Children are associated with happiness-games, toys, playful laughter and not having a care in the world. Yet, says child and adolescent psychiatrist Dr Jacqueline Sharpe, international averages show that five per cent of children in the general population at any given time suffer from depression, a mental disorder characterised in part by sadness and a loss of self-worth.
Depression: A Global Crisis is the theme for this year's World Health Organization (WHO) World Mental Health Day (celebrated on October 10). Depression is the leading cause of disability worldwide and WHO estimates that over 350 million people of all ages suffer from depression globally.
Sharpe said she was not aware of any studies on the prevalence of depression among children and adolescents locally, but she estimates the local rate may be similar to or slightly higher than international estimates. "Children who are under stress, for instance children living in situations of chronic domestic violence or situations of community stress where interpersonal violence is prevalent, comes to mind. Kids who have attention, learning, conduct or anxiety disorders and children who experience loss are all at risk for depression. "All of these situations exist for children here," said Sharpe.
A recent AP article said the rate of mental-health disorders among children in countries still affected by the 2008 global financial crisis is increasing although many children remain untreated due to a lack of diagnosis. Contributing factors to their depression included stress from a decrease in family income and housing problems. Pressure to excel academically can also contribute to the onset of depression, which can affect children as young as seven or eight, said Sharpe. "Severe stress increases the risk for depression in individuals, including children. So if this pressure (in school) constitutes a severe stress for an individual child, then the risk for depression is increased."
Sharpe said childhood or adolescent depression was a "real illness" requiring the same professional diagnosis and treatment that adult depression does. She said treatment can include individual psychotherapy, family therapy and antidepressant medication in some cases. Children living in the East-West Corridor and central Trinidad can access these treatments at the North West Regional Health Authority. The South West Regional Health Authority provides for southern patients and the Tobago authority operates one child psychiatric clinic in Scarborough.
Many referrals to Child Guidance come from the Ministry of Education's Student Support branch under which guidance counsellors and social workers fall. However, teachers are not trained to recognise signs of depression and other mental-health disorders, according to a former guidance officer in Port-of-Spain. The retired officer also said Student Support was critically understaffed.
WHO says access to treatment is a global problem, with less than ten per cent of those suffering from depression receiving proper care in some countries. Sharpe agreed: "WHO estimates of mental health coverage speak to the fact that facilities for mental health generally and child mental health even more so are inadequate worldwide and this applies to Trinidad and Tobago as well."
Suicide
Depressed adolescents are also at a heightened risk for suicide according to Sharpe. Since September 2011 there have been three suicides by teenagers between 12 and 19. Whether or not these suicides represent an increase in suicide deaths or depression among adolescents, Sharpe could not say. "The death by suicide of any child is something to be concerned about. A youngster who says that she or he wants to kill her or himself or who gives verbal hints, like, 'I won't be seeing you much longer,' 'I won't be here to bother you any more,' should be taken seriously and professional mental healthcare should be sought."
Thoughts of suicide were very real for Grace Holiday (not her real name) who was diagnosed with bipolar disorder at 15. Holiday, 24, who lived in the US at the time, saw both child psychologists and psychiatrists (both psychologists and psychiatrists provide therapy but only psychiatrists can prescribe medicine as part of treatment). "My aunt, who was a nurse, felt that I was not behaving normally for a child my age. I was always tired, always sleeping, never eating and spent most of my time alone and asleep," she said. "Being bipolar means I am depressed intermittently. I have major highs and sinking lows. It's like a literal mental and emotional roller coaster."
Since returning to T&T three years ago, however, Holiday has been unable to follow up with treatment. "The fact is the (public) health system isn't the most dependable. I planned to continue treatment here but seeing a psychologist is expensive and I can't afford it." Holiday has also had to deal with a general lack of empathy about her condition. "I have told a few people in T&T that I have bipolar disorder, and I don't think there is much of a stigma. But I do think not many people understand mental illnesses. They seem to think it's a Caucasian thing, or tell me that I need to pray more, or I have too much time on my hands. They don't get the reality of the situation-which is that I am sick."
Depression facts
Depression is a common mental disorder, characterised by sadness, loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep or appetite, feelings of tiredness, and poor concentration. Depression is a common illness worldwide, with an estimated 350 million people affected. Depression is different from usual mood fluctuations and short-lived emotional responses to challenges in everyday life. Especially when long-lasting and with moderate or severe intensity, depression may become a serious health condition. It can cause the affected person to suffer greatly and function poorly at work, at school and in the family. At its worst, depression can lead to suicide. Suicide results in an estimated one million deaths every year. -Info from the World Health Organization
