A conference this week focuses on childhood depression. Sylvia Thompson reports.
There is a widely held view among mental health professionals that depression in children and teenagers is on the increase.
However, the reasons for this are complex, not least because more parents are aware of the symptoms of depression and keen to seek treatment for their sons and daughters, but also because of a growing awareness among professionals that there is a link between mental health problems in children and full blown psychiatric disorders in adulthood.
"One New Zealand study found that for 75 per cent of adults with mental illness, the origins of their illness was in childhood. This points to the importance of early intervention so that children and adolescents can be treated early before secondary family problems occur," says Prof Fiona McNicholas, consultant child and adolescent psychiatrist at Our Lady's Hospital for Sick Children, Crumlin, Dublin and the Lucena Clinic Child and Adolescent Mental Health Services.
"Educating people about how to recognise kinds of unhappiness and distress that may go on to become a [psychiatric] disorder can help reduce the numbers who progress from a mild problem to a disorder and can also reduce the severity of the symptoms of a disorder in others," she adds.
Prof McNicholas is one of the organisers of the Lucena Clinic Services 50th Anniversary conference on child and adolescent psychiatry at St John of God Hospital, Stillorgan, Co Dublin later this week.
Dr Michael Sweeney, assistant professor of clinical psychology at Columbia University, New York, will speak about the modern approaches to treating depression at the conference. "There is a belief now that depression is largely genetic and those with a pre-disposition towards it will be at greater risk or more affected by events such as if their parents divorce or they experience failures at school.
"There is also an understanding that more than half of the parents whose children are depressed aren't alcoholic, neglectful parents and this has changed parents from being adversaries in the treatment to co-therapists," he adds.
In terms of treatment, Prof McNicholas says there is no recognised best treatment for depression - and the majority of those children who get depressed will improve with their own support networks - but the predominant approaches are anti-depressants and/or cognitive behaviour therapy.
As the debate on whether the group of anti-depressant drugs called selective seretonin release inhibitors (SSRIs) increase the risk of suicide in young people continues, Prof McNicholas says, "there needs to be good justification for using medication. It depends on the severity of the depression and whether there is a strong family history of depression with a good response to medication. Also, it should never be a stand-alone treatment but combined with psychological therapies."
Drug therapy aside, depression and other severe forms of mental illness have been linked to suicide in a more general way and finding ways to get young people with depression treated is seen to be a key to suicide prevention. "The leading cause of death in 15-24 year-old males in Ireland is suicide and it is known that 90 per cent have a psychiatric illness before taking their lives," says Prof McNicholas.
One initiative aimed at picking up undiagnosed mental health problems in children is the Department of Health Programme for Action for Children. Through this, primary care practitioners are trained to screen children for emotional and behavioural problems.
"It is a very welcome addition and we hope that it will be spread throughout the country so that there can be more early detection of mental health problems," she says.
In the US there is a countrywide screening programme for psychiatric disorders run through secondary schools. "It's called Teen Screen and it involves the teenagers [with parental consent] answering questionnaires, doing an interactive interview administered by a computer and then seeing a doctor all in the one day. If a problem is found, the parents are contacted and a plan is put in place to go to the local clinic or community doctor. We have found that the voluntary disclosure of depression is common among teenagers but about one in 20 will have a psychiatric illness," explains Dr Sweeney.
Ultimately, the aim of all mental health professionals is to de-stigmatise depression and other mental illnesses so that families can access treatment for their children just like they would for cancer or other serious life-threatening illnesses.
Another aim is to promote mental wellbeing in everyone so that we can build in activities into our lives that will keep us in good mental health, which will, in turn, give our children better strategies for dealing with unhappiness and distress in their lives.
The 50th Anniversary Conference on Child and Adolescent Psychiatry for healthcare professionals is on Thursday and Friday. A half-day conference for parents with free workshops on depression, substance misuse, eating disorders, bullying at school, autism and attention deficit hyperactivity disorder is on Saturday.
See also Coping with Depression in Young People - a guide for parents by Prof Carol Fitzpatrick and John Sharry (Wiley).