Childhood depression

We look at the alarming rise of teenage suicide in South Africa
By Glynis Horning

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Durban-based marketing assistant Lwazi* was delighted when her salary finally allowed her to move her 12-year-old daughter from a township school to one in the city and rent a flat nearby. But in the months that followed, her once bubbly child grew increasingly moody. She struggled to make friends and her grades dropped. “I kept telling her the move was to give her a better life, and she must just work harder,” says Lwazi. “I sacrificed, she must too.”
Then in 2012, Lwazi returned from work to find her child unconscious, empty pill bottles and her school report beside her. “She’d failed three subjects, but I couldn’t believe a child would try to kill herself.”
According to the South African Depression and Anxiety Group (SADAG), the suicide rate for children aged 10 to 14 has more than doubled in the past 15 years. Of the 6 000 to 8 000 people that commit suicide every year, one in three patients admitted to hospitals are children or teens. Around 60% of those who commit suicide are estimated to suffer from depression, which affects at least two in every 100 children, and five in 100 teens.
Until 1994 the incidence of depression and suicide was lower among black South Africans, says stress and suicide expert Prof Lourens Schlebusch, author of Mind Shift: Stress Management and Your Health (UKZN Press). Since then the stress of new expectations and the pressure from family and the community to succeed have seen “a huge increase”, he says.
Spot the problem
Occasional moodiness and sadness is normal, particularly with the hormone changes around puberty, which today can start at age nine or 10. But when these or other signs persist for more than a few weeks and affect your child’s ability to function, it’s important to seek help, says Mpumi Mbhele, a Joburg clinical psychologist. “Untreated, it can result in poor self-esteem, and the child becoming demoralised and unmotivated.” It may also precede more serious mental illness later in life.
Yet many parents are loath to accept that their children suffer from depression, says Linda Naidoo, former director of Childline Durban. They fear the stigma is still linked to mental health problems, or believe it reflects on their parenting. “Depression is nothing to be ashamed of, but parents often blame themselves when children are diagnosed,” says Mbhele. “Even if they partly played a role through divorce, for example, there are always multiple contributing factors.”
This became clear to Lwazi when her employer arranged counselling after her daughter had recovered in hospital. A change of school and home, fear of failure, and guilt at disappointing her mother all had a role in the child’s depression. “I see now that taking those pills was her shouting for help,” says Lwazi. “I wish I had known the danger earlier.”
Realise the risks
Risk factors for depression and suicide in children include break-ups with friends, bullying, illness, bereavement, neglect, physical or sexual abuse, fanatical belief systems, chaotic or conflicted family, a family history of depression or suicide, academic or mental problems and an imbalance in brain chemicals. “Peer pressure and the need to belong also play a significant part in shaping teens’ perceptions of themselves,” says Cape Town counselling psychologist Diane Mallaby. “Those who feel rejected by their peer group take it very seriously and as a personal rejection.” A recent UK study suggests that children whose mothers are depressed in pregnancy also run a small increased risk of depression later in life. The researchers advise that women who are depressed get treatment before becoming pregnant, and if they are already pregnant, find treatment urgently.
Head off depression
The surest way to protect your child from depression is to remind them that you love them and are there to support them. “Developing an open, honest, trusting relationship will encourage them to come to you when they’re in distress,” says Mbhele. If you are unable to assist, make sure your child has a trusted relative, teacher or counsellor to talk to. Teach them to see mistakes as a chance to learn and grow, and help them analyse what went wrong and what they can do in future. When disciplining them, focus on their behaviour, not their personality, and on finding solutions. “Understanding teen depression is key, and patience is required because often they are moody, defiant and irritable, and they can present differently to adult depression,” says Mallaby. “Parents need a support base, and if they’re not coping they need to get help. It’s not an individual treatment plan that works best, but rather a holistic intervention.”
Find treatment
Start with a school counsellor or doctor, who can rule out physical problems and direct you to other professionals, or go to SADAG. “Don’t delay getting help, and always follow your intuition as a parent,” says Mallaby. The most effective form is cognitive behavioural therapy (CBT), which focuses on changing the child’s dysfunctional thoughts and beliefs, and gives them coping and problem-solving skills. “It’s important that parents are involved,” she says. “CBT combined with medication, exercise and a good support system is the best approach.”
Never tell your child to “snap out of it”. It’s not disrespect or laziness; they are unwell, says Mbhele. Tell them, “You look upset, is there something you’d like to tell me?” Then listen quietly. Unburdening can help them feel better and find their own solutions. Encourage them to follow their treatment and take any medication exactly as prescribed.
Also encourage them to exercise regularly to release stress and feel-good endorphins, and to eat healthily. Also, control your own emotions – unburden with friends and don’t escape in drugs or alcohol. “A child will react better to life’s challenges with a positive role model,” says Mbhele. Lwazi’s daughter is today “a different child”. She now sees what someone at SADAG said to her: “Suicide is a permanent solution to a temporary problem.”
*Name changed to protect identity
Know the signs
If your child shows the following for more than a few weeks, get help:
  • low, flat mood, tearfulness;
  • tiredness, lack of energy;
  • loss of interest in things or people;
  • change in eating/sleeping patterns;
  • feelings of worthlessness, failure or guilt;
  • complaints of aches and pains that don’t improve;
  • drop in grades;
  • irritability, anger or aggression;
  • regressive behaviour (bed-wetting, thumb-sucking); and
  • increased risk-taking, use of alcohol or drugs and acting out in rebellious or sexual behaviour.
Should your child talk, even indirectly, about dying or suicide, get help fast. Contact SADAG: 0800 567 567 (sms 31393) or Lifeline 0861 322 322

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