Depression is a mental illness that exists across all the age groups. Recently we are witnessing it in children younger than 10 years and in adults older than 70 years. In these extreme age groups, it becomes very difficult to recognise this illness as it has a different presentation in these groups.
Eight-year-old Roshan’s mother was narrating his behaviour. Roshan had become extremely irritable, constantly fighting with his siblings and friends, throwing his school bag, pens and pencils. He had become adamant and was not listening to any one in his family. He was not studying. He would play with his friends and fight with them. He was not eating properly. He would not sleep properly. Sometimes he would get nightmares.
Recently, he had become extremely aggressive towards his teacher in the school. He was shouting at her, was about to hit her. The teacher had just asked him about his father. Roshan lost his father when he was two years old. He had never reacted on this issue, but recently his behaviour has changed totally.
Research in India has shown depression occurring in 4 years to 11 years of age. It is prevalent amongst 1.6 % to 4.4 % of children. Children show different symptoms of depression — mostly, it is altered behaviour rather than emotional symptoms. The child becomes reluctant to go to school, academic performance starts deteriorating. The child becomes extremely quiet in the class, gets easily agitated or aggressive.
Children start blaming themselves, feel that they can't do anything, they are useless. They keep thinking that the teacher will punish them. They lose their confidence, and cry often without significant reason.
Another important symptom in kids are unexplained pains and aches. Headache or abdominal pain is very common. These pains present often but there is no apparent physical cause. Varying pains can be symptoms of depression. Hence it becomes difficult to diagnose depression when it is disguised as a physical symptom.
In the elderly, extreme anxiety and worry can be a symptom of depression. Physical symptoms which are unexplained, where all physical parameters are normal and still physical symptoms of pain or ache persists, can indicate depression in elderly people. One gentleman brought his 75-year-old father with the complaint that his father would become restless and keep on reminding him several times in a day to bring his medicines. He would worry whether he would be cared for or not; he would feel no energy and enjoyment.
Depressed mood, lack of enjoyment, lack of meaning in life, feeling helpless and hopeless, keeping quiet, loneliness, multiple pains and aches, and crying could be symptoms of depression in the elderly.
The incidence of elderly depression in various studies conducted in the community, elder-care homes and public hospitals worldwide ranges from 9% to 62%. On an average, worldwide depression persists in 5.4% of population, but in India it is 18.2% which is really high as compared to others. Incidentally, we are the first in the world’s population. It is estimated that in 2050, India would have 300 million elderly depressed people which will be 19% of India’s population. Will it not be a huge burden to society?
Let's route in possible reasons for depression. In children, a dysfunctional family is an important reason for depression to be induced at an early age. Parental fights and separation could cause a lot of guilt in children. Lack of a parent or death of a parent is a huge burden on young minds. And needless to say, child abuse — physical, emotional or sexual — can lead to severe depression.
Burden from academics, slow learning, bullying in school are other reasons. Frequent changes of school or going away from home for studies can lead to depression.
In elderly, the brain chemicals are depleted due to ageing. Physical illness causes disability, inability to care for self and dependence on others — these may lead to depression.
Familial neglect, loneliness and financial difficulty can contribute further.
Uneducated, jobless, single, divorced or widowed — all these factors may lead to depression. Addiction, lack of family support, multiple physical illness are the reasons of depression in any age group. Kids who don't get quality parental time have depression; on the other hand, older people who don’t spend time with kids have depression.
Depression is a disorder of major public health importance, in terms of its prevalence and the suffering, dysfunction, morbidity and economic burden. Depression is more common in women than men. Untreated depression leads to a further burden in the community, and it can have more severe consequences too. Untreated depression can lead to suicide and addiction, in addition to a poor quality of life and lack of productivity.
However, depression can be treated easily. Medications and counselling can be of great help.
Increasing urbanisation is leading to a nuclear family system. In a joint family, the elders can care for the children while adults are busy in their work. This might increase the emotional bond between children and older people. In fact one of the strategies to prevent depression in the elderly is for them to spend quality time with kids.
Developing hobbies can be of great help to maintain emotional health. Adequate sleep and proper food is very helpful. Regular physical exercise and laughter clubs can help curtail depression.
The above health tips are not a substitute for treatment.
Dr Shailesh Umate is a consultant psychiatrist, sexologist and addiction specialist, whose mission is spreading awareness about mental health and well-being
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