Depression among Children and Youths - Literature review Example

Depression among children and youths Name Subject Instructor Institution Date Abstract Children and youths are the most important future investment. Community and families have a responsibility of ensuring that, children and youths have access to facilities that promote mental wellbeing and the optimal human development. Despite the effort applied in relation to child and youth mental health, some children and youths develop health issues. Apparently, depressive disorder is one of the most significant health issues in children and youths. This feeling leads to children and youth to develop conduct disorder and may greatly affect them in their growth. Various clinical issues have stipulated the causes of depression, such as stress and environmental factors. This paper elucidates the nursing relation with the family concept in coping with depression among the children and youths as it concerns their mental health. Introduction Depression among children and youths Children and youth who exhibit symptoms of depression exhibit maladaptive behaviors. The environment that children and youths grow up today is not supportive to their development. Inherently, depression is condition where an individual constantly experiences an irritable mood that makes one to lack pleasure in any activity carried out as noted by (Berne, 2007). The number of young people who are suffering depression has increased over a couple of years. Furthermore, there has also been an increase in the cases of depression diagnosis at a very tender age. According to (Kemp, 2007), in America, about 3 million American young people are suffering from depression a condition which was absent in earlier years. Depression is impairing, not only to the person affected, but also to the entire family. Firstly, about 15% of children and youths suffer from depressive disorder. This causes significant impairment and distress to their development as noted by Varcarolis & Margaret (2010). Moreover, they exhibit social withdrawal symptoms that affect their academics and daily activities. Most of these children and youths do not access services and the needs they require, resulting to increase in impairment and suffering affecting their functioning, and productivity in their adulthood. In children and young people, depressive disorders are a major disabling mental health issue as noted by (Canty-Mitchell, et al., 2004). Depression is termed as one of the major factor contributing to substance abuse, adolescent suicide and a major cause of school dropouts and school failure. Many children and young people suffering from depression are at greater risk of physical illness, substance abuse, suicidal behavior, early pregnancy, impaired psychosocial function-ability, teenage pregnancy and being prone to negative events. Although, similarities exist between depression in children and adults, depression in children may show itself in a different way compared to depression in adults as noted by (VerLee, 2010). This is succinct in the diagnostic criteria that portray the differences in development stages amongst the children and adults. There are many questions in regards to the cause and the outcome of depression affecting children and young people. According to (Dosser, 2001), juvenile depression has emphasized that, clear diagnostic criteria, clinical assessment, and rigorous method, are some of the techniques, which could fight depression in this population. Allender & Barbara (2005) pointed that, depression mainly occur in 2% to 4% of children and about 4% to 8% in youths. Depression prevalence among girls and boys is virtually the same during childhood, but during adolescent prevalence of depression in girls tend to double. Girls appear to be faced with more depression risk factor than boys are, this may be due to early onset of puberty, concern about their body image, introspective problem solving style, pressure to conform to too many social roles and high risk of sexual harassment (Merry et al, 2004). A depressed young boy faces parasuicidal behavior such as, substance abuse and risk taking. Different studies have shown that, depression trends are higher in earlier ages of children depression worldwide as noted by (Kuster & Lina, 2006). There exist strong link between depression and different indicators of adversity such as chronic stress, family disruption, homelessness, poverty, and reduced opportunities as stipulated by (Kemp, 2007). Clinical picture on depression includes; different features associated with changes of moods such as dysphoria, sadness, suicidal ideation, and feeling of worthlessness. These symptoms are prevalent in depressed adults than in children. Unlike adults, though, children are less likely to develop suicidal attempts but demonstrate symptoms of anxiety, depressed appearance, apathy and disinterest, physical complaints, hallucination, irritability and frustration, lack of cooperation and withdrawal from friends and family. In contrast to children, youths are likely to display symptoms of weight loss, delusion, sleep and appetite disturbances, poor school performance, suicide attempts and suicidal feelings and thoughts as stated by (Galanter & Peter, 2009). Children and youths often suffer from episodic disorder with each disorder lasting for a period of about eight months. Most of them recover from an episode in one to two years, whereas other suffers from chronic depression after their first episode disorder. According to (Townsend, 2008), almost half of young people experience a relapse within two months. However, in clinical setting, it is easy to identify children and young people with major depressive disorder (MDD). The criteria may lack sensitivity in developing differences in manifesting depressive problem as noted by (Merry et al, 2004). Effectiveness of nursing responses are influenced by age in which, the first episode of depression