Depression in Children: What Causes It and How We Can Help
Irina V. Sokolova Rochester Institute of Technology
This review describes the occurrence of depression in children, symptoms, causes based on the Cognitive Model, Parent x Child Model of Socialization and Tripartite Model of Depression and Anxiety. The study performed based on the latter model showed existence of differentiation between depression and anxiety in children. Depression in children is not the same as in adults and most times it is unnoticed by the parents and untreated by health-care professionals. Causes of depression in children vary from combination of genetic vulnerability, early developmental experiences, exposure to stressors, marital satisfaction in the family, parents and social pressure and many more. When diagnosed there are various ways to treat depression. Some treatments involve antidepressants, family intervention, family education on prevention of depression, on acknowledgment of the symptoms and cognitive behavioral techniques.
How serious is the issue of depression in children? Read the following and judge for yourself. One in five children have a diagnosable mental, emotional or behavioral disorder. And up to one in 10 may suffer from a serious emotional disturbance. Seventy percent of children, however, do not receive mental health services (SGRMH, 1999). Attention deficit hyperactivity disorder is one of the most common mental disorders in children, affecting 3 to 5 percent of school-age children (NIMH, 1999). As many as one in every 33 children and one in eight adolescents may have depression (CMHS, 1998). Suicide is the third leading cause of death for 15- to 24-year-olds and the sixth leading cause of death for 5- to 14-year-olds. The number of attempted suicides is even higher (AACAP, 1997). Studies have confirmed the short-term efficacy and safety of treatments for depression in youth (NIMH, 2000) (Aspen Youth Services, http://www.aspeneducation.com/factsheetdepression.html; National Mental Health Association, http://www.nmha.org/chhildren/green/facts.cfm).Mental illnesses in children are so complex that health-care professionals can not always detect them (Kalb & Raymond, 2003). Symptoms for mental disorders can be so nonspecific, that even parents cannot tell if the child is being rambunctious or seriously ill. Children with depressive disorders lack interest in activities that they previously enjoyed, criticize themselves, pessimistic and hopeless about the future. They tend to have lack of energy, have problems at school, have trouble sleeping, may have stomach aches and headaches (Hazell, 2002). Depressed kids do not look like depressed adults: they are often irritable, rather than sad and withdrawn. Depressed kids showed less pleasure in play and some explored themes of death (Kalb & Raymond, 2003). It was found that bipolar disorder, an ongoing cycle of depression and mania, can easily be confused with attention deficit hyperactivity disorder. It was observed that bipolar kids are more prone to elated moods, grandiose thoughts and daredevil acts. They also have more rapid periods of depression and mania.
Depression can arise from a combination of genetic vulnerability, suboptimal early developmental experiences, and exposure to stresses. How children respond to different stressors is different depending on the child's personality and situation. Most children become silent and do not open up to the parents about what is wrong and what is bothering them. Symptoms go unnoticed because of a tendency of depression to have an insidious onset in children, and because symptoms may fluctuate in intensity (Hazell, 2002). There are several theories of depression that exist to define the causes of this mental illness and to explain what is going on in the mind of a depressed person, whether that individual is an adult or a child. What Causes Depression in Children
Models of Vulnerability
Cognitive Theory of Depression. According to cognitive theory, thinking negatively greatly affected the likelihood of developing a depression and maintaining it during stressful events in a person's life. Individuals who think negatively are more vulnerable towards depression because they perceive the environment, their future and themselves in a negative, depressive context. This negative way of thinking guides child's or adult's perception, interpretation, and memory of personally relevant experiences, thereby resulting in a negatively biased construal of their personal world, and ultimately, the development of depressive symptoms (Beck, 1967).Parent x Child Model of Socialization. Parent x Child Model of Socialization is another model used by clinicians. The model was applied to development of depressive symptoms. It was expected that when parents used intrusive support frequently, children engaging in negative self-evaluative processes would be more vulnerable to depressive symptoms that children engaging in positive self-evaluative processes (Pomerantz, 2001). The results of the study performed on the model suggest that both parents and children contribute to the development of depressive symptoms. Parents use of control with children had been identified as a central dimension of socialization model. Two forms of control are: psychological - parents attempt to oversee and regulate children's psychological and emotional development through constraining verbal expression and invalidating feelings; and behavioral--parents try to regulate children's behavior by using limit setting and positive reinforcement (Pomerantz, 2001). Psychological control appears to have negative consequences for children because it communicates to them that they are incompetent and intrudes their individuality. Behavioral control causes positive consequences because it provides guidance in meeting standards and shows support of the parents (Pomerantz, 2001). The term intrusive support, used in the study, identifies with those two forms of control and yet it is defined as monitoring and helping children when they do not request help. The study was done to investigate the hypothesis that when parents frequently used intrusive support, children engaging in negative self-evaluative processes would be more vulnerable to depressive symptoms than would children engaging in positive self-evaluative processes (Pomerantz, 2001). The results showd that hypothesis was right to assume. The findings also showed the importance of use of the model for studying of the depression disorder and relevance of the model to the current research in the area of depression.
