Depression, anxiety and stress in children and adolescents: a guide to understanding and supporting

For many people, it's almost inconceivable to link depression to childhood or adolescence. These years are often considered the happiest, most intense, and most rewarding of life. However, we must be aware of an essential aspect: Being a child is not easyAnd coping with the complexities of adolescence requires great inner balance and adequate family and social support. Believe it or not, the ages between 10 and 24 are one of the most difficult periods. for today's youth, as the mental health in adolescentsbecause it is when identity, self-esteem, life project and the most significant social relationships are consolidated.

According to National Institute of Mental Health, almost the 14% of teenagers studying secondary education think about suicide at some point.Of those, almost 6% have attempted it at some point, with the most critical ages being between 13 and 18. These are alarming and truly serious figures that should raise awareness, first among families and then across all sectors of society, to implement measures to prevention, early detection and specialized care.

Although there are no exact figures on the number of annual suicides worldwide in these age groupsExperts point out two key facts to keep in mind: Suicide attempts are increasing, and the age threshold is decreasing.We are seeing more and more self-harm thoughts in pre-adolescents, and many of these thoughts are associated with depression, intense anxiety, bullying or unaddressed traumatic experiences.

A truly tragic example that occurred in Spain was that of Diego, an 11-year-old boy who ended his life because of bullyingWe invite you to reflect on this in "Mothers Today" and understand that, behind many cases of extreme suffering, There are warning signs that can be detected. if we have information and are emotionally present.

Depression in children and adolescents

What is a teenager or child with depression like? We might have, for example, a girl obsessed like any other with Harry Potter, with learning how to do makeup from YouTube tutorials, who occasionally uploads photos to Instagram, but who nevertheless spends hours immobilized in her bed staring at a point outside the window while sadness embraces and suffocates her, with no desire for anything else and even less for going to class. It's quite possible that she herself doesn't even really know what's wrong with her, and that she's even unaware that what's happening to her has a name: depression.

Sometimes, families themselves label this behavior as "normal." They're at that age where their behavior is like a rollercoaster of changes, of energy and lethargy, of shouting and whining. "They'll grow up," "They'll get over it," some think. fathers and mothersHowever, it is necessary to keep in mind that, When it comes to children and teenagers, the best time is always "now".Education cannot be postponed, conversations cannot be delayed, and worries cannot be scheduled. Children need us right now, and we must be intuitive and receptive to their behavior, body language, and changes in their daily lives.

Childhood and adolescent depression is a common and serious psychiatric illnessDepression is classified as a mood disorder. Various studies indicate that approximately 5% of children and adolescents, or one in 20, will experience a depressive episode before the age of 19. Even so, less than half receive adequate treatment. good mental health of children and adolescents, partly because Adults underestimate the severity of symptoms or they attribute them to "things of old age".

Research shows that children and adolescents can present symptoms similar to adults (sadness, apathy, thoughts of death), but also specific manifestations according to the evolutionary stagesuch as marked irritability, behavioral problems, somatization (pains without medical cause) or a sudden change in school performance.

Depression in children and adolescents: symptoms

The WHO (World Health Organization) itself has warned of Increase in children and adolescents diagnosed with depression and anxietyThe professionals highlight two important ideas: first, that sadness is not exclusively synonymous with depression. Sadness is a normal human emotion, linked to losses or frustrations. We speak of depression when that sadness (or irritability) becomes persistent, intense and maladaptiveinterfering with school, family, and social life. Secondly, the WHO recommends being very cautious with the administration of antidepressants in the younger population and always prioritize evidence-based psychological interventions, such as cognitive-behavioral therapy, and many cities and entities are mobilizing for the world mental health day, which helps to make these needs visible.

We must be attentive to the emotional, physical, cognitive, and behavioral symptoms which may indicate a depressive or anxiety problem in our children. In childhood and adolescence, the clinical presentation varies with age:

• In preschool age They may experience sadness, irritability, very frequent tantrums, changes in appetite and sleep, delays in developmental milestones, repeated somatic complaints (stomach ache, headache), violent or death-themed play, and great dependence on the attachment figure.
• During school age (7-13 years) Irritability, aggressiveness, apathy, poor school performance, worsening relationships with family and peers, excessive guilt, recurring thoughts of death, concentration problems, and sleep disorders are common symptoms.
• In adolescenceThe symptoms are similar, but antisocial behaviors (substance abuse, running away, serious confrontations), social isolation, neglect of personal hygiene, excessive screen time, abrupt changes in peer groups, and above all, are frequently added. suicidal ideation and attempts.