would be; to realize the presence of other disorders, severity of the depression, presence of parental disorders exposure to stressing life events, quality treatment and family conflict as noted by (Guberman, 2007). Combination of psychodynamic therapy, psychiatric medication, cognitive-behavioral therapy (CBT), and the family therapy are most efficient methods in treating acute phase of depression disorder. To treat a child suffering from depression, the family of the child needs to be involved. The application of a family may act as co-therapist depending on the child case by use of a structured approach like, cognitive-behavioral therapy as noted by (Kuster & Lina, 2006). Home based intervention methods may help the family in developing supportive home environment thus, reducing stress at home. Family may also apply social work intervention in dealing with different issues relating to psychosocial stress and poverty such as homelessness, unemployment, and social support accessibility. Consequently, inpatient admission may be helpful to individual adolescent in countering long-standing depression problems in interpersonal functioning with their family and peers. The severity of adolescence depression symptoms may include; suicidal thoughts and involvement juvenile delinquency. These baseline characteristics relate to different treatment outcomes of the reduced depression severity, re-hospitalization, and reduced suicidal risk according to (Guberman, 2007). Though clinical judgment is significant in assessing individual situation, guidelines in dealing with youth who have suicidal thoughts includes removing from home all lethal agents such as guns, assessing physical and sexual abuse, assessing substance abuse, personality disorders and school problems. While many people undergoing, mental disorders may be discriminated, children and youths are the least capable to advocate for themselves. This is because, children think more dichotomously as compared to adults about some categories such as “good” or “bad,”. According to (Bartlett & Greninger, 2006), they are less likely to temper a positive remark with more negative feedback and, may easily accept a negative and misapplied label. Different studies shows that bias, fear, stereotyping, anger, embarrassment, and rejection may in one way or another contribute to depression in children and young people. Moreover, in contrast to child physical illness where the community may support the family, Townsend (2008) believes that, depression exhibited in children is because of family issues. Children between four and six years mostly suffer from hyperkinetic and conduct disorders. Clinician in different parts of the world categorizes symptoms relating to this problem differently. In some countries, child depression disorders are common in childhood with 10% prevalence among the male children and 5% among the female children as itemized by (Nelling, 2008). If developmental and hyperkinetic disorders are untreated and, continue in the adolescence and adulthood, they may increase school dropout, poor employment history, and antisocial behavior. This may impair parenting leading to intergenerational cycle and self-perpetuating. Health care professional can easily recognize physical and emotional disorders, which are not apparent to parents and teachers as noted by (Smith, 2005). Emotional disorder in children and youths may include mood and neurotic disorders such as obsessive-compulsive disorder and depressive episode, which develop during school age. Many children and youths who suffer depression experience a recurrence of this in their adulthood. Depression often occurs with many co-morbid psychiatric disorders, behavioral problems and increased suicidal risk as asserted by (Townsend, 2008). Depression often affects person life as a whole, impairing social, occupational, emotional, and physical health of an individual. Very young primary school pupils suffering from depression may appear sad and helpless. Slightly old pupils may develop a feeling of being unloved or unfair treatment. Varcarolis & Margaret (2010) overtly states that, guilty feeling followed with desperation may possess most of the teenagers. Assessing depression in children may be difficult as a depressed child my answer by remaining silence, shrugging or nodding. On the other hand, youth undergoing depression may be manipulative and difficult to discuss with them. They may be unsatisfied by one opinion and may always require a second opinion. Due to the problem in diagnosis of depression in children and young people, variable access to psychological intervention in relation to primary care and controversy on the efficacy of antidepressant medication to individual who are18 years and below, management care is mostly based on secondary care with primary care support as stated by (Varcarolis & Margaret, 2010). Primary care comprises; health visitors, social workers, school nurses, juvenile justice workers, and pediatricians. Primary care is essential in exposure of undesirable single event when there is absence of other depressing risk factors and in the exposure to undesirable event where there was one or more family member with a multiple history of depression. Children and youth mental health care personnel include pediatricians, clinical child psychologists, psychiatrists, educational psychologists, child and youth psychotherapists, nurse specialists, counselors and family therapists as stated by (Bartlett & Greninger, 2006). They assist in fighting against mild depression in children and, youths who have not responded to primary care after a period of about 2-3 months. Moreover, moderate and severe depression, unexplained self-neglect to a child which can be harmful to a child mental health, symptoms of depression recurrence and active suicidal ideas (Smith, 2005).Children and youths with moderate and severe depression must get first line treatment in specific