Mental illnesses in children are so complex that health-care professionals can not always detect them (Kalb & Raymond, 2003). Symptoms for mental disorders can be so nonspecific, that even parents cannot tell if the child is being rambunctious or seriously ill. Children with depressive disorders lack interest in activities that they previously enjoyed, criticize themselves, pessimistic and hopeless about the future. They tend to have lack of energy, have problems at school, have trouble sleeping, may have stomach aches and headaches (Hazell, 2002). Depressed kids do not look like depressed adults: they are often irritable, rather than sad and withdrawn. Depressed kids showed less pleasure in play and some explored themes of death (Kalb & Raymond, 2003). It was found that bipolar disorder, an ongoing cycle of depression and mania, can easily be confused with attention deficit hyperactivity disorder. It was observed that bipolar kids are more prone to elated moods, grandiose thoughts and daredevil acts. They also have more rapid periods of depression and mania.
What Causes Depression in Children
Models of VulnerabilityCognitive Theory of Depression. According to cognitive theory, thinking negatively greatly affected the likelihood of developing a depression and maintaining it during stressful events in a person's life. Individuals who think negatively are more vulnerable towards depression because they perceive the environment, their future and themselves in a negative, depressive context. This negative way of thinking guides child's or adult's perception, interpretation, and memory of personally relevant experiences, thereby resulting in a negatively biased construal of their personal world, and ultimately, the development of depressive symptoms (Beck, 1967).
Parent x Child Model of Socialization. Parent x Child Model of Socialization is another model used by clinicians. The model was applied to development of depressive symptoms. It was expected that when parents used intrusive support frequently, children engaging in negative self-evaluative processes would be more vulnerable to depressive symptoms that children engaging in positive self-evaluative processes (Pomerantz, 2001). The results of the study performed on the model suggest that both parents and children contribute to the development of depressive symptoms. Parents use of control with children had been identified as a central dimension of socialization model. Two forms of control are: psychological - parents attempt to oversee and regulate children's psychological and emotional development through constraining verbal expression and invalidating feelings; and behavioral--parents try to regulate children's behavior by using limit setting and positive reinforcement (Pomerantz, 2001). Psychological control appears to have negative consequences for children because it communicates to them that they are incompetent and intrudes their individuality. Behavioral control causes positive consequences because it provides guidance in meeting standards and shows support of the parents (Pomerantz, 2001). The term intrusive support, used in the study, identifies with those two forms of control and yet it is defined as monitoring and helping children when they do not request help. The study was done to investigate the hypothesis that when parents frequently used intrusive support, children engaging in negative self-evaluative processes would be more vulnerable to depressive symptoms than would children engaging in positive self-evaluative processes (Pomerantz, 2001). The results showd that hypothesis was right to assume. The findings also showed the importance of use of the model for studying of the depression disorder and relevance of the model to the current research in the area of depression.
Tripartite Model of Depression and Anxiety The Tripartite Model of Depression and Anxiety was developed by L. A. Clark and D. Watson (1991). They theorized that depression is specifically characterized by anhedonia or low positive effect (PA), anxiety is specifically characterized by physiological hyperarousal (PH), and general negative affect (NA) is a non specific factor that relates to both depression and anxiety (Joiner & Lonigan, 2000). The study was performed to examine whether the model could discriminate youth with depressive disorders from youth with externalizing symptoms. The results found corroborated the hypothesis. It was shown that the model can be used to differentiate between the depressive conditions from anxious syndromes (Joiner & Lonigan, 2000). The model that represented anxiety (NA), depression (PA) and fear (PH) as distinct factors provided best fit for data from the child and parent report for 216 clinically anxious children. Results supported the expected pattern of relations of NA and PA with current symptoms of depression and anxiety in a community sample. NA was significantly associated with symptoms of both depression and anxiety, whereas PA was mostly strongly associated with symptoms of depression. Thus, the model was shown to be a useful tool for differentiation between anxiety and depression symptoms in children. Children with a depressive disorder diagnosis may be identified by using the factors of the tripartite model (Joiner & Lonigan, 2000). Specifically, children with a depressive disorder were distinguishable from other youth psychiatric patients on the basis of low PA and high NA. Low PA was found to distinguish inpatient children with depression from those with anxiety (Joiner & Lonigan, 2000).
