According to statistics from the South African Depression and Anxiety Group (Sadag), up to 20% of South African youngsters suffer from depression. Clearly, a sizeable proportion of our children need support.

When our children are little we cure their ‘owees’ with a quick kiss and cuddle their nightmares away. However, as they move towards the teen years and beyond, the pain they suffer isn’t always so obvious, and fixing it even less so – particularly when it comes to mental illness.

Read more about mental health illness in young children.

burden of a modern world

Depression is not a modern affliction, but the pressures of our time seem to be bearing down on our youth more heavily than ever before, affecting children at a younger and younger age.

Mark de la Rey, a clinical psychologist at the Akeso Kenilworth Clinic in Cape Town, says that raised levels of anxiety are driving this trend: “I believe that there is a higher incidence of anxiety levels, which are contributing to more difficulty in social and family settings. In most cases, the increased anxiety levels are precursors to depression, rather than the other way around.”

Sadag’s operations director, Cassey Chambers, echoes this, saying the organisation is seeing increased cases of depressed young children and teens. She adds that it is receiving more and more calls from children who feel helpless and hopeless, and even suicidal.

the role of tech

The use of technology and a breakdown in family structures are common refrains when it comes to the factors contributing to anxiety and depression among children and teens.

“The stress and anxiety created by the ‘always online’ lifestyle we parents allow our children to engage in at increasingly early ages is a major factor,” says de la Rey. “They can never switch off from being available to friends, being bullied even when away from school, and being open to other predatory elements designed to look ‘benign’ to them and us.”

Rondebosch Boys’ Preparatory School head Ian Ryan agrees: “Technology, which obviously has many benefits, is a reality that’s not going to go away. It presents new challenges to our children’s wellbeing. Parents have a responsibility to educate themselves and monitor what their children are doing online.”

a lack of support

Then there’s the breakdown in family structures and a consequent decline in the trusted parties that children can confide in, contributing to their sense of isolation.

“It takes a village to raise a child. However, for many, that village does not exist, meaning there’s not a support structure for children,” says Ryan. “Mom and/or dad may be absent. So it’s critical that there are other people for children in need to talk to.”

De la Rey also notes the fact that parents are increasingly unavailable because of work and social demands. “The time we spend with our children is being replaced by the electronic nanny (television, the internet, gaming, etc.).”

first line of defence

It is against this background that those closest to children from an emotional and physical point of view – parents and teachers – become critical in providing the safety net for those who might be suffering from depression and need intervention.

For parents, a number of signs can indicate a child needs help, although a complicating factor is that all children, especially teenagers, exhibit ‘red flag’ behaviour at some point or another.

“Children, preteens and adolescents can exhibit behavioural and mood symptoms that mimic depression, but are actually appropriate for their developmental phase or age,” says De la Rey. “A general rule of thumb would be if the behaviour is prolonged and out of character for your child. That’s when you should be sitting up and taking note. Start by having a talk with your child about how they are feeling and doing. If you feel uneasy about anything, a visit to the GP might be the first point of call. I believe that prevention is better than cure.”

As is so often the case, open communication is an important ally for parents. “Hearing and understanding what your children think, feel and say doesn’t mean you have to agree with it,” says De la Rey. “However, open dialogue makes it more likely that they will tell you when things go wrong.”

the role of schools

Schools – where our children spend the majority of their young life – are critical partners.

De la Rey says schools play “an increasingly vital role in identifying, if not necessarily treating” children who are at risk. Educational psychologist Heidi Theo agrees: “Teachers are in an excellent position to identify when children are depressed, if they are sensitive to changes in their pupils’ behaviour.”

For those children who do require professional help, de la Rey suggests that school support could extend to facilitating time for learners to attend programmes, either as in- or out-patients. They can also encourage information sessions for parents and teachers with professionals, who are mostly open to doing talks, often free of charge.

Creating community

Ultimately, it is ideal for schools and parents to work together, says Theo. “A collaborative approach is the most valuable approach when dealing with children who are at risk. Regular meetings between parents and staff to help with the early identification of concerns are invaluable. Talks hosted by schools can also help both parents and staff recognise and identify the early warning signs.”

Red flags for teachers

Theo lists the warning signs that can indicate a learner is suffering from depression:

• no participation in previously enjoyable school activities
• weight loss (and less frequently, weight gain), due to changes in appetite
• lethargy
• telltale bags under his/her eyes because of a lack of sleep
• signs of demotivation, for example, not completing homework or remembering to bring sports kits
• a lack of participation during classroom discussions
• a drop in marks
• difficulty sustaining concentration
• an increase in social isolation (a depressed child is likely to be found alone during break)
• an irritable mood, disengaged and/or apathetic
• a flat and sad demeanour, and quick to cry
• physical indicators: they may walk with stooped shoulders and may take less pride in the way they look and in their general self-care routine.

behavioural signals for parents

Sadag provides this list of behavioural signals that can indicate a child needs help:

Preadolescents

• inexplicable decrease in academic performance
• increasing social isolation
• loss of interest in sports
• development of unusual physical complaints for no medically sound reason
• increased childish and dependent behaviour
• being excessively demanding

Teenagers

• marked moodiness
• over-reactions to frustrations out of all proportion to the provocation
• marked self-isolation and social withdrawal
• unrealistically low self-esteem
• unwarranted belief that others dislike or reject him or her
• unrealistic belief that one’s personal appearance is ugly or offensive
• loss of interest in hobbies, sports, and personal self-care
• development of delinquent activities, in particular the abuse of drugs and alcohol.

Read more about recognising depression in children.

where to go for help

Sadag runs a Schools Outreach Programme that provides talks to learners (class-by-class), workshops for parents and teachers, and materials on various mental health issues to provide resources and practical tips and tools.

Schools can also contact their nearest psychologist or psychiatrist, or a unit offered by groups such as Akeso.

Parents can try a GP as a first stop, or their nearest psychologist or psychiatrist. Sadag can also provide direction (011 234 4837).