Depression in Kids and Teens – PediaCast 521
- Dr Ariana Hoet and Dr Kristina Jiner return to the studio as we consider depression in children and teenagers. We explore risk factors, signs and symptoms, diagnosis, management… and the latest research topics. We hope you can join us!
- Depression in Kids and Teens
- Psychiatric Crisis Department at Nationwide Children’s Hospital
- Big Lots Behavioral Health Services at Nationwide Children’s
- On Our Sleeves: The Movement for Children’s Mental Health
- PediaCast Behavioral Health Playlist on SoundCloud
- National Suicide Prevention Lifeline: 1-800-273-TALK (8255)
- Crisis Text Line: Text START to 741-741
- Dial 9-8-8 (Nationwide Mental Health Crisis and Suicide Prevention)
Announcer 1: This is PediaCast.
Announcer 2: Welcome to PediaCast, a pediatric podcast for parents. And now, direct from the campus of Nationwide Children's, here is your host, Dr. Mike.
Dr. Mike Patrick: Hello, everyone, and welcome once again to PediaCast. It is a pediatric podcast for moms and dads. This is Dr. Mike coming to you from the campus of Nationwide Children's Hospital. We're in Columbus, Ohio.
It's Episode 521 for July 13th, 2022. We're calling this one "Depression in Kids and Teens". I want to welcome all of you to the program.
We have another important topic for you this week as we consider depression in children and teenagers. Now, back in April, we considered anxiety in kids and teens. Our behavioral health panel is here again joining us, this time for a discussion about depression.
And like anxiety, depression is common in kids and teenagers but it's also treatable with therapy, counseling and/or medication and long-term monitoring of symptoms.
So, we're going to explore the types and causes of depression, common sign and symptoms, diagnosis, management. And again, that's going to include therapy, counseling, and medication. We'll consider risk factors and complications of depression, long-term outcomes, and the latest research topics. So, buckle in and enjoy the ride as we cover depression in kids and teens.
As I mentioned, our trustworthy mental health panel is back in the house. Dr. Ariana Hoet is a pediatric psychologist at Nationwide Children's Hospital. And Dr. Kristina Jiner is a pediatric psychiatrist at Nationwide Children's. They're going to be joining us on a regular basis as we consider a wide range of pediatric mental and behavioral health conditions moving forward.
Again, we covered anxiety in April. And you can find that episode in the show archives. We'll talk about depression today and then we will explore more pediatric mental health topics in the coming weeks and months.
Of course, behavioral health has always been an important topic on PediaCast. If you head over to SoundCloud, you'll find a behavioral health playlist with over 25 episodes on it. So, hours upon hours of trustworthy content as we explore behavioral health concerns relevant to children and teenagers. And to help you find that playlist easily, I will put a link to it in the show notes for this episode, 521, over at PediaCast.org.
All right, before we consider depression, let's quickly cover our usual reminders. Don't forget, you can find PediaCast wherever podcasts are found. We're in the Apple and Google podcast apps, iHeart Radio, Spotify, SoundCloud, Amazon Music, and most other podcast apps for iOS and Android.
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So, let's take a quick break. We'll get back to Ariana Hoet and Dr. Kristina Jiner settled into the studio and then we will be back to talk about depression in kids and teens. It's coming up right after this.
Dr. Ariana Hoet is a pediatric psychologist at Nationwide Children's Hospital. She serves as clinical director of the On Our Sleeves Movement, more on that to come. And she is an assistant professor of Pediatrics at the Ohio State University College of Medicine. Dr. Kristina Jiner is a pediatric psychiatrist at Nationwide Children's and an assistant professor of Psychiatry at Ohio State.
They are both passionate about treating and supporting children, teenagers, and families impacted by mental and behavioral health conditions including depression. That's what they're here to talk about, depression in kids and teens. So, let's give a warm and PediaCast welcome to our guests, Dr. Ariana Hoet and Dr. Kristina Jiner. Thank you both so much for stopping by today.
Dr. Ariana Hoet: Thank you for having us.
Dr. Kristina Jiner: Hello.
Dr. Mike Patrick: Good to see both of you again. Dr. Hoet, I wanted to start with just a brief definition of depression. Sometimes you say, "Oh, you seem depressed," but there really is a real definition of what this means, right?
Dr. Ariana Hoet: Yes, it is an actual medical condition, a mental health diagnosis that really is characterized by feeling of sadness or irritability and a lack of interest in things. Nothing seems fun or it's hard to find motivation or joy in the day-to-day life.