StressorsStressors in everyday life take place and affect an individual's emotional state. Such stressors as school problems, problems with peers, family , loses, medical illness affect children. Stressors lead to feelings such as sadness, crabbiness, being bored, and not enjoying anything; lead to behaviors such as withdrawal, decreased activity, irritability with others; and lead to thoughts such as pessimism, negativity, low self-esteem, and hopelessness. All the factors come together to evolve into clinical depression with physical problems: trouble sleeping, poor concentration, low energy, agitation and appetite problems. Clinical depression may go a step further to evolve into more severe depression and depletion of brain chemicals (Asarnow, Jacox, & Tompson, 2001).
Family Instability. Certain types of family organizations are closely related to the development and maintenance of symptoms in children. According to family systems theory, when the married couple has conflict and can not solve it in a constructive way, they are likely to involve their children in the conflict to release some anxiety and tension between them (Wang & Crane, 2001). Child is physiologically vulnerable to everything going on between his parents. Tension and conflict in the family induces emotional arousal in the child, triggering physiological and psychological responses (Wang & Crane, 2001). The results of the study conducted in investigation of the relationship between parents' marital stability, triangulation and the level of depression in children showed that children of marital dissatisfied fathers were more likely to have depressive symptoms than those of dissatisfied mothers. When fathers felt unstable in the marriage and, experienced triangulation in their families at the same time, their children were likely to have depressive symptoms. When fathers felt stable but unsatisfied in their marriage, their children were also more prone to develop depressive symptoms. The finding that the mothers' scores do not affect children as the fathers' do was consistent with the results found in that other studies comparing fathers' and mother's influences on children (Wang & Crane, 2001). It may be explained by the roles in the family in bringing up children and taking care of the family financially, and by the difference of gender in solving a marital conflict. Mothers are often thought of as primary care-takers of the family, fathers are the providers. It is quite common to believe that mothers are more emotionally involved with their children and more emotionally available to them. They consciously separate their roles as mothers and wives, and therefore the independence between roles takes place. When men feel dissatisfied and unstable in their marriage, they may concentrate their energy on the outside of their family, on their friends and society and abandon their role as providers. There is evidence that intense marital conflict is related to a husband's withdrawal during conflict interaction (Wang & Crane, 2001). When man withdraws from a unstable marriage, he withdraws from the mother and the child at the same time, his role as a father is greatly affected by the level of marital satisfaction. Men are also more likely to express an unusual overt behavior such as being aggressive, angry, argumentative, unaffectionate and withdrawn. Women on the other hand, will tend to be more internally hurt, more likely to have depression. Thus, for a child it is easier to identify their father's over behavior and be disturbed by it, rather that their mothers depressive symptoms, such as being sad and crying. When mothers experience marital instability, they become more involved with their children than previously (Wang & Crane, 2001).
Depressed Parents. The study mentioned above, also leads to a theory that depressed children are more likely to live with depressed parents. In single parent families the stress is always present because of the family situation. One parent performs dual roles for the child and that is stressful for both of them. The single mother is a provider for the family and also a care-taker. But the first role is of primary concern because that rile was not her role originally, that is why the mother has to work harder at it. At that time the second role of the mother as a care-taker is partially abandon because of the lack of time left to spend with a child. The mother may express overt changes in behavior, such as anger and frustration, to show hew feelings of helplessness. In this case the child can sense the depression and unhappiness of the mother because there is no father figure to be more influential than the mother.
How We Can Help
Treatment of Depression in ChildrenCognitive Therapy. Once the depression disorder is diagnosed there are several ways to approach the treatment. Cognitive behavioral therapy is one therapy most used for treating depression. Treatment consists of identifying copying strategies for kids and their parents. The therapist helps kids to identify cognitive distortions. Beck's (1967, 1976) cognitive theory suggests that depressed children's negative self-perceptions reflect cognitive distortions about the self and about the environment. Cognitive theories assume that errors in depressive judgment result form negative bias introduced by the negative self schemas of depressed persons (Johnson & DiLorenzo, 1998). Aaron T. Beck and his colleagues initially developed cognitive therapy as treatment for depression. Cognitive behavioral treatment or CBT of depression involves the application of specific strategies directed at the following three domains: cognition, behavior and physiology (McGinn, 2000). In the cognitive domain, patients are taught to correct their negative thinking. In behavioral domain, patients learn activity scheduling, social skills and assertiveness. In physiological domain patients are taught relaxation techniques, meditation and pleasant imagery to calm themselves. Numerous studies conducted showed that cognitive therapy was more effective that tricyclic antidepressant therapy (McGinn, 2000).
