Unfortunately, that means letting go of the popular notion that a return to “normal” for children—personal education, no more masks—will reverse those trends. In fact, such measures could exacerbate the stress many college students already feel, said Lisa Fortuna, UCSF chief of psychiatry at Zuckerberg San Francisco General Hospital. And an estimated 200,000 children in the US who have lost a parent or guardian to Covid-19 may need additional support. Screening for depression and anxiety in schools and pediatric practices will be critical, as the symptoms associated with these conditions are easier to treat and cause less damage if addressed early. For adolescents, substance abuse, eating disorders, and suicidal thoughts can be complications of both anxiety and depression.
In preadolescent children, Fortuna says, depression can manifest as irritability and irritability rather than sadness. For all ages, withdrawal from routine activities is a warning sign, as is excessive worry. Symptoms vary widely, but in general, depressed girls may withdraw, while boys may fight or act out, labeling them as a behavioral problem rather than, say, a mood disorder. “Clinically, I see a lot of young men with depressive symptoms,” Fortuna says. That’s despite the decline in male visits to the ER that the CDC found. “They’re still there,” she says. “They may not present as loudly.”
Engaging in a dialogue with children about how they feel and listening without judgment are critical. “I would encourage parents to talk to children and ask them, ‘Are you feeling sad?’” said Anita Everett, director of the Center for Mental Health Services at the Administration of Substance Abuse and Mental Health Services. “We encourage people to ask about suicide as well,” she adds. Doing this will not plant the idea. If there is a problem, don’t ignore it and hope it will go away. “Some sort of path forward is important,” Everett says.
That path can be tough. A recent survey in Annals of Family Medicine found that 85 percent of primary care practices struggle to access evidence-based mental health services for children. Nationally, Fortuna says, some children wait six months to a year for help. She suggests seeking advice from a GP or school counselor first. The SAMHSA website includes a treatment finder, and churches and other community groups can be valuable resources. Everett urges health care providers to ensure that weapons, especially guns, and medicines and other hazardous materials are properly secured in any home where a child will be. And, she says, parents should seek support themselves. Perhaps it’s helpful – but also tragic – to know that it won’t be difficult to find others whose children are having a hard time, and who are having a hard time themselves.
If you have suicidal thoughts, call the National Suicide Prevention Lifeline at 1-800-273-8255 (TALK). You can find a list of additional resources at SpeakingOfSuicide.com/resources.
Kim Tingley is a contributing writer for the magazine.