Tripartite Model of Depression and Anxiety The Tripartite Model of Depression and Anxiety was developed by L. A. Clark and D. Watson (1991). They theorized that depression is specifically characterized by anhedonia or low positive effect (PA), anxiety is specifically characterized by physiological hyperarousal (PH), and general negative affect (NA) is a non specific factor that relates to both depression and anxiety (Joiner & Lonigan, 2000). The study was performed to examine whether the model could discriminate youth with depressive disorders from youth with externalizing symptoms. The results found corroborated the hypothesis. It was shown that the model can be used to differentiate between the depressive conditions from anxious syndromes (Joiner & Lonigan, 2000). The model that represented anxiety (NA), depression (PA) and fear (PH) as distinct factors provided best fit for data from the child and parent report for 216 clinically anxious children. Results supported the expected pattern of relations of NA and PA with current symptoms of depression and anxiety in a community sample. NA was significantly associated with symptoms of both depression and anxiety, whereas PA was mostly strongly associated with symptoms of depression. Thus, the model was shown to be a useful tool for differentiation between anxiety and depression symptoms in children. Children with a depressive disorder diagnosis may be identified by using the factors of the tripartite model (Joiner & Lonigan, 2000). Specifically, children with a depressive disorder were distinguishable from other youth psychiatric patients on the basis of low PA and high NA. Low PA was found to distinguish inpatient children with depression from those with anxiety (Joiner & Lonigan, 2000).
Stressors
Stressors in everyday life take place and affect an individual's emotional state. Such stressors as school problems, problems with peers, family , loses, medical illness affect children. Stressors lead to feelings such as sadness, crabbiness, being bored, and not enjoying anything; lead to behaviors such as withdrawal, decreased activity, irritability with others; and lead to thoughts such as pessimism, negativity, low self-esteem, and hopelessness. All the factors come together to evolve into clinical depression with physical problems: trouble sleeping, poor concentration, low energy, agitation and appetite problems. Clinical depression may go a step further to evolve into more severe depression and depletion of brain chemicals (Asarnow, Jacox, & Tompson, 2001).Family Instability. Certain types of family organizations are closely related to the development and maintenance of symptoms in children. According to family systems theory, when the married couple has conflict and can not solve it in a constructive way, they are likely to involve their children in the conflict to release some anxiety and tension between them (Wang & Crane, 2001). Child is physiologically vulnerable to everything going on between his parents. Tension and conflict in the family induces emotional arousal in the child, triggering physiological and psychological responses (Wang & Crane, 2001). The results of the study conducted in investigation of the relationship between parents' marital stability, triangulation and the level of depression in children showed that children of marital dissatisfied fathers were more likely to have depressive symptoms than those of dissatisfied mothers. When fathers felt unstable in the marriage and, experienced triangulation in their families at the same time, their children were likely to have depressive symptoms. When fathers felt stable but unsatisfied in their marriage, their children were also more prone to develop depressive symptoms. The finding that the mothers' scores do not affect children as the fathers' do was consistent with the results found in that other studies comparing fathers' and mother's influences on children (Wang & Crane, 2001). It may be explained by the roles in the family in bringing up children and taking care of the family financially, and by the difference of gender in solving a marital conflict. Mothers are often thought of as primary care-takers of the family, fathers are the providers. It is quite common to believe that mothers are more emotionally involved with their children and more emotionally available to them. They consciously separate their roles as mothers and wives, and therefore the independence between roles takes place. When men feel dissatisfied and unstable in their marriage, they may concentrate their energy on the outside of their family, on their friends and society and abandon their role as providers. There is evidence that intense marital conflict is related to a husband's withdrawal during conflict interaction (Wang & Crane, 2001). When man withdraws from a unstable marriage, he withdraws from the mother and the child at the same time, his role as a father is greatly affected by the level of marital satisfaction. Men are also more likely to express an unusual overt behavior such as being aggressive, angry, argumentative, unaffectionate and withdrawn. Women on the other hand, will tend to be more internally hurt, more likely to have depression. Thus, for a child it is easier to identify their father's over behavior and be disturbed by it, rather that their mothers depressive symptoms, such as being sad and crying. When mothers experience marital instability, they become more involved with their children than previously (Wang & Crane, 2001).