Dr. Mike Patrick: And this is not just a couple of days of this, right? I mean, we all kind of have our ups and downs and good days and bad days sometimes but this is really like day in and day out for a prolonged period of time, correct?
Dr. Ariana Hoet: Exactly. We're talking about almost every day of my life. And it's happening for weeks and weeks and weeks at a time and a feeling of I can't control it and it's getting in the way of my success.
Dr. Mike Patrick: Yeah, and I think that's an important part, that last part that you said, because it really affects your quality of life. It affects your relationships with your family, your friends. It may affect your schoolwork, your work. And so, it really just sort of impacts your entire life.
Dr. Ariana Hoet: Exactly, yes.
Dr. Mike Patrick: And then how common is this condition, Dr. Jiner?
Dr. Kristina Jiner: So, we have data. We don't have the most recent data from the last couple of years. But looking back on the most recent data we have, it suggests that on a yearly average for teenagers, somewhere between 48% will develop depression. If you look across the entire adolescence, by the time we reach adulthood, close to 20% will have developed depression.
Dr. Mike Patrick: So, that's like one in five adults?
Dr. Kristina Jiner: Yes.
Dr. Mike Patrick: Who have depression and then lots of kids kind of start in childhood and the teenage years and the into adulthood. So, this is really something that affects lots of people. And if not, I mean, if you have a family of five, it's likely one of you is going to have depression.
Does it tend to run in families? Is there a genetic component to depression, or not really?
Dr. Kristina Jiner: So, absolutely. So, we know that in families who there's history of depression and that could even be, for example, post-partum depression or anxiety, you're definitely more likely at a higher risk of developing depression. So, there's definitely a family risk.
Dr. Mike Patrick: Are there peak ages? So, if we think about depression in childhood, because that's what really talking about and the teenage years, even though you can see it at any point, are there particular points in time, certain ages, when you are more likely to see depression?
Dr. Kristina Jiner: Certainly, it is higher in our adolescent population, post-puberty as compared to our pre-pubertal ages. And we also see a difference in sex, so we know that after puberty, so in adolescence, girls are affected twice as likely as boys.
However, the opposite is true in those who haven't gone to puberty. So, the estimates are about 60% more boys than girls will develop depression.
Dr. Mike Patrick: Before puberty?
Dr. Kristina Jiner: Yes.
Dr. Mike Patrick: But then after puberty, it's more likely to be girls…
Dr. Kristina Jiner: Yes.
Dr. Mike Patrick: At that point. What about cultural or ethnic differences? Is it pretty much across the board? Or do we see it more in certain groups compared to others?
Dr. Kristina Jiner: I think that one of the things that difficult is how each culture identifies depression, understands depression, or even acknowledges it. So, I think that's a challenge to study. And so, I think we're still looking to see the differences there.
Certainly, one of the risk factors for depression is adverse childhood events, things like abuse, trauma witnessing violence, poverty, things such as that. So, in the group in which we're more likely to see those, we would expect that there could be a higher rate of depression.
Dr. Mike Patrick: And I would suspect that there's also going to be a higher rate of diagnosed and managed depression in folks who have access to healthcare. And so, there's likely some disparities in awareness and diagnosis and treatment in some groups who may not have access to the medical system to the same degree that others, which is a real problem.
Dr. Kristina Jiner: Absolutely. And so, you can't be diagnosed or treated if you're never able to present for treatment.
Dr. Mike Patrick: Yeah. And then what are some of the risk factors for depression in an individual? So, we've talked about some of those in terms of age, sex. But are there certain other things? We've also mentioned genetics and family history. Other things that put us at risk for depression?
Dr. Kristina Jiner: There are. So, even they described low birth rate. It might not be something folks think of at first. The other big one is a negative style in interpreting events. And so, this could be seen in child or adolescent who always seems to have kind of a negative spin on things. And so that can set a person up for depression.
Child and caregiver conflict can certainly do it. Then, we also think about medical potential risk factors. So traumatic brain injury is definitely known to be at risk, as well as just chronic health conditions that really impact quality for life. Certainly, we see depression in those folks. And then other mental health diagnosis, so things such as anxiety, for example, ADHD, substance use are certainly risk factors.
Dr. Mike Patrick: You had mentioned, I'll say like the glass-is-half-full or is the-glass-half-empty kind of attitude within an individual. And if you're more of the glass is half-empty person, then maybe you're set up more that you could end up with depression.
