Last partial update: July 2016 - Please read disclaimer before proceeding

 

Depression in Australia

Depression is the most common mental illness in Australia, with 3.4 per cent of males and 6.8 per cent of females reporting the condition in 1997. About 20 per cent of the population will suffer a significant bout of depression at least once in their lives. It is also the fourth most common reason for GP consultations.

About two per cent of children and four to eight per cent of adolescents will develop depression. In children the rate is equal in males and females but in adolescents the rate is twice as high in females; the adult pattern. Only about 30% of adolescents with depression are appropriately diagnosed and treated for the condition.

Depression is a disease that usually starts in young adults and adolescents and for this reason it is important that prevention strategies target this group and younger children. About 50% of adult mental illness starts before the age of 14 years.

The boundary between depression and anxiety is often unclear and it is very common for people to have symptoms of both conditions at the same time. (Their causes and treatments are similar.)

Episodes of depression in children and adolescents tend to last about nine months. Recurrence rates are high, with about 70 per cent experiencing a further bout of depression with the next three to eight years. The younger the person is when they have their first bout of depression, the more likely they are to have recurrent episodes.

As with adult depression, adolescent depression is often accompanied by other mental illnesses that exacerbate the problem, with about 66% of depressed adolescents having at least one additional mental illness and about 50% having two or more. Common accompanying conditions include anxiety disorders (40 per cent), attention-deficit hyperactive disorder (24 per cent), substance abuse (mainly alcohol) (25 per cent), anti-social behaviour, oppositional defiant disorder and personality disorders. These illnesses often precede the depression. An important part of assessing a depressed adolescent is looking for such associated illnesses, especially substance abuse.
  

Depression children graph 1

Source – Adapted from Australian Institute of Health and Welfare: Mathers 1999.
Note: While depression (and attempted suicide) is much more common in females, completed suicide is much more common in males. When the illness associated with both is combined, as in the diagram above, the overall burden of illness is slightly greater in males.

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What causes depression?

Psychological, biological and environmental factors can all cause depression and any combination of these can be present in one person. Psychological causes relate primarily to early life experiences, inappropriate parenting and learned negative thoughts. Some personality traits that are more common in depressed people include shyness, perfectionism, chronic worrying, unassertiveness, self criticism, anxiety in social situations and low self-esteem.

Contributing environmental factors are usually causes of significant stress, including friendship / relationship problems, school stress, emotional / physical abuse (including sexual abuse, which is more common in females), bereavement and traumatic events. In general, long standing problems such tend to be more important than recent stressful events.

The prime biological factor is genetic predisposition and this is a major cause in around 40 per cent of depressed people. Depression often runs in families. Other biological causes include chronic illness, hormonal changes and some medications. Biological factors (and quite probably many psychological and environmental factors) cause depression by altering chemicals in the brain as follows;

Risk factors for adolescent / childhood depression

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Preventing depression in children

This very important topic is dealt with in a separate section; Preventing anxiety and depression in children and adolescents. All parents need to adopt the preventive strategies mentioned in this section as they can help all children lead happier lives and prevent some from developing actual anxiety and depression. They also need top rwsd the separate section on parenting: Parenting

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Diagnosis of depression

Symptoms of depression in children and adolescents

Symptoms indicating more severe depression include:

Criteria for diagnosing depression in teenagers

The criteria mentioned below for diagnosing depression in teenagers is a guide only. It is no substitute for assessment by a suitably qualified health professional. Anyone who is worried that a teenager they know has depression needs to seek medical advice from a practitioner qualified to make this diagnosis.

Depression is very likely in teenagers if all the three of the following occur:

  1. For most of the day, nearly everyday, for two weeks, the teenager is either:
    • unhappy or irritable
    • shows loss of interest or pleasure in most activities
  2. The teenager shows at least five of the following symptoms:
    • depressed or irritable mood
    • loss of interest in activities
    • significant weight or appetite change
    • insomnia or hypersomnia
    • psychomotor agitation or retardation
    • fatigue or loss of energy, often for school / leisure activities.
    • feelings of worthlessness or guilt
    • diminished ability to think or concentrate, or indecisiveness. (This can lead to impaired school performance and attendance.)
    • recurrent thoughts of death or suicide
  3. The above symptoms are causing significant distress or impairment in school, social or family functioning.

The onset is often slow and insideous, which is an important reason for the condition being missed.

As with adult depression, adolescent and child depression is often accompanied by other mental illnesses that exacerbate the problem. Common accompanying conditions include anxiety disorders (40 per cent), attention-deficit hyperactive disorder (24 per cent), substance abuse (mainly alcohol) (25 per cent) and anti-social behaviour. These illnesses often precede the depression. An important part of assessing a depressed adolescent is looking for such associated illnesses, especially substance abuse.

