Understanding depression in students
As Rollo May puts it ‘depression is the inability to construct a future’. Depression is of major public health importance, in terms of its prevalence and the suffering, dysfunction and economic burden and more common in women. It is estimated by 2020, if current trends for demographic and epidemiological transition continue, the burden of depression will increase to 5.7% of the total burden of disease and it would be the second leading cause of disability-adjusted life years (DALYs), second only to ischemic heart disease.
It is reported a 3% prevalence of depression among school attending adolescents (13–19 years) in a study that specifically assessed the prevalence of depression. It is very important to point out that the prevalence of depression in children and adolescents in India needs to be understood in the context of the high and ever increasing evidence of suicidal behaviour in young Indian population.
This article describes how teachers should provide first aid to student who may experience depression. The role of the teacher is to assist the student until appropriate professional help is received or the crisis is resolved.
How do I know if someone is experiencing depression?
If you notice changes in the student’s mood, behaviour, energy levels, habits or personality, you should consider depression as a possible reason for these changes. It is important to learn about depression so that you are able to recognise these symptoms and help someone who may be developing a depressive episode. Take time to find out information about depression such as its causes, its symptoms, how it can be treated, and what services are available in your area. It is important that you do not ignore the symptoms you have noticed or assume that they will just go away. It is also important that you do not make excuses for the student’s behaviour as this may delay getting assistance.
Symptoms of depression
It is also important to know that for a student to be diagnosed with clinical depression, s/he must have 4 or more of the following symptoms. An unusually sad or irritable mood that does not go away + 4
SIGECAPS = Depression
SIGECAPS – Mnemonic for Depression for easy recall to identify depression. Sleep (increase/decrease); Having sleeping difficulties or, sometimes, sleeping too much Interest (diminished); Loss of enjoyment and interest in activities that used to be enjoyable Guilt/low self esteem; Feeling worthless or feeling guilty when they are not really at fault Energy (poor/low); Lack of energy and tiredness Concentration (poor); Difficulty concentrating or making decisions Appetite (increase/decrease); Loss of interest in food or, sometimes, eating too much Changes in eating habits may lead to either loss of weight or putting on weight Psychomotor (agitation/retardation); Moving more slowly or, sometimes, becoming agitated and unable to settle Suicidal ideation; Thinking about death a lot or wishing they were dead.
Normally Indians report depression in the following statements like; Mann/Mood theek nahi hai, Mann nahi lagta, Dil nahi karta, Mann kharab hai, Gussa ata hai, Tension hoti hai, Concentrate nahi kar pata hu & Soch nahi pata hu. Visible Symptoms to look for: Anger out bursts, Hyper sensitive, Touchy, Crying spells, Non responsive, Sad mood, Irritable, Slow in speaking, Saying not happy and I am depressed.
How should I approach someone who may be experiencing depression?
Before you try and help the student who may be experiencing depression, it is important that you learn about things like the causes and treatments for depression. Try to find out what treatment services are available in your area, especially those of trained Clinical Psychologists and Psychiatrists.
Contrary to myth, talking about depression makes things better, not worse. If you think that a student you know may be depressed and needs help, you should have a comfort level with that student. It can be helpful if you allow the student lots of opportunity to talk and let him/her choose when to open up. It is important to choose a suitable time when both you and the student are available to talk, in a space where you both feel comfortable. Let the student know that you are concerned about him/her and are willing to help. If the student doesn’t feel comfortable talking to you, you should encourage him/her to discuss how s/he is feeling with someone else.
You should ask the students about their mood, for instance, if the students say that they are feeling sad or down, you should ask them how long they have been feeling that way. Ask the student if they are feeling depressed and respect the way the students interprets their own symptoms. It might be helpful to reassure the student that feelings of depression are very common. If the students would like some information about depression, it is important that you give them resources that are accurate and appropriate to their situation. The students you are helping may not have the energy or strength to find out information on their own and you may need to help them; be mindful of the severity of the students’ symptoms when you are giving them information. One source of information that may be helpful is telephone numbers of support services provided by mental health professionals.
How can I be supportive?
Treat the students with respect and dignity. Each student’s situation and needs are unique. It is important to respect the students’ wishes while considering the extent to which they are able to make decisions for themselves, and whether they are at risk of harming themselves or others. You should respect the students’ privacy and confidentiality unless you are concerned that the students are at risk of harming themselves or others. It is important to be honest with the students. Let them know in advance that you will need to intervene and seek professional help for them if you ever believe that their life may be in danger.
Do not blame the students for their illness
Depression is a medico-psycho-social illness and the students cannot help being affected by depression. It is important to remind the students that they have an illness and that they are not to blame for feeling ‘down’. Beware that there is no point in just telling someone who is depressed to ‘get better!’ Telling people with depression to snap out of it is just like telling people with cancer to just get over it.
Have realistic expectations from the students
Let the students know that you don’t think less of them as students, and that they are not weak or failures, because they have depression. Everyday activities like getting up, doing homework, or coming to school may seem overwhelming to them. You should acknowledge that the students are not ‘faking’, or being lazy’, ‘weak’ or ‘selfish’. Ask the students if they would like any practical assistance, but be careful not to take over, or to encourage them to become dependent on you.
Offer consistent emotional support and understanding
It is more important for you to be genuinely caring than for you to say all the ‘right things’. The students genuinely need additional love and understanding to help them through their illness so you should be empathetic, compassionate and patient. People with depression are often overwhelmed by irrational fears; you need to be gently understanding of someone in this state. It is important to be patient, persistent and encouraging when supporting a student with depression.