Could parents somehow then prevent maybe a child from developing depression by, if they are glass-half-empty kind of kid, helping them see that this is problem but here's the silver lining or here's the good thing? So really trying to turn negative things to see the positive in negative things just from an early age, could that possibly help prevent some depression?
Dr. Kristina Jiner: I think so. I think the other thing too is parents modeling that kind of glass-is-half-full approach, so modelling that for children. So that, again, children pick up on what they see and hear. And so, I think that could be a benefit for families.
Dr. Mike Patrick: So, then what causes depression? So, if we're looking at the pathophysiology, big word, but in the brain, what is it that causes depression? Do we know?
Dr. Kristina Jiner: So, we have what we think is a good understanding. We don't know for a 100%. We can't say, "Okay, this is exactly in the spot in the brain is the issue." What we believe though is serotonin, one of the neurotransmitters is involved. And we somehow came into that kind of backwards in part because our medications work on serotonin.
And so that's one of the ways in which we know that there could be a problem with serotonin there. And that's one of the big ones from pathophysiology standpoint. We're still learning learn more and more every day. And so, we don't have a definitive answer to that question, but we do believe that certain aspects of the brain involving serotonin put folks at risk.
Dr. Mike Patrick: And even if it's not serotonin, we know that if you have more serotonin because of the medicines that you're using that's available, then maybe that counteracts whatever other thing is happening inside the brain.
Dr. Hoet, do you have other insights into the pathophysiology of depression?
Dr. Ariana Hoet: I think what we've been talking about and one thing I like to highlight to parent because I often hear when I'm seeing a family, they'll say things like, "Well, no, my child doesn't have a reason to be depressed. They have everything. Their life is good." And so, I like to highlight to parent that sometimes it's not something we did or it's not a stressor in the environment.
As Dr. Jiner mentioned, it can be genetic. It can be a personality trait. It can be a change in hormones through adolescence. It can be a lot of different things.
So, there is a difference between a diagnosis of PTSD, for example, where there is a trauma that has to happen for that diagnosis with depression. It doesn't necessarily have to be an environmental trigger for that diagnosis to exist.
Dr. Mike Patrick: And so that goes back to, even if you are a glass-is-half-full parent all the time, you still could end up with the child who suffers from depression. It's not necessarily the child's fault because of how they had an outlook on things. And certainly, if you have depression as a young kid that's been undiagnosed, maybe you'll be more glass-is-half-empty because of the depression, not necessarily from a personality thing.
So, it does get pretty complicated and probably the most important thing is to recognize it and treat it when we can. And so that leads us to the next question which how do we recognize depression in our kids? What are the signs and symptoms of that?
Dr. Ariana Hoet: I want to answer that in two ways. One is the symptoms and then the other one is the signs because depression is what we call an internalizing disorder. Meaning that the symptoms are sometimes just felt by the person, and we don't notice. And so, parents may not be aware that the child is having these symptoms.
So, symptoms are changes in mood, "I'm feeling sad a lot," or "I'm feeling irritable," Changes in interest in things, what we call anhedonia, "I don't want to do anything. Nothing seems fun. I'm not motivated."
But then also changes in sleep and appetite, decrease in energy, difficulty focusing. And in our thoughts, we can have thoughts of guilt, hopelessness, worthlessness, suicidal thoughts. And so, all of those things can indicate depression.
In terms of signs, things parents may notice, we look for changes in school performance, isolation, not doing the activities they used to enjoy doing. And this goes beyond growing up and I have different interest. It's "I don't want to do anything. Nothing is interesting. I just want to be left alone."
Or you see kids who start getting into trouble. There's a lot of conflict between them and their friends or teachers or parents and even their personal hygiene. So, all of those can be signs that the symptoms are going on in the child.
Dr. Mike Patrick: Are those signs a little different for the various age group? So, especially in younger kids who might have depression, what might that look like?
Dr. Ariana Hoet: Yeah, absolutely. So younger kids tend to show us their feelings with behaviors. They don't have the language yet or they don't even know what they're feeling. And so, we tend to see more of the tantrums, the meltdowns, more of what we call the oppositional "I don't want to do that." Whereas, the older kids, you see more a lot of what I was describing in the school or social settings.
Dr. Mike Patrick: That make sense. How young down does depression go? What's the youngest person that you have seen and treated for depression?
Dr. Ariana Hoet: Probably between six and eight?
Dr. Mike Patrick: So, school age, would you say?
