In children, signs of depression include excess sleep, avoidance, the creation of headaches and stomach aches to avoid activities, excess eating and a decrease in the enjoyment of pleasurable activities. Seek a family physician or therapist if a child shows signs of depression with help from a psychotherapist and licensed mental health counselor in this free video on depression.

Each teenager is an individual with a unique personality and special interests, likes and dislikes. In general, there is a series of developmental tasks that everyone faces during the adolescent years. A teenager’s development can be divided into three stages – early, middle and late adolescence. The normal feelings and behaviors of adolescents for each stage are described below:
EARLY (12 – 14 years) MOVEMENT TOWARD INDEPENDENCE

Struggle with sense of identity
Moodiness
Improved abilities to use speech to express oneself
More likely to express feelings by action than by words
Close friendships gain importance
Less affection shown to parents, with occasional rudeness
Realization that parents are not perfect; identification of their faults
Search for new people to love in addition to parents
Tendency to return to childish behavior, fought off by excessive activity
Peer group influences interests and clothing styles

CAREER INTERESTS

Mostly interested in present and near future
Greater ability to work SEXUALITY
Girls ahead of boys
Same-sex friends and group activities
Shyness, blushing and modesty
Show-off qualities
Greater interest in privacy
Experimentation with body (masturbation)
Worries about being normal

ETHICS AND SELF-DIRECTION Rule and limit testing Occasional experimentation with cigarettes, drugs and alcohol Capacity for abstract thought

MIDDLE ( 14 – 17 years) MOVEMENT TOWARD INDEPENDENCE

Self-involvement, alternating between unrealistically high expectations and poor self-concept
Complaints that parents interfere with independence
Extremely concerned with appearance and with one’s body
Feelings of strangeness about one’s self and body
Lowered opinion of parents, withdrawal of emotions from them
Effort to make new friends
Strong emphasis of the peer group with the group identity of selectivity, superiority and competitiveness
Periods of sadness as the psychological loss of parents takes place
Examination of inner experiences, which mat include writing a dairy
CAREER INTERESTS

Intellectual interests gain importance
Some sexual and aggressive energies directed into creative and career interests

SEXUALITY

Concerns about sexual attractiveness
Frequently changing relationships
Movement towards heterosexuality with fears of homosexuality
Tenderness and fears shown towards opposite sex
Feelings of love and passion

ETHICS AND SELF-DIRECTION

Development of ideals and selection of role models
More consistent evidence of conscience
Greater capacity for setting goals
Interest in moral reasoning

LATE (17 – 19 YEARS)

MOVEMENT TOWARD INDEPENDENCE

Firmer identity
Ability to delay gratification
Ability to think ideas through Ability to express feelings in words
More developed sense of humor
Stable interests
Greater emotional stability
Ability to make independent decisions
Ability to compromise
Pride in one’s work
Self-reliance
Greater concern for others

CAREER INTERESTS

Higher level of concern for the future
Thoughts about one’s role in life

SEXUALITY

Concerned with serious relationships
Clear sexual identity
Capacities for tender and sensual love

ETHICS AND DIRECTION

Capable of useful insight
Stress on personal dignity and self-esteem
Ability to set goals and follow through
Acceptance of social institutions and cultural traditions
Self-regulation of self-esteem

Teenagers will naturally vary slightly from the descriptions above, but the feelings and behaviors listed for each area are, in general, considered normal for each of the three stages. The mental and emotional problems that can interfere with these normal developmental stages are treatable.

If a teenager seems very different from the descriptions presented here, it may be appropriate to consult with a mental health professional.

Can Children Really Suffer From Depression?

Yes. Childhood depression is different from the normal “blues” and everyday emotions that occur as a child develops. Just because a child seems depressed or sad, does not necessarily mean they have depression. But if these symptoms become persistent, disruptive, and interfere with social activities, interests, schoolwork and family life, it may indicate that he or she has the medical illness called depression. Keep in mind that while depression is a serious illness, it is also a treatable one.

