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Depression Often Starts in Childhood

New research shows that depression starts early in life.

By Carol Sorgen
WebMD Feature

Reviewed By Cynthia Haines

Depression rates are rising and researchers and clinicians now say that depression often begins in childhood.

Kathleen P. Hockey is a licensed social worker who has also suffered from depression. As a parent, Hockey wanted to keep her own children safe from the illness. After a few years of reading virtually everything she could find on the topic of depression, she realized that very little had been written for the general public on childhood depression. Hockey stepped in to fill the void with her book, Raising Depression-Free Children: A Parent's Guide to Prevention and Early Intervention.

There was a time, says Hockey, when the prevailing philosophy was that kids couldn't become depressed. That's no longer the case. "Approximately one of 11 children experience some form of depression by the time they are 14 years old," says Hockey. "Further, if childhood depression is not prevented or caught early and properly treated, the risk for relapse is very high, with each successive episode growing more severe."

Kids do suffer from mental health problems, explains Kathy HoganBruen, PhD, senior director of prevention for the National Mental Health Association (NMHA). "Childhood depression is very real and very common, but also very treatable," says HoganBruen.

In fact, depression affects as many as one in every 33 children and one in eight adolescents, according to the Federal Center for Mental Health Services.

There is no one thing that causes depression in children, according to the NMHA's Children's Mental Health Matters campaign. A family history of depression, life stresses such as losing a parent, divorce, or discrimination, and other physical or psychological problems can all contribute to the illness. Children who have been abused, neglected, have experienced other traumas, or suffer from chronic illness are also at a higher risk for depression.

Depression in children often occurs along with other mental health problems such as anxiety and bipolar or disruptive behavior disorders, says David Fassler, MD, clinical associate professor of psychiatry at the University of Vermont College of Medicine, and co-author of Help Me, I'm Sad: Recognizing, Treating and Preventing Childhood and Adolescent Depression. Adolescents who become clinically depressed are also at a higher risk for substance abuse problems.

Children who are depressed may not do well in school, may become socially isolated, and may have difficult relationships with family and friends, Fassler says. Depression in children is also associated with an increased risk for suicide. The rate of suicide among young people has nearly tripled since 1960 and is the sixth leading cause of death among children between the ages of 5 and 14, the third leading cause of death among 15- to 24-year-olds, and the second leading cause of death among college students.

According to the NMHA, the following symptoms in children may indicate depression:

  • Frequent sadness, tearfulness, or crying
  • Feelings of hopelessness
  • Withdrawal from friends and activities
  • Lack of enthusiasm or motivation
  • Decreased energy level
  • Major changes in eating or sleeping habits
  • Increased irritability, agitation, anger, or hostility
  • Frequent physical complaints such as headaches and stomachaches
  • Indecision or inability to concentrate
  • Feelings of worthlessness or excessive guilt
  • Extreme sensitivity to rejection or failure
  • Pattern of dark images in drawings or paintings
  • Play that involves excessive aggression directed toward oneself or others, or involves persistently sad themes
  • Recurring thoughts or talk of death, suicide, or self-destructive behavior

If your child is exhibiting any of these symptoms for longer than two weeks, you should consult your pediatrician, says Hockey. "Many of these symptoms can also be traced to physical complaints -- such as thyroid problems, mononucleosis, immune system disorders, long-term antibiotic use, or chronic, long-term allergies -- so it's important to get an accurate diagnosis."

Infants and toddlers, who are not at the same stage of expressing themselves as older children, may still exhibit symptoms of depression; in their case, says Fassler, pay attention if your child is withdrawn, doesn't smile, doesn't want to play, won't interact with other people, and starts losing weight.

If your doctor does think treatment for depression is indicated, childhood mental health experts emphasize that it's usually very successful. With a multi-pronged approach of individual, family, and/or school counseling -- and perhaps the use of antidepressants -- 75% to 80% of children suffering from depression can be successfully treated, says Fassler. Without treatment, he says, many will go on to have a second episode of depression within two years.

Children who are too young to talk can still be effectively treated through play therapy, says Fassler. "Even when kids don't have words, we can still find out what's going on."

Hockey says that childhood depression can be prevented -- or at least, the risk factors for depression can be lowered, just as risk factors for heart disease or type 2 diabetes can be lowered.

There are many risk factors for childhood depression, Hockey says. Many of them are environmental and changeable. "Reducing the number of risk factors reduces the chances a child will experience most forms of clinical depression," she says.

"In addition to the more obvious things like being sure your children eat healthily, get exercise, and are not under unreasonable stress for their age, you can reduce the risk factors for depression by being aware that there are certain life skills, ways of perceiving life events, and problem-solving skills that seem to shield children from depression," she explains.

Having a depressed parent is one of the most critical risk factors for a child, says Hockey. "Children of depressed parents are four times more likely to experience depression than children with non-depressed parents. It is vital that depressed parents seek treatment for their own depression if they want their children to be depression-free."

While childhood depression is a serious illness, Hockey says, parents need to know they can do something about it. "Don't sit back and take a 'wait-and-see' approach," she stresses. "That doesn't cut it."

Originally published February 2, 2004.
Medically updated September 2004.


SOURCES: Kathleen P. Hockey, LICSW, author, Raising Depression-Free Children. Kathy HoganBruen, PhD, senior director of prevention, National Mental Health Association. David Fassler, MD, clinical associate professor, psychiatry, University of Vermont College of Medicine; co-author, Help Me, I'm Sad: Recognizing, Treating and Preventing Childhood and Adolescent Depression. National Mental Health Association.

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