In addition to this evolutionary perspective, there are a number of general warning signs that should be closely monitored:

• Negative when going to classWhen it's time to get ready for school, they react with refusal, fear, anxiety, crying, or repeated physical complaints (stomach aches, nausea, headaches) without a clear medical cause. Sometimes this refusal is linked to separation anxiety as depression or bullying.
• Sleeping problems: difficulty falling asleep, frequent awakenings, nightmares, or sleeping much more than usual, waking up restless and feeling exhausted, even when they have apparently slept enough hours.
• Eating disordersLoss of appetite and weight, or conversely, overeating, especially of high-calorie foods, as a form of emotional self-regulation. In adolescents, these changes may be mixed with Eating disorder such as anorexia or bulimia.
• Irritability and sudden mood swings: quickly going from anger to tears, responding disproportionately, getting angry over small things, being "defensive" to any comment, which is often mistaken for "bad temper", when in reality it may be an expression of deep inner discomfort.
• Social isolation and withdrawalThey stop seeing friends, spend more time locked in their rooms, avoid family activities, respond with monosyllables, or avoid eye contact. Often, they take refuge in screens to escape their emotions.
• Abandonment of activities they previously enjoyedThey no longer want to practice their favorite sport, they give up music, they lose interest in games, hobbies, or projects that once excited them. This loss of interest or anhedonia It is one of the core symptoms of depression.
• Slowness, apathy, and constant tiredness: moving slowly, taking a long time to get dressed, complaining of lack of energy, headaches, or vague discomfort that is not explained by a physical illness.
• Problems with concentration, memory, and decision-makingFrequent forgetfulness, difficulty following instructions, exams that go worse even though they study, a feeling of "blank mind" or of not being able to think clearly.
• Negative messages about themselvesThey express that they feel like "a burden," "a failure," that they are "worthless," or that "nothing matters." They may appear thoughts of death or disappearancesometimes disguised as jokes.

From a clinical point of view, professionals rely on international diagnostic criteria (ICD and DSM) to identify a major depressive episode in childhood and adolescence. These criteria require, for at least two weeks, the presence of a minimum number of symptoms, including: depressed or irritable mood for most of the day, loss of interest or pleasure, fatigue, sleep and appetite disturbances, cognitive difficulties, excessive guilt, and thoughts of death or suicide. In younger children, many of these symptoms are observed more through behavior than through the child's verbal account, so The perspective of parents, teachers, and pediatricians is fundamental.

Possible causes

The reasons why a child or adolescent ends up being diagnosed with depression or an anxiety disorder are very diverse. There is no single explanation, but rather a combination of factors. biological, psychological, family and social factorsUnderstanding them helps reduce unnecessary blame and better focus the intervention.

• Biological and genetic factorsThere is significant heritability. When one of the parents has had depression, anxiety disorders, or other mood disorders, the child's risk increases. At the brain level, alterations in neurotransmitters such as serotonin and norepinephrine have been described, along with a higher risk of developing depression, anxiety, or other mood disorders. biological vulnerability to stressThat is, a stress system that is activated more easily and turned off less effectively.
• Temperament and developmental factorsChildren who are highly inhibited, shy, and sensitive to mistakes and rejection are at greater risk of developing anxiety disorders first and, later, depression. If this temperament is compounded by experiences of constant criticism, bullying, or lack of support, the likelihood increases significantly.
• Identity construction processDuring adolescence, young people must integrate their changing bodies, their sexual orientation, their gender identity, their life goals, and their place within their peer group. The feeling of "not fitting in" in a demanding society, highly exposed through social media, can generate deep suffering, shame, and isolation.
• Family contextThe family factor has an important weight. Parents' mental health problemsHighly critical or overprotective parenting styles, severe family breakdown, intense relationship conflicts, violence, or neglect are factors that increase vulnerability. Unresolved grief, forced migration, or abrupt changes (changing schools, moving, breakups) also contribute.
• Peer relationships and bullyingThe quality of the bond with peers is key at these ages. bullying Whether in person or online, social exclusion or repeated humiliation seriously damage self-esteem and are associated with depression, anxiety, suicidal ideation, and somatic symptom disorder (pains without a clear organic cause).
• Stressful life eventsContentious parental separations, chronic illnesses, hospitalizations, physical, emotional or sexual abuse, situations of extreme poverty or community violence are common triggers of emotional problems, especially when There are no protective adults to contain and explain what is happening.

In addition to these factors, modern life demands that many children and adolescents live in a kind of constant "race": too many extracurricular activities, academic pressure, the demand for success, early exposure to social media and shocking news… All of this on a brain that is still developing in key areas such as the impulse control, emotional regulation, and planning ability.

