even over small matters
  • Feeling hopeless or empty
  • Irritable or annoyed mood
  • Loss of interest or pleasure in usual activities
  • Loss of interest in, or conflict with, family and friends
  • Low self-esteem
  • Feelings of worthlessness or guilt
  • Fixation on past failures or exaggerated self-blame or self-criticism
  • Extreme sensitivity to rejection or failure, and the need for excessive reassurance
  • Trouble thinking, concentrating, making decisions, and remembering things
  • Ongoing sense that life and the future are grim and bleak
  • Frequent thoughts of death, dying, or suicide

Behavioral changes

Watch for changes in behavior, such as: 3-6

  • Tiredness and loss of energy
  • Insomnia or sleeping too much
  • Changes in appetite – decreased appetite and weight loss, or increased cravings for food and weight gain
  • Use of alcohol or drugs
  • Agitation or restlessness – for example, pacing, handwringing, or an inability to sit still
  • Slowed thinking, speaking, or body movements
  • Frequent complaints of unexplained body aches and headaches, which can include frequent visits to the school nurse
  • Social isolation
  • Poor school performance or frequent absences from school
  • Less attention to personal hygiene or appearance
  • Angry outbursts, disruptive or risky behavior, or other acting-out behaviors
  • Self-harm – for example, cutting, burning, or excessive piercing or tattooing
  • Making a suicide plan or a suicide attempt

How You Can Help

Depression doesn't usually get better on its own – and symptoms can get worse or lead to other problems when untreated.4 

Any adult can play a critical role in determining whether a young person needs help. Try having an open discussion with the person you are concerned about. When asked directly how they are feeling or if something is bothering them, some children will say that they are unhappy or sad, while others might say they want to hurt or kill themselves or be dead. Take these statements very seriously. Depressed children and adolescents are at increased risk of self-harm, even when the signs and symptoms don't appear severe.3-5

Communication tips when talking about depression with a young person:5

  1. Communicate in a straightforward manner
  2. Speak at a level that is appropriate to a child’s or adolescent's age and development level
  3. Discuss the topic when the individual you are concerned about feels safe and comfortable
  4. Watch for reactions; slow down or back up if the child becomes confused or looks upset
  5. Listen openly and let him or her tell you about his or her feelings and worries
  6. Inquire about thoughts of suicide or self-harm in a calm, supportive manner; seek additional professional assistance and resources when these thoughts are present.

If you haven't had success in talking directly with the young person you are concerned about, then don't give up. If you think a child is depressed, then it's important to find help. You can consult with a school counselor or nurse, a child's doctor, a mental health provider, or other health-care professional. A qualified professional can refer a child to someone who can conduct a comprehensive assessment, diagnose depression, and identify the right treatments.

Treatment Helps Kids Feel Better

For a young person with symptoms of depression, treatment can help prevent more severe, lasting problems in adulthood.4 Treatment can improve the ability to cope effectively, increase self-esteem, help children develop and maintain healthy relationships, succeed in school, and feel better overall.3-5

Treatment options include psychotherapy (talk therapy), pharmacotherapy (medication), or a combination of both. A physician will recommend a specific treatment plan based on the severity of symptoms with input from the child and family.

Children and adolescents diagnosed with mild depression are usually treated with psychotherapy alone. If symptoms don't improve or get worse within six to eight weeks, then an antidepressant medication might be recommended. Young people diagnosed with moderate-to-severe depression generally require psychotherapy and one or more medications.3-5  

The bottom line is that depression is common, serious, treatable, and doesn't usually go away on its own. If you think a young person is suffering from depression, then it's important to seek help.  

Seek immediate assistance if you think a child is in danger of harming himself or herself or others. 

To learn more about depression and other mental health issues or to find support, visit:

References

  1. National Alliance on Mental Illness. What families need to know about adolescent depression. https://www.nami.org/Your-Journey/Teens-Young-Adults. [Accessed Aug. 10, 2021]
  2. Yard E, Radhakrishnan L, Ballesteros M, et al. Emergency department visits for suspected suicide attempts among persons aged 12-25 years before and during the COVID-19 pandemic — United States, January 2019-May 2021. MMWR Morb Mortal Wkly Rep 2021;70:888-894.   
  3. Bonin L. Patient education: Depression in children and adolescents (beyond the basics). https://www.uptodate.com/contents/search. [Accessed Aug. 10, 2021]
  4. National Institute of Mental Health. Child and adolescent mental health. https://www.nimh.nih.gov/health/topics/child-and-adolescent-mental-health. [Accessed Aug. 8, 2021]
  5. U.S. Department of Health & Human Services. Talk about mental health. For parents and caregivers. https://www.mentalhealth.gov/talk/parents-caregivers. [Accessed Aug. 10, 2021]
  6. Mayo Clinic. Teen Depression. https://www.mayoclinic.org/diseases-conditions/teen-depression/symptoms-causes/syc-20350985. [Accessed Aug. 10, 2021]