Depressed Parents. The study mentioned above, also leads to a theory that depressed children are more likely to live with depressed parents. In single parent families the stress is always present because of the family situation. One parent performs dual roles for the child and that is stressful for both of them. The single mother is a provider for the family and also a care-taker. But the first role is of primary concern because that rile was not her role originally, that is why the mother has to work harder at it. At that time the second role of the mother as a care-taker is partially abandon because of the lack of time left to spend with a child. The mother may express overt changes in behavior, such as anger and frustration, to show hew feelings of helplessness. In this case the child can sense the depression and unhappiness of the mother because there is no father figure to be more influential than the mother.
How We Can Help
Treatment of Depression in Children
Cognitive Therapy. Once the depression disorder is diagnosed there are several ways to approach the treatment. Cognitive behavioral therapy is one therapy most used for treating depression. Treatment consists of identifying copying strategies for kids and their parents. The therapist helps kids to identify cognitive distortions. Beck's (1967, 1976) cognitive theory suggests that depressed children's negative self-perceptions reflect cognitive distortions about the self and about the environment. Cognitive theories assume that errors in depressive judgment result form negative bias introduced by the negative self schemas of depressed persons (Johnson & DiLorenzo, 1998). Aaron T. Beck and his colleagues initially developed cognitive therapy as treatment for depression. Cognitive behavioral treatment or CBT of depression involves the application of specific strategies directed at the following three domains: cognition, behavior and physiology (McGinn, 2000). In the cognitive domain, patients are taught to correct their negative thinking. In behavioral domain, patients learn activity scheduling, social skills and assertiveness. In physiological domain patients are taught relaxation techniques, meditation and pleasant imagery to calm themselves. Numerous studies conducted showed that cognitive therapy was more effective that tricyclic antidepressant therapy (McGinn, 2000).Family Therapy. Numerous studies have shown the importance and effectiveness of family intervention, family participation in the treatment, parents' demonstration of positive control over the child, and lower stress level within the family. Five negative outcomes have been shown to appear if the family is not participating in the intervention (Asarnow, Jaycox, & Tompson, 2001). First, among children with depression, greater family stress has been found to be associated with a longer initial episode and lower social competence at 3-year follow up. Second, depressed children whose homes were characterized by high levels of parental criticism or emotional overinvolvement demonstrated significantly lower recovery rates at the end of the first year after hospitalization than did children whose parents scored low on those variables. Third, during depressive episodes, children demonstrate more negative and guilt-inducing behavior in laboratory-based family interactional tasks when compared to nondepressed psychiatric and control participants, underscoring the high level of stress experienced by families of depressed children. Fourth, maternal and child depressive symptoms may be temporarily linked such that symptoms in one member of the dyad potentiate symptoms in the other. Fifth, although studies of depressed adults indicate strong family histories of depression in the first degree relatives, familial loading appears to be even more substantial in children and adolescents with major depression. Parental depression, conflict in the family, criticism of a child, dysfunction, family stress contribute to child depression which in turn also fuels family stress and dysfunction. A therapist works with both the parents and the child to identify the negative thoughts and behaviors influencing depression of both and tries to turn those into a positive influence to correct the disorders.