Dr. Kristina Jiner: Yes.
Dr. Ariana Hoet: Yeah.
Dr. Mike Patrick: So, in the preschool years, I mean, you can certainly have oppositional behavior. Some of that's age-appropriate, though, right? As kids are learning to be independent and to push boundaries and all of those things, but really sort of the school age is when you would start really considering it. Good to know.
Dr. Jiner, what causes similar signs and symptoms? So, you could have feelings of being down or not having an interest in doing the things that you're used to doing. Are there other conditions other than depression that could possibly cause those same things?
Dr. Kristina Jiner: Sure. So, some of the things we consider when we're presented with this constellation of signs and symptom is could you have an adjustment disorder? Which means that there has been some stressor, and this is the response of that stressor. And so, certainly, there will be a trigger if you will, and we look to see what signs and things are showing up. Typically, for adjustment disorder, you're not going to have the severity of symptoms or the number of symptoms as you do in depression
Other things we consider would be is this a presentation of bipolar disorder? So, for bipolar disorder, you can have major depression in addition to the manic symptoms. And so that's one of the things we're looking for. And so, in addition to screen for depression, we're also screening for mania or hypomania.
We also think about grief, so that often is a time in which a child or adolescent has lost a loved one, someone close to them. Could these be symptoms of grief? Which then is a common normal reaction to loss. And so, we don't want to go down the wrong treatment path for something that's to be expected.
There are also some medical conditions that we think about, not common but things we should keep in the back of our minds. So, one if the thyroid is not functioning like it should be. It's under-functioning or hypothyroid. That can present as depression. Substance use can certainly present as depression.
And then, depression-like symptoms are part of many of our diagnoses. So, a child might have ADHD and it can look very much like depression or learning disorders. If a child is really struggling in school because they don't understand, they may become very sad, down, not really wanting to do anything. And really, it's because they're not able to keep up with their peers. So, they're all quite a few different diagnoses that we think about.
Dr. Mike Patrick: And this is really why it's going to be important if a parent does suspect depression, not necessarily just need your, "Oh, we're going to put someone on medication," but really try to get at what is what is happening at home, what's happening in school, what are the relationships like. Just really tease out if there's any underlying causes that maybe you could correct without having to use medicine.
Dr. Kristina Jiner: Absolutely.
Dr. Mike Patrick: And then, how do you go about diagnosing depression? So, you have all these other options that are out there. How do you get to that diagnosis?
Dr. Kristina Jiner: So, a couple different things. One, we do screening. And so that's important to help us kind of pick up on it.
And then, if the screen is positive or a family comes in presenting with those symptoms, we do a really good interview, both with the child or adolescent, as well as their caregivers. Oftentimes, if necessary, seek additional information from other caregivers, whether it be at daycare or at school.
There are some rating scales that we can use. Again, they're not diagnostic in themselves but can give you some additional information. And sometimes kids just respond differently to different ways questions are asked. So, it can provide some additional information. But at the end of the day, we kind of take all of that information together to decide if what we're seeing is most representative of depression.
Dr. Mike Patrick: Good to know. Every time I go to see my doctor, I get a checklist, one for anxiety, one for depression. It's kind of write-on write-off board so they can use it over and over again. But that seems like a pretty good screening tool.
And so, I would say if your child's doctor, whoever they see, is not screening for anxiety and depression, maybe ask them, "Can you screen my child for this? Ask those questions?"
Dr. Kristina Jiner: Absolutely. So, the recommendation is for beginning around the age 11, that they should be screened every year, their annual physical. Certainly, children younger than that can be screened if parent is concerned. There's a family history or something just seems not quite right. You can go ahead and screen, too. So absolutely very important and we know that screening does makes a difference.
Dr. Mike Patrick: And then, Dr. Hoet, so now we have a child who we thought could be depressed. We've screened them, maybe run through some more complicated checklist and surveys, and see if they meet the criteria that set out. Then how do we go about treating depression once we've found it?
Dr. Ariana Hoet: Sure. So, the good news is that we have treatment that work really, really well for depression. And it can be psychotherapy. It can be medication, or it can be a combination of both. And that really depends on the severity of the depression, the symptoms, what's going on, and of course, that conversation between the family, the child, and their medical provider.
And when it comes to therapy, really, our goal is to teach children the coping strategies they need, but also to increase that insight about themselves, understanding into their thinking and behaviors and teach those problem-solving skills.