How Can I Tell if My Child is Depressed?

The symptoms of depression in children vary. It is often undiagnosed and untreated because they are passed off as normal emotional and psychological changes that occur during growth. Early medical studies focused on “masked” depression, where a child’s depressed mood was evidenced by acting out or angry behavior. While this does occur, particularly in younger children, many children display sadness or low mood similar to adults who are depressed. The primary symptoms of depression revolve around sadness, a feeling of hopelessness, and mood changes.

Signs and symptoms of depression in children include:

• Irritability or anger
• Continuous feelings of sadness, 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 do not 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

Not all children have all of these symptoms. In fact, most will display different symptoms at different times and in different settings. Although some children may continue to function reasonably well in structured environments, most kids with significant depression will suffer a noticeable change in social activities, loss of interest in school and poor academic performance, or a change in appearance. Children may also begin using drugs or alcohol, especially if they are over the age of 12.

Although relatively rare in youths under 12, young children do attempt suicide — and may do so impulsively when they are upset or angry. Girls are more likely to attempt suicide, but boys are more likely to actually kill themselves when they make an attempt. Children with a family history of violence, alcohol abuse, or physical or sexual abuse are at greater risk for suicide, as are those with depressive symptoms.

Child sexual abuse has been reported up to 80,000 times a year, but the number of unreported instances is far greater, because the children are afraid to tell anyone what has happened, and the legal procedure for validating an episode is difficult. The problem should be identified, the abuse stopped, and the child should receive professional help. The long-term emotional and psychological damage of sexual abuse can be devastating to the child.

Child sexual abuse can take place within the family, by a parent, step-parent, sibling or other relative; or outside the home, for example, by a friend, neighbor, child care person, teacher, or stranger. When sexual abuse has occurred, a child can develop a variety of distressing feelings, thoughts and behaviors.

No child is psychologically prepared to cope with repeated sexual stimulation. Even a two or three year old, who cannot know the sexual activity is wrong, will develop problems resulting from the inability to cope with the overstimulation.

The child of five or older who knows and cares for the abuser becomes trapped between affection or loyalty for the person, and the sense that the sexual activities are terribly wrong. If the child tries to break away from the sexual relationship, the abuser may threaten the child with violence or loss of love. When sexual abuse occurs within the family, the child may fear the anger, jealousy or shame of other family members, or be afraid the family will break up if the secret is told.

A child who is the victim of prolonged sexual abuse usually develops low self-esteem, a feeling of worthlessness and an abnormal or distorted view of sex. The child may become withdrawn and mistrustful of adults, and can become suicidal.

Some children who have been sexually abused have difficulty relating to others except on sexual terms. Some sexually abused children become child abusers or prostitutes, or have other serious problems when they reach adulthood.

Often there are no obvious external signs of child sexual abuse. Some signs can only be detected on physical exam by a physician.

Sexually abused children may also develop the following:

1. unusual interest in or avoidance of all things of a sexual nature
2. sleep problems or nightmares
3. depression or withdrawal from friends or family
4. seductiveness
5. statements that their bodies are dirty or damaged, or fear that there is something wrong with them in the genital area
6. refusal to go to school
7. elinquency/conduct problems
8. secretivenes
9. aspects of sexual molestation in drawings, games, fantasies
10. unusual aggressiveness, or suicidal behavior

Child sexual abusers can make the child extremely fearful of telling, and only when a special effort has helped the child to feel safe, can the child talk freely. If a child says that he or she has been molested, parents should try to remain calm and reassure the child that what happened was not their fault. Parents should seek a medical examination and psychiatric consultation.