There is emerging support for the value of psychoeducational family programs. The sessions are taught by the professionals in the field of depression greatly increase awareness and knowledge of parents in the area of child depression. The parents are taught to identify the symptoms, how to approach a depressed child, how to help him, information about mood disorders, interpersonal skills, stress reduction, medication and medication side effects. The effect of various stressor in a child's life is also examined in the context of different environments such as school, home, community. Participants of the programs get to meet other parents and their children to discuss common issues such as symptoms, social skills, approaches to accepting depression disorder. Other therapeutic strategies include a non blaming reforming of the goals of treatment from a focus on the child's symptoms to a focus on the quality of parent-child relationships, building alliances between the therapist and both parents and child, promoting attachment between the parents and the child, and competencies within the child.
Medications. Use of different antidepressants such as clomipramine, tricyclic antidepressants (amitriptyline, desipramine, notriptyline), selective serotonin inhibitors (Prozac, Zoloft, Lexapro) showed a reduction in depression for certain children. Mood stabilizers and possibly antipsychotic or anticonvulsant drugs have been also used successfully (Kalb & Raymond, 2003). In the study exploring the effectiveness of antidepressants in treating depression it was found that fluoxetine was superior to a placebo in the acute phase of major depressive disorder in child and adolescent outpatients with severe, persistent depression. After 5 week follow up with the outpatients the superiority of fluoxetine was not seen. There were no significant differences between patients in both placebo and fluoxetine groups on measures of general psychiatric symptoms, global functioning or self-reported depressive symptom measurements (Moldenhauer & Melnyk, 1999). In the second study performed to evaluate tricyclic antidepressant amitriptyline, it was found that there were no significant differences between the control and measurement groups, so there was no evidence recorded that tricyclic antidepressant amitriptyline is effective to use in treatment for depression (Moldenhauer & Melnyk, 1999). The findings suggest that there are no an effective antidepressant to treat depression successfully. Different depressed children respond differently to various antidepressants and some may get better and some may not. It is very common for clinicians to prescribe serotonin selective reuptake inhibitors or SSRIs such as fluoxetine, sertraline, paroxetine, fluvoxamine rather than tricyclic antidepressants such as amytriptyline, imipramine, desipramine, due to better tolerance and fewer side effects (Moldenhauer & Melnyk, 1999). Ultimately, depression is a prevalent mental disorder in children and adolescents that requires a comprehensive, multidisciplinary treatment plan to prevent its persistence or reoccurrence into adulthood. If prescribed, antidepressants should always be used in combination with other treatment strategies such as cognitive-behavioral therapy, family intervention, family education and various prevention strategies (Moldenhauer & Melnyk, 1999).
In children and adolescents, the recurrence rate of depressive episodes first occurring in childhood or adolescence is 70 percent by five years, which is similar to the recurrence rate in adults. Young people experiencing a moderate to severe depression may be more likely to have a manic episode in their adulthood (Hazel, 2003). Bottom line is that children with symptoms of depression are likely to develop depression in the adulthood if not treated, than children without the symptoms.
Prevention of Depression in Children
According to the models of depression, the same skills that would reduce depression could be used to inoculate children against it. Prevention of depression includes early detection of the symptoms and immediate treatment. One of the studies done by Jaycox, Reivich, Gillham and Seligman in 1994 on the children at risk for depression by virtue of subthreshold depressive symptoms or a high degree of family conflict at home. Immediately after treatment the 69 treated children showed lower levels of depressive symptoms and better classroom behavior compared to 73 children in the nontreated condition (Asarnow, Jaycox, & Tompson, 2001). Moreover, the treated children continued to report fewer depressive symptoms at a 2-year follow-up assessment, with the number of treated children who reported symptoms of depression in the moderate to severe range reduced by one-half (Asarnow, Jaycox, & Tompson, 2001). Another approach to prevent depression in children was tested by Beardslee in 1992, who identified the children at high risk for depression as having a parent with a serious mood disorder. The psychoeducational session was attended by the parent and the child and was aimed on helping parents to convey to their children an understanding of the parent's mood disorder, and assisting the child in identifying questions and concerns for the parent to address (Beardslee, Gladstone, Wright, Cooper, 2003). Compared to the participants in the control group with lecture to the parents only, parents in psychoeducational session reported greater satisfaction, more behavior and attitude changes, increased understanding of disorder by the child, improved communication between the parent and the child (Beardslee, Gladstone, Wright, & Cooper, 2003).
