A child shrouded in haze
Li Ting, 12 years old
The girl had more than a dozen knife marks on her arm
Anger can smash things, quarrel with family members, and even self-harm
The initial diagnosis of depression was recommended by the doctor and hospitalization
The girl's mother did not agree
Until the girl almost jumped from the 15th floor
Chen Rui, 14 years old
She wanted to heal
I don't really want to be cured
Because of her repressed family
Daddy was grumpy and often ordered her to do this and that
Mom gave her a tabloid cram school
Thoughts of suicide flashed through her, and she felt like she was depressed
Mom didn't believe it
Until the girl cuts her wrists with a knife and hits her head against the wall
Zhao Yue, 14 years old
Since childhood, he has been spoiled by his parents
Her parents had high expectations for her
It is more about control and restraint for children
The child is found to be depressed, withdrawn, and self-harming
Mistaken for an adolescent problem
Parents who don't want to believe
The kid is getting stupid!
The child is so disobedient!
How can children always be lazy!
The child's adolescence is simply too rebellious!
We didn't treat the baby badly, how could the baby be depressed?
Shocking data
According to a survey
Among students aged 6-16 years old
The prevalence of mental disorders in children and adolescents was 17.5%
Among them, depressive disorders accounted for 3.2%
Anxiety disorders accounted for 4.7%
Tsundere, rebellious, disobedient, maybe, the child is just sick.
Don't ignore the changes in your child!Adults, please read about your child's depression
Smashing things, arguing with family members, and even self-harm
Sometimes irritable, sometimes sad, and crying for no reason
Grades drop and it is difficult to concentrate
In May 2021, the first survey report on the prevalence of mental disorders in children and adolescents in China was published in the journal Child Psychology and Psychiatry. The survey was launched at the end of 2012 and selected about 74,000 children and adolescents from five provinces (municipalities) of Beijing, Liaoning, Jiangsu, Hunan and Sichuan.
The survey results show that among school students aged 6-16, the total prevalence of mental disorders among children and adolescents is 17.5%, of which 3.2% are depressive disorders and 4.7% are anxiety disorders.
Zheng Yi, chief expert and chief doctor of child psychiatry at Beijing Anding Hospital affiliated to Capital Medical University, led the investigation. "Based on the number of students in China, this number is already very large, and the target of our survey at that time was school students, and it did not cover those children who could not go to school for various reasons, and if we counted them, the prevalence rate would be even higher. Zheng Yi said.
In his view, children's mental health problems have become a serious public health problem, and this cannot be solved by doctors, it requires the integration of family, school, medicine and society.
According to the survey, the overall prevalence of mental disorders among children and adolescents is 17.5%, but in fact less than 20% of adolescents have received appropriate diagnosis and treatment.
"This is a big problem, why are so many children not being treated?" Zheng Yi said, the most important reason is that parents do not have enough understanding, and second, there is a misunderstanding, because there is still serious discrimination and stigma against mental illness in society.
Compared with their children's mental health, many parents pay more attention to their children's functions, as long as they can go to school and study well, everything is fine. It is only when a child is unable to go to school that there is a real concern about the child's psychological problems. In fact, it has been a long time since a child has developed depressive symptoms to not being able to go to school, which is the main reason for the delay in early identification and diagnosis of children and adolescents.
A child's world
When you are in a bad mood, you will smash things and quarrel with your family
Sometimes irritable, sometimes suddenly crying in pain
There are only sad feelings in my head
In the consultation room, Li Ting's mother rolled up her daughter's sleeves, revealing more than a dozen knife marks on her two arms, of different shades. The day before the visit, Li Ting almost jumped from the 15th floor, and the family was terrified.
Li Ting had just turned 12 years old, with a handsome face and a red necklace around her neck. It is at her age that she cares a lot about her image.
Qi Junhui is the attending physician of the Department of Child and Adolescent Psychiatry at Beijing Anding Hospital, and this is not the first time she has met Li Ting. A week ago, her mother brought her here for the first time and told her that her daughter had been staying at home since June last year, and when she was in a bad mood, she would smash things, quarrel with her family, and even harm herself.
"Depressive state", this is Qi Junhui's initial diagnosis of Li Ting. Last time, she had suggested that Li Ting be hospitalized, but her mother did not agree. This time, Li Ting's idea of jumping off the building made her mother change her mind.
When Li Ting was about to be hospitalized, Chen Rui had been living here for 18 days.
Chen Rui, 14, is a native of Beijing, and her parents are "traditional" in her eyes: her father is short-tempered, preachy, typically machismo, and often speaks in a commanding tone. Her mother had a strict education, and she enrolled in various cram schools since she was a child, and she didn't even have free time on weekends.