And just like there's a lot of different kinds of medication for depression, there's a lot of different kinds of therapy. So, there's therapy, for example, cognitive behavior therapy has a lot of research and evidence behind it to show it's helpful for depression.
Cognitive behavioral therapy focuses on the idea about our thoughts is what creates our emotions. And so, we teach kids how to notice their negative thinking patterns like glass-half-empty thinking and how do I challenge that? How do I start to help myself think more like glass half-full?
It also focuses on behaviors. We know when we're depressed, we don't want to do a lot but that make us more depressed. And so, we help the families get the child more active in doing fun activities.
Outside of CBT, there's other therapies like acceptance and commitment therapy that focuses on the values and helping a child live a life that they value and enjoy. There is dialectical behavior therapy which is more focused on how do I cope with really strong overwhelming emotions? How do I stay in control of that emotion and not let the emotion guide me?
There are also therapies like interpersonal therapies that focus more on the social relationships and communication and problem solving. So, lots of different ways that we can treat depression.
Dr. Mike Patrick: And when you're talking therapy, I would imagine sometimes it's important get the whole family involved with that too, right?
Dr. Ariana Hoet: Yes. Almost always, I have the whole family involved. As the kids grow older, I will have session with just the adolescent, for example, but then at the end, I will bring the parent in and talk about what the practice for that week is.
I'm not with the child every day and really the change is going to happen after they leave the therapy session. And so having a parent, a caregiver, family member be there to help them with that practice in their day-to-day life is important.
Dr. Mike Patrick: Absolutely. You mentioned incorporating fun activities during the day can be helpful. Really, exercise, just in general, being active can help decrease the symptoms of depression, right? And sleep, we need enough sleep at night.
Dr. Ariana Hoet: Gosh, we need enough sleep, yes. So, depression works in a cycle. A downward spiral depression is what we talk about. So, "I wake up. I don't want to do anything. So, I sit in bed, and I get to the end of the day. And now I feel like, wow, what a waste of a day." Or "I'm worthless."
"And now, I feel worse," and you just kind of keep spiraling down. So, we know that to interrupt that cycle, you do fun activities, you do the physical activity or learn a new skill or socialize with someone. Do something that you feel proud of what we call a mastery activity where I accomplish something.
And so, it may not feel good at first because you're stuck in that depression but you're interrupting that cycle. And the more you do it and push yourself to kind of do that few minutes a day, that spirals in and it start going up instead of down.
Dr. Mike Patrick: Yeah. And there really is plasticity to our brains, right? I mean, we can change patterns of thinking. We can change our view of the world in our relationships. And so, we need to exercise our brain, too, not just our bodies, right?
So sometimes we do have to turn to medications. And so, Dr. Jiner, what are your favorite medicines do you use in kids and teens for depression?
Dr. Kristina Jiner: So, the medicines that we have the most evidence for, the most research for, are what we call our selective serotonin reuptake inhibitors or SSRI as they're commonly called. And they go by, there's a variety of them, but there are several common tradenames, would be things like Lexapro, Zoloft, and Prozac. And how I explain that they work is our cells in our brain communicate to one another by releasing serotonin. And we have like recycling trucks that come along, pick up the serotonin and recycle it, so the brain can use it again.
These medicines work by disabling the recycling trucks for a little bit. That way the serotonin can communicate longer. And we know that, and we believe that certain parts of the brain, that completely help with the depression symptoms. And so that's the most common type of medication that we use. We have other medications that we have a little less evidence for, but we will use to target other neurotransmitters in the brain.
And as I always remind families, the medication is good but it's not going to eliminate depression. It's very important to do the other things Dr. Hoet was talking about. If you don't incorporate those as well, you're still going to have depression symptoms.
So, I talked about the medicine helping to take the edge off the symptoms. So, you can do those things, you can get out of bed, hang out with friends, go for a walk. [0:25 XX] the role of medication.
Dr. Mike Patrick: So, the behavioral part of it is in retraining our brain, is really an important component in addition to medicine. Medicine by itself is probably, I mean, it's going to help but not as much as it otherwise could, right?
Dr. Kristina Jiner: Yes.
Dr. Mike Patrick: How do you monitor progress then when someone is on a medicine? How do you know this medicine is not working, we need to try something different, or we need to change the dose, up or down? How do you monitor things?
Dr. Kristina Jiner: So, one of the things we can do is the patient health questionnaire, which is a very common, well-studied, well-validated tool. We could administer it over time. So that's kind of a quick and easy way we can see is the score decreasing, increasing, staying the same?
