Depressed, alone and ignored
Close to 10 million teenagers, aged 1317, have mental health problems that need active intervention but diagnosis and treatment remains elusive
“I am stuck playing the Blue Whale challenge. I am depressed and I’m afraid I will do something really bad soon. Please help me.” This desperate SOS from a 17-year-old student in Vishakhapatnam to a police suicide helpline in Indore saved his life but many others don’t get help in time.
The Blue Whale challenge is an online game that goads teens to commit suicide. Over the past month, a dozen teen deaths have been linked to the game in India.
“There’s need to shift discourse from the trigger, to address the underlying mental health vulnerabilities that are getting these children manipulated by an administrator who slowly works on strengthening dormant suicide ideation in someone with depression,” said Dr Rahul Shidhaye, associate professor, mental health, Public Health Foundation of India (PHFI). The Blue Whale challenge is not the only indication of depression in teens and young adults.
The triggers vary but the over-the-top reactions indicate underlying depression that drives them to extremes — both withdrawing into a self-destructive shell and losing control over trivial issues.
Last week, Haridwar Police rescued a girl, now 18, who locked herself up in her room and lived in voluntary solitary confinement for three years because her parents nagged her to study. Her 15-year-old brother followed her example in 2016 and locked himself in another room because he didn’t want to go to school either.
A similar example of over-the-top reactions have been reported from across India. A teenager shot his father dead in Allahabad for asking him to study, two teens stabbed a classmate to death in Delhi because he refused to drink with them, and a student slapped a teacher in Vadodara when asked to apologise for spilling coffee over another teacher.
ANGRY AND AFRAID
Online interactions are far more superficial than interpersonal bonding, say experts, which makes people lonely, depressed and often unable to vent about worries and fears. The result is loneliness, depression and behavioural problems, which are increasingly diagnosed after the damage is done.
“Spending time with family and friends provides emotional and social support, but with virtual interactions replacing interpersonal friendships, coping skills get compromised and teens find themselves isolated in both the real and virtual world and find it harder to express their need for emotional support,” said Dr Samir Parikh, director, department of mental health and behavioural sciences, Fortis Healthcare.
Restricting interaction to social media feeds isolation in the urban milieu. “While social networking does not directly lead to isolation or depression, it helps mask it. Sharing is superficial on social media, which is mostly used as a tool to vent. It lacks the empathy of reallife conversations,” he said.
Close to 10 million teens, aged 13-17, have mental health problems that need active intervention but diagnosis and treatment remains elusive.
Oddly enough, the parents of the Haridwar siblings did not consider seeking psychiatric treatment. Police swung to rescue because the neighbours suspected parental abuse as they hadn’t seen the children for a while. “The stigma associated with depression prevents people from seeking help but denial and ignorance also play a role. Most people identify sadness and crying with depression and do not think irritability, anger, change in behaviour, falling grades, sleeplessness and withdrawal from friends and family are also signs of depression,” said Dr Parikh.
DRIVEN TO DEATH
Even those who recognise symptoms don’t know where or who to visit. With only 5,615 psychiatrists — almost all of them in metros and state or district capitals — registered with the Indian Psychiatric Society, there’s a lack of professionals to diagnose and treat. “The few psychiatrists we have are busy treating severe mental illnesses and very few step out to treat illnesses in the community, so early signs of sub-clinical depression are often missed,” said Dr Shidhaye.
Under-diagnosis has made suicide the biggest cause of death of 15- to 24-yearolds in India, followed by road traffic accidents, shows data from Global Burden of Disease Study that tracked death from 306 diseases, injuries and risk factors across 188 countries. Globally, road injury is the biggest killer in this age group.
“Deaths in youth (in India) have been rising for the past decade while other countries such as China and Sri Lanka have achieved the opposite. As a priority, the Centre must launch a national programme with active youth participation to address these causes of death and illness,” said Dr Vikram Patel, professor of global health and social medicine at the department of global health and social medicine, Harvard Medical School.
Teenagers are more reckless than children and adults as their brains are wired to react rather than retreat from danger. This proclivity for risk due to changes in the brain during teenage and early 20s explains why more young people die in suicides and accidents than people in other age groups. Gender plays a role in impulsive response, with men more reckless, perhaps because the male hormone testosterone peaks during late teens and early 20s. This corresponds with the ratio of crime, substance abuse and road accidents in men versus women, reported a study in Development Neuroscience.
LET’S TALK
“We need a discourse on depression but to do that, there’s need to de-hyphenate distress from psychosis. Bollywood icons such as Deepika Padukkone and Karan Johar have made a start but we need far more people joining the conversation,” said Dr Shidhaye.
In a run-up to the World Health Day, PM Modi also underlined the need to bring depression out of the closet in his Mann Ki Baat on March 26. “We (in India) are afraid to talk about it (depression) openly,” he said. “Suppression of depression is not good. Expression is good. If depressed, share your feelings with others, it will make you feel better.”
It’s not that people are not seeking treatment — antidepressant sales are up by more than 30% over the past four years — from ₹760 crore in 2013 to ₹1,093 crore in 2016 —but those getting help is just the tip of the proverbial iceberg. Psychological first aid from friends and family can help youngsters be more resilient. “In the absence of specialists, drawing support from the existing evidence-based cultural resources and social support mechanisms — yoga, mindfulness/vipassna — helps lower distress,” said Dr Shidhaye.
“We can’t wait for specialists or government to provide solutions, each of us has to do our bit to improve mental wellbeing in whatever way we can,” he said.