Parents can prevent or lessen the chance of sexual abuse by:

1. Telling children that if someone tries to touch your body and do things that make you feel funny, say NO to that person and tell me right away.
2. Teaching children that respect does not mean blind obedience to adults and to authority, for example, don’t tell children to, always do everything the teacher or baby-sitter tells you to do.
3. Encouraging professional prevention programs in the local school system
4. Sexually abused children and their families need immediate professional evaluation and treatment. Child and adolescent psychiatrists can help abused children regain a sense of self-esteem, cope with feelings of guilt about the abuse, and begin the process of overcoming the trauma. Such treatment can help reduce the risk that the child will develop serious problems as an adult.

Depression Affects 1 in 10 U.S. Adults Depression affects many Americans at different levels. Learn how you can work with health providers to treat and monitor depression. Chart: Age-standardized (to U.S. population) percentage of adults meeting criteria for current depression based on responses to Patient Health Questionnaire 8 by state/territory – Behavioral Risk Factor Surveillance System, United States, 2006 and 2008§ §Data presented were collected by 16 states in 2008 and by 29 different states, the District of Columbia, and two territories in 2006. Five states (Kentucky, New Jersey, North Carolina, Pennsylvania, and South Dakota) did not participate in either year. Nine states (Hawaii, Kansas, Louisiana, Maine, Mississippi, Nebraska, North Dakota, Vermont and Washington) participated in both years, but only 2008 data were included.Depression can adversely affect the course and outcome of common chronic conditions, such as arthritis, asthma, cardiovascular disease, cancer, diabetes, and obesity. Depression also can result in increased work absenteeism, short-term disability, and decreased productivity.

Current Depression in U.S. Adults

To estimate the prevalence of current depression, CDC analyzed Behavioral Risk Factor Surveillance System (BRFSS) survey data from 2006 and 2008. Current depression was defined as meeting criteria for either major depression or “other depression” during the 2 weeks preceding the survey. The MMWR report on current depression among U.S. adults summarizes the results of that analysis, which indicated that, among 235,067 adults (in 45 states, the District of Columba [DC], Puerto Rico, and the U.S. Virgin Islands), 9% met the criteria for current depression, including 3.4% who met the criteria for major depression. In this study, increased prevalence of depression was found in southeastern states, where a greater prevalence of chronic conditions associated with depression has been observed (e.g., obesity and stroke). By state, age-standardized estimates for current depression ranged from 4.8% in North Dakota to 14.8% in Mississippi. The map below displays prevalence of current depression among US adults by state and territory for 2006 and 2008 BRFSS data.

Who Tends to be Most Depressed?

This study found the following groups to be more likely to meet criteria for major depression:

persons 45-64 years of age
women
blacks, Hispanics, non-Hispanic persons of other races or multiple races
persons with less than a high school education
those previously married
individuals unable to work or unemployed
persons without health insurance coverage
Other depression (or minor depression) results were similar except that 19-24-year-olds reported it more than other age groups.
Treatment of Depression

The U.S. Preventive Services Task Force recommends that health-care providers screen adults for depression when programs are in place to ensure that accurate diagnosis and effective treatment can be provided with careful monitoring and follow-up. The Task Force on Community Preventive Services recommends collaborative care, an approach that involves the collaboration of primary care providers, mental health specialists, and other providers to improve disease management for adults with major depression on the basis of strong evidence of effectiveness in improving short-term depression outcomes.

Suicide has become much more common in children than it used to be. For children under age 15, about 1-2 out of every 100,000 children will commit suicide. For those 15-19, about 11 out of 100,000 will commit suicide. These are statistics for children in the USA. Suicide is the fourth leading cause of death for children ages 10-14 and the third leading cause of death for teenagers 15-19. Recent evidence suggests it is the lack of substance abuse, guns, and relationship problems in younger children which accounts for the lower suicide rates in this group.

