A CONVERSATION WITH KIRSTY LOUDEN-BELL
One-in-six New Zealanders will experience depression at some time in their life. Approximately one-in-seven young people in New Zealand will suffer from a major depressive disorder before the age of 24. And, if you narrow it down to the ages between eight and 18, the statistics point to one-in-five. That means that out of the 30 young people in your child’s class, six of them will likely suffer from depression or anxiety at some point during their high school years.
And the scary thing is … your child could be one of them.
Kirsty Louden-Bell is a registered clinical psychologist and co-author (along with her husband Elliot Bell and rugby coach John Kirwan) of a new book on this subject: ‘STAND BY ME’. She took time out to chat with Grapevine about depression and anxiety amongst Kiwi youth.
GRAPEVINE: Kirsty, let’s start at the very beginning. In your professional understanding, what is depression? And what is anxiety?
KIRSTY: That’s such a hard first question! In medical terms, depression and anxiety are both illnesses – psychological illnesses or illnesses of emotion. With depression, sufferers are dealing with sadness which is maintained by ruminating on things. With anxiety, they’re dealing with fear which is maintained through worrying and avoiding. Medically speaking, that’s what depression and anxiety are. But I think for people to get a real understanding of these illnesses, they need to hear the voices and the stories of people who have experienced it.
GRAPEVINE: I’ve seen some great stories online around depression.
KIRSTY: There are some amazing videos on YouTube. A guy called Matthew Johnstone wrote a book called ‘I had a Black Dog, his Name was Depression’. He’s now turned it into an online video, and it’s an incredibly powerful overview of what it’s like to experience depression. Watching something like that, or reading a book about somebody’s personal story, is the best way to really understand how it feels.
GRAPEVINE: With depression and anxiety so prevalent, what sort of symptoms should we be looking out for in the young people we’re close to?
KIRSTY: The symptoms in youth-depression are very similar to what adults experience – which is one of the reasons we class this as an illness. The same clusters of symptoms appear across the demographics. There are a few differences, however. In an adult, one of the more obvious symptoms is a low mood. But that’s often not the way depression will reveal itself in youth. It’s more likely to show up as anger and irritability, or challenging behaviours like alcohol and drug use.
Because they’re not seeing what they consider to be classic signs of depression, parents and family members can easily miss the signs in young people.
GRAPEVINE: Irritability and anger … isn’t that just typical teenage behaviour? When do you know that it’s something more serious – and how do you tell the difference?
KIRSTY: Good question. The biggest thing to look out for is a change in their behaviour or mood. Do they seem more irritable than they used to be? Is their mood lower? Are they coming across as angrier? Look for changes in physical things too: like their sleep patterns, their risk-taking, appetite, energy or concentration. They may have lower self-esteem, consistent feelings of worthlessness or hopelessness. Or they may feel overwhelmed.
GRAPEVINE: Again, though, isn’t it normal to see pockets of these things throughout teen development?
KIRSTY: Yes. So what you need to be asking yourself is, has this changed? Is this different to what they were like this time last year? Is it persistent and ongoing, or is it just over a break-up that happened recently? Their relationship with you will naturally be strained at times, but can you see their friendships or other family relationships changing? Maybe they’re pulling out of sports teams or other activities that they’ve always enjoyed?
GRAPEVINE: Those changes would be having a negative impact on their lives, surely …
KIRSTY: That’s right. So look for change and take the time to think about whether it’s been persistent and across lots of different areas. You’ll notice if those changes you’re seeing are having a negative impact. If they are (along with that cluster of symptoms), you need to be concerned about what’s going on for that young person.
GRAPEVINE: Then what? What’s the next step to take?
KIRSTY: The first thing is to do a bit of research and get a good understanding of depression – so you can have a conversation with them that actually makes sense. There are some fantastic online resources, so spend a bit of time having a look and doing a decent amount of reading.
GRAPEVINE: And then attempt a conversation?
KIRSTY: And then attempt a conversation! It’ll potentially be pretty difficult, because if they’re experiencing depression or anxiety, one of the symptoms is wanting to withdraw, and another is a lack of energy … which is not very conducive to good conversation! But it’s really important that you do actually talk to them.
GRAPEVINE: Can you give us an example of how we might embark on a conversation like that?
KIRSTY: I’d start by just pointing out some things that you’ve been noticing, and then giving them your thoughts on how, together, you might work towards improving things. “I’ve been noticing this, this and this, and I think it’d be really helpful for us to go and see someone about it.”