Also, on clinical interview, we'll talk about those symptoms. And we're also assessing on physical exam. You can definitely see differences in hygiene, in interaction, eye contact, whether someone is smiling, not smiling, and how they're interacting with their family. And again, we take all of those pieces together and decide to do we need to make an adjustment?
Dr. Mike Patrick: And you're talking to families who the parents are with their child day in and day out.
Dr. Kristina Jiner: And they probably have observations and insight for you as well.
Dr. Mike Patrick: Dr. Hoet, we know that depression often does not live in isolation, that sometimes there are other health conditions, especially mental health conditions that we would call comorbid conditions. Meaning they're there with the depression and we can't ignore those. We have to treat those as well in order to successfully help the depression. What are some of those mental health problems that we see with depression?
Dr. Ariana Hoet: Sure. The one we see the most is anxiety. I talk to my patients a lot about how they're kind of like sisters. They often go together. But we also see comorbidities with ADHD or substance-use disorders when it comes to depression.
Dr. Mike Patrick: And so, we're really screening for those things as well, not just the depression because there are different treatments for those things, correct?
Dr. Ariana Hoet: Right.
Dr. Mike Patrick: And then you had mentioned one of the symptoms of depression is suicidal thoughts and then that could move on to suicide attempts. How is depression related to suicidal thoughts? Is it always something that's there or is it just depend on the person?
Dr. Ariana Hoet: Yes. It places you at risk for the suicidal thoughts. You can have depression without suicidal thoughts, but it is something that a person is at higher risk for. And so, we are always assessing in one of the symptoms of depression.
Dr. Mike Patrick: And how can parents screen, especially if they have child with depression, is that something they should talk about?
Dr. Ariana Hoet: Yes, absolutely. We always encourage adults, whether parents, caregivers, or school staff members to check in with children. We know that asking, "Are you having thoughts of suicide or thoughts of hurting yourself," does not increase the likelihood that a child will think about it. All you're doing is creating that safe space.
You're opening the door for the child to know, "Wow, this person I can really share how I'm feeling." And it can, again, open that door to having that conversation and getting them the help that they need.
Dr. Mike Patrick: If you have young children at home, I would think it's important at a very early age to start talking about feelings and what are you feeling, how are you feeling, have you thought about hurting yourself? And if you do those kinds of conversations at an early age as kids gets older, it just becomes easier, whereas if you have a teenager who you haven't really communicated with a lot, it can be very difficult and awkward conversation, right?
Dr. Ariana Hoet: Yes. Everything takes practice, right, for us to feel comfortable with it. And so, conversation is the same and conversations about our mental health, it can be hard for kids to share with their parents how they're feeling. And so, if you make it a habit, something that they know you're going to do, every day you're going to check in and they know how the conversation is going to go, they know how you're going to react, they are a lot more likely to be open with you.
Dr. Mike Patrick: And maybe we should be open with our feelings, with our kids, too, because we have all the same feelings that they have. And sometimes, we try to hide those feelings from our kids. And I guess there are times when it's appropriate and times when it's not appropriate. And we certainly want to be a rock for our kids but sharing our feelings from time to time is always going to be a good modeling behavior, right?
Dr. Ariana Hoet: Yes. Modeling is so important to normalize it. And like you're saying, maybe I'm not sharing in a moment. Maybe I have to take a time to process and cope, and then I can share, "You know, yesterday I was feeling really sad about this situation and here's what I did to feel better." And that we were normalizing that.
Dr. Mike Patrick: Yes. That's a great point. If we do have a child who endorses suicidal thoughts, what are the next steps for families? What should they do?
Dr. Ariana Hoet: There are many different things that a parent can do. You can reach out to the child's pediatrician. You can reach out to our national suicide hotlines. There's both call or text numbers. And then if you have, for example, for us, the local children's hospital, we have our own line that a parent can call and talk to, a trained crisis counselor for guidance.
Dr. Mike Patrick: We also have our psychiatric crisis department which is a part of our Behavioral Health Pavilion here at Nationwide Children's Hospital. And I'm going to put a link to that in the show notes. Especially if you're in Central Ohio, it's good to just be familiar with that as a resource because you never know when you're going to need it. And so, if you have awareness about it, that can be helpful.
And then I will put some other information in the show notes over at pediacast.org, the National Suicide Prevention lifeline, the phone number. And then you can also text START to 741-741 and that will get you in connection with a mental health counselor.