Substance abuse and medical conditions, such as hypothyroidism and brain injury / disease (e.g. stroke, epilepsy or Parkinson’s disease) can cause similar symptoms and need to be excluded as causes of the depression symptoms by a doctor, as does recent bereavement.) Grief following a significant life event can sometimes appear like depression. However, grief reactions are usually short-lived with reduced functioning usually returning relatively quickly. The person also does not usually experience feelings of hopelessness or thoughts of ones own death. Of course, unresolved grief can lead to depression.

A family history of depression, especially a parent, increases the risk of depression occurring as does the death of a parent, separation / divorce, sexual abuse, physical illness and poor school performance.

Suicidal thoughts are common and suicide attempts occur in up to 30 per cent of cases. About 15% of teenagers with a depressive illness will complete suicide at some time in their lives.)

Always seek help if worried

It is important to recognise that assessing such symptoms is how doctors, psychologists and other health workers diagnose depression when seeing patients. Affected young people and relatives need not and indeed should not keep to such rigid definitions as they are not trained in making diagnostic decisions. The message is that such lists of symptoms are only a guide and anyone who is concerned about them self or a friend or relative should always seek help.

The possibility of bipolar disease

If the teenager suffers from periods of elation or elevated mood or there is a family history of bipolar disorder, then this diagnosis should also be considered. (About 40% of teenagers with depression develop a bipolar disorder.)

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How can a parent help a child they suspect might suffer from depression?

  • Initiating discussion about concerns regarding a child with possible depression is a delicate matter, so try to choose a mutually convenient occasion when there is sufficient time to have a long conversation. Also choose a low stress location with no distractions. (Not in front of the TV.) Tell them they seem to have changed and that it is causing concern. Try to ask general, open-ended questions, such as ‘What is troubling you?’. Try to do more listening than talking / giving advice. Often what the child initially likes to do most is express the way he or she is feeling. Try to show empathy and understanding by listening carefully and looking at the child and resist the temptation to be judgmental. Leave advice for later. Discussing such issues can make the person become irritated and aggressive. In this situation, the parent needs ensure he or she remains calm, fair and in control.
  • Encourage and assist them in getting professional help and accompany them on visits to health professionals involved. (The parent may need to be persuasive as the feeling of hopelessness that is often part of depression will mean that the child feels no one can help them.)
  • If suicidal thoughts are mentioned do not dismiss them or avoid talking about them. Show sympathy and understanding. Try to emphasise that their situation is NOT HOPELESS and they have a well recognised, common and very treatable illness. Hopelessness is a very distressing symptom and one that needs to be overcome quickly. It is obviously important to get medical help as soon as possible and someone should stay with the person if there is immediate concern for their safety.
  • Don’t be afraid to talk with them about their depression and how their treatment is going.
  • Help them in controlling their social alcohol / other drug use if this is a contributing problem.
  • Encourage friends and family to be similarly supportive.
  • Encourage them to exercise and eat well.
  • Encourage them to become socially involved and help them organise social activities.
  • Children taking medication for depression need to be encouraged to continue taking it as prescribed or, if they are having problems with side effects etc, see their doctor. Try to ensure they don’t just stop the medication as abrupt cessation can have detrimental side effects as well as increase the likelihood the depression will recur.
  • Part of treating adsolescent depression includes having a crisis plan that can be implemented if things deteriorate quickly and there is concern for the adolescent’s safety. This may include going to casualty.

Being the primary carer for a depressed person is often a difficult task and it is important to remain in good mental and physical health by having time off and doing some enjoyable activities. Everyone will be better off. Ask family members and friends to help.)

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Mental health resources

Mental Health Branch of the Department of Health and Aged Care  www.mentalhealth.gov.au
This site provides information about crisis supports and contacts, general mental health information, mental health information brochures / publications about specific topics such as depression, anxiety, information about suicide prevention etc.
Ph 1800 066 247

Beyond Blue: The National Depression Initiative https://www.youthbeyondblue.com/?&gclid=CICs69Tvgc4CFQiVvQodF-0MFA

ybblue (Beyond Blue’s youth program)  www.ybblue.com.au
Beyond Blue’s youth program (Self harm at ybblue (https://www.youthbeyondblue.com/understand-what's-going-on/self-harm-and-self-injury

Black dog institute www.blackdoginstitute.org.au
Provides information for clinicians and patient education.

Moodgym   www.moodgym.anu.edu.au
An interactive program of CBT, more aimed at depression, developed by the Centre for Mental Health Research at the Australian National University.)

Reachout www.reachout.com.au
A resource for young people with depression.