GRAPEVINE: And would that be a psychologist? A counsellor?
KIRSTY: In the first instance, I’d head to your GP. But, before doing that, check that your GP is user-friendly for youth – some are more so than others.
GRAPEVINE: How do you check that sort of thing?
KIRSTY: When you phone to make an appointment, explain that you’re concerned your son or daughter may be experiencing depression or anxiety – and ask if the GP is experienced in working with young people. There are some doctors around the country who specialise in this, so if your usual GP doesn’t seem like a great fit, it would be worth moving on and finding someone better.
GRAPEVINE: Should you go along to the appointment with them?
KIRSTY: Take them along, definitely. As to whether or not you actually go in with them? That would depend on their age and whether they felt comfortable with you being there. If not, it could be a good idea to go and see the GP beforehand, so you have a chance to explain the situation. Ask your young person afterwards how they felt it went. Make sure they felt safe and that they were listened to. A couple of families in the book actually talked about trying different GPs. So it might mean persisting a little bit until you’ve found someone who’ll be a strong support.
GRAPEVINE: And what about after the doctor’s appointment?
KIRSTY: Make sure you’ve talked with the doctor about a plan for moving forward. The reality is, most cases won’t be ‘severe’ enough to involve mental health services – so the majority of your help will come from school guidance counsellors, online resources, youth workers or mentors. There are a wide range of options if you do some research. Increase the amount of support around your young person, help them access resources, increase their protective factors …
GRAPEVINE: Protective factors?
KIRSTY: ‘Protective factors’ are the things that give them strength and enhance their well-being. The sorts of things that will help them manage when there’s harder stuff going on for them.
GRAPEVINE: In the book, your husband Elliot writes about the four ‘P’s. Is that one of them?
KIRSTY: It is! The four ‘P’s all start with ‘P’ (funnily enough!) – which makes them easier to remember. They’re all about putting things in place and thinking things through, in order to help protect and prepare your young person.
GRAPEVINE: Take us through the others …
KIRSTY: ‘Predisposing factors’ are those things that may make a young person more vulnerable to anxiety or depression. The next is ‘precipitating factors’, which are basically events or situations that may trigger a depressive episode. And then there’s the ‘perpetuating factors’ – what’s keeping this going? What is it that’s contributing towards and maintaining this depression or anxiety?
GRAPEVINE: That’s a good question. What does keep depression going?
KIRSTY: It’s often things that combine to become quite a vicious cycle – like withdrawing or avoiding. And interestingly, lots of the treatments for depression or anxiety are designed to break those cycles that keep it going.
So, coming up with a few ideas under each of those ‘P’s – and having a good understanding of them – can be really helpful for a young person.
GRAPEVINE: You could help, I guess, by getting them to think: What might make me vulnerable to anxiety or depression again?
KIRSTY: Exactly. What are going to be my triggers? And if the illness does pop up again, what are the things that will perpetuate it or make it worse? It’s a useful way to get back on track in the here and now, while also avoiding or at least minimising any relapse in the future.
GRAPEVINE: Are there things we should be aware of as parents (or friends or family members) that might put our children at a higher risk of depression or anxiety?
KIRSTY: The bottom line is, depressive disorders can and do happen to anyone. There’s a myth out there that depression only happens to weak people or those who’ve gone through some really tough things in their lives. So when you get people like John Kirwan, who’s had a great life, but still got depressed … people think, What do you mean? So let’s just make that clear: depression can happen to anyone.
But it’s also clear: there are things that make people more vulnerable. A stressful environment will do it – financial stress, relational stress, violence in the home, abuse. These sorts of things can definitely make someone more susceptible to depression or anxiety, but they don’t need to be present for it to occur.
GRAPEVINE: What about a family history?
KIRSTY: Definitely. If you have a family history of depressive disorders, you need to be mindful that both you and your children are much more exposed to experiencing it yourselves.
GRAPEVINE: So let’s go back to that idea of ‘protective factors’. Knowing the stats, there will be a huge number of Grapevine readers who have depression or anxiety somewhere in their family history. What can we put in place to help minimise the risk for our children?
KIRSTY: Well, obviously, the absence of that really negative stuff – abuse, violence, etc – is a massive protective factor. But a really important thing to think about is identity. If young people have a strong sense of belonging to a family, a culture, a faith or a community, they have a lower risk of developing depression or anxiety.