In the past 20 years our knowledge and awareness of the depression in children have greatly increased. Major advances have been achieved in knowledge regarding the phenomenology, correlates, etiology, and psychosocial factors. Clinicians now know how to approach depression in children and treatment for it. The parent's knowledge of children's' depression has increased as well. Even though additional research is needed to explore the other treatments, evaluate their effectiveness, compare it to the previous treatments, strategies for promoting recovery among unresponsive to any treatment patients, now clinicians have a clear understanding of what to do when depression is discovered. There is also need for research aimed at developing strategies for ensuring that efficacious treatments are available in real-world clinical practice settings (Asarnow, Jaycox, & Tompson, 2001). As the field progresses, results of treatment research will further inform our models for development and progression of depressive disorders in children, as the studies mentioned above continue to inform our treatment strategies. Conclusion
Peer Commentary
"Depression in Children: What Causes It and How We Can Help," by Irina V. Sokolova, discussed the causes and cures of childhood depression. Her work attempted to explain some different theories regarding the issue, but in reality she only made an argument for family instability as the leading cause of depression in children. Consequently, the paper seemed to have an identity crisis. If the author wanted to discuss family instability, then the paper should concentrate solely on it. If the author wanted to discuss multiple theories, then the paper should attempt to argue how they relate to the topic of childhood depression instead of simply describing them. Not All Families of Depressed Children Are Unstable
Josiah P. Allen
Rochester Institute of TechnologyConcentrating on what the author focused on (family instability), however, one can scrutinize the arguments. The author operated under the assumption that all families are made up of a mother and a father as the caretakers. Therefore, one can deduce that in this familial layout, given marital stress between the caretakers, often the children show signs of depression. To be fair, the study by Wang and Crane (2001) is seemingly good evidence, but if the author was attempting to give a good feeling for how a child develops depression, then she did so only for a subgroup of children, which leaves one to conjecture that the issue actually goes deeper.
It is widely theorized that children's peer relationships are stronger influences on their behavior than familial relationships; the author, however, hardly mentions this phenomenon. What of children being raised by single mothers or single fathers? Certainly they are prone to depression on similar levels. This topic was only mentioned in conjunction with depressed parents, which again is a specific instance. Another large factor concerning depression is poverty and the stress concerned with it. Many children suffer under harsher conditions than those related in the paper. Even children with seemingly perfect family relationships are prone to depression. The point here is that depression is by no means dependent on the familial situation, and the paper did not delve into these issues, because it attempted to cover a larger area. To be fair, the author did at times project the idea that the issue was larger then what is at hand, but in comparison to the paragraph on family instability, this disclaimer loses its sense of importance. The author set out to explain the causes of depression in children, but the tone of the paper seemed confined when the only strong argument given was for family instability. It is of course incorrect to see a depressed child and think "There must be marital or familial stress."
Were the paper titled "A Look at Family-Related Depression in Children," then the layout of the paper would have been more proper. Although the paragraph on family stability was not large, it was the first time that the reader got a sense that the author was arguing a point about the cause of depression in children.
One lingering question throughout the paper was how does one know these children are depressed? Sokolova herself stated, "Depressed kids do not look like depressed adults," and, "Symptoms for mental disorders can be so nonspecific that even parents cannot tell if the child is being rambunctious or seriously ill." The author never described the methods by which the results were obtained after describing how difficult they are to measure, so it is perfectly logical for a reader to say, "We cannot trust evidence relating to children and depression." Obviously, this thinking is not sound, but if the author is going to caution readers about difficulties in measurement, then she should reassure readers that the studies she cited used sound measurement procedures.
