Young and desperate

The latest in a series of reports says that one British child in ten suffers depression. In fact, the real figure may be only one in 100. But constant exams, pushy parents and 24-hour communication mean many more are anxious and unhappy

by Carol Midgley

John Marshall still feels jabs of nausea in his stomach at the recollection of those hellish days when he would have to drag his screaming, squirming child to school.

Sometimes Matthew, 12, would claw at his own skin throughout the journey or try to jump out of his father's car at traffic lights. The headmaster and school chaplain would look on as the boy was hauled through the school gates, weeping and pleading to go home.

John and his wife, Alison, were congratulated for not caving in to their son's daily refusals to go to school: everyone seemed to agree that it was for the best. The Marshalls had grave doubts. This was the 21st century, yet to them this treatment seemed almost medieval in its cruelty. Matthew had been given a diagnosis of depression.

Surely an adult with the same illness would not be treated in this way?

Probably not. But then, the idea of children becoming clinically depressed is still relatively new. Until the 1980s it was not thought that a child could suffer from the illness in the same way as an adult.

Indeed, some doctors still hold with the Freudian view that before puberty children are incapable of experiencing depression in the true sense because they have not yet developed a superego. Some teenagers seeking help for symptoms of depression say that they have met with scepticism and, at times, dimissiveness from their GPs.

Yet at the same time we are being told continually that the incidence of childhood depression is increasing. Between 1991 and 2001 the number of children prescribed antidepressants in the UK rose by 70 per cent, amid an apparent epidemic of self-harm and eating disorders. An estimated 35,000 children and teenagers are currently being treated with Prozac-type drugs.

In recent months experts have cited various possible reasons for an increase in depression: huge pressure from exams; the embedded drink culture; fragmentation of the traditional family unit; a materialistic society that seems to value looks, wealth, thinness and clothes above happiness; and pushy parents who expect too much of their offspring and cram their every waking hour with "improving" activities.

The Institute of Psychiatry said that the number of teenagers with emotional and behavioural problems doubled between 1974 and 1999. The General Teaching Council has called for exams to be scrapped for under16s because they are putting too much stress on teachers and pupils.

A letter signed by 110 teachers, psychologists and other experts, circulated to the press last year by Sue Palmer, the author of Toxic Childhood and a former head teacher, blamed junk food, marketing, overcompetitive schooling and electronic entertainment for poisoning children and accelerating their physical and psychological growth, causing "an escalating incidence of childhood depression".

In addition, some experts believe that the increasing tendency for both parents to work - meaning that many children coming home from a hothouse school environment have no parents, only nannies or childminders, in whom to confide their problems - exacerbates their anxiety and sense of worthlessness.

But could it be that childhood depression has always been with us, and that its apparent "rise" is because we now acknowledge it and are better at detecting it?

Three months ago The Times placed a small appeal in the health pages asking for children or the parents of children who were suffering or had recently suffered from depression to contact the newspaper. The response was far greater than we expected.

Over the past few months I have interviewed dozens of those parents and children about their experiences.

Depressed child

This article is an attempt to understand what it is to be a depressed child in modern Britain - recently declared by Unicef to be the worst of 21 Western states in which to be a minor - and if depression is on the increase, to examine why this might be so. Many experts in the field have spoken to The Times about a subject that is being debated increasingly.

It is estimated that 10 per cent of 5 to 16-year-olds suffer from significant emotional and behavioural problems (ranging from depression to eating disorders), compared with between 5 and 10 per cent for adults.

Serena was 16 when, last year, she found herself standing at the top of a multi-storey car park in Hampshire, willing herself to jump off. She is a bright, engaging and cynically funny young woman from a middle-class home but she had spent the previous two years in what she describes as a profound state of "disconnectedness" from the world. She had become so low that she had ceased to feel anything except a thudding sense of pointlessness.

Her experience of "the system" has not been good, she says. The symptoms started when she was 14 and working towards her GCSEs. Like many teenagers at that age she was arguing with her mother. But instead of her feelings of worthlessness dissipating, they started to mount.

"At first I just felt a bit strange, a bit unconnected," she says. "Then I started to hate absolutely everything about myself - my hair, my body, everything. I pushed everyone away; I was angry. I would spend five days in bed just lying there, crying." She went to see her GP but, she says: "I got the feeling that he wasn't taking me seriously. He thought it was normal teenage stuff."

Her family were not overly sympathetic, adopting a "snap out of it" attitude. Gradually Serena did - but a year later the feelings returned with a vengeance.

This time the GP gave her antidepressants. The first batch made her so sick with hot flushes and uncontrollable shaking that she failed one of her GCSEs. The prescription was changed and she had no further violent reactions but felt no better. In fact she felt worse. She doesn't attribute the beginning of her illness to any one thing, just to a general sense that she wasn't good enough.