For example, there’s been some amazing research come out of Auckland that says: families who eat dinner together more frequently are at a lower risk of suicide!
Kids that have a good sense of purpose and positive expectations are also at lower risk. It gives them a sense of meaningful involvement and responsibility. Being able to problem-solve is another really valuable skill – as is having a good range of coping-strategies to deal with failure and difficult situations.
GRAPEVINE: How do we teach those skills to our children?
KIRSTY: Well, there’s the challenge, because they learn those through us! So we need to be mindful of what we’re modelling. When things don’t go well, do we fall apart or argue? Or do we model good ways of coping? As our kids get older, they see us more for who we are, they see that we’re real. So it’s really important for them to see that, even if we do fall apart over something, we pick ourselves up and keep going. It’s important that they see us trying again.
GRAPEVINE:You mention in the book that it can be tempting for parents to back-off once their children reach their teens …
KIRSTY: Yes! And, developmentally, it’s also a time when children pull back a bit from their parents. They’re obviously becoming more capable in a lot of areas of their lives. If anxiety or depression is present they’re like to withdraw even more and not want to engage.
GRAPEVINE: But it’s important for parents to be present?
KIRSTY: Absolutely! And, if necessary, you really do need to step in. I guess my advice would be: don’t let your kids determine your actions – because, in the middle of something like this, they probably won’t give you positive feedback! A lot of the young people we talked to in the book could quite clearly recall the times their parents had been there for them … even though they didn’t acknowledge it at the time. But their view of that parental involvement changed, once they’d come out the other side of it all.
GRAPEVINE: I guess some parents are afraid of smothering their teenagers?
KIRSTY: Which is why it’s important you do your best not to order them around or have all the answers. One of my favourite quotes from the book is the young person who said, “I don’t want the PowerPoint.” In other words, “I don’t want the lecture … I don’t want all of your thoughts … I just need you to walk alongside me.”
When our children become young men and women, our relationship with them naturally changes. If we think about the types of relationships we have with other people – like our partner or friends – we can still be very close to them without smothering them. That’s the kind of relationship we need to grow with our teenagers. It’s a normal developmental thing, but probably amplified a bit in the case of depression or anxiety. Even if everything in you is burning to tell them what to do, you really just need to hear them out. But you must see it as a shift in the relationship rather than the end of it.
GRAPEVINE: Are depressive disorders more common these days? Or is it that we’re just more aware?
KIRSTY: We are more aware. And we’re getting better at identifying it. But there’s also new stress on our young people these days that hasn’t been there before. They lead a more consumer-focused life. They have student loans, which bring financial pressures at a young age. Parents have often been under economic stress, with both often having to work as the children are growing up.
We also have a growing number of young people in New Zealand belonging to multiple ethnic groups. That brings with it a real richness, but it can also create stress in terms of where they belong. Alcohol is much more readily available. And the Internet introduces them to stuff that they couldn’t access previously – and right at the time when they’re trying to work out who they are!
GRAPEVINE: Speaking of the Internet … what are your thoughts about social media?
KIRSTY: Parents often question whether social media is good or bad – but it’s really not that black and white. Social media can definitely have a negative effect on someone with depression or anxiety – especially if they’re on it all night and not getting enough sleep. If they’re comparing themselves to other people online, or if they’re being bullied on Facebook, then that will obviously impair their mood.
GRAPEVINE: But there are positives?
KIRSTY: Yes. It’s a great way to access resources and support – like an auntie, maybe, who lives in Australia – that, otherwise, they may not have had. It can increase their sense of belonging and decrease their sense of isolation. There are also some fantastic online programmes for young people to make use of. So yes, there are a lot of positives!
GRAPEVINE: How do parents recognise if it is having a negative impact?
KIRSTY: Just look at your young people after they’ve been using social media. Has their mood shifted? Is it lower? Do they seem more positive – or more negative? Talk to them about it: “After you’ve been on Facebook I notice you’re really low, and you disappear into your room. But when you’re on this site, or that site it seems to really lift your mood.” Have a discussion with them about how different sites might affect them and how they could make wise choices around that.
GRAPEVINE: That’s probably a good conversation for us adults to have with ourselves, too! What are your thoughts around medication versus the ‘talking’ therapies?