Peer Commentary
The paper, "Depression in Children: What Causes It and How We Can Help," by Sokolova, discussed the symptoms of childhood depression, what causes it, and treatments for it. Sokolova talked about the several things that can cause childhood depression, including family instability and depressed parents. She stated that if the parents' marriage is unstable and the father is more dissatisfied with the marriage, then the child is more likely to develop depression. This seems logical reasoning, because, as Sokolova stated, the mother is more likely to hide her marital problems and focus more on the child, keeping all of her problems on the inside. The father, on the other hand, is more likely to start spending more time away from the home and away from the child. Depression: It Doesn't Just Affect Adults
Erin J. Lee
Rochester Institute of TechnologyIt is also more likely for a child to develop depression if one of the parents is depressed. Sokolova talked about how, in a single parent home, the single parent must play two roles, that of the mother and the father. In most cases, the mother is the single parent. This puts more pressure on her, because she has to be both the caregiver and the provider. The mother may express symptoms of depression and unhappiness, which the child can pick up on. I wonder how common it is for a child to become depressed because of this. I would not think it to be that common. Sokolova said that it is a theory, but she did not give any studies or examples of this happening.
The two therapies for treating depression that Sokolova discussed are cognitive and family therapy. In cognitive therapy, the patients are treated in three different areas. The first is cognitive, where they are taught to correct their negative thinking. The second is behavioral, where they are taught activity scheduling, social skills, and assertiveness. The third is physiological, where they are taught relaxation techniques, meditation, and pleasant imagery to calm themselves down. This therapy seems as if it would be effective in children, but there are no example studies or statistics to show it.
The other type of therapy is family therapy. It has been shown that the more involved the family is with the child's therapy, the more likely the child is to overcome depression. In this treatment, a therapist works with both the child and parents to identify what negative influences are causing the depression and how to change those. This seems like it would be a very effective treatment in treating depressed children, and Sokolova stated that it is becoming a popular form of treatment.
A third form of treatment is medication. It seems that in this day and age, people are all too quick to put their children on some kind of medication. In the paper, Sokolova mentioned attention deficit/hyperactivity disorder as being one of the most common childhood mental disorders. But she did not discuss the fact that, along with attention deficit disorder, this is often misdiagnosed. Doctors will often diagnose one of these two disorders and put children on some type of medication for it when the doctors cannot come up with any other explanation for a child's behavior. Many conditions can mimic these disorders but are only temporary. Sokolova said that often medication alone is no help in treating depression but is helpful when used with therapy.
This paper went into detail about childhood depression. It had a few interesting statistics in it, like the suicide rates among young people. There were many strong points, but a few of them just need to be backed up with some studies or statistics.
Peer Commentary
This paper by Irina V. Sokolova "describes the occurrence of depression in children, symptoms, causes based on the cognitive model, parent x child model of socialization, and tripartite model of depression and anxiety." It further supplies the causes of depression in children, which can be attributed to a combination of genetic vulnerability, early developmental experience, exposure to stressors, marital satisfaction in the family, parents, social pressure, and many more. Treatments noted for adolescent depression include antidepressants, family intervention, family education, and cognitive-behavioral techniques. Why Adolescents Have the Blues and How to Help
Christina M. Mulé
Rochester Institute of TechnologyOne area of particular interest was the family instability section. I thought it odd that children of maritally dissatisfied fathers were more likely to develop depression than were children of maritally dissatisfied mothers. Well-documented research suggests that mothers partake in childcare significantly more than fathers. Thus I find it peculiar that children are more affected by their fathers than their mothers. I also find it peculiar because women express their feelings more overtly than do men. Feelings expressed are also to some extent more self-evaluative.
Many women appear to exhibit "pessimistic" explanatory styles where they make internal and stable attributions (e.g., attributions to ability) for failure while males tend to make external attributions (e.g., attributions to task difficulty) for the same negative events. This pessimistic attributional style, coupled with tendencies to ruminate, is theorized as the primary cause of the increasing incidence of depression in women. (Rozell & Gundersen, 1998, p. 266)Consequently, depressed feelings in women are more often overtly expressed than depressed feelings in men. Perhaps this is a discrepancy that needs to be further elaborated on or researched.
