A 13-year-old from Pune tried to slash her wrist. In sessions with a psychiatrist, she revealed that she felt left out as girls in her peer group had begun menstruating except her. “To start with, we had to make her aware about menstrual cycles,” says Pune-based child and adolescent psychiatrist Bhooshan Shukla. “We told her that some girls have a delayed cycle, others experience it early.” She was so pressured to fit in with her friends, share their experiences, that it began to upset her. “She had been experiencing a very low mood for six months and eventually she started harming herself. That’s when the alarm bell rang for her parents.” She has now commenced a course of antidepressants and counselling, but her case demonstrates how social pressure can push children as young as 12 and 13 into clinical depression.
A recent UK study covering more than 10,000 children born in 2000–01 showed that 24% of girls and 9% of boys showed signs of depression at age 14. While there is no specific data from India, WHO says that worldwide, 10–20% of children and adolescents experience mental disorders. Half of all mental illnesses begin by age 14 and three-quarters by the mid-20s.
Social pressure, information children aren’t ready for — via WhatsApp groups and other online channels — or even too much time alone all play a role, doctors say. “About a decade ago, we did not see so many children at a very young age showing signs of depression,” says Dr. Shukla, who has been practising since 1999. “But now it is not unusual to get a child even 10 years and slightly younger.” He says he gets at least one patient aged 10 or less every week.
Difficult to gauge
“It is very difficult to gauge the trigger when the signs set in,” says Rajendra Barve, a psychiatrist in Mumbai, “But one has to deal with it with a lot of empathy. Often, refusal to go to school is seen as child being lazy, falling academic performance is seen as the child being ignorant, a bout of anger is seen as being difficult. But, often, there is more to it than what parents see.” Dr. Barve mentions a 12-year-old who suddenly began phoning his mother multiple times a day. It turned out that the mother had escaped the 26/11 terror attack at CST station, but the feeling that she could have been hurt had made a deep impression in the child’s mind. “He couldn’t express much, but he began calling her repeatedly, asking if she was doing alright.” Then, when the first anniversary of the attacks came around and people talked about them again, the boy spent the day crying, and did not go to school. “That is when the parent’s figured out that something was amiss.” The boy was put on medication for three months, plus continuous counselling; his parents too had to be counselled on changing their attitude with him.
Often, an underlying and undiagnosed condition — for example, a learning disability, Attention Deficit Hyperactivity Disorder, Attention Deficit Disorder — may trigger depression. Dr. Barve had a 14 year old patient who stopped going to school for three months. “We found he had a learning disability and it was difficult for him to cope in school. He could manage till Class VIII, but in Class IX, as the academic pressure increased, he began giving up.” The boy was referred to a developmental psychologist in addition to medication for the significant depression he was diagnosed with.
Dr. Sagar Mundhada, from KEM Hospital, says that a family history of depression is another warning sign, Also, “a shortage of serotonin, the chemical in the brain that regulates happiness and mood, may often be the reason in children.”
