Incorporating "mood" into physical examination screens so that teenagers no longer suffer depression alone
Incorporating adolescent depression screening into the physical examination can indeed help achieve "early detection and early treatment."
Early intervention can also enable young people to get help early in the struggle against depression and loneliness and pain.
On the weekend of the week before school started, high school student He Lin (pseudonym) said to his parents: "Could you take me to see a psychologist."
Depressed, long in a daze, tears for no reason... She has been fighting with these symptoms for several months.
At that time, He Lin had acute gastritis.
The physical and psychological distress made her finally decide to ask for help.
After examination, He Lin was diagnosed with depression.
"I don't feel anything. My parents are a bit surprised, they think I'm usually lively." He Lin recalled.
Some time ago, the Ministry of Education pointed out in its response to the CPPCC "Proposal on Further Implementing Measures for the Prevention and Treatment of Depression in Adolescents" that depression screening should be included in the content of student health examinations, students’ mental health files should be established, students’ mental health conditions should be assessed, and the evaluation results should be evaluated. Special attention is given to abnormal students.
Sha Sha, deputy chief physician of the Department of Psychiatry, Beijing Anding Hospital, told the reporter of Science and Technology Daily that according to epidemiological surveys, overall, the prevalence rate of depression in children in China is 1%-2%, and the prevalence rate of depression in adolescents is 2%. %-8%.
In order to increase the detection rate of depression in children and adolescents, the inclusion of depression screening in the physical examination is the most extensive and highly operable way.
"The child is very weak." After being a psychiatrist for more than ten years, Sha Sha has treated too many children suffering from depression and understands their powerlessness and involuntary.
"They need doctors, professionals, protect them, speak for them."
A little awkwardness or a psychological problem? To see if the child can go to school normally
Xu Kaiwen, the founder of Daru Psychology and a doctor of clinical psychology, has done some psychological evaluations of middle school students.
"We not only do tests, but also conduct one-to-one interviews. We found that the incidence of depression among teenagers is indeed not low." He said.
A frequently reported number is given in the "Chinese National Mental Health Development Report (2019-2020)"-the detection rate of depression among Chinese adolescents in 2020 is 24.6%.
However, depression is not the same as depression.
Sha Sha said that the diagnosis of depression must be made by a professionally trained and licensed psychiatrist.
It is not a "bad mood" literally, but a mental illness.
UNICEF’s previous report on “The State of the World’s Children in 2021” pointed out that because of the new crown pneumonia epidemic, children have suffered additional psychological stress.
Judging from the reception situation, Sha Sha also truly felt the impact of the epidemic.
Isolation, study at home, excessive use of the Internet, day and night upside-down... These disrupt the normal rhythm of life for teenagers.
Adults may not be able to empathize with the psychological impact of the epidemic on their children.
The severe impact or isolation of the external environment may make children feel more worries and fears.
While teenagers are in the dual stage of physical and psychological growth and development, the unbalanced thinking and psychological development may cause children to be unable to accurately express their inner experience, have varying degrees of emotional or behavioral problems, and even fall into a certain extreme state in serious cases. , It is difficult to get out of it voluntarily.
"The impact of the epidemic on adolescent depression requires continuous attention and research from the whole society," Sha Sha said.
Depression is currently diagnosed based on phenomenology.
Xu Kaiwen introduced that depression has some common symptoms, such as low mood, loss of interest, lack of anhedonia, slowness of action, slower speech rate, inattention, memory loss, etc.... If you are in this state most of the day and continue More than two weeks, you need to pay attention.
The media person Zhang Jin once described his feelings when he was suffering from depression in a book like this-his head was filled with lead and he was groggy; his chest was burning and uncomfortable; he didn't want to do anything, or hesitated and cowered when he did anything.
Teenagers with depression also have similar symptoms.
Shasha said, but they also have a feature that distinguishes them from adults-irritability.
"If you ask why children with depression hurt themselves, many people will say, I don't know, I just feel very annoying." Sha Sha said.
That group of irritating, incapable things, pressed against the children's hearts, and ran into them.
Sometimes when they scratch themselves, they feel that they can release some and feel better.
Some children will have physical symptoms, such as abdominal pain and headaches.
The common manifestations of depression are insomnia and loss of appetite, but some teenagers have reverse physical symptoms such as binge eating and lethargy.
Their thinking ability, concentration and memory may also decline.
"Some children will not feel their emotions, the difference between themselves and the environment, and feel numb and unreal." Sha Sha said.
In depression, adolescents may also have symptoms of anxiety, making them easy to feel nervous and afraid.
"The characteristics are many and messy, and there are many complications." Sha Sha introduced.
Therefore, when everything first appears, it is difficult to detect and may be misunderstood.
He Lin's onset was during the epidemic.
She stayed alone in the room to take the Internet class, but she didn't actually listen to it. She was just in a daze and wandering.
