From the May 2019 issue

Depression in Kids: Identifying and Treating This Mental Health Issue

Clinical depression in kids and adolescents is rising, along with correlated suicides. Here's how to spot this often-hidden mood disorder – and help kids.

A sad small boy surrounded by vines
Illustration by Lainey Yehl

Editor’s note: This report on depression in kids is part II of III in a series on mental illness in kids. Read about anxiety in kids, and watch for a forthcoming report on ADHD.

“High school was probably the lowest point of my life,” says Joshaunna Belkiewicz, who went to Avondale High School in Auburn Hills. Diagnosed with bipolar disorder at the age of 9, Belkiewicz struggled to cope with what felt like overwhelming feelings of sadness, at times leading her to self-harm and thoughts of suicide.

“What went through my head is that my family doesn’t really need me, and they’ll be better off without me,” Belkiewicz says. “I felt hopeless, so suicide seemed like the only logical thing to do.”

Through therapy and medication, Belkiewicz, now in her 20s, learned how to navigate her sadness and express her needs to others. She now draws on those experiences as she works with youth going through similar thoughts and emotions – including clinical depression – and helps to teach them coping skills as a youth peer support specialist with Easterseals Michigan.

Belkiewicz is not alone. In Michigan, about 37 percent of high schoolers reported thoughts of sadness or hopelessness lasting daily for two weeks, according to data from the Centers for Disease Control and Prevention’s Youth Risk Behavior Survey (in Detroit, the figure was 34 percent).

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And around 21 percent had seriously considered suicide in the previous year – up from about 15 percent a decade prior. Recent research also shows girls are twice as likely to experience it as boys.

When it comes to any mental illness, but especially depression, mental health experts agree that education and awareness are key to guiding children and teens to the support and help they need.

It’s a vital lesson as the mood disorder grows more prevalent.

The odds an adolescent will have clinical depression grew by 37 percent between 2005 and 2014, notes a recent study out of Johns Hopkins Bloomberg School of Public Health. Currently, 3 percent of children and 8 percent of adolescents have been diagnosed, the American Academy of Pediatrics adds – and the chance it will persist lifelong is “significantly higher at 18-20 percent.”

But even kids who arediagnosed aren’t always getting the help they need, notes a University of Michigan report released in early 2019. It found about half of all U.S. kids diagnosed with the three most common, and treatable, mental health disorders – anxiety, depression and ADHD – weren’t receiving treatment. Here in Michigan, that number is 40 percent, or an estimated 100,000 kids.

When it comes to depression in kids, vigilance is crucial, both in detecting the condition and treating it.

Signs of depression in kids

While depression may hide under many layers, it also gives hints. And those clues can look different for different ages, for younger kids versus tweens and teens.

In general, mental health professionals diagnose children (and adults, for that matter) through identifying how many common symptoms of depression they’ve been experiencing and for how long.

With younger children, the symptoms can be especially difficult to pinpoint, as kids may not be able to verbalize, or even understand, their feelings. Judith Malinowski, clinical supervisor at Ascension Eastwood Behavioral Health in Novi, explains some common signs.

“In younger children, they may have difficulty falling asleep or staying asleep. They may have changes in their appetite, moodiness, outbursts of anger, become easily frustrated, they may become somewhat withdrawn or have a lack of energy or lack of engagement.”

Parents can look for these symptoms along with an overall shift in behavior. “As (kids) get into the school age, it’s usually a very stable time – they like to engage, they like to do a lot of things, they’re generally positive.”

However, if your school-aged child seems to have an overall negative view, he or she may be experiencing depression. Additionally, younger kids may have physical symptoms, like stomachaches or headaches.

As children get older, the symptoms become more closely aligned with those of adults. For example, tweens and teens may express feeling depressed or sad and may even talk about feeling worthless. No matter your child’s age, Neera Ghaziuddin, M.D., a child and adolescent psychiatrist at University of Michigan C.S. Mott Children’s Hospital, says the key is the seriousness of the symptoms, and their persistence.

“Both the duration and the severity should be kept in mind by the parent. If the child looks a little unhappy and that clearly seems to be related to a friend moving away or something specific, then it’s probably not cause for concern.”

Depression doesn’t always look sad, Ghaziuddinj adds.Even children that seemingly have everything going for them are at risk. For example, adolescents with significant depression can “perk up” when they’re with their friends, leading parents to think everything is fine

If your child has had bouts of depression for more than two weeks, or if you have any concerns about his or her mental health, contact your child’s health care provider.

If the symptoms continue and affect the child to the point that it’s impacting his or her life, seeking expert help is important, Ghaziuddinj. And anyexpressions of suicide or not wanting to be alive must be taken seriously, and parents should contact a mental health professional for support.

Depression isn’t a phase

Jalen Mims was diagnosed with depression at age 12 after the death of his father. Mims found his thoughts revolved in a loop of negative emotions – he wasn’t good enough; no one wanted to be around him.

“I felt all alone,” says Mims, who, like Belkiewicz, is a youth peer support specialist with Easterseals Michigan (these specialists receive training and ongoing education through a state-run program). “The thoughts in my head were like having a bad best friend. It didn’t feel like things would ever work out, and if anything went wrong, it felt like it was my fault.” Mims worked through a variety of therapy programs to overcome his negative self-talk. 

Mims still recalls trying to mask his emotions from friends and family – something he’s also seen in the youth he works with. It’s no wonder separating out potential signs of depression from typical teenage behavior isn’t easy, yet parents need to understand that depression isn’t something that will just go away on its own or that kids and teens will simply grow out of.