The main way children kill themselves depends on what lethal means are available and their age. In countries where guns are readily available, such as the USA, that is the usual cause of suicide. Other causes are strangling and poisoning. Suicide attempts that do not result in death are more common. In any one year, 2-6% of children will try to kill themselves. About 1% of children who try to kill themselves actually die of suicide on the first attempt. On the other hand, of those who have tried to kill themselves repeatedly, 4% succeed. About 15-50% of children who are attempting suicide have tried it before. That means that for every 300 suicide attempts, there is one completed suicide. What makes a child more likely to attempt suicide? If a child has major depressive disorder, he or she is seven times more likely to try suicide. About 22% of depressed children will try suicide. Looking at it another way, children and teenagers who attempt suicide are 8 times more likely to have a mood disorder, three times more likely to have an anxiety disorder, and 6 times more likely to have a substance abuse problem. A family history of suicidal behavior and guns that are available also increase the risk. The vast majority (almost 90%) of children and adolescents who attempt suicide have psychiatric disorders. Over 75% have had some psychiatric contact in the last year. If a number of these are present, suicide risk needs to be carefully assessed regularly. If children are constantly dwelling on death and think being dead would be kind of nice, they are more likely to make a serious attempt.

Many people have thought that the main reason that children and adolescents try to kill themselves is to manipulate others or get attention or as a “cry for help”. However, when children and adolescents are actually asked right after their suicide attempts, their reasons for trying suicide are more like adults. For a third, their main reason for trying to kill themselves is they wanted to die. Another third wanted to escape from a hopeless situation or a horrible state of mind. Only about 10% were trying to get attention. Only 2% saw getting help as the chief reason for trying suicide. The children who truly wanted to die were more depressed, more angry, and were more perfectionistic.

Predicting suicide is very difficult. It is even more difficult in children and adolescents. When we discuss suicide, there are three different levels of concern.
Suicidal Thinking in Children

This means a person is thinking about suicide but has no plan. This is not uncommon. About 3-4% of adolescents will have considered suicide in the last two weeks. However, these thoughts are much more likely, and more likely to be serious, if the child has previously made a suicide attempt is depressed, or is pessimistic. Children who are still depressed and have made previous suicide attempts are extremely likely to be thinking seriously about suicide.

Example: Jenna is 13. She is quite depressed. She has most of the symptoms mentioned. She sleeps poorly, she has no energy, can’t concentrate on her work and is super cranky. She thinks about running away or how nice it would be to out of this horrible life. She thinks sometimes about killing herself, but she doesn’t think about how she might do it. At the moment, she says she is too scared to actually do something. This is suicidal thinking.

Children and Teens with Suicidal Plans This means that you are thinking about suicide and have a way to do it in mind.

Examples: Allan is 12. From what he can see, life gets worse every year. He can not imagine living like this for 50 more years. He is very irritable, is always getting in fights with his parents, and mostly says and thinks that “Life sucks!”. He goes out for walks and thinks about two things. First, jumping in front of a truck. He doesn’t do this because he is afraid it won’t work. That is, he will end up hurt but not dead. Second, he thinks about going down to the wharf and jumping off. He is not exactly sure how to do this to make sure no one saves him.

Tina is 15. She is also very depressed. She is waiting until Friday night. Her parents are going out and leaving her home. She has been collecting Tylenol and her Grandmother’s heart pills for the last two weeks. She has almost 100 pills. She has been working on a suicide note. She is scared that she will “blow it” and tell someone.

Ryan is 15. He is depressed, but has not been thinking about suicide. In fact, he told his mother this a few days ago. He told the doctor the week before that he wasn’t thinking about suicide. But now, at 10:15 at night, he has had it. His mom will not let him go and see his girlfriend. That is, his ex-girlfriend. She told him on the phone this evening that she just wants to be friends. Ryan can’t take it anymore. He has decided to break a light bulb and cut his wrists and just see what happens. If he dies, fine. That’s okay with him.

These are all suicidal plans. Some suicide plans are well thought out, like Tina’s. Others are very impulsive, like Ryan. Others are not that serious yet, like Allan’s.