I work in a large trauma hospital and this time of year we see things no one should see. Road and air ambulances are delivering patients and our incredible teams of emergency specialists, surgeons, anaesthetists, intensive care physicians and other highly trained specialists work around the clock to give these patients another chance.
Depression and dark thoughts can occur anytime, but towards the end of the academic year, as deadlines and pressures peak, so too can despair.
When I first saw *Bec in hospital, who had thoughts to end her life, she was coming to terms with the fact of surviving, her split-second decision that could have ended differently and the treatment road ahead. She didn’t want to die any more, but a short time before, things had looked different and much bleaker.
Her parents never left her side but were afraid to ask for fear of making things worse. Guilt is often the first and strongest emotion. Her parents wanted the best for her, including education, and anxiety sometimes spilled into harshness. Her mother said she regretted her own missed opportunities and not achieving her own potential. They wanted better for their daughter.
Bec’s depression was only partly about upcoming exams. She also had on her mind worries she felt she couldn’t share with anyone: friend group issues, not fitting in, self-image, body image. She knew her parents had financial and health worries. They had given up a lot to prioritise her schooling. She felt she was letting everyone down and could see no way forward.
Importantly, depression does not define Bec. She can see paradoxes and hypocrisy, she’s witty, teases our staff good-naturedly, she can anticipate how adults may judge and downplay her concerns. While feelings of guilt are inevitable for parents, the way forward must be constructive. There’s no place for blame. In sessions, Bec and her family shared and reset mutual fears and expectations. Seemingly impassable barriers shifted enough for a way forward.
After decades of professional training, I’m still struck by the fact it is our patients who teach us the most valuable lessons. Adolescents have richly complex lives where imaginings, hopes and uncertainty intersect with friendships, plans and dreams in a way no theory prepares us. Listening with respect gives us a starting point for shared understanding.
Adolescents are sponges of intuition and understand parents and adults in their lives far better than they can describe, or sometimes than they feel safe to say. They read us better than we know ourselves and adapt accordingly, often with the goal to make their complex lives easier. They know our expectations and fears for them. They know their achievements this year may affect their lives in 10 or 20 years. But that destination is inconceivably far away.
As a child and adolescent psychiatrist, every year I’m asked by other parents about the end-of-year exam period. Of course, each situation is unique. Persistent depression, like all mental illness, needs professional help. But learning from the many stressed kids I’ve seen, here are some insights.
Is my child working hard enough?
Most likely yes! Kids generally do as much as they can, pacing work, concentration, rest. Self-esteem and feeling good about yourself are based on more than results and confidence aids performance.
How can I help my child manage pressure?
The same ways adults can manage pressure. A few deceptively simple things can go a long way toward more resilient kids: sleep, diet, exercise, healthy habits. For some families it may be among the most challenging of times in managing expectations and accepting limitations. Listening uncritically can be a parenting superpower. Take time to decompress.
Should I limit gaming and social media?
We know (often first-hand) these can be an addictive distraction. Kids know this too without being told (repeatedly). Weigh it up: will you have more sway strengthening your relationship first and then dishing out advice second? It may be easier to work toward agreed goals than angry conflict.
Am I putting too much pressure on my child?
Actually, this question is rarely spoken but it’s there and it’s a hard one. If you’re worried about the results, your child almost certainly knows. That makes it a double worry for your child.
Is it harder for kids today?
Yes I believe so. I think the pressures for performance are increasingly higher and achievements and disappointments so immediately broadcast. Thirteen years of education shouldn’t be reduced to a linear scale, band or number and are no measure of lifetime achievement, but it can feel like it is. The world is bigger, expectations and possibilities greater, security less assured. Their existential fears are genuine.
Can I do more to help my child?
This is individual. Personally, I feel it important for my kids to take responsibility for themselves, their clothes, their room, their deadlines, their dishes. At the very least, then they have the accomplishment of self-care to make their way in the world.
Saretta Lee is a child, adolescent and adult psychiatrist from Sydney
All names have been changed to protect privacy
In Australia, the crisis support service Lifeline is 13 11 14. In the US, the National Suicide Prevention Lifeline is 1-800-273-8255. In the UK, Samaritans can be contacted on 116 123. Other international suicide helplines can be found at befrienders.org