Depression, anxiety and somatic symptoms: a single core of suffering

In clinical practice it is frequently observed that depression, anxiety and somatic symptoms Headache, abdominal pain, and extreme fatigue without a medical cause often appear together in children and adolescents. This cluster is sometimes called internalizing disordersbecause the discomfort is directed inwards: it is suffered in silence, it is kept inside, it is not always expressed in obvious problematic behavior.

Chronic abdominal pain, recurring headaches, or constant fatigue affect up to 25% of children and adolescents in general population samples. In many cases, these symptoms are associated with anxiety or depressionThis triples the risk of developing a psychiatric disorder. The relationship is bidirectional: anxiety and depression can cause or amplify pain, and sustained chronic pain can trigger depressive and anxious symptoms.

Several mechanisms which explain this close relationship:

• Increased biological sensitivity to stressSome young people have a particularly reactive nervous system, with hyperactivity in brain structures involved in fear, such as the amygdala. They may also exhibit heightened sensitivity to physical pain and bodily sensations, interpreting them as dangerous.
• Hypervigilance and negative anticipationAnxiety is characterized by a tendency to anticipate catastrophic outcomes and to be in a constant state of alert. Anxious adolescents or those with chronic pain interpret normal sensations as threats ("something bad is going to happen to me," "I'm going to get sick"), which in turn increases the intensity of their distress.
• Maladaptive cognitionsAutomatic thoughts such as "I won't be able to bear the pain," "I won't be able to handle this," "everything will go wrong" are associated with depression, anxiety, and somatic disorders. These thinking styles lead to ruminate on problems no longer see any possible solutions.
• Behavioral inhibition and avoidanceWhen faced with discomfort, many children choose to avoid what scares or upsets them (classes, social activities, physical education, exams). In the short term, they feel relief, but in the medium and long term, this avoidance reinforces their fears, increases sadness, and can strengthen the belief that they "are not capable."

Therefore, when a child or adolescent repeatedly consults for recurring pains without a clear medical cause, it is essential that the pediatrician consider the possible presence of an underlying anxiety or depressive disorder and consider referral to child and adolescent mental health services. The goal is not to "psychiatrize" every pain, but avoid unnecessary medical tests and offer a comprehensive explanation that will bring relief to the child and their family.

"My son has stress"

Stress is not an emotion exclusive to the adult brain. Anxiety and stress are instinctive reactions Human responses arise in response to a real or imagined "danger." When our brain detects a threat, it prepares the body for fight or flight: heart rate increases, breathing accelerates, muscles tense, and hormones such as hormones are released. cortisol.

Today, we don't have to flee from bears or other hostile human groups as our ancestors did. Today, we have invisible enemies that activate our body: academic pressure, overload of activities, family conflicts, bullying, social media, economic uncertainty… All of this generates a high level of cortisol in our body to the point of affect physical and mental health.

And children are not immune to this emotion. The Stress, anxiety, and depression are real problems in childhoodIn the case of stress, it is the everyday "substrate" in many families with very high expectations for their children.

• They expect excellence and perfection from them.They want to have the most beautiful, the most skillful, and the most competent children. By doing so, they introduce the child to something so familiar to us all: the "acceleration." We have to be everywhere, do five things at once, do today's tasks while simultaneously preparing for tomorrow's; we don't tolerate mistakes, and a failure is almost a stigma. This pressure connects with issues about... mental health as a mother and family expectations.
• If all these dimensions are harmful in adults, the effect In a child, it is devastating.Therefore, it is worth recalling the topic we already discussed in our space «Breeding over low heat"It would be about respecting the child's rhythm, offering them time for free play, real rest, and authentic emotional connection."
• There's no point in raising "perfect" children if they aren't happy, safe and emotionally resourceful childrenIn today's world, there's often an attempt to educate hyper-competitive children for an uncertain and complex job market. No one knows what the future holds, so it makes more sense. focus on the present and teach our children the value of being happy, of taking care of themselves and of taking care of others.
• A suitable Emotional IntelligenceThis, combined with the humility and joy of these children, can allow them to become adults capable of changing the world in the future, instead of passively adapting to a toxic environment.

For families and educators, it is key to learn to Identifying stress in children and adolescentsIrritability, frequent physical complaints, insomnia, excessive fears, extreme perfectionism, frequent crying, anxiety about exams or new activities, difficulty concentrating, and changes in school performance. These signs indicate that the child is overwhelmed and needs adjustments to their expectations, emotional support, and sometimes professional help.