KIRSTY: It’s not really ‘one versus the other’ – although medication for teens is not usually the first port of call. The effects of anti-depressants are not as well established in young people as in adults. I’d definitely recommend that, at first, the teen and their family try counselling and online resources. It’ll help them identify what has contributed to their illness. It’ll also help them develop their strengths and identify some of the triggers to avoid in the future.
What we do find, though, is that with some people the symptoms of depression are so challenging that they’re unable to do any of the above. In that instance, I think medication can be immensely helpful. But I wouldn’t recommend medication on its own, as there’s very little learning to come out of it.
GRAPEVINE: People often feel very reluctant about labelling themselves or their children with depression or anxiety. But doesn’t hiding it just make the problem worse?
KIRSTY: Ooh, this is something I get quite passionate about! For two reasons. Firstly, the fact that people think this way highlights that there’s still a stigma attached to mental illness in our society. And we need to work on changing that. The fear of being labelled stops people from seeking help early enough – which means their depression or anxiety has an even greater impact on their work and their relationships.
GRAPEVINE: How do we go about changing that stigma?
KIRSTY: We have to keep chipping away at it. And that starts in families. As parents we need to take the lead in showing that it’s okay to talk about mental health … that depression and anxiety are health conditions that lots of people have. just like diabetes or asthma.
GRAPEVINE: And the second reason you get passionate about this?
KIRSTY: A diagnosis of anxiety or depression is putting a label on an illness – not a person. Rather than saying, “My child is depressed” … it’s better to say, “My child has depression …” And as fornot wanting it labelled, people can actually feel hugely relieved when they’re able, finally, to put a label on what they’ve been experiencing. It separates them from the illness and can normalise what’s going on for them, making them feel less alone.
Having the problem identified also opens them up to incredible resources and support – which can be very normalising for both them and their family. And that, in turn, then gives them hope – which is one of the key things that gets damaged when someone’s depressed.
GV: So don’t let the fear of being labelled hold you back?
KIRSTY: Definitely not. The sooner you seek help, the sooner things can get better.
John Kirwan – A Personal Picture
GRAPEVINE: What motivated you to write ‘Stand By Me’?
JOHN KIRWAN: The first line in the book reads, I’m a dad and I’m scared. That’s my motivation. I want to learn, and I want other parents to learn the skills needed to recognise mental well-being in the house as well as the skills to identify mental illness. Studies show that if you can get to mental illness early then you’re more likely to have success in overcoming it.
We have a high rate of youth depression in New Zealand – and one of the highest suicide rates in the developed world. That scares me.
GV: What do you want to achieve by getting this book out there?
JK: I want to keep depression at the forefront of people’s minds. People still seem to consider it a weakness rather than an illness, and so they hold back from getting help. The most important thing to me is that we normalise it, and that we get the help for our adolescents as quick as possible.
GV: What was your experience with depression and anxiety?
JK:A living hell! It’s like a stranger in your head driving you to think negatively. You have incredible fear about things that don’t deserve that amount of fear. The anxiety brings worry – about the future, about what people think of you, about most things in life.
GV: Were there signs of anxiety or depression that you can see now when you look back on your youth?
JK: Yeah … I remember being homesick at a camp in Hunua when I was about 13 or 14. Everyone else was having a great time, but I was just very, very homesick. I think that was a sign. I was also really shy and often quite stressed-out about stuff – another early sign of anxiety.
GV: You mention in the book that parents often tend to back off once their kids reach adolescence. How involved should parents be?
JK: I think they need to do the opposite of backing off! They need to step up and step in. If they see signs of anxiety or depression they need to get in there and work really hard. Keep telling them you love them. Keep trying to listen. Keep trying to understand. If you get on top of it early then it can be managed.
GV: You, Kirsty and Elliot all talk about ‘trusting your gut’ as a parent. Why?
JK: Because no one knows your child like you. You’ve had 13 or 15 or 18 years with this young person. You know him or her best. So if you think something’s up, keep investigating.
GO TO WWW.DEPRESSION.ORG.NZ AND WWW.SPARX.ORG.NZ FOR MORE INFORMATION. TO SEE MATTHEW JOHNSTONE’S VIDEO ON YOUTUBE, SEARCH FOR ‘I HAD A BLACK DOG, HIS NAME WAS DEPRESSION’ ON YOUR INTERNET BROWSER, OR WATCH IT ON GRAPEVINE’S FACEBOOK PAGE.