I think it is also important to highlight the fact that environment is a key factor in the susceptibility to depression in children. Often children of depressed parents are depressed themselves. This environmental stressor is extremely potent in split families. The primary caretaker of children is more often stressed than the secondary caretaker. I believe Sokolova did an excellent job illustrating this particular fact.
Another area that was put together well was the section on the treatment of depression. Information that would be useful to include under the medications subcategory is the age at which children are able to start the use of antidepressants and, additionally, the ethical standpoint on this type of treatment: "Children can report accurately on their own depressed mood and symptoms and can recognize readily various different emotions (positive/negative valence and self/other perspectives) after age 9" (Hankin & Abramson, 2001, p. 775). Some feel that the use of antidepressants by adolescents is ludicrous. On the other hand, it may be the only way that certain children can be treated. Obviously, because the patients are children, all other methods to cure depression should be evaluated before the use of antidepressants.
Not only did Sokolova provide information about depression in adolescence, but also she provided solutions and recommendations for the problem. This is an excellent way for the public to learn about depression and help decrease the risks for depression in children.
Peer Commentary
Sokolova's paper began with a brief overview of statistics that were both disturbing and shocking. I never realized how serious the problem of depression in children was until I read this paper. Later the author described stressors; this is where I felt that a bit more could have been discussed about the parents. The way parents pay attention, or the type of attachment they have with their child, can have a great effect on how the child will develop and what type of disorder the child may develop. The Effect of Parental Attachment on Childhood Psychological Disorders
Elizabeth E. Stock
Rochester Institute of TechnologySecure attachment is hypothesized to allow the child to explore the environment in unimpeded fashion, because the child expects the caregiver to be available and responsive when needed (i.e., the caregiver serves as a secure base). Both types of insecure attachment, avoidant and anxious/ambivalent, are thought to hamper exploration. Avoidant attachment is hypothesized to lead to rigid exploration devoid of true interest, as the child defensively tries to cope with the perceived unavailability of a secure base. Anxious/ambivalent attachment is hypothesized to make the child anxious and distracted during exploration, as the child is preoccupied with the uncertainty of whether a secure base will be available when needed (Elliot & Reis, 2003).
The type of attachment has a great effect on children. It is a major contributor to the development of depression as well as of other childhood psychological disorders. I felt that the effect of attachment could have been addressed a bit more in this paper.
Author Response
I want to thank the authors of the peer commentaries for reading my paper, expressing their thoughts, and advising me on how to improve it. I agree with Stock, who stated in her peer commentary that "The way parents pay attention, or the type of attachment they have with their child, can have a great effect on how the child will develop and what type of disorder the child may develop." A study was conducted in Turkey on the relation between the attachment styles and depression in children, testing the group of children who had both parents and those who were orphans. One basic assumption of attachment theory is that children's relationships with sensitive and responsive caretakers are important for their consequent psychological health. Children experiencing such relationships as infants are likely to develop schemas of secure relationships, whereas those who do not are more likely to adopt either avoidant or anxious varieties of insecure relationship schemas. According to attachment theory, these early relationship schemas serve as prototypes affecting later relationships and self-schemas (Hortacsu & Cesur, 1993). The results of this study also revealed that avoidant attachment scores, but not secure and anxious attachment scores, were significant predictors of depression in children. It is so true and understandable that attachment is important, and it very well may contribute to the development of depression in children, but my paper was not intended to go so deeply into the causes of depression, the paper was intended only to provide an overview. I probably should have mentioned attachment theory along the way when describing factors that influence the development of depression, but I wanted to be brief and precise about the topic. Talking about parenting and attachment styles is a whole, separate, and deep topic by itself. That is why I did not includ it in my paper. No Clear and Definitive Answers on the Topic of Children's Depression
Irina V. Sokolova
Rochester Institute of TechnologyMulé stated that she found it "peculiar that children are more affected by their fathers than by their mothers, because women express their feelings more overtly than do men." She went on to say that "feelings expressed are also to some extent more self-evaluative." Then she cited a study (Rozell & Gundersen, 1998) in which women showed more internal attributions, and men showed more external attributions. What does overt expression of feelings mean? It means behavior that is open and observable, not hidden, not concealed or secret--in other words, external expression. It is easier for a child to see the father leaving or showing disinterest in the child when the father is depressed or not satisfied with the marriage. The mother, on the other hand, suffers internally and expresses her feelings of depression due to marital dissatisfaction secretly from the child. It makes all the sense in the world that the child is more affected by seeing that father does not want to play with the child and is never at home. Expressed feelings are not easy for a child to evaluate--children are not psychologists. I am sure that sometimes, when women feel overwhelmed, they will show some overt emotional expression, but as far as depressed parents go, depressed mothers do not show overt expressions more than depressed fathers do.