The environment at home made her feel depressed. Chen Rui felt that she began to have psychological problems when she was in the third or fourth grade. At that time, she was already able to get to the top of her class, but her mother would still scare her with the words "If you don't study well in elementary school, you won't go to high school". "She wanted me to be at the top of my grade, and I didn't think it was possible. ”
The trigger was that after entering junior high school, her long-time friends broke up with her, and her relationship with her classmates became strained. Later, her emotional problems became more and more serious, sometimes irritable, sometimes suddenly painful and sad, and on two occasions she couldn't control her crying when she went to class, "there was no sign at all, only sad feelings in her head".
Her body began to show abnormalities: sometimes her mind was confused and she couldn't hear the outside world, sometimes she woke up with distorted vision, and she vomited a lot...... She later learned that this was a somatization symptom of a depressive state. Naturally, academic performance is also declining. She had difficulty concentrating and her memory had deteriorated. Even, the idea of suicide began to flash, she would want to stab herself with a fruit knife, but she didn't dare, because she was reluctant to let go of the kitten at home. She would rather someone suddenly stab her on the street.
She told her mother that she was afraid she was suffering from depression. But her mother didn't believe it, and it wasn't until she cut her wrists with a knife and banged her head against the wall in order to be sober that her mother took her to see a doctor.
Parental vision
The child becomes stupid, disobedient, and lazy
Adolescent rebellion is too powerful
How can a child get sick?
"Why do children do this?" is the question that most parents will ask when they see He Fan, either directly or tactfully. He Fan is the chief physician of the Department of Child Psychiatry of Anding Hospital, and often after some examination and explanation, she will tell her parents gently but seriously: because he is sick!
He Fan introduced that depressive disorder is an objective disease, just like people can break bones, not as many parents think: children become stupid, disobedient, lazy, or rebellious in adolescence.
In fact, she said, adolescent rebellion will have some emotional problems and oppositional disobedience, but it is all within acceptable limits, and it will not self-harm, suicide, loss of social functions such as schooling, etc. According to the results of epidemiological surveys, the prevalence of depressive disorders in children and adolescents is almost the same as that of adults, which is an international consensus.
Qi Junhui said that for teenagers, the age of 12 is a watershed. At this age, they have to face the pressure of the junior high school entrance exam, and after entering junior high school, they will face the pressure of adapting to a new environment, dealing with new interpersonal relationships, and academic pressure is also greater, if they can't cope with these pressures well, they may have psychological problems. In addition, physiologically speaking, the age of 12 is also the beginning of puberty, a period of drastic changes in hormone levels in the body, they are becoming more and more like adults in appearance, but the psychological maturity is not enough to cope with the problems of life.
In March this year, 14-year-old Zhao Yue was hospitalized for the third time in nearly a year. Mother Zhang Ye admits that she has been more spoiled by her children since she was a child, and her expectations are also very high, but she is not overly "chicken baby" like other parents. "I don't think there's a lot of company for children. Before the child's illness, I never felt that I had neglected her feelings, and I had never treated her badly materially and spiritually. Zhang Ye said, but after her daughter fell ill, she felt that it had become a "appearance".
Zhang Ye said frankly that at first, she and her lover couldn't accept it, "How can a child get sick?" She once blamed herself, feeling that she had done a lot of wrong things in the child's growth, and even felt that she had ruined the child. "When you see another child going to school happy, no matter how well he studies, at least he is healthy. But when I see my own children, I always feel that I have suffered too many sins, both physically and mentally. She said.
Doctor's concern
The stigma of parents is much heavier than that of children
It seems that as long as you don't see a doctor, you can assume that you don't have a disease
Discharge from the hospital is often the beginning of treatment
Wang Gang, president of Anding Hospital and director of the depression treatment center, said that some parents have a strange mentality, as if the disease does not occur, but is "dispensed" by the doctor, as long as they do not see a doctor, they can be regarded as no disease. Some parents come to him not to treat their children, but to declare that their children are not sick, so that they can tell their children that the experts say that you are not sick, you have to study hard, and don't think about it. The essence of this mentality is that parents fear that their children will be labelled if they are diagnosed with mental illness, and they feel the stigma attached to depression by society, which creates stigma.
"The stigma of parents is much heavier than that of children. Qi Junhui found that there are two types of parents of children, one is aware of the seriousness of the child's problem and is willing to cooperate with the doctor's treatment. The other type is to "pull the hind legs", the parents come and say: "I don't know what's wrong, I think it's okay, it's just that the mobile phone is playing too much, it's all the ....... he wants to come" In short, try to find all kinds of explanations to prove that the child is not sick. "Every month, more than a dozen children in the paediatric ward are taken in and discharged early by their parents when they are not ready to be discharged, and the doctors try to persuade each parent to continue treatment, but to no avail. "There are not a few parents who stop their children's medication, change the dose, and do not discharge their children from the hospital according to the doctor's instructions.