Lifeline www.lifeline.org.au  Ph 13 1114
Lifeline provides an immediate counseling service for all people)

Kids Help Line www.kidshelp.com.au
A national 24 hour counseling service for children and young people)
Ph 1800 551 800

CRUfAD, The Clinical Research Unit for Anxiety and Depression www.crufad.com 
CRUfAD is a group of researchers and clinicians concerned with anxiety and depression. It is a joint facility of St Vincent's Hospital Ltd and the University of New South Wales in Sydney, Australia. The self-help section of the web site has useful information about both anxiety and depression for the general public.

Anxiety Panic Hub www.panicattacks.com.au
A consumer web site with a focus on meditation / mindfulness.

Mindmatters  http://www.mindmatters.edu.au
A program that introduces mental health education to secondary schools.

A helpful Australian Government web site:
Children of Parents with a Mental Illness ('COPMI') (An Australian Government web site.)
http://www.copmi.net.au/

 

Further reading on mental health topics

Rowe L, Bennett D and Tong B. I just want you to be happy. Preventing and tackling teenage depression, Allen and Unwin 2009.

Rapee, R., Spence, S., Cobham, V. and Wignall, A. Helping your anxious child. A step by step guide for parents. New Harbinger, 2000.

Macquarie University Child and Adolescent Anxiety Unit
This unit runs 12 week courses for anxious children in the 6 to 12 year age group.
www.psy.mq.edu.au/muaru.

Rapee, R.M. (2001). Overcoming shyness and social phobia: A step by step guide. Sydney: Lifestyle Press.
Deals with social phobias and shyness

Wells, A. (1997) Cognitive therapy of anxiety disorders; a practice manual and conceptual guide. Chichester. John Wiley and Sons, 1997.
  
Beating the blues by Susan Tanner and Jillian Ball. Published by Susan Tanner and Jillian Ball. Distributed by Tower books.
A good book for issues dealing with the treatment of depression.

Don’t panic. Overcoming anxieties, phobias and tensions by Andrew Page. Published by Liberty One Media.
Deals with panic disorders, phobias and anxiety.

Aisbett, B. Living with it; a suvivor’s guide to panic attacks. Pymble, NSW. HarperCollinsPublishers, 1993.

Aisbett, B.Taming the black dog. Pymble, NSW. HarperCollinsPublishers, 2000.

Calrk, S. After suicide: help for the bereaved. Melbourne. Hill of Content Publishing Company Pty Ltd, 1995.

 

Further information on parenting

The Sydney Children's Hospitals Network (includes The Children’s Hospital at Westmead.)

This hospital network's web site (https://www.schn.health.nsw.gov.au) is a great source of information on children’s health topics. It provides fact sheets about many child health issues that are free and downloadable and lists books on most child health topics that have been assessed by members of the medical staff at the hospital. These books are available for purchase from the Kids Health Bookshop at The Children’s Hospital at Westmead (Phone 02 – 9845 3585) or they can be purchased via the ‘e-shop’ on the web site. Any profits go into supporting the work of the hospital.

Some suggested books on parenting children

Every parent. A positive approach to children’s behaviour  by  Matthew R Sanders, PhD.

More Secrets Of Happy Children  by Steve Biddulph

Raising Kids- A parent’s survival guide by Charles Watson, Dr Susan Clarke and Linda Walton.

Bully Busting by Evelyn M. Field

Raising Boys  by Steve Biddulph

Your Child's Self Esteem  by  Dorothy Corkhille Briggs

(All these books and many more appear in the ‘self esteem, behaviour and family life’ section of the books section in parents section of the Children’s Hospital at Westmead web site. https://kidshealth.schn.health.nsw.gov.au/bookshop-and-products) There is information about each book on the web site; just click over the title.) Better still, for parents able to visit the hospital, most of the books are available to view and there will be someone there to help with book selection.)

Some suggested books on parenting adolescents

What to do when your children turn into teenagers  by Dr D. Bennett and Dr Leanne Rowe (This is a wonderful book that is unfortunately now out of print. Second hand copies may still be available.)

You can't make me  by Dr D. Bennett and Dr Leanne Rowe

I just want you to be happy. Preventing and tackling teenage depression. by Professors Leanne Rowe, David Bennett and Bruce Tonge. Published by Allen and Uwin, 2009.

Puberty boy  by  Geoff Price

Puberty girl  by  Shushann Movsessian

The puberty book  by  Wendy Darvill and Kelsey Powell

Teen esteem by Dr P. Palmer and M. Froehner

Most children suffer anxieties at some time and another book (not on the above list) that is very useful for parents is - Helping your anxious child. A step by step guide for parents. by Rapee, R., Spence, S., Cobham, V. and Wignall, A.New Harbinger, 2000.

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