Youths these days have a lot on their plate. Teenagers have to cope with the highly competitive education system, and the fresh graduates are worried about employment opportunities or career advancement. Coupled with the need to maintain good relationships with their friends and family, these individuals may be experiencing high levels of stress. Some people do thrive well under stress, but what happens when stress levels exceed the healthy range? For those who are unable to cope, chances are their mental wellbeing would take a toll.
With young people unable to attend school in person regularly or go into the workplace during the circuit breaker, they might have felt increasingly isolated due to the lack of face-to-face social interaction over this extended period of time. Furthermore, having to fight for their own space while at home with their family members may have caused some conflict and frustration for some. Undoubtedly, cabin fever may have also kicked in for some of them. Although circuit breaker measures have recently been eased, youths may not be able to adjust back to the norms as easily as one might expect. Reports have shown thatit is expected that more youths will be prone to developing mental health issues such as depression due to the various implemented COVID 19 pandemic coping measures.
Depression is one of the world’s leading mental health disorders, and youths have become increasingly prone to it. Studies have shown that depression affects up to 18% of Singaporean youths. People with depression may turn to self-harm or experience thoughts of suicide. These are often methods they adopt in order to cope with their difficult emotions. According to the suicide prevention agency Samaritans of Singapore (SOS), suicide remains the leading cause of death among youths aged 10 to 29 in Singapore, and as of 2018, 94 of them had succumbed to suicide. In order to curb the rise of depression cases among youths, it is important that we are able to identify the early stages of depression. Doing so will allow them to seek treatment earlier and to help them get back onto their feet. Depression, if left untreated, will severely