Lee wondered how common it is for a child of a single depressed parent to get depressed. I was unable find any interesting theories to answer her question. But single parents who are not depressed can have depressed children and vice versa. There are also families with different situations in which a child can develop depression--for example, if a child found out that he was adopted, and then it would be clear why he thought he did not fit into the family. The number of different family situations that can affect the development of depression in children is simply enormous and probably uncountable. There are also other factors and stressors that contribute to the development of depression in children: attachment styles, problems at school, problems with peers, negative thoughts, negative seft-schemas, and so on. As far as diagnosing depression or any childhood disorder, it is a challenge for a health care professional to accurately identify that particular disorder and to recommend a particular treatment. I understand how hard it is accurately to evaluate all the symptoms, because sometimes they overlap with symptoms of other disorders. But I think that careful analysis and observation of the child's activities and behaviors can tremendously help in making a diagnosis. There is no single treatment for depression. Several treatment techniques may need to be used to achieve success. Most children are very receptive to medications, and medications combined with cognitive behavioral therapy often produce positive results.
Finally, Allen stated that I "operated under the assumption that all families are made up of a mother and a father as the caretakers. Therefore, one can deduce that in this familial layout, given marital stress between the caretakers, often the children show signs of depression." That was not my intention at all--I think Allen misread the example. I was exploring the causes of depression in children by looking at families with two parents and also with a single parent. I made no such assumption that all families have two caretakers. My paper was just a brief overview of several causes of depression and several studies, not a collection of all possible studies on this issue. Of course the issue is much deeper than I suggested, but the purpose of this paper was to introduce the topic of depression in children and to emphasize the importance of it. I guess Allen misunderstood that point. Allen also stated, "What of children being raised by single mothers or single fathers? Certainly they are prone to depression on similar levels." I believe that I addressed that topic; some single parents are prone to depression because they have a dual role to perform and struggle with time management, having to work a lot and to provide for the children and not having time to spend with them, which may well influence the development of depression as well. Allen stated, "Another large factor concerning depression is poverty and the stress concerned with it. Many children suffer under harsher conditions than those related in the paper. Even children with seemingly perfect family relationships are prone to depression. The point here is that depression is by no means dependent on the familial situation, and the paper did not delve into these issues, because it attempted to cover a larger area." I disagree with this statement. First of all, poverty does not affect children directly but may cause depression in parents, which sometimes leads to depression in children. Depression depends mainly on family issues, but other factors affect it as well, as I described in my paper. The family is the biggest part of a child's world, and it greatly affects the child. Allen said, "Were the paper titled 'A Look at Family-Related Depression in Children,' then the layout of the paper would have been more proper." I also disagree with that, because the paper covers factors that cause depression, and emphasis was put on family issues because they are the most important in affecting the child. Allen asked, "One lingering question throughout the paper was how does one know these children are depressed?" It is not easy to see the symptoms, but, if they continue to occur many times, then it is obvious that something is going on with the child. It is not easy to determine what type of disorder a child has, but, as I said earlier when responding to Mulé, there are many ways to identify the behavior and determine the disorder. Perhaps I should have mentioned those techniques in my conclusion, but I wanted to keep the paper on the overview level not get off the main topic.
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