"Eventually I had to quit my A levels because I just couldn't function in the world like everyone else," she says. "Lying there for days on end not being able to get yourself out of it but desperately wanting to - it's the worst feeling you can have.

"There are no obvious symptoms - you don't have a great big bandage round your head - so people can't understand why you don't just go out, have a drink and cheer up. But it's just with you all the time, and you can't understand why other people can cope and you can't."

This sentiment is echoed by Anna Booth, 15, from Yorkshire, who began to suffer "crippling" anxiety and depression after her parents separated acrimoniously. She is now having cognitive behavioral therapy. "There is a lot of emphasis in youth culture on having a great time, partying, everything being 'wicked'," she says. "It sounds like a very liberal, anything-goes culture but it's not. You are expected to conform and to have that 'great time', or you're nowhere.

"There isn't much interest in people like me who, at our worst, can't see anything to get out of bed for. And the more you can't do it, the more you feel like an alien until the only answer is to stay in bed, crying. And you feel that's where you deserve to be."

The lack of support from Serena's family (her mother is still unaware of the full extent of her illness) increased her feelings of failure. One day, when she should have been at school, she walked to the top of the multi-storey car park. "I think I did want to die," she says. "I didn't see myself as being any use to anybody. But then my mate called me on my mobile and asked why I wasn't at school. It made me think that someone cared, and that stopped me."

Serena is now 17 and works in a burger bar. It is all she can cope with at the moment and she enjoys its simplicity. She hopes to return to college to sit her A levels when she feels better, but has told few people about her illness. Nobody, she believes, can understand her feelings of "horrific blackness".

So why do some children plunge into depression while others, faced with the same stresses, don't?

There is strong evidence that some people are born with a genetic predisposition to depression (many of those to whom I talked for this article had parents, grandparents, aunts or uncles who suffered from depression. Some had committed suicide).

Staying at home

Generally it is advisable to try to keep a depressed child in school as much as possible. "Forcing yourself to do the thing that you dread usually makes you feel better," says Professor Cottrell. "Staying at home and disappearing into your bedroom is terribly bad for you."

However, he adds that Matthew should have been offered a part-timetable by the school and been given therapy to teach him strategies for coping with the school day. "I'd like to think horror stories like that wouldn't happen now," he says.

In some ways, of course, "depression" is unquantifiable: it is not a straightforward disease or infection. The Royal College of Psychiatrists says that depression is "real" when the feeling of lowness or sadness goes on and on, or dominates your whole life.

In her new book on childhood depression, Happy Kids, Alexandra Massey says: "The figures on child mental health demonstrate that more children are unhappy than ever before, but no one organisation or authority . . . can pinpoint the reason why. It's mystifying and worrying because these children are the next generation of adults who will lead the world into a new age."

Research from the World Health Organisation found that by 2020 neuropsychiatric disorders will rise proportionately by more than 50 per cent to become one of the five most common causes of morbidity, mortality and disability among children.

But Childline, which in 2005 took 6,000 calls from children complaining of mental health problems as a major issue, says that although thousands of distressed children call each year complaining of depression, numbers have remained steady over the past 20 years with no huge increases. The under12s account for only 5 per cent of calls about depression. Of the 1,200 calls about suicide, 80 per cent were made by girls.

Life events

Among the life events that callers say are causing them the most distress are bereavement, divorce, moving house and changing school. Depression is no respecter of wealth or class. Indeed, children of relatively wealthy professional parents are often more at risk.

A study in Brittany indicated that local increases in anxiety and suicide closely tracked rising local success in the critical Baccalaur‚at exams and expanding local access to further education. Fran‡ois Dubet, Professor of Sociology at Bordeaux University, has said: "The middle classes have more to lose. In this country, you keep your social position by getting good diplomas. That guarantees you access to work that is seen as honourable and you are esteemed socially. The working classes have less to lose in terms of social position, so the pressure is commensurately less."

Whether many children are wrongly being classed as having depression or whether modern, affluent life is more conducive to triggering the illness among less resilient individuals, it seems certain that a lot more children today claim to be profoundly unhappy.

But Massey says it is important to remember that while up to 10 per cent of children may become depressed, 90 per cent do not and cope quite happily with exam pressure and the landscape of modern life. Even if your child is depressed, coping with the illness can have unexpected positive effects.

"What emerges from the changes can be profound for the whole family and really enhance personal growth for the parents as well as the child," she says. "I have known families that have been transformed as a result of a child's recovery from depression, because of the impact that their recovery has had on the family as a whole."

Sufferers such as Jessica, Matthew, Sebastian and Rachel are living proof that depression can be overcome. As Alison Murphy says of her university student son, Matthew, he still has bad days when "he can go to bed right as rain, then wake up the next day and not want to get up". But he has learnt how to manage it. "He is a really well-rounded young man," she says.

Childhood depression may well be increasing. But while it can be an exceptionally traumatic time for a family, it is important to remember that having a depressed child really does not have to be the end of the world.

London Times