Many factors can trigger depression in children and teenagers.
BY the time she was six years old,
Amy (not her real name) had already been sexually abused by her father for four years.
Amy
never told anyone about it because her father had said it was their
“little secret”. The secret was blown when Amy's uncle somehow found out
about it, and informed her mother about the abuse.
Sadly, instead of believing her, Amy's mother turned her anger on the child, insisting that Amy must have been lying.
Dr Lai: Every time they get a compliment, it’s like a deposit for their self-esteem.
With
her mother furious with her, Amy believed that she must have done
something wrong, and that she was responsible for the mess her family
was in. She took it upon herself to somehow make things right. She
killed herself.
While this case did not happen in
Malaysia,
experts say there is definitely a disturbing trend where children as
young as six years old are expressing suicidal tendencies.
Penang Hospital consultant (child and adolescent) psychiatrist
Dr Lai Fong Hwa says he started noticing suicide cases among Malaysian children in the last five to 10 years.
“Kindergarten-going
children can suffer from depression. Actually, even children who are
four or five years old can suffer from depression, but usually these
cases are due to biological causes rather than external causes,” he
says.
Many factors can trigger depression in children and teenagers that, if left undetected and undealt with, could lead to suicide.
One
factor, he explains, is the overemphasis on academic performance and
achievement, even among pre-schoolers, which makes schools an extremely
stressful environment.
“Some parents have the tendency to say
things like If you want mummy to love you, you must get straight As in
your exam.' What happens is the child then equates academic performance
with whether his parents will love him. So if the child doesn't do well,
in his mind, his parents don't love him anymore.
“Even though
parents may have good intentions, they should never say things like that
because it can have serious negative repercussions. What they should
say is We will love you no matter what',” says Dr Lai.
Children, he says, need what is called an “emotional bank account”.
“Every
time they get a compliment, it's like a deposit for their self-esteem.
But every time they are criticised, the account gets depleted. What's
important is that they should always have a good emotional bank account,
because otherwise, when difficulty comes, they have nothing to draw
from.”
He adds that children these days are constantly drummed
with the message that they're “not good enough” because society expects
them to achieve certain academic standards.
In the younger children, this stress can cause them to fear school.
“If
a child has been quite happy attending school, and then suddenly fears
school a few months down the road, it shows that something is not right.
School should be fun, not torture. This is why I encourage parents to
send their
pre-school children to playgroups, rather than to
classroom-environment kindergartens,” says Dr Lai.
Apart from academic achievements, shoving a child into multiple co-curriculur activities can also be extremely stressful.
According to
Childline project
director Michelle Wong, the helpline has received calls from children who are stressed out from having “too many exams”.
“One
girl contacted us, saying she was having piano, violin, ballet and
school exams all in the same month, and she could not cope with the
pressure. She didn't know what to do,” Wong says.
Dr Lai adds
that when a child has so much on his plate, the actual time spent with
his parents is usually minimal, which is unhealthy for the child.
One
question he frequently uses in his clinic when testing children on who
they turn to for support is: “If you are alone on an island, and you can
wish for one person to be with you, who would it be?”
“A normal
child below the age of 12 would usually name their mother, or father, or
a sibling whom they're close to. If they've been brought up by their
grandparents, then it's also quite normal for them to name a
grandparent.
“But when a child starts wishing for a friend
instead, it shows that he doesn't look to his family for support. This
can be dangerous as his friends are not likely to be able to fully help
him should he get into any problem,” Dr Lai explains.
His concern
is very real. In the last few weeks, there have already been several
sudden deaths involving students under the age of 18.
Last month,
a 14-year-old boy hung himself after having a fight with a friend.
Another 17-year-old boy hung himself over “academic issues”.
In
another case, an 11-year-old boy who fell to his death from the 14th
floor of a flat in Penang left behind a handwritten note. His family
has, however, denied it is a suicide note, saying that he had always
written letters to express himself.
Early this week, a
12-year-old boy in Sabah hung himself with his shoelaces he was
apparently upset over not being able to return to his hometown to see
his grandfather.
Dr Ng: Children often use acting out as a way to express their inner distress.
“The trend is worrying. Children shouldn't be killing themselves,” Dr Lai says.
Depression
among children and teenagers, more often than not, may appear as
irritation or agitation, as opposed to the typical expression of
sadness, says clinical psychologist
Dr Ng Wai Sheng
who has served in various settings including children social services,
substance abuse rehabilitation and inpatient and outpatient psychiatric
settings.
“This may partly explain why adults often overlook
depression in young people. Depressed children and adolescents may be
mislabelled as “angry” or “moody” kids. For young children, their
behaviour may be confused with
Attention-deficit hyperactivity disorder
(ADHD).
“Children often use acting out as a way to express their
inner distress, resulting in some being labelled as the bad kid'.
Another common sign is the deterioration in academic performance and
motivation, which may lead to the mislabelling of being lazy' or not
smart enough',” she explains.
Divorce between parents has also
frequently been linked to depression among children, but Dr Ng says it
is not so much the divorce per se but rather how the divorce is handled
that could be the determining factor.
“There is evidence to show
that when a divorcing couple handles the matter prudently and maturely,
and remain supportive of their children, the children continue to fare
well in their lives,” says Dr Ng, a Fulbright alumni.
This
includes communication between the parents and the child, whereby the
child is assured of continuous love and support, and there is emphasis
that the child is not responsible for the parents' decision.
However,
she notes that the stigma of belonging to a single-parent or blended
household could pose a challenge for children in Asian societies.
Senior community consultant paediatrician
Datuk Dr Amar Singh
says that based on his 30 years of experience working with children,
child abuse (physical, emotional, or sexual) is also a trigger factor
for suicide among children. For teenagers, peer relationship (including
boyfriend or girlfriend problems) is also a common cause.
So, what can be done about children and teenagers who are suicidal?
The key is communication, say the experts.
“A
majority of those who commit suicide would tell at least one person
before they carry out the plan, so look out for the warning signs (refer
to graphic above). If one suspects that a child/adolescent may have
suicidal tendency, it is important to stay with the person, and raise
the issue sensitively but directly with the person. Talking about death
or suicidal thoughts does not mean you're putting ideas in the person's
head'. That is a myth!
“Instead, talking about it openly, albeit
with care and respect, gives the child the opportunity to share with you
what's already in his head, and allows you to show that you care about
him. Discussing the issue also provides for at least a 50% chance for
him to consider alternative options to suicide. Avoiding the subject
means you lose even that 50% chance of influencing him,” says Dr Ng.
Dr Amar, who is also Head of Paediatric Department Ipoh Raja Permaisuri Bainun Hospital, agrees.
“Many
Malaysians are afraid to talk about this issue, but they need to
realise that drugs aren't always the solution (for depression).
“You need to probe and ask the right questions, and you most definitely need to talk about it,” he says.
Stories by LISA GOH lisagoh@thestar.com.my
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