depression among chronically ill children (2)
TRANSCRIPT
Are they sad or Are they depressed?
If a child or teenager’s symptoms become
persistent, disruptive, and interfere with social
activities, interests, schoolwork and family life,
he or she may be depressed.
Depression is one of the most common
complications of chronic illness.
It is estimated that up to 1/3 of individuals with a
serious medical condition experience symptoms of
depression.
Common chronic diseases
associated with depression Cancer e.g. leukemia, lymphomas
Respiratory e.g. Asthma, Cystic fibrosis
Renal e.g. Chronic renal failure
Hematological e.g. Hemophilia, Thalasemia
Rheumatology: e.g. SLE, Rheumatoid artheritis, FMF
Endocrine e.g. Diabetes
Neurological e.g. Epilepsy, myopathy
Cardiology e.g. Heart failure, Rheumatic heart disease
HIV, HBV, HCV
Metabolic diseases e.g. wilson, gaucher, niemannpick
It is very tricky to diagnose
depression in a chronically ill child
Some of the symptoms of depression
may overlap the symptoms of the
chronic disease e.g.
Tiredness
Lose of interest in activities
eating more,
Difficulty to concentrate.
if child feels sad or gloomy most of the time, has lost
interest in his usual activities for 2 or more weeks, and
shows some of the other symptoms listed, he may have
depression.
Symptoms of depression in a child
1. Grumpy, irritable or sad mood
2. Loss of interest or enjoyment in activities that she typically finds fun
3. Inappropriate feelings of guilt, worthlessness, inadequacy, or incompetence
4. Poor or increased appetite; weight gain or loss
5. Insomnia, or sleeping more than usual
6. Low energy or exhaustion after doing simple tasks
7. Feelings of hopelessness
8. Decrease in productivity (e.g., being absent from school more than usual, cutting classes, or a drop in grades)
9. Trouble thinking or making decisions
10. Outbursts of shouting, complaining or crying
11. Excessive boredom
12. Loss of interest in friends and poor communication with people
13. Fear of death
14. Sensitivity to rejection or failure
15. Acting recklessly
How is a child's life affected
by a chronic disease?
Discomfort or loss of energy
Restriction of activities
Disruption of his life due to medical
treatment
Isolation from family and friends
Feeling self-conscious, embarrassed, or
stigmatized if his disease makes him
different from other people
1) The symptoms of the
chronic disease.
The symptoms that are caused by the chronic
disease may be stressors that lead to
depression.
2) Treatments for chronic
disease
How a child's chronic disease is
treated medically may lead to
depression in two ways:
1. The medications for the chronic
disease may cause depression e.g.
prednisone and phenobarbital
2. The treatment regimen may be
difficult to follow. Or needs relying on
other people to help him with her
treatment
3) The sporadic nature of the
chronic disease
Most chronic diseases have symptoms
that come and go e.g. SLE.
The uncertainty can be very upsetting.
The child may feel helpless and out of
control, which may result in depression.
4) Loss of social contact with
people A child's chronic disease may cause
him to lose contact with people for many reasons:
1. He may have less energy or less time to do things he finds pleasurable.
2. Healthy friends may assume that he cannot act like them so they spend less time with him.
3. In immune deficient children, parents tend to isolate their children to protect them from any possible source of infection
5) The chronic disease may
be stressful to the family Family members may have to take on new roles
they may be disappointed that they can no longer participate in activities that they all used to enjoy together.
They might feel some how blamed for their child illness which can be reflected in form of overprotection or negligence
6) Chemicals in the brain
For example, pain from a child's chronic
disease may be related to too little
serotonin. Lack of serotonin also causes
depression
Why is depression a problem
for children with a chronic
disease?
Depression is harmful whether or not a child
has a chronic disease
However, if a child has a chronic disease
and is also depressed, the problems are
compounded
Why is depression a problem for
children with a chronic disease? (
Cont.)
1- Chronic disease symptoms may increase or get worse.
2-The risk of dying from the chronic disease is increased when the child is depressed.
3-Child may be hospitalized more frequently and for longer durations.
4-The child may not be motivated to take good care of himself if he is depressed.
Role of parents Parents can help by being present for all procedures,
staying with their child (when possible) during hospitalizations and interacting with them as much as possible
Parents can help by allowing children to help in the management of their illness (with supervision), as this increases compliance.
Parents should also reassure their children that the illness is not their fault
Parents should help facilitate their child’s participation in school or other activities to the extent allowed by the child’s doctors. Parents should avoid being over protective
Role of Physicians Develop new coping strategies for the chronic disease e.g.
1- positive reappraisal (reassessing the disease in a positive light)
2-putting in perspective (making a rational assessment of the impact of illness)
3- positive refocusing (shifting one’s thoughts to pleasant matters)
4-focusing on planning (using one’s energy to plan for the future, and make the best of the situation)
Change the medication used to treat the chronic disease if depression is a side-effect of the drug
Enroll the child or family in a support group
Have the child seen in individual psychotherapy or begin family therapy
Change the child's lifestyle to reduce stress levels e.g. healthy food and enough sleep
Take medication for the depression
Role of society
Awareness campaigns for children at
schools
Funding psychotherapy centers that
treat chronically ill children for free
Arranging events for the sick children to
meet and have fun