High school learners were invited to design posters that depict aspects of depression as part of the Health4Life initiative. The winning poster, designed by Hannah Goslett of Belgravia High School, has a powerful message: The words ‘I am the victim of my own pain’ are illustrated by a stark black, red and white image of a girl enchained by her negative emotions.
Hannah’s poster has been used in social media and distributed to 19 high schools where talks about mental health issues raise awareness, especially in terms of the signs and symptoms of depression, explains Sofia Neves, director of Salesian Life Choices.
“One of the focus areas of the organization is to run health awareness campaigns and provide youth friendly health services in schools. We work in adolescent health for two main reasons. Research has shown roughly 70% of premature deaths among adults can be linked to behavior initiated during adolescence. Secondly, while it is commonly accepted that young people enjoy better health than older people, almost 15% of diseases and injuries that burden the world population happen to youth,” Sofia says.
Some important public health issues that start during childhood are depression, substance use, smoking, sexually transmitted infections, unplanned pregnancies and trauma injuries among others, Sofia explains. “Salesian Life Choices runs youth-lead campaigns in school addressing these issues. The campaigns have the format of interactive health talks after school, followed by crowdsourcing competitions where teenagers develop creative posters that address risk perception, basic information and links to help. The winning posters are used in communication campaigns. Young people did not disappoint and the entries for the first campaign were excellent,” Sofia says.
Salesian Life Choices has psycho-social support as part of all their interventions with youth from the Cape Flats, explains Programme Manager at the NPO Tatenda Mawoyo. “Based on our experience, we felt that depression should be the first health issue targeted by the health campaigns. Our counselors make an effort to help young people distinguish between normal teenage emotional turmoil (feelings such as moodiness or grief after a traumatic event) and persistent and debilitating negative emotions that could indicate depression. We encourage youth to speak openly about the things they’re grappling with so we can refer serious cases to health professionals,” says Tatenda.
Young people who grow up in situations of prolonged abuse, violence or neglect are particularly vulnerable to developing long-term psychological difficulties such as depression and anxiety, Tatenda warns. “For children living in communities plagued by violence, traumatisation is a perpetual and chronic condition. Most cases of depression and anxiety in teenagers we encounter are linked to trauma.”
Violence exposure, both in the form of witnessing and being victimised, has lasting negative psychological consequences for young people. Research has shown 17% of children and adolescents in Western Cape have mental difficulties, with generalised anxiety disorder the most common, followed by Post Traumatic Stress Disorder and Major Depressive Disorder.
Young men sometimes mask their depression in various ways such as through alcohol and drug abuse, Tatenda says. “The rate of depression amongst South African men is at an all-time high. That is why more mental health education is so important, we need to tell young people it’s okay to seek help.”
The most worrying aspect is the well-established link between depression and suicide. According to research done by the World Health Organisation in 2016, suicide is the second leading cause of death among 15- to 29-year-olds globally and in African countries with low and middle-income, suicide rates increased by 38% between 2000 and 2012.
Given South Africa’s high rates of child physical and sexual abuse and school-based violence and bullying many young South Africans are at risk of different types of trauma and depression, says psychiatrist for children and adolescents Dr. Gawie Malherbe from Somerset West.
Children with neuro-developmental disorders are particularly susceptible and vulnerable, Dr. Malherbe cautions. Neurodevelopmental disorders are a group of disorders in which the development of the central nervous system is disturbed such as Attention Deficit/Hyperactivity Disorder (ADHD); learning disorders; Autism Spectrum Disorder (ASD) and intellectual disability. “Under normal circumstances, about 20% of children are born with neuro-psychiatric developmental disorders, if we include the mild cases. In an environment where there are constant triggers for trauma, the percentage of kids not functioning optimally neuro-psychiatrically can be much higher,” Dr. Malherbe says.
While anti-depressants can be an effective treatment for depression in young people, it needs to be complimented by other kinds of interventions for youth living in disrupted communities, Dr. Malherbe advises. “Violence in the home often predicts child depression. But you cannot simply give a pill to a depressed child living in a chaotic home where the dad comes home drunk and attacks everybody. You have to address all the issues including safety, a healthy diet, support networks and access to help.”
In some cases, schools and parents play an active role in young people’s mental problems because of competition and pressure to excel, says Dr. Malherbe. “Schools and parents that use kids to compete with one another should be warned about the negative outcomes of their actions. The pressure from competition sometimes comes down to child abuse. I’m also against homework for younger children, especially in struggling communities where parents simply don’t have the resources to help. School should be enjoyable for young people and not contribute to stress and anxiety,” he insists.
Experts agree that part of the problem in South Africa is that depression is seen as a “luxury” not afforded to people in poorer communities. In a blog entry that was circulated widely on social media recently, a young student described this sentiment eloquently: “I grew up in the Cape Flats. By virtue of being born of color, I inherited socio-economic issues at birth. From an early age, I became accustomed to abuse, suffering and torment. My community struggles to cope under the blanket of poverty thrown over it by apartheid. In the midst of pressing socio-economic issues, there was and there is no space for anxiety or depression.
“There is no space for feelings when you’re struggling to cope with basics necessities such as feeding your family. My depression is a luxury. Growing up, I never had the privilege of having the space to feel and recognize my illness. I was never self-aware. I thought that this is just ‘part of life’. In the midst of gangsterism, violence and drug abuse, I didn’t think my depression was potent enough for it to be special or recognized.” (www.thenakedflowerblog.wordpress.com)
The writer of the article says a combination of medication and talk therapy helped her through her darkest times. The anti-depressants she was initially prescribed had very bad side-effects. Her suicidal thoughts only subsided when she started taking a different kind of anti-depressant and made lifestyle changes, such as taking up regular exercise. She talks movingly about the continued struggle for acceptance in her community and family where there is little understanding or sympathy for her depression.
Luckily the stigma around mental illness is slowly starting to change as more and more people and role models come forward. South African comedian Trevor Noah recently said his early brush with poverty and abuse at the hands of his stepfather contributed to his depression. He has been widely praised for opening up about his mental illness.
Experts warn that untreated depression of young people will have dire consequences on present outcomes and future generation’s wellbeing. That’s why it so crucial that we engage young people now, Sofia believes.
WHAT IS DEPRESSION?
Depression is not disappointment or feeling sad about something. However, if you experience such feelings for more than two weeks, it might be the onset of depression.
Early diagnosis of depression can save lives – recognize these symptoms:
Constant anxiety; persistent sad or “empty” feelings; difficulty concentrating, remembering details and making decisions; fatigue and decreased energy; feelings of guilt, worthlessness, and/or helplessness; feelings of hopelessness and/or pessimism; insomnia, early-morning wakefulness, or excessive sleeping; irritability, restlessness; loss of interest in activities or hobbies once pleasurable; overeating or appetite loss/weight gain or weight loss; involuntary thoughts of suicide (called suicide ideation). [SOURCE: ITHEMBA FOUNDATION]
SIGNS OF DEPRESSION TO LOOK OUT FOR
Psychiatrist Dr. Gawie Malherbe says parents or caregivers should suspect depression when their child becomes withdrawn, crying more than usual, is complaining about all sorts of pains, aches and other negative feelings. When a child starts to underachieve, not only academically but also socially and in other aspects of his or her life, a parent or family members should seek help. Withdrawal from family life is an ominous sign. Persistent reading, writing, drawing and persistence in occupying self with negative thinking, including death and other dark philosophical concepts, are all reason for concern, Dr. Malherbe warns. An assessment for depression or anxiety or unhappiness should include an assessment for an underlying neurodevelopmental disorder example ASD or ADHD.