Encourage the students to talk to you
Don’t be afraid to encourage the students to talk about their feelings, symptoms and what is going on in their minds. Try to use openended questions so that the students can say what they want to, rather than questions that are likely to be answered with a ‘yes’ or ‘no’. Let the student know that you are available to talk when they are ready; do not put pressure on the student to talk right away.
Be a good listener
You can help students with depression by listening to them without expressing judgment. Be an active listener; reflect back what the students have said to you before responding with your own thoughts. It is important to listen carefully to the students even if what they tell you is obviously not true or is misguided. Although the students may not be communicating well, and may be speaking slower and less clearly than usual, you must be patient and must not interrupt. If the students are repetitive try not to get impatient, but rather keep trying to be as supportive as possible. Be aware that silence may be better than talking. If the students don’t want to talk, then try just to be with them for a while.
Give the student hope for recovery
You need to encourage the students to believe that, with time and treatment, they will feel better. If the students are constantly negative, try to point out the positive things that are happening.
What doesn’t help?
- Don’t tell the student to ‘snap out of it’ or ‘get over it’.
- Do not be hostile or sarcastic when the students attempt to be responsive. Instead, accept their responses as the best the students have to offer at that time.
- Do not adopt an over-involved or overprotective attitude towards someone who is depressed.
- Do not nag the students to try to get them to do what they normally would.
- Do not tell the students that they just need to stay busy or get out more.
- Do not trivialise the students’ experiences by pressuring them to ‘put a smile on their face,’ to ‘get their act together’, or to ‘lighten up’.
- Do not belittle or dismiss the students’ feelings by attempting to say something positive like, ‘You don’t seem that bad to me’.
- Avoid speaking to the students in a patronising tone and do not use overlycompassionate looks of concern.
- Avoid using the words ‘I know how you feel’ or ‘I understand‘ as it is unlikely, unless you have also been with depression, that you can exactly imagine the students’ sadness. Rather use ‘I understand from your words, I understand from what you have said’.
- Try not to show the student if their depression is bringing you down.
- Do not tell the student that they are unpleasant to be around, even if you feel that way.
- Resist the urge to try to cure the student’s depression or to come up with answers to their problems.
Should I encourage the students to seek professional help?
Ask the students if they have tried to get help and if they need help to manage how they are feeling. Everybody feels down or sad at times, but it is important to be able to recognise when depression has become more than a temporary experience for someone and when to encourage those students to seek professional help. If this is the case, you should tell the students how treatment might help them to feel better, discuss the options that they have for seeking help, and encourage them to use these options. It is important to encourage the students to get appropriate help and effective treatment as early as possible. If the students do not know where to get professional help, offer to assist them. You should encourage the students to first see a clinical psychologist for immediate treatment. If the students would like you to support them by accompanying them to a doctor’s appointment, you must not take over completely; students with depression need to make their own decisions as much as possible.
Unless there is a specific risk of harm to self or others, do not push the student into seeking professional help before they are ready. Once they have sought help, ask the students if they need any help understanding or clarifying any medical words that were used by the therapist/clinical psychologist.
What about self-help strategies?
People who are depressed frequently use self-help strategies. Before speaking to the students about self-help strategies, you should know which ones are helpful for depression, so that you can recommend them like, regular low to moderate exercise, interacting with friends and family, not spending lonely time, etc. Ask the students if they are interested in talking about self-help strategies. If the students say yes, then provide them with information about the ways that they can help themselves feel better. It might also be useful to ask the students what they have done in the past to help themselves cope, and to ask whether they could use those strategies again to help themselves now. However, if the student is using drugs, alcohol, watching excessive television, playing excessive computer games or sleeping excessively, you should encourage them to reduce their use.
What if the student doesn’t want help?
The student may not want to seek professional help. You should find out if there are specific reasons why this is the case. For example, the students might have had bad experiences in the past, be concerned about costs, or they might be worried they will be sent to hospital. These reasons may be based on mistaken beliefs, or you may be able to help the students overcome their worry about seeking help. If the students still don’t want help after you have explored their reasons with them, let them know that if they change their mind in the future about seeking help, they can contact you.
Sometimes they do not want their friends to know about their depression. Just to hide this, some adolescents don’t share till it blows over the top. (Here teachers must have non judgemental and non pointing discussions about depression in the class and try to reduce the negativity and myths regarding depression. Sometimes the student may need time to accept the need for treatment. If this is the case, slowly and respectfully persist in trying to get the students to seek help. However, at all times you must respect the students’ right not to seek help, unless you believe that they are at risk of harming themselves or others. You must only intervene without permission when the student’s life is in danger.
Life isn’t about waiting for the storm to pass, it’s about learning how to dance in the rain. –Author Unknown.
John Victor is a Senior Clinical Psychologist, formerly with VIMHANS as Faculty & Consultant. Trained all the counsellors of MSF India, CANSUPPORT and SPARSH in association with MSD (Merck Pharmaceuticals) in Basic Counselling Skills. Conducted workshops on Fear and Love for Maths, Living with Teachers Stress, Dealing with Anger and Aggression in Children, etc. Worked with all the staff of MSF Kashmir (Médecins Sans Frontières) in dealing with their professional burnout at the time of severe conflict in 2011, (Kashmir) Conducted series of public awareness programmes at IHC on topics like ‘Violence & Aggression in Children’ and ‘Personality Re-Engineering’. Currently associated with SANOFI in conducting Conscious Parenting Workshops all over India.