For Families > Disorders and Treatments > A-Z Disorder Guide > Depression

Depression in Children and Adolescents with a Chronic Disease

by Jean-Marie Bruzzese, PhD

Introduction

Children and adolescents who have a chronic disease may also be depressed, and it is not difficult to understand why. When children have a chronic disease their lives can be turned upside down. For example, they may not be able to run around and do what they used to do. Family members may have to help take care of them in ways that are new. Or they may feel different from their friends. These changes in their lives may lead to feelings of depression.

What is a chronic disease?

As its name implies, a chronic disease is an illness that lasts for a long period of time, is characterized by symptoms that come and go, and often progresses slowly. This means that treatments for chronic diseases are long-term, sometimes lasting months or years. Even with treatment, the outcome of a chronic illness is often uncertain.
Following are some chronic diseases that affect some children and adolescents:

  • Asthma
  • Cancer
  • Cystic fibrosis
  • Diabetes
  • Emphysema
  • Epilepsy
  • Heart disease
  • HIV/AIDS
  • Inflammatory bowel disease
  • Juvenile arthritis

Most children and adolescents with chronic diseases have symptoms that can be acute, which means they start suddenly and last a short period of time. Some youth with chronic diseases may go into remission, or not have symptoms for some time.

How is a child's life affected by a chronic disease?

Different chronic diseases affect children differently. However, chronic diseases typically affect children's lives in negative ways. If a child has a chronic disease, some problems might include:

  • 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

It is easy to understand why depression often goes hand in hand with a chronic disease. While only 1% to 3% of teenagers in the general population are diagnosed with depression, adolescents with a chronic disease have a much higher rate of depression. For example, depression is found in 15% of teenagers with asthma and more than 25% of children and teenagers with inflammatory bowel disease.

Why are children with chronic disease at risk for depression?

There are many reasons why a child with a chronic disease may be at risk for depression. Some of these reasons are:

  • The symptoms of the chronic disease. The symptoms that are caused by the chronic disease may be stressors that lead to depression. For example, if a child has pain or nausea because of the illness, these symptoms may limit his activities, which may be upsetting. Or, if the symptoms of the chronic disease are visible and obvious to other people, they may treat her differently, making her feel embarrassed and inadequate.

  • 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. For example, depression is a side effect of high doses of prednisone, a drug used to treat severe asthma, arthritis, and inflammatory bowel disease. Depression can also be caused by phenobarbital, a medication used to treat children with epilepsy. However, carbamazepam, another medication used to treat epilepsy, causes depression less frequently than phenobarbital.
    • 2. The treatment regimen may be difficult to follow. A child or adolescent may have to change his lifestyle or need help to follow his treatment regimen. The lifestyle changes may mean he can no longer do certain activities that were pleasurable, and this may make him feel unhappy. Similarly, relying on other people to help him with her treatment (for example, reminding him to take him medication) may make him feel like he cannot do things for himself and lower his self-esteem.
  • The sporadic nature of the chronic disease. Most chronic diseases have symptoms that come and go. Sometimes the child may not be able to predict when she will have a flare-up of symptoms, and the uncertainty can be very upsetting. She may feel helpless and out of control, which may result in depression.

  • Loss of social contact with people. A child's chronic disease may cause him to lose contact with people for two 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.
    Regardless of the reason, loss of social contact may be upsetting to the child and lead to depression.

  • The chronic disease may be stressful to your family. A chronic disease affects not just the child but the whole family. Family members may have to take on new roles, or they may be disappointed that she can no longer participate in activities that they all used to enjoy together. The resultant stress may give rise to conflict in the family, which in turn may lead to depression in the child.

  • Chemicals in the brain. Chemicals in the brain that cause some of the symptoms of chronic disease also cause depression. For example, pain from a child's chronic disease may be related to too little serotonin, a chemical in his brain. When he doesn't have enough serotonin, he may also be depressed.

  • Family members with depression. There is a genetic link to depression. If a first-degree relative (for example, mother, father, brother, or sister) has problems with depression, the child may have an increased risk for depression.

Why is depression a problem for children with a chronic disease?

Depression is harmful whether or not a child has a chronic disease. Depression prevents her from enjoying life, hurts her relationships with family and friends and may also prevent her from working hard at school.

However, if a child has a chronic disease and is also depressed, the problems are compounded. She will have all the problems depression causes on top of the complications from her chronic disease. Some of these complications may include:

  • Chronic disease symptoms may increase or get worse. For example, children with juvenile diabetes and depression have a greater risk of having eye problems than children with juvenile diabetes who are not depressed.

  • The risk of dying from the chronic disease is increased when the child is depressed. For example, depression has been found to increase the risk of death in people with asthma.

  • She may be hospitalized more frequently. If a child has a chronic disease and is depressed, she may be at risk for more hospitalizations. Also, when she is hospitalized, she may have to stay for longer periods of time. She may also undergo more medical tests while in the hospital than children with the same disease who are not depressed.

  • He may take worse care of himself. He may not be motivated to take good care of himself if he is depressed. This may mean he may not follow the treatment plan his healthcare provider has given him.

How do we know if a child has depression?

Because depression hurts a child in many ways, it is important to know if she is depressed. The signs of depression are not the same for all youth, and they differ somewhat from the signs seen in depressed adults. Some symptoms of depression in children and adolescents include:

  • Grumpy, irritable or sad mood
  • Loss of interest or enjoyment in activities that she typically finds fun
  • Inappropriate feelings of guilt, worthlessness, inadequacy, or incompetence
  • Poor or increased appetite; weight gain or loss
  • Not being able to sleep (insomnia), or sleeping more than usual
  • Low energy or exhaustion after doing simple tasks
  • Feelings of hopelessness
  • Decrease in productivity (e.g., being absent from school more than usual, cutting classes, or a drop in grades)
  • Trouble thinking or making decisions
  • Outbursts of shouting, complaining or crying
  • Excessive boredom
  • Loss of interest in friends and poor communication with people
  • Fear of death
  • Alcohol or drug abuse
  • Sensitivity to rejection or failure
  • Acting recklessly

Many of these symptoms are normal reactions to the stresses that come with a chronic disease. For example, if your child has juvenile arthritis, he may feel sad and hopeless when he has a flare-up of symptoms. However, if he 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 above, he may have depression.

Diagnosing depression in a child with a chronic disease may be difficult

If a child has a chronic disease, it may be difficult to figure out if she also has depression because some of the symptoms of depression may overlap the symptoms of the chronic disease. For example, the chronic disease may make her tired and cause her to sleep more. She may also lose interest in activities that she usually finds enjoyable because the chronic disease now makes them difficult to do. Or the chronic disease or the medications she takes to treat the disease may cause her to eat more, or make it difficult for her to concentrate. Or death may be a risk associated with the chronic disease and this may frighten her.

How to help children who have depression and a chronic illness

If a child has a chronic disease and parents think that he may also have depression, it is important to get help in managing and treating the depression. One important thing parents can do is talk to their child to see how he is feeling. This will help them develop a better understanding of what he is experiencing and how to help him.

The healthcare provider who treats the chronic disease should also be informed that he may be feeling depressed. Together the family and the health care provider can decide what to do. Some options may include:

  • Develop new coping strategies for the chronic disease with the healthcare provider
  • 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
  • Minimize or prevent withdrawal of the child from family and friends - help him to reach out to them and adjust participation in activities if necessary.
  • Have the child seen in individual psychotherapy or begin family therapy, preferably with a mental health specialist who is familiar with the chronic disease
  • Take medication for the depression
  • Change the child's lifestyle to reduce stress levels