psychological therapy, interpersonal therapy, cognitive behavioral therapy, and short-term family therapy. Most patients suffering from depression need to be encouraged so that they can have courage of talking about their fears and anxiety without fear. Medication Antidepressant medication is the mostly used medication in fighting depression among children and youths. It has to be used in combination in cooperate psychological therapy. Bartlett & Greninger (2006) study shows that, antidepressant show limited efficacy in the juvenile depression, but in adolescent fluoxotine may be effective. Townsend (2008) notes that, use of fluoxotine is the most efficient method as, its benefit outweighs the risk involved. The second line antidepressant recommended is the sertraline. Electroconvulsive therapy (ECT) finds its application in young people between 12-18 years who portrays very severe depression cases and, suicidal behavior that have not responded to other treatments as noted by (Townsend, 2008). The use of ECT should be used rarely, and if it has to be used it must be assessed carefully by a practitioner who is experienced in its use. This application should not be used to children who are between 5-11 years as noted by (Pillitteri, 2007). Varcarolis & Margaret (2010) pointed out that, depressed children could generate very high childhood cost. A related finding show that cost of antisocial behaviors is ten times greater for individuals who were previously antisocial in their childhood than the adults who were not as noted by (Pillitteri, 2007). Studies conducted by (Smith, 2005) show that, no country has clear defined mental health policy concerning children and youths as noted by (Andrews & Joyceen, 2008). However, some countries have identifiable health policies that may be beneficial to children and young people. Lack of policies and comprehensive nursing plan for children and young people suffering from depression is unfortunate since, children and youth heath policies in regards to mental health can enhance quality of services. As (Kuster & Lina, 2006) notes, this would promote good mental health throughout a country. Different systems such as education, welfare, and health have to function effectively in order to ensure that, mental services provided to children and youths are efficient and effective as stated by (Scully, et al., 2005). An overriding consideration is on the way in which disorders manifest themselves and the way in which they can be treated. Therefore, developmental perspective is essential in understanding mental disorders and in developing appropriate children and youth mental health, and nursing policy. Key issue that have to be addressed is on whether children and youth mental health and nursing policy should be included in general mental health policy or should it be developed as alone policy. An independent children, youth mental health, and nursing policy will focus on major issue and make sure that the needs of this population are not lost when developing the broader policy. A broader approach in addressing the need of this group may give room for a more comprehensive mental health response for children and youths as (Smith, 2005) notes. It is of utmost significance to understand the health worker and family attitude towards the current system and the possible changes that can be done in the system to make it more appropriate for children and youths mental health wellbeing (Pillitteri, 2007). Conclusion Quality of children and youth mental health depends on the knowledge and motivation possessed by this group. Different structures on the existing organization of care and services given to children and youths need to be examined to identify various components and ensure that, benchmarking is enabled. Assessment of the issue relating to their well-being should comprise gaining knowledge on the different settings where children and youths live, socialize and where they are educated. Children and youths suffering from depressive disorders require appropriate diagnostic facilities accessibility without any barrier. After undergoing diagnosis, they should be availed with friendly services to treat their needs. Family should coordinate effort to ensure that, the mental health of their children is monitored. The Family needs to work with educators to help in reducing depression cases and suicide ideation among children and youths. They also have to seek nursing care from pediatricians’ assistance in understanding mental health problems and abnormal behaviour in their children. Some people argue that prevalence of depression in young people is because children are reaching their puberty earlier and most of depressive signs show up during adolescence. However, some thinks that availability of safer antidepressant is the main cause of the increase in depression. The current outlook of young people who are suffering depression is not bright. When an individual suffers from depression, both psychotherapy and medication should be administered to the affected individual. Finally, the efforts to boost children and youth physical health that have profound implication in improving the mental well being need to be applied in fighting depression among this group. Unless children and youths with mental disorders such as depression should receive appropriate treatment, their problems are likely to continue, and their vocational, educational, social prospect diminished. The result is a direct loss to the family, society and the nation at large. References Allender, A. & Barbara, S. (2005). Community health nursing: Promoting and protecting the public's health. Philadelphia: Lippincott Andrews, M. &Joyceen, B. (2008). Transcultural concepts in nursing care. Philadelphia: Wolters Kluwer Health. Bartlett, H. & Greninger, L., 2006. "Using a system of care framework for the mental Health treatment of children and adolescents." 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