It is estimated that, in Europe, the number of depressed girls is much higher than that of boys. But could it be that boys' general difficulty in communicating their feelings is leading experts to underestimate the depth of the problem?
Around 9 million young people aged between 10 and 19 are estimated to suffer from depression in Europe, according to the most recent data from 2021 - before experts were able to assess the full impact of the Covid-19 pandemic, which has destroyed the networks that normally unite children and teenagers, such as schools, sports and social clubs.
Since then, experts expect that the number of children and adolescents with depression has actually increased. "The problem has become greater between 2010 and now," Ian Goodyer, Professor of Child and Adolescent Psychiatry at the University of Cambridge, UK, told Euronews.
"If we asked 100 teenagers whether they had been clinically depressed in the past six months, between six and 10 would say yes at this time."
The numbers speak of a health emergency that is dangerous to ignore: suicide is the second leading cause of death among teenagers in Europe, according to the World Health Organization (WHO), with depression considered one of the main factors of suicidal behavior.
That is why it is particularly important to understand where this epidemic of depression among young adults in Europe is coming from and to know how to recognize the telltale signs of its impact on children and adolescents.
This is particularly difficult when it comes to boys.
Officially, data show that depression rates are higher among girls, because of the negative impact of being exposed to impossible beauty standards on social media and being pressured to fit into society's suffocating expectations about women's appearance and behavior often blamed for this imbalance. Furthermore, violence against women and hostility to women's rights can contribute to feelings of despair and hopelessness among girls.
According to OECD data from 2018, 10% of 11-year-old boys and 14% of girls in 28 European countries said they felt down more than once a week, on average. As they age, the gender gap widens, with 29% of girls reporting feeling down compared to 13% of boys.
It is also estimated that depression in girls is more severe than in boys. However, experts consider that identifying depression in boys can be more difficult than in girls, which means that the issue is very little publicized.
"We don't understand why, it could be a measurement problem related to how we ask boys about depression," Goodyer said. "Or it could be that there are different features of mild depression in boys that we still don't quite understand."
A key factor at play may be sexism. Among children under 13, there is no sexism or differences between the sexes, Goodyer said, adding that it is very unusual in young children. When teenagers between the ages of 12 and 19 are asked about depression, girls suffer from it more severely.
"If we continued to measure depression in 19- to 30-year-olds, we would likely find more young men, more men in the equation," Goodyear said. "It's quite complicated and I'm not sure we can give the public a good understanding of what this sex difference really means."
How do boys suffer from depression?
Since guys are tricked into believing that crying when they feel down is a sign of weakness, many of them react with anger or act as if they are irritated when in reality they are sad. For the same reasons, boys - like adult men - are more likely to seek help when they are suffering from emotional problems.
But teenage girls are just as likely to be irritable and angry when they are depressed, says Goodyer, adding that treating depression differently according to gender is neither helpful nor beneficial. "The response to difference in presentation between the sexes has no impact on the risk of suicide or non-suicidal self-harm," he says.
But there is something to explore in how we detect depression in teenagers.
"Adolescent depression tends to show greater variation in mood states than adult depression," says Goodyer. "If you look at the mood phase of young people between the ages of 11 and 19, they are often more irritable and angry, which is not so true among adults."
But it is true that in boys, Goodyear said, "irritability is present and perhaps this has masked the depressive characteristics." What is more likely, the psychiatrist added, is that when people see an angry boy, they think it's normal, whereas an adult who sees an angry girl is likely to ask what the problem is with her, due to the prejudices we have."
Do we need a new approach to the problem?
Perhaps we need a new way of talking about feelings and depression with boys, suggested Goodyer, adding that experts should conduct as many professional and hands-on interviews with boys as possible to learn the skills needed to understand them.
"Boys are less able to articulate and talk about their inner constraints," Goodyer said. "That's why people are needed who know how to talk to boys and who are not affected by an aggressive and irritable presentation. And that is a fundamental skill that needs to be learned."
For Goodyer, efforts to combat depression among young people must focus on early detection. It's something that's being worked on, "but it's going to be some time before we know what the best thing to do is," he says.
"The next thing that needs to be done is better treatment for depressed young people. The availability of treatment right now is dire and most child mental health services in Europe have been scaled back due to general income changes and because there has been a reduction in some countries, particularly the UK, in the number of people available to treat depressed teenagers, which is a huge source of concern."
According to Goodyer, "young people's mental health has not been a priority in any European country", and it has to be.
The issue of poor mental health in children and teens has come out into the public eye, Goodyer said, but "there's a big gap between improving public perception and the scientific evidence available for policy makers to consider, and putting money into teen mental health to improve things for them, because that will, of course, improve mental health in the future."
Progress in this area is slow, says Goodyer, and there is much more to discover about the impact of depression on teens as they become adults.
"The long-term consequences for teens who don't respond to treatments are very bad," he says. "They become mentally ill. They have poor employment records and worse social relationships in later life. So it's not a trivial matter to try to improve the availability of mental health treatment for young people. It's a serious matter."
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