Family Therapy. Numerous studies have shown the importance and effectiveness of family intervention, family participation in the treatment, parents' demonstration of positive control over the child, and lower stress level within the family. Five negative outcomes have been shown to appear if the family is not participating in the intervention (Asarnow, Jaycox, & Tompson, 2001). First, among children with depression, greater family stress has been found to be associated with a longer initial episode and lower social competence at 3-year follow up. Second, depressed children whose homes were characterized by high levels of parental criticism or emotional overinvolvement demonstrated significantly lower recovery rates at the end of the first year after hospitalization than did children whose parents scored low on those variables. Third, during depressive episodes, children demonstrate more negative and guilt-inducing behavior in laboratory-based family interactional tasks when compared to nondepressed psychiatric and control participants, underscoring the high level of stress experienced by families of depressed children. Fourth, maternal and child depressive symptoms may be temporarily linked such that symptoms in one member of the dyad potentiate symptoms in the other. Fifth, although studies of depressed adults indicate strong family histories of depression in the first degree relatives, familial loading appears to be even more substantial in children and adolescents with major depression. Parental depression, conflict in the family, criticism of a child, dysfunction, family stress contribute to child depression which in turn also fuels family stress and dysfunction. A therapist works with both the parents and the child to identify the negative thoughts and behaviors influencing depression of both and tries to turn those into a positive influence to correct the disorders.
There is emerging support for the value of psychoeducational family programs. The sessions are taught by the professionals in the field of depression greatly increase awareness and knowledge of parents in the area of child depression. The parents are taught to identify the symptoms, how to approach a depressed child, how to help him, information about mood disorders, interpersonal skills, stress reduction, medication and medication side effects. The effect of various stressor in a child's life is also examined in the context of different environments such as school, home, community. Participants of the programs get to meet other parents and their children to discuss common issues such as symptoms, social skills, approaches to accepting depression disorder. Other therapeutic strategies include a non blaming reforming of the goals of treatment from a focus on the child's symptoms to a focus on the quality of parent-child relationships, building alliances between the therapist and both parents and child, promoting attachment between the parents and the child, and competencies within the child.
Medications. Use of different antidepressants such as clomipramine, tricyclic antidepressants (amitriptyline, desipramine, notriptyline), selective serotonin inhibitors (Prozac, Zoloft, Lexapro) showed a reduction in depression for certain children. Mood stabilizers and possibly antipsychotic or anticonvulsant drugs have been also used successfully (Kalb & Raymond, 2003). In the study exploring the effectiveness of antidepressants in treating depression it was found that fluoxetine was superior to a placebo in the acute phase of major depressive disorder in child and adolescent outpatients with severe, persistent depression. After 5 week follow up with the outpatients the superiority of fluoxetine was not seen. There were no significant differences between patients in both placebo and fluoxetine groups on measures of general psychiatric symptoms, global functioning or self-reported depressive symptom measurements (Moldenhauer & Melnyk, 1999). In the second study performed to evaluate tricyclic antidepressant amitriptyline, it was found that there were no significant differences between the control and measurement groups, so there was no evidence recorded that tricyclic antidepressant amitriptyline is effective to use in treatment for depression (Moldenhauer & Melnyk, 1999). The findings suggest that there are no an effective antidepressant to treat depression successfully. Different depressed children respond differently to various antidepressants and some may get better and some may not. It is very common for clinicians to prescribe serotonin selective reuptake inhibitors or SSRIs such as fluoxetine, sertraline, paroxetine, fluvoxamine rather than tricyclic antidepressants such as amytriptyline, imipramine, desipramine, due to better tolerance and fewer side effects (Moldenhauer & Melnyk, 1999). Ultimately, depression is a prevalent mental disorder in children and adolescents that requires a comprehensive, multidisciplinary treatment plan to prevent its persistence or reoccurrence into adulthood. If prescribed, antidepressants should always be used in combination with other treatment strategies such as cognitive-behavioral therapy, family intervention, family education and various prevention strategies (Moldenhauer & Melnyk, 1999).