Many doctors said that to some extent, mental disorders, including depressive disorders, are a chronic disease, and patients need to improve their lifestyle and adjust their mentality in addition to long-term medication, so family care is crucial. "Discharge from the hospital does not mean the end of treatment, it may just be the beginning. After the child is discharged from the hospital, a family still has a long way to go. ”
惑
After the child is sick
How should parents get along with their children?
Chen Rui's mother said that recently because she didn't buy a concert ticket, her daughter suddenly had an emotional breakdown. Then she raised a puzzle that many parents have: how should parents get along with their children when they are sick, and how can they adhere to the principles of education in front of their children?
Psychotherapist Ms. Tian gave an example of a child who told her that since she fell ill, her family had met all her demands unconditionally. "When they were satisfied, I was stunned, my request was obviously wrong, why did they agree, didn't they have their brains? I did something wrong, and they said I was right, they didn't have a basic view of right and wrong?" said the child, who actually knew why, because the family thought she was sick.
Through this case, Mr. Tian wants to tell parents that due to their age, children sometimes have the psychology of "benefiting from illness", which is also a test of parents' parenting wisdom. Parents should keep the basic bottom line under the principle of "life safety first, harm minimization".
Shi Daoming, an intermediate psychotherapist, advises parents to maintain a basic judgment of right and wrong when dealing with their children. For example, what should be done and what should not be done, what can be bought, and after how much money is exceeded, you can't buy it.
"These bottom lines must be conveyed to the child, and on the premise of ensuring the safety of his life, the bottom line should be adhered to, and the whole family must agree on this bottom line, otherwise it will be invalid. Shi Daoming said that every parent may want a fixed answer, but in fact, no, because the situation of each family is different, and the child's condition is constantly changing, parents should achieve a dynamic balance like a seesaw in the interaction with their children.
Parents need to face up to depressive disorder as a disease and neither take it lightly nor panic. It should not be underestimated, that is because more than 50% of mental illnesses are first manifested in adolescence, there is no need to panic, that is because in this period, often in the early stage of the occurrence of the disease, early identification and standardized intervention can prevent the occurrence and chronicity of the disease, as long as through adequate treatment, to ensure that the condition is stable, all children have great hope to return to a healthy state.
Why are there more and more children with emotional problems?
Xu Tao, an adult psychiatrist at a district-level hospital in Beijing, went to the pediatric ward of Anding Hospital this year for further training. In recent years, more and more relatives and friends have come to him to consult on the psychological problems of children and adolescents, and he is limited by his professional knowledge, so he cannot answer many questions. However, more people asked, and he began to wonder, why are there more and more children with emotional problems?
A number of child psychiatrists said that in the medical community, the cause of depressive disorder has not yet been clarified, but it is certain that it is a mental illness that is highly related to biological, psychosocial and environmental factors. Biological factors are more related to genetic factors, which are not controllable by human beings, and theoretically do not become the main factor in the surge of depression among children and adolescents in a society.
Zheng Yi said that the biggest reason for the mental health problems of children and adolescents is family relationship problems. According to a survey conducted by the World Health Organization, family factors account for 70% of people's mental health, while biological factors and genetic factors only account for 15%-25%.
He Fan's feeling is that in recent years, in general, the number of diseases with high genetic factors has not increased significantly, but the number of diseases with high social psychology and family environment has increased significantly. "In recent years, there have been significantly more children with emotional problems, among which anxiety and depression are more prominent. ”
A parent once told Zheng Yi that he panicked when he saw his child playing, because everyone else was learning.
Psychotherapist Shi Daoming believes that the reason why some parents have such high requirements for their children is because they feel a lot of competitive pressure in society, and these pressures will naturally be passed on to their children.
"With the development of society, schools are becoming less and less tolerant of children. Not to mention the phenomenon of '10 minutes between classes is not free', frequent calls to parents, parent-teacher conferences, and the burden of schoolwork...... These will increase the child's stress, and the impact of stress on people is inverted U-shaped, appropriate pressure has a promoting effect on the child's psychological development, but too much pressure will have the opposite effect, this pressure can not be solved at their psychological age, it may lead to various emotional problems and behavioral problems. ”
In Zheng Yi's view, like many diseases, early screening and early treatment are the key to prevention and treatment, and children's mental illnesses are no exception. Among them, the coordination of medical education should be a very important part of the prevention and treatment process. (Li Ting, Chen Rui, Zhang Ye, and Zhao Yue are pseudonyms in the article) Comprehensive CCTV and so on