> Deb Gould is a STARTTS Clinical Psychologist and clinical supervisor.

Sadness, grief and depression are all characterised by an affective state referred to as down, black or blue. All might involve sadness and tearfulness but the last two mentioned also involve a reallocation of energy from the present to preoccupations with negative thoughts and/or lost loved ones.

There is no clear or single cause of childhood depression but the following are hypotheses:

• Difficulties meeting developmental challenges due to trauma, disability or illness;
• Responding to or representing parental depression;
• Unresolved grief;
• The enormous adjustment required of the refugee child and their family.

You and/or the child’s parents will notice changes in several areas of their lives – they usually occur both at home and at school. These changes map to criteria used to diagnose depression and include:

Affective – sad, flat, irritable, no enjoyment;
Cognitive – negative thoughts, reduced concentration/attention, bland or bleak themes in essays/art;
Somatic/vegetative – increased or decreased sleep and appetite, lowered energy;
Existential – “life is not worth living” and “what is the point of all of this?” - the kinds of thoughts that will need referral even in the adolescent whose developmental crises might take them there as part of an identity resolution; 
Social – withdrawn or disengaged, school avoidance;
Sense of self – low self esteem, feelings of guilt.

Many children will struggle to identify and express internal states including thought processes and emotions, particularly where an interpreter is needed. For that reason, the child might not talk about these experiences. Similarly, they might struggle to engage in certain therapeutic modalities where the work relies on the verbalisation of thoughts.

While it might be part of popular discourse that depressed people need to “think positive”, depression usually prevents these positive thoughts being convincing. The more powerful dynamic in maintaining depression is the power and abundance of negative thoughts. School counsellors might more usefully spend time with the child in focused activity, particularly physical activity, and especially if it is geared towards a gradual development of age-appropriate mastery.

The child who cannot engage with this and responds to activities with flatness or frequent tearfulness does need active referral to the child and family unit in the local area health service and/or the family doctor. The idea of childhood suicidality is a confronting one and it is important that we respond in a contained and active way including immediate referral to a crisis team being the first action.

Finally, the Black Dog institute at the University of New South Wales has run programes for school counsellors specifically dealing with depression in scholars.  Check out http://www.blackdoginstitute.org.au/

> Deb Gould
Deb is a Clinical Psychologist and clinical supervisor at STARTTS. She was trained in South Africa and has over 20 years experience as a clinician and supervisor in the psychotherapy field.

© 2009 STARTTS  Contact: hintsforhealing@startts.org.au