In children and adolescents, the recurrence rate of depressive episodes first occurring in childhood or adolescence is 70 percent by five years, which is similar to the recurrence rate in adults. Young people experiencing a moderate to severe depression may be more likely to have a manic episode in their adulthood (Hazel, 2003). Bottom line is that children with symptoms of depression are likely to develop depression in the adulthood if not treated, than children without the symptoms.
Prevention of Depression in ChildrenAccording to the models of depression, the same skills that would reduce depression could be used to inoculate children against it. Prevention of depression includes early detection of the symptoms and immediate treatment. One of the studies done by Jaycox, Reivich, Gillham and Seligman in 1994 on the children at risk for depression by virtue of subthreshold depressive symptoms or a high degree of family conflict at home. Immediately after treatment the 69 treated children showed lower levels of depressive symptoms and better classroom behavior compared to 73 children in the nontreated condition (Asarnow, Jaycox, & Tompson, 2001). Moreover, the treated children continued to report fewer depressive symptoms at a 2-year follow-up assessment, with the number of treated children who reported symptoms of depression in the moderate to severe range reduced by one-half (Asarnow, Jaycox, & Tompson, 2001). Another approach to prevent depression in children was tested by Beardslee in 1992, who identified the children at high risk for depression as having a parent with a serious mood disorder. The psychoeducational session was attended by the parent and the child and was aimed on helping parents to convey to their children an understanding of the parent's mood disorder, and assisting the child in identifying questions and concerns for the parent to address (Beardslee, Gladstone, Wright, Cooper, 2003). Compared to the participants in the control group with lecture to the parents only, parents in psychoeducational session reported greater satisfaction, more behavior and attitude changes, increased understanding of disorder by the child, improved communication between the parent and the child (Beardslee, Gladstone, Wright, & Cooper, 2003).
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Interesting Research Paper Topics On Depression: Expert Choice
The study of the human behavior involves a lot of investigation and a complex research to understand why or how actions affect the totality of an individual. There are some challenges along the way because the outcome or result of the study must be based not only on medical history but also on social and economic factors. To get a glimpse of some interesting research paper topics on depression, check this site.
Here are a few recommended topics to consider:
- Personality crisis as the main factor in aggravating adolescent depression
- The causes of depression as a result of parental neglect
- The outcome of a broken family to the life of a teenager
- The role of academic stress to depression
- Peer pressure and social anxiety as contributory factors to depression
- The result of romantic or love problems leading to depression
- A comparison of the levels of depression in adolescents and adults
- The role of the individual’s traumatic experience to depression
- Divorce and legal separation as factors in causing depression among children
- Hereditary factors contributory to depression
- Depression caused by financial or economic struggle
- Depression as an outcome of physical abuse
- Depression as a result of emotional abuse
- The outcome of psychological abuse leading to depression
- Depression as a result of physical and emotional neglect
- The role of low self-esteem to depression
- Depression as an outcome to feelings of different struggles and helplessness
- Identifying the early signs of depression among teenage boys and girls
- A study on how teenagers cope up with their problems at home
- The role of the school in coping with stress among teenagers
- The role of school officials and education stakeholders in solving depression
- A comparison on how teenagers and adults react to the medical intervention in treating depression.
- A comparison in the treatment of depression between older and younger teenagers
- The government’s failure in solving economic and social problems in the community which leads to mental health problems among its constituents
- The issue of mental health problems among prisoners or correctional inmates
- A study on how prepared is the government to solve mental health issues like depression
- An investigative study on how public and private medical institutions intervene with mental health problems in their areas of responsibility
- An examination of the impact of domestic violence on women experiencing different levels of depression.
There are a lot of solutions in solving depression. Some may cope up easily with minor problems in life, but others don’t have the ability to cope up with stress easily, which leads to this unfortunate situation. The best treatment is not found in medicines, nor with doctors and experts in mental health. It is only you who can do something about it.