Children's Mental Health

Early mental health issues are highly correlated to continued mental and physical health problems. Explore the symptoms of depression in children and why it is important to screen for diabetes, siblings with developmental disabilities, and mental health issues in fathers. 

In any given year, approximately 4-5% of adolescents experience a major depressive episode which is a major risk factor for suicide which, according the World Health Organization (WHO) (2017), is the second most common cause of death among young people aged between 15 and 29. An additional 2-5% of adolescents may experience what the DSM V refers to as Disruptive mood dysregulation disorder  which is characterized by severe recurrent  verbal or behavioral outbursts which often occur as the result of frustration. This disorder was added to the DSM-5 due to doubts arising in relation to how to classify and treat children presenting with chronic persistent irritability.

Regardless of the exact diagnosis, parents, clinicians and teachers should be alert to symptoms of depression in children which can be caused by organic issues, exposure to trauma, diabetes, thyroid dysfunction, sleep deprivation, cognitive or social issues.

Symptoms include:

• Irritability or anger
• Continuous feelings of sadness and hopelessness
• Social withdrawal
• Increased sensitivity to rejection
• Changes in appetite -- either increased or decreased
• Changes in sleep -- sleeplessness or excessive sleep
• Vocal outbursts or crying
• Difficulty concentrating
• Fatigue and low energy
• Physical complaints (such as stomachaches, headaches) that don't respond to treatment
• Reduced ability to function during events and activities at home or with friends, in school, extracurricular activities, and in other hobbies or interests
• Feelings of worthlessness or guilt
• Impaired thinking or concentration
• Thoughts of death or suicide

Another issue that may contribute to depression and need to be a part of the differential diagnosis includes diabetes. Depression and diabetes have two physical similarities: hyperactivation of the HPA-Axis and increased levels of proinflammatory substances. According to the ADA Type 2 diabetes impacts approximately 9% of the US population and many people go years with the disease undiagnosed. The risk of developing type 2 diabetes increases with obesity, and lack of physical activity having first or second degree relatives with type 2 diabetes, hypertension, high cholesterol or poly cystic ovarian syndrome.   Other symptoms which may indicate diabetes include excessive fatigue, sudden increase in hunger, thirst and/or urination, slow healing sores or darkened skin especially in the armpits or neck.

Clinicians should be aware of the frequent mild or asymptomatic manifestation of type 2 diabetes mellitus in childhood and screen for diabetes risk factors, regardless of weight in order to address underlying physiological causes of symptoms.  Additionally, the presence and severity of mood disorders has been associated with the duration of the diabetes and development of complications such as painful peripheral neuropathy which can often be minimized with early, effective intervention.

Social factors such as family issues, socioeconomic status, parental education and parental mental health also are risk factors for depression in children and adolescents. 

Many studies have shown that lower socioeconomic status is correlated with an increased risk of the development of a mental health disorder in children.  The current study found that parental education and the number of stressful life situations were the biggest significant predictors of the persistence and severity of children’s mental health problems.  Preventative activities include educating parents in how to access resources, advanced problem solving skills and enhancing self-efficacy.

One family issue which may contribute to the development of depression is having a sibling with a developmental disability. Siblings of children who have a developmental disability experience higher odds of a depression or other mental health diagnosis regardless of family income level. Clinicians should educate families about the impact of having a child with a physical or mental developmental disorder on siblings and effective skills to prevent the non-DD sibling from developing a mental health disorder and should regularly inquire with the caregivers about the presence of any behavioral changes in the non-DD siblings.  

Another factor is the mental health of the caregivers. In one recent study it was found that children whose fathers had poor physical or mental health overall health were approximately 3 times more likely to have poor physical or mental health which provides robust support of the importance of the physical and mental health of fathers in the prevention of mental and physical health issues in children. Unfortunately, in many cultures, men’s mental health issues are vastly underdiagnosed as a result of stigma associated with diagnoses like depression and anxiety and a different presentation of these disorders in men than women. Symptoms of depression and anxiety in men may be very different than that seen in women, tending more toward irritability, aggression, withdrawal, physical complaints and substance use.

Caregivers should regularly be screened for depression and anxiety and provided resources to assist them in coping with adversity and increasing resilience. When children are brought in with symptoms of a mental health issue, it is also important to screen for the presence of strengths and/or mental health issues in the home environment which may impact the effectiveness of treatment.