Stories about: grief

Coping with grief

illustration of sunset to symbolize grief
PHOTO ILLUSTRATION: FAWN GRACEY/BOSTON CHILDREN’S HOSPITAL. BASED ON ORIGINAL ARTWORK BY ELIZABETH DOVICH

The line wraps around the stage in the Joseph B. Martin Conference Center and extends down the aisle. Stepping up to the microphone, a man in a yarmulke says a name, then places a long-stemmed rose in a nearby vase. Behind him, a little blonde girl whispers her sister’s name and walks to the vase. Behind her, a large family clad in matching t-shirts emblazoned with a baby’s smiling face follows suit. When everyone has had a turn and returned to their seats, a medical resident begins reading dozens more names as clinicians and staff from Boston Children’s Hospital cycle past the vases, each adding another rose.

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5 things to know about teens and depression

No1

How does depression impact children and teens?

 

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Depression impacts many youth and families across the U.S. Up to 28% of young people experience an episode of major depression by age 19 with an average onset age of 13 years old. However, only 38% of teens experiencing depression receive treatment. Raising awareness is a key step to addressing depression.

Depression is treatable, and early detection and treatment are effective. With increased awareness and early intervention efforts, both teens and adults can learn to identify the signs of depression and get help sooner.

Left untreated, depression can lead to deteriorating school work, strained relationships with peers and adults, high rates of absenteeism, school dropout, substance abuse and suicide. There is a strong and significant connection between students’ emotional health and their academic progress: students who are battling emotional problems are not able to learn as well as students who can devote their full attention and concentration to their education.

Depressive disorders are the largest single contributor to adolescent suicide risk. Seventeen percent of U.S. high school students report having seriously considered suicide during the previous 12 months.

No2

What causes depression?

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Depression is caused by a combination of factors, not a single factor. Depression is not just a phase and is nobody’s fault. It is a medical illness that includes a combination of biological, psychological and social components. Everyone’s experience with depression is different— there is no formula that can predict the influence of each factor in the development of depression. It is important to meet with a professional who can assess the teen and provide an accurate diagnosis.

  • Biological—Depression is a medical illness with chemical and genetic links. One factor that is linked to depression is a difference in the structure and functioning part of the brain that affects mood. Children and teens with a family history of depression are 25 to 45 percent more likely to develop depression. Youth with chronic illnesses such as diabetes or cystic fibrosis may be at increased risk for depression.
  • Psychological—Cautious or pessimistic thinking does not mean a person suffers from clinical depression. The negative thoughts that people who struggle with clinical depression have are significant, debilitating and limit functioning. A few examples are: jumping to conclusions (They didn’t say hi to me because they don’t like me.), focusing only on negative feedback (Even though the teen gets a good grade on a paper, she only focuses on the negative comments the teacher made.), negative judgments about self (I should be smarter, I shouldn’t make so many mistakes, I will never amount to anything.) or personalizing everything (It’s my fault, I did something wrong.).
  • Social—There are many different environmental factors that can have a positive or negative impact on a teen’s depression. Relationships with family and peers, school experiences and community connections can impact a teen’s depression.

No3

What are the signs and symptoms of depression? 

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Everyone experiences some symptoms of depression at times—and that is normal. Clinical depression is diagnosed when multiple symptoms occur daily, last most of the day, are persistent over time, and interfere with the teen’s ability to function at school, with friends and with family members. Symptoms of depression include:

  • depressed or irritable mood most of the day, nearly every day
  • decreased interest or pleasure in all or almost all activities
  • significant weight loss or gain
  • sleeping too much or sleeping too little
  • agitated, can’t stay still, restless
  • fatigue or loss of energy
  • worthlessness or excessive or inappropriate guilt
  • difficulty concentrating or thinking
  • recurrent thoughts of death

In teens, mood change is more often characterized by irritability than sadness. Irritable teens are often quick to snap back at people and tend to argue a lot. Teens can be depressed if they are irritable at home but seem to be happy with their friends.

No4

What other problems might depressed teens have?

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 Children and teens who struggle with depression often experience other difficulties. Sometimes teens don’t have the language to express what they are experiencing with depression. Many don’t realize they are experiencing depression. Sometimes depression shows in other ways.

You might see:

  • symptoms of anxiety (frequent worries and fears, nervousness, edginess, nightmares, panic attacks)
  • physical symptoms (headaches, stomachaches, numbness, difficulty breathing, heart pounding)
  • change in day-to-day functioning (Perhaps a typically outgoing and active teen becomes more silent and withdrawn.)
  • acting out behavior (being rebellious, breaking rules, being defiant, threatening to run away, delinquent acts)

Most teens may experience one or a few of these difficulties. This is common in response to stress, and it does not mean that they necessarily indicate clinical depression. It’s the combination of several symptoms, their severity, duration, frequency and impact on functioning that determines if a teen has depression.

If you notice these symptoms in your teen, don’t worry about having to make the distinction between what is or is not clinical depression. The important action is to report this to a medical doctor, psychologist, psychiatrist or guidance counselor so your teen can be assessed.

No5

How does depression differ from stress and grief?

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The main differences between stress and clinical depression are:

  • Symptoms of stress (irritability, stomachaches, headaches, lack of focus) generally go away once the source of stress (family stressors, tests, deadline) is resolved.
  • Symptoms of clinical depression (irritability, lack of motivation, lack of focus, hypersomnia, insomnia, hopelessness) persist for weeks and months, even when stressors are no longer present and even when happy things happen in the person’s life.

An example may be an adolescent who experiences stress might display crankiness, insomnia and loss of appetite during final exams, but these symptoms quickly disappear after the exams are over. On the other hand, the teen who experiences clinical depression displays these same symptoms in a sustained way before the final exams, throughout the final exam period and beyond.

The American Psychiatric Association states, “The death of a loved one, loss of a job or the ending of a relationship are difficult experiences for a person to endure. It is normal for feelings of sadness or grief to develop in response to such stressful situations. Those experiencing trying times often might describe themselves as being depressed. But sadness and depression are not the same.” Grief is in response to an incident of loss or change whereas depression is a pervasive disorder that is the result of a combination of factors.

If you are concerned about your teen, there is help available. Contact your teen’s pediatrician, or if you feel that your teen is at immediate risk, call 911 or the suicide hotline at 1-800-273-8255.

In next week’s blog, we will talk about levels of depression and treatment, how to talk to your teen if you are concerned and how to promote healthy coping skills.

Learn more about depression at bostonchildrens.org/breakfree.

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Life's losses–and blessings

Claire McCarthy, MD

Today is the anniversary of my friend Jim’s death.

It’s been a hard few weeks. The first year after a death is always the worst, I think, because every day is an anniversary; there is nothing in between when they were with you and when they weren’t.

Everything about the light and the smells and the air has been reminding me of last year, when I was spending so much time with him at the hospital or the church rectory where, as a priest, he lived. All I have to do is think of him, and tears rush in.

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Remembering Aidan

This past weekend we celebrated my dead son’s birthday.

It’s the same every year; it’s easier that way. There’s no thought or planning involved; we can just slip into it and let the ritual carry us. At 5 pm on October 17th, the family and friends who are coming meet at our house. We walk down the back path, down the hill to the cemetery, carrying a bunch of balloons. When we get there, the balloons get distributed and when everyone’s ready and we’ve ascertained the direction of the wind, someone counts to three and we let them go as we all say, “Happy Birthday, Aidan!”

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