She doesn't go out, doesn't want to move, and her parents just say, why are you lazy?
Children's changes can easily be regarded as a rebellious period, and misunderstood as a trick to avoid learning.
In fact, there is another very important criterion-to see whether the child's social function has been damaged.
More simply, it is to see if they can still complete their studies normally and keep going to school.
Worry of learning is a common symptom in adolescents with depression.
Xu Kaiwen said: "Almost every day, my parents find me, asking if my child has not gone to school for a while, can I give my child a psychological consultation."
However, it is rare for parents to associate their children's weariness with their children's psychological problems.
Parents who don't know about depression, faced with children who don't want to go to school, may intensify reprimands and criticisms.
Behind the problematic children are mostly problematic families
He Lin didn't know what was the cause of her illness.
In fact, there is currently no scientific conclusion about the cause of depression.
It can only be said that biological, psychological and social environmental factors are all related to it.
From a certain day in March and April last year, He Lin fell into a situation where she couldn't be happy.
When she was in a daze, some of the past scenes repeated in her mind.
That was already when she was in elementary school.
Once, when she procrastinated and didn't finish her homework, her father was so angry that she kicked things and fell into the pot.
Ping-pong-pong, the voice hit her heart.
The young He Lin couldn't even get along with her impatient father alone.
Every time her mother was on a business trip, she would have a fever.
After receiving psychological counseling, He Lin realized with hindsight that she had already been hurt at that time.
Chen Qing, who has worked for more than 20 years, is He Lin's psychological counselor.
He repeatedly emphasized to reporters of Science and Technology Daily that in order to solve the psychological problems of children and adolescents, they must be solved together with the problems of their parents.
"The difficulty is that many parents are unwilling to admit that they have problems." Chen Qing said.
Many families who asked him for help, the parent-child relationship is on the verge of collapse.
The communication between the children and their parents is almost interrupted, and they even become enemies of each other.
Chen Qing has seen too many anxious parents.
Emotions are contagious, children will take over the emotions from their parents and amplify it.
Anxiety that can be tolerated for adults may overwhelm the child when it comes to it.
Chen Qing compared psychology to a big tree.
If it has a good foundation and luxuriant branches, even if one day is hit by a violent storm, a few leaves may be knocked down, but when the wind stops and the rain stops, it can still thrive.
But if the tree is already unstable and ill, a rain or a gust of wind may blow it down.
The foundation was laid since childhood.
The child's mental health status has a greater relationship with the family's care and love at the early growth stage.
"Children are actually very sensitive to their parents' emotions. They can clearly perceive whether their parents love him or not. If parents often force their children to discipline, violently, and ridicule their children, the children will lose safety in the family if things go on like this. Feelings.” Chen Qing said, the psychological tree that grows in such a family environment is more likely to be overwhelmed by setbacks.
Xu Kaiwen also said that one of the important reasons for children's depression is parent-child conflict.
Parent-child conflict actually stems from the conflict of values between the two generations.
Parents and children grew up in different ages. If they blindly arrange their children based on their own experience and demand their children based on their own standards, it is tantamount to "carving a boat for a sword."
Xu Kaiwen talked about a case that made him sigh.
The child attempted suicide, and his parents turned to Xu Kaiwen for help.
In the beginning, Xu Kaiwen didn't find any obvious problems.
The parents seem to care about their children very much. In order to take care of him, they retire early and concentrate on company.
But the child always feels desperate and feels that everything is "meaningless".
After further understanding, the child finally brought up a detail to Xu Kaiwen-I am so old, and my parents would not knock on the door before entering my room.
Encouraged by Xu Kaiwen, the child tried to "knock on the door" request with his parents, but was flatly rejected.
When everyone communicated in person, the parents still couldn’t understand this request: “This is my home, my child, why would I knock on the door when I enter my room? When I was your age, my parents came into my room. I never knock on the door."
Xu Kaiwen understands that children can't control such a small thing, so he feels that life is not his own, so he doesn't want it at all.
"Parents have excessive control over their children." Xu Kaiwen said.
Over-concern or over-ignorance is also the parenting problem of parents of children with depression that Sha Sha often sees.
Too much attention is that the child has a little problem, and if he is a little bit out of control, the parents are very nervous and worry that the child will go astray or be in danger.
Too much neglect means dissatisfaction with the child's experience of the disease, and even feels that the disease is pretending.
They said that the child was "squeaky" and "not brave", and they said, "Other children are fine, why is something wrong with you?" "When I was your age, why wasn't you as fragile as you?"
In addition to improper parenting styles of parents, positive family history of depression, personal innate personality, academic pressure, peer competition, exposure to negative information that is not suitable for your age, or chronic chronic diseases, physical suffering, etc. , Are all factors influencing the onset of depression.
Xu Kaiwen specifically explained the academic pressure.