“As parents, we talk about phases,” notes Malinowski. “Depression is not a phase. Depression is a symptom of a deeper, psychological problem that needs to be addressed. Most people don’t grow out of it; they grow deeper into it.” 

While depression does run in families, it can have a variety of causes including triggers like abuse, loss, bullying, social media use and any number of other life events.

“Chronic stress and unresolved trauma also seems to have a strong correlation with depression,” says Uriel Stephens, director of family services at Easterseals Michigan. “One of the things we find is that high achievers can often be overlooked, yet they may be experiencing depression.”

Depression often occurs alongside other mental health disorders, too.

Treatment and support for depression in kids

Jocelyn McCrae, a clinical psychologist at Children’s Hospital of Michigan in Detroit, notes that when assessing children and teens for depression, mental health professionals go through an extensive evaluation with them. If they are diagnosed, treatment will be customized for the child’s needs.

“Many times parents are concerned that a child will be put on medication and that they’ll come out looking like a ‘zombie,'” says McCrae, who points out that a variety of therapy options are available. 

There’s also an elevated, though rare, risk that kids on antidepressants may experience suicidal thoughts – a warning that’s clearly labeled. While experts aren’t in a rush to prescribe these medications to kids, they can be very helpful in certain cases.

McCrae adds that doctors work with the children and families to understand what might be the most beneficial, including individual, family and group therapy.

Indeed, depression affects more than just your child – it affects the whole family, which is why additional support services that address the needs of the family are critical. Besides your health care provider, your child’s school can point you to resources, or you might contact Easterseals Michigan or the National Alliance on Mental Illness (NAMI), a grassroots organization dedicated to family support.

Kevin Fischer, NAMI Michigan’s executive director, has witnessed the benefit of connecting directly with other families who have walked the same road.

“I would say to any parent that the big barrier (to seeking care) is the stigma of mental illness, and then, in seeking help, parents aren’t comfortable explaining themselves, having to say, ‘I have a child who’s living with depression,'” he says. “They don’t even know how to articulate it. But when you walk into (a NAMI support group) the people who are there, they understand. You feel like, ‘I’m in the right place. They’ve been where I am.'”

His advice is that it’s never too soon to seek help. “If you have a cold for more than a few days, you’d go and see a doctor, right? With mental illness, it shouldn’t be any different.”

Ultimately, each of the experts Metro Parent spoke with encouraged parents to talk to their kids about how they’re feeling as a first step – and also ask if they’ve had thoughts of suicide. While this is a difficult conversation, it can help you tap into what your child is feeling and it can help your child feel validated and heard.

That was part of the process for both Joshaunna Belkiewicz and Jalen Mims – who’ve managed their depression-related challenges and now help their peers do the same.

“One thing Jo always expresses is that we’re that light at the end of the tunnel. Real change is possible,” Mims says. “We’ve made it through, we’re doing well, there is hope.” 

5 ways to talk to kids about depression

Several mental health experts in the metro Detroit area offer advice on broaching a difficult – but crucial – talk about depression and suicide.

  1. Start early. “As a community, we tend to be reactive, instead of being proactive in having these conversations with our kids,” says Terry McLaughlin, Easterseals Michigan youth peer support specialist supervisor. “Certainly 25 years ago it would seem like it was too early to start talking to 9- or 10-year-olds about suicide, but today that’s not too young.” 
  2. Be honest about your concerns. “Honesty is always good,” says Neera Ghaziuddin, M.D., a child and adolescent psychiatrist at the U-M C.S. Mott Children’s Hospital. With younger children, she suggests starting with, “Hey, I’m worried about you, you don’t look so well” – “anything to draw out a conversation.” Adolescents may be reluctant and see questions as a criticism, as opposed to genuine concern. Try, “Hey, we should go talk to someone about this; it would help me to understand what you’re going through.” 
  3. Encourage your child to talk to a trusted friend. “I encouraged my (sons) that if they didn’t feel comfortable coming to me that they could to talk to their friends’ parents,” says Judith Malinowski of Ascension Eastwood Behavioral Health in Novi. “If your children don’t feel comfortable talking to you, don’t take it personally. Our children can get in a place of wanting to protect us from something that’s going on.” 
  4. Ask them how their friends are doing.“There’s a myth that if you talk to your children about suicide, you might be encouraging it,” says Uriel Stephens, director of kids behavioral health for programs offered through Easterseals Michigan. That’s simply not true; kids are hearing about suicide from social media, school hallways or their friends. Ask your child about his or her friends, Stephens says, and if they have any concerns about them. That can help turn the conversation to your child’s thoughts and feelings, too.
  5. Let them know they won’t get in trouble for expressing their feelings. “Sit down and have a heart-to-heart with them,” says Jocelyn McCrae, a clinical psychologist at Children’s Hospital of Michigan. Discuss as you feel you need to; this is not a one-and-done conversation. And make sure to let kids know they won’t be punished. “Sometimes they can feel like they’re going to get in trouble for saying what they’re thinking,” McCrae says. “Sit down and have a heart-to-heart with them,” says Jocelyn McCrae, a clinical psychologist at Children’s Hospital of Michigan. Discuss as you feel you need to; this is not a one-and-done conversation. And make sure to let kids know they won’t be punished. “Sometimes they can feel like they’re going to get in trouble for saying what they’re thinking,” McCrae says.

Note: If you have any concerns that your child may have depression, you should see a qualified mental health professional for evaluation. Learn more about depression in parents, too.

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