Many factors can trigger depression in children and teenagers.
Dr Lai: Every time they get a compliment, it’s like a deposit for their self-esteemBY the time she was six years old, Amy (not her real name) had already been sexually abused by her father for four years.
Amy never told anyone about it because her father had said it was their “little secret”. The secret was blown when Amy’s uncle somehow found out about it, and informed her mother about the abuse.
Sadly, instead of believing her, Amy’s mother turned her anger on the child, insisting that Amy must have been lying.
With her mother furious with her, Amy believed that she must have done something wrong, and that she was responsible for the mess her family was in. She took it upon herself to somehow make things right. She killed herself.
While this case did not happen in Malaysia, experts say there is definitely a disturbing trend where children as young as six years old are expressing suicidal tendencies.
Penang Hospital consultant (child and adolescent) psychiatrist Dr Lai Fong Hwa says he started noticing suicide cases among Malaysian children in the last five to 10 years.
“Kindergarten-going children can suffer from depression. Actually, even children who are four or five years old can suffer from depression, but usually these cases are due to biological causes rather than external causes,” he says.
Many factors can trigger depression in children and teenagers that, if left undetected and undealt with, could lead to suicide.
One factor, he explains, is the overemphasis on academic performance and achievement, even among pre-schoolers, which makes schools an extremely stressful environment.
“Some parents have the tendency to say things like If you want mummy to love you, you must get straight As in your exam.’ What happens is the child then equates academic performance with whether his parents will love him. So if the child doesn’t do well, in his mind, his parents don’t love him anymore.
“Even though parents may have good intentions, they should never say things like that because it can have serious negative repercussions. What they should say is We will love you no matter what’,” says Dr Lai.
Children, he says, need what is called an “emotional bank account”.
“Every time they get a compliment, it’s like a deposit for their self-esteem. But every time they are criticised, the account gets depleted. What’s important is that they should always have a good emotional bank account, because otherwise, when difficulty comes, they have nothing to draw from.”
He adds that children these days are constantly drummed with the message that they’re “not good enough” because society expects them to achieve certain academic standards.
In the younger children, this stress can cause them to fear school.
“If a child has been quite happy attending school, and then suddenly fears school a few months down the road, it shows that something is not right. School should be fun, not torture. This is why I encourage parents to send their pre-school children to playgroups, rather than to classroom-environment kindergartens,” says Dr Lai.
Apart from academic achievements, shoving a child into multiple co-curriculur activities can also be extremely stressful.
According to Childline project director Michelle Wong, the helpline has received calls from children who are stressed out from having “too many exams”.
“One girl contacted us, saying she was having piano, violin, ballet and school exams all in the same month, and she could not cope with the pressure. She didn’t know what to do,” Wong says.
Dr Lai adds that when a child has so much on his plate, the actual time spent with his parents is usually minimal, which is unhealthy for the child.
One question he frequently uses in his clinic when testing children on who they turn to for support is: “If you are alone on an island, and you can wish for one person to be with you, who would it be?”
“A normal child below the age of 12 would usually name their mother, or father, or a sibling whom they’re close to. If they’ve been brought up by their grandparents, then it’s also quite normal for them to name a grandparent.
“But when a child starts wishing for a friend instead, it shows that he doesn’t look to his family for support. This can be dangerous as his friends are not likely to be able to fully help him should he get into any problem,” Dr Lai explains.
His concern is very real. In the last few weeks, there have already been several sudden deaths involving students under the age of 18.
Last month, a 14-year-old boy hung himself after having a fight with a friend. Another 17-year-old boy hung himself over “academic issues”.
In another case, an 11-year-old boy who fell to his death from the 14th floor of a flat in Penang left behind a handwritten note. His family has, however, denied it is a suicide note, saying that he had always written letters to express himself.
Early this week, a 12-year-old boy in Sabah hung himself with his shoelaces he was apparently upset over not being able to return to his hometown to see his grandfather.
Dr Ng: Children often use acting out as a way to express their inner distress.“The trend is worrying. Children shouldn’t be killing themselves,” Dr Lai says.
Depression among children and teenagers, more often than not, may appear as irritation or agitation, as opposed to the typical expression of sadness, says clinical psychologist Dr Ng Wai Sheng who has served in various settings including children social services, substance abuse rehabilitation and inpatient and outpatient psychiatric settings.
“This may partly explain why adults often overlook depression in young people. Depressed children and adolescents may be mislabelled as “angry” or “moody” kids. For young children, their behaviour may be confused with Attention-deficit hyperactivity disorder (ADHD).
“Children often use acting out as a way to express their inner distress, resulting in some being labelled as the bad kid’. Another common sign is the deterioration in academic performance and motivation, which may lead to the mislabelling of being lazy’ or not smart enough’,” she explains.
Divorce between parents has also frequently been linked to depression among children, but Dr Ng says it is not so much the divorce per se but rather how the divorce is handled that could be the determining factor.
“There is evidence to show that when a divorcing couple handles the matter prudently and maturely, and remain supportive of their children, the children continue to fare well in their lives,” says Dr Ng, a Fulbright alumni.
This includes communication between the parents and the child, whereby the child is assured of continuous love and support, and there is emphasis that the child is not responsible for the parents’ decision.
However, she notes that the stigma of belonging to a single-parent or blended household could pose a challenge for children in Asian societies.
Senior community consultant paediatrician Datuk Dr Amar Singh says that based on his 30 years of experience working with children, child abuse (physical, emotional, or sexual) is also a trigger factor for suicide among children. For teenagers, peer relationship (including boyfriend or girlfriend problems) is also a common cause.
So, what can be done about children and teenagers who are suicidal?
The key is communication, say the experts.
“A majority of those who commit suicide would tell at least one person before they carry out the plan, so look out for the warning signs (refer to graphic above). If one suspects that a child/adolescent may have suicidal tendency, it is important to stay with the person, and raise the issue sensitively but directly with the person. Talking about death or suicidal thoughts does not mean you’re putting ideas in the person’s head’. That is a myth!
“Instead, talking about it openly, albeit with care and respect, gives the child the opportunity to share with you what’s already in his head, and allows you to show that you care about him. Discussing the issue also provides for at least a 50% chance for him to consider alternative options to suicide. Avoiding the subject means you lose even that 50% chance of influencing him,” says Dr Ng.
Dr Amar, who is also Head of Paediatric Department Ipoh Raja Permaisuri Bainun Hospital, agrees.
“Many Malaysians are afraid to talk about this issue, but they need to realise that drugs aren’t always the solution (for depression).
“You need to probe and ask the right questions, and you most definitely need to talk about it,” he says.