To conclude this section, we recommend watching the following short film. Educating children and adults in the emotional control of stress and anxiety. Enjoy it and discuss it with your children or students to open a space for sincere dialogue about how they feel and what worries them.

https://www.youtube.com/watch?v=sTy9FhIvAro

Anxiety in childhood and adolescence

Anxiety is one of the most frequent forms of psychopathology in childhood and adolescence, with estimated prevalence rates between one 10% and an 20%Anxiety is more common than depression and behavioral disorders. However, it often goes unnoticed: many anxious children are neither diagnosed nor treated, and are simply considered "shy," "fearful," or "nervous."

Adaptive anxiety is normal and necessary: It prepares us for dangerIt helps us concentrate and respond to challenges. It becomes pathological when it is disproportionate, persistent, or appears for no apparent reasoncausing intense suffering or interfering with daily life (not wanting to go to class, avoiding activities, sleep problems, somatic pains).

throughout development, fears are changing:

• En early ages The most common fears are separation from parents, loud noises, strangers, or darkness.
• At school age Fears of natural phenomena (storms, earthquakes), illness, thieves, or imaginary "monsters" appear.
• At adolescence Social fears (making a fool of oneself, being judged, not being accepted), fear of academic failure, and issues of health and physical appearance are gaining strength.

Main anxiety disorders in childhood These include separation anxiety disorder, generalized anxiety disorder, specific phobias, social phobia, selective mutism, panic attacks, and agoraphobia. Often, several of these overlap and coexist with depression, conduct disorders, ADHD, or eating disorders.

From the pediatrician's and the family's point of view, it is important to observe:

• Babies that show hypertonia, irritability, inconsolable crying, sob spellsvomiting or hyperventilation in the presence of new people or places.
• School-aged children with intense fears, recurrent somatic symptoms (abdominal pain, headaches), anxiety-related disobedience (tantrums when separated, refusing to sleep alone), rituals, and serious sleep problems.
• Adolescents with marked irritability, dizziness, chest paininsomnia, fatigue, fear of social situations, and phenomena of depersonalization or derealization (feeling that oneself or the world are not real or are "far away").

The good news is that anxiety responds very well to specific psychological interventions, especially the cognitive behavioral therapyThis approach focuses on gradual exposure to fears, restructuring negative thoughts, and training in coping skills. When anxiety is severe or does not improve with psychotherapy, specialists may consider using [other methods/procedures]. SSRI antidepressants (fluoxetine, sertraline, etc.), always under strict medical supervision. In addition, complementary interventions such as The music They can be useful in some cases.

The role of families and pediatricians

Detecting and addressing depression, anxiety, and stress in childhood and adolescence is a shared responsibility. The familiesPediatricians, teachers, and the teenagers themselves form a essential support network to prevent these problems from becoming chronic or leading to serious complications, such as dropping out of school, substance abuse, or suicidal behavior.

Some key recommendations For the child or adolescent's environment, they are:

• Always take emotional complaints seriouslyDon't trivialize phrases like "I don't want to live" or "I'm good for nothing," even if they seem exaggerated. They can be the tip of the iceberg of deep suffering.
• Observe changes in behavior more than in words: abrupt changes in sleep, eating habits, academic performance, group of friends, screen time, or interest in previously enjoyable activities.
• Speak openly and respectfully about emotions, without ridiculing or minimizing. Ask directly about thoughts of death if there is suspicion; talking about suicide does not "infect" the desire, on the contrary, Open the door to ask for help.
• Go to the pediatrician or a family doctor when anxiety or depression is suspected. These professionals have age-appropriate questionnaires and interviews, and can refer the patient to child and adolescent mental health services when necessary.
• Actively participate in the treatment: accompany the child in therapy, apply the guidelines of the professionals at home, reduce stress factors as much as possible (overload of activities, constant arguments, excessive criticism) and promote healthy habits (sleep, nutrition, exercise, real leisure time).

When detected early and treated with a multimodal approach (psychoeducation, individual or family psychological therapy, school interventions and, if necessary, medication), Anxiety and depression disorders in children and adolescents have a much better prognosis.The goal is not to raise children without suffering, but to support them in developing inner resources, secure attachments, and the certainty that asking for help is always a possible and valuable option.

Understanding how depression, anxiety, and stress intertwine in childhood and adolescence allows us to look at many behaviors often labeled as "rebellion" or "laziness" in a different light; behind them, there is often an overwhelmed child who It needs to be seen, heard, and supported. with patience, rigorous information and unconditional love.