"Whether it is family education or school education, we have always regarded grades as the only criterion for evaluating a child. It seems that the entire support of a student's self-esteem is grades." Xu Kaiwen said that when grades become the only criterion, children will continue to encounter frustration.
"They will feel that once I have poor grades, I am worthless, I can't do anything, I lie flat, collapsed, and become rubbish."
The country has proposed a "double reduction" policy to reduce the burden of excessive and unnecessary learning for children. From the perspective of a psychological counselor, Xu Kaiwen bluntly said that this is a "policy of morality."
"We must learn to empathize, respect and understand the pressure of children. Even an adult, if he cannot guarantee long-term sleep, games and leisure time, he will still have problems with long-term high expectations, and more Besides, it's a child?"
From screening to treatment, family and school doctors work hand in hand, hard days will always pass
Incorporating adolescent depression screening into the physical examination can indeed help achieve "early detection and early treatment."
Early intervention can also enable young people to get help early in the struggle against depression and loneliness and pain.
"The scale screening is a more conventional method. It is necessary to choose a standardized scale that has been tested for reliability and validity and is suitable for adolescents. In order to ensure that important information will not be missed, we will also involve parents in the survey. Sha Sha said that the Depression Scale will involve multiple dimensions of measurement, such as mood, body, sleep and other related factors, as well as suicidal thoughts and behaviors.
"From the perspective of health management, we need to mark children who have thoughts of suicide to prevent risks. But we also need to think about how to make these questions raised in a more acceptable way during screening."
Home-school communication is also very important.
Sha Sha suggested that adolescent depression screening should be done and parents should be given "informed consent" as much as possible.
The school informs parents of the content and significance of the screening. If parents have questions or concerns, the school can work with professional organizations to answer questions and eliminate some misunderstandings during the informing stage.
"For the application of screening results, we must pay attention to protecting the privacy of young people." Xu Kaiwen reminded that the scope of knowledge of mental health assessment results should be controlled to the necessary limit; teachers also need to master some basic psychology and mental hygiene knowledge for children Appropriate level of care.
"It is especially important to be clear that do not cause discrimination and prejudice against children because of the screening results. Otherwise, everyone will not fill in the scale truthfully in the future, and the role of screening will be weakened." Xu Kaiwen emphasized.
Screening is to screen the child for the possibility of depression and remind parents to take the child to a doctor.
Don't treat depression as a terminal illness.
It needs to be taken seriously, but don't be intimidated by it.
According to the overall data, more than half of depression patients can be cured.
Sha Sha said that comprehensive treatment should be given to young people’s psychological problems; drugs should be used and psychological healing should be carried out; when treating children, families should also be included, and parents should be given education and counseling.
"The ideal situation is an alliance composed of families, schools, psychotherapists, and psychiatrists. From medication to psychotherapy to daily life, follow up and follow the children in all directions, and focus on the children’s recovery. Communicate closely with rehabilitation strategies."
Of course, it is not easy to do this.
Compared with the needs of mental health, the number of psychiatrists and experienced psychological counselors in our country is insufficient.
An important role of parents is to help their children cooperate with treatment.
If your child needs medication, try to get enough treatment.
This is a long battle.
The effect of the drug is not immediate, and sometimes side effects come before the therapeutic effect.
The family should be the backing and support of the child, help the child understand his situation and the necessity of treatment, and improve the child's compliance with medication.
"Parents should also evaluate their own parenting methods to see what went wrong." Sha Sha said, if it is excessive control, then relax a little; if it is excessive neglect, then be more concerned.
"It's not about ignoring children, but with love to support and love to limit. Let love flow in the family."
When the child's condition is stable, classes can be resumed.
"The school must trust our psychiatrist's diagnosis." When the doctor issues a certificate of return to school for a child, it means that the child can return to school after careful evaluation.
Sha Sha said that the school does not need to be excessively anxious and worried, and it is enough to maintain communication with the parents and give the children continuous and effective attention.
Before doing psychotherapy, Chen Qing Helin repaired the family relationship.
The whole family received psychological counseling together, and his father apologized to He Lin for his violent temper.
"I gave my mom and dad a 9.9 points for their performance after being ill." He Lin said that her father's changes were particularly obvious. His temper became much more restrained and he paid more attention to himself.
For more than a year, He Lin can feel that her parents are trying to make her happy and trying to understand her.
Now, He Lin's depression symptoms have disappeared, and she has the ability to be happy again.
"Let's not take depression so seriously." He Lin wanted to say to her peers who were in the same situation as she used to be. "Treat them with a normal heart. These difficult days will always pass."
He Lin likes dancing, calligraphy and painting, and also wants to find time to learn a musical instrument.
In the recent circle of friends, she sent birthday wishes to her girlfriends, complained about homework, discussed fan dramas, and posted her own photos and short videos.
She shows the vivid youth belonging to her age, as well as an infinite future.