And then apparently, I don't know that it started yet but I think in the next month or so, they were rolling out a 988, kind of like 911, except that this is 988 which is a National Mental Health Crisis and Suicide Prevention hotline. So, I think the way it's going to work is it will route your call to someone local in your area, wherever you are if you dial 988. Just like when you dial 911, you get emergency in your area. Am I right about that?
Dr. Ariana Hoet: Yes. It's just taking the place of the current National Suicide Hotline.
Dr. Mike Patrick: Great. So, it'll just make it easier to remember moving forward. So, I'm not 100% certain that it will work today but I think it's coming like soon, from what I've heard.
A lot of parents may be hesitant to want to acknowledge that their child is suffering from depression. Maybe they don't really want them in counseling or they're not endorsing the counseling. Just pull yourself up by the bootstraps and get on with things or they may not want their child on medication. What complications can arise if we just ignore depression and say, "Oh, this is going to get better." I mean, there's really a consequence of not doing something, right?
Dr. Kristina Jiner: So, I think the scariest one, the one we worry about the most is death from suicide. And so, we certainly worry about that.
The other thing is that we know that if we don't treat it in childhood and adolescence, you're going to develop it as an adult. And so that, of course, has far-reaching consequences as an adult.
But there's other things that we worry about. So, for example, substance use. Sometimes, our teenagers will, in an effort to feel better, kind of reach out looking for things to feel better and run across substances. And so then can develop some substance abuse and that can cause its own set of consequences.
Learning disorders, certainly, if your depression is such that you're unable to concentrate and focus, that's going to cause problems at school. It's going to cause problems with interacting with others.
Something that's also come up the last of couple of years is that depression has an inflammatory component to it in terms of how it works in the body. And so, there's some thought that that can set a child up for premature cardiovascular disease. And so that's something that we're becoming more acutely aware of. And the American Heart Association has recognized it as a potential risk factor. And so, I think that in and of itself is another reason to we want to treat it, we want to take it seriously.
I always tell parents depression is no different than asthma. Nobody wakes up one day and says, "Hey, I think I have asthma today." It's something they develop, and they can cope with and learn to manage it well.
And same is true for depression. No one wants to have depression. It's something that kind of pops up but there are ways to cope, there are treatments. There are supports. And so, anything that we can do to help support a child and their family makes a difference.
Dr. Mike Patrick: Yes, absolutely. You mentioned like the consequences of depression in adulthood really, I mean, there's probably higher divorce rates if you have untreated depression. You're less likely to be able to hold a job or to be productive and excel at your job. And the same thing with the schooling if you're in elementary school, high school, college, wherever, I mean, your academic performance is going to suffer if you're not really treating the depression.
And then I love that you brought up substance abuse because the purpose of the medications that we use is that this is a chemical that's been very well studied. Whereas the substances that you get on the street are not well-studied. But you can understand why someone goes to that because they just want to feel better.
Dr. Kristina Jiner: Absolutely.
Dr. Mike Patrick: What are the long-term outlooks for those who have depression? Is this something that is just a moment in time, maybe it will last a few months or maybe a couple of years and then, you don't need the medicine anymore? Or is this a lifelong issue that you're going to have or is it different from one person to another?
Dr. Ariana Hoet: Yeah, I was going to say a little bit of both. The American Psychiatric Association has a stat that says 80% to 90% of people with depression respond to treatment, and that can be whether therapy or medication. And so, we know that treatments work. They take time. It's not just I'm going to start a medicine and tomorrow I'm going to feel better. Same thing with therapy, it's going to take weeks, but you can get better.
We also know that depression can be a chronic health condition. And so, I may feel better, but something may happen, and the symptoms come back. And it's something that you just have to be aware of for the rest of your life that the symptoms may resurface. And our goal through therapy is that, well, now, you've learned to have that insight to notice the symptoms before they take control and then you now have the skills of what to do to help yourself. But I do sometimes discharge families from therapy and tell them if in a few months, a few years, you need to come back, that's okay.
Dr. Mike Patrick: I would imagine there's certain things that can happen to one in the course of their life, if they have been prone to depression, that could kind of head them in that direction, again, like a death of a loved one, loss of a job, the diagnosis of a new chronic illness. I mean, lot of things can cause bumps on the road. And then, you want not only to treat and deal what that bump is, but then also the depression that you may have an issue with underlying.
Dr. Ariana Hoet: Exactly.
Dr. Mike Patrick: What about current research in depression? Or is there anything hot out there that our listeners ought to know about?
Dr. Ariana Hoet: I think what I've been really into recently is we know there's this increased need for mental health services and just not enough therapists, psychiatrists to help children. And so, there's a lot of cool research coming out about brief intervention, single session interventions, whether one session or four sessions. And they're showing a lot of promise, especially for kids with mild depression or at risk for depression.
There's also a lot of cool research on treatments through smartphones or websites where it's self-guided. And so, I find that really exciting because it allows us to have, again, those kids that maybe their symptoms are less severe, get the help that they need. And then we have therapists that are available for more of the moderate or comorbidity presentation.
Dr. Mike Patrick: This is something that we need more workers in mental health, not just for kids but for adults, too. But as your children are growing up, you may encourage them to go into mental health work. It's a great field and certainly one that is needed, right?
Dr. Kristina Jiner: Absolutely. It's very rewarding to be able to work with children and families and to see that progress. Like Dr. Hoet is saying, we have research that shows it's very treatable. And then we see progress, and that is incredibly rewarding and one of the best of parts of what I do.
Dr. Mike Patrick: It seems like we hear about anxiety and depression a lot more. Is there more of it out there today compared to 10, 20 years ago or it's just more awareness or both?
Dr. Kristina Jiner: My suspicion is that it's a little bit of both. One, we're recognizing it more. But two, we think too, kind of the last couple of years in particular with the pandemic, there are folks who perhaps have a predisposition or were at risk for developing depression.
We have a worldwide pandemic that changed a lot of our lives in many different ways. And so, we may have started to see more depression. The research, of course, will tell in time if the pandemic itself has increased but there's probably a little bit of both.
Dr. Mike Patrick: And then I want to wrap up with just a quick discussion about our Big Lots Behavioral Health Services at Nationwide Children's Hospital. We really have a super well-developed program. Tell us a little bit more about what you guys do.
Dr. Kristina Jiner: Sure. So, we have a variety of services across the continuum of care. Everything from emergency or crisis care, as you mentioned the Psychiatric Crisis Department to outpatient care, whether that's in the office or more community-based or school-based. And we have higher levels of care whether that's an intensive outpatient program, partial hospitalization. I mean, if need be, the in-patient care.
We have program set up for special populations. So, for example, autism, eating disorders. Those who identified as gender diverse. So, we have a wide variety of services that also collaborate very closely with our primary care colleagues, as well as our medical specialists.
Dr. Mike Patrick: And we have the largest free-standing Behavioral Health Pavilion for kids and teenagers in the entire our country, right?
Dr. Kristina Jiner: Yes, that is true.
Dr. Mike Patrick: And then we also have a fantastic program called the On Our Sleeves Movement. Dr. Hoet, I know you are the medical director of that program. Tell us more about On Our Sleeves.
Dr. Ariana Hoet: Sure. So, at On Our Sleeves, our mission is to give free resources, every community in the US, resources that are evidence-informed on how to support and promote the mental wellness of children.
And so, we have information for parents and caregivers, but we also have information for teachers that they can implement in their classroom. We have information for coaches and even working parents. So, anyone looking for ways to support them unto wellness of their children, they can find it at On Our Sleeves.
Dr. Mike Patrick: Perfect. And we'll put a links to both the Big Lots Behavioral Health Services at Nationwide Children's and also On Our Sleeves: The Movement for Children's Mental Health. We'll put links to both of those in the show notes so folks can find it easily.
Well, once again, we really appreciate both of you stopping by. I know we have some more programs in the future that we have planned that we're going to be excited to bring folks. We did one a few months back on anxiety. So, I'd encourage folks to head back in the archives and listen to that one too because there's lot of kids affected by not only depression, but by anxiety as well.
So, Dr. Ariana Hoet and Dr. Kristina Jiner, both with Nationwide Children's Hospital, thank you so much for stopping by today.
Dr. Kristina Jiner: My pleasure.
Dr. Ariana Hoet: Thanks for talking with us.
Dr. Mike Patrick: We are back with just enough time to say thanks once again to all of you for taking time out of your day and making PediaCast a part of it. Really do appreciate that. Also, thanks again to our guests this week, our behavioral health panel, Dr. Ariana Hoet, pediatric psychologist and Dr. Kristina Jiner, pediatric psychiatrist, both from National Children's Hospital.
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Thanks again for stopping by. And until next time, this is Dr. Mike saying stay safe, stay healthy and stay involved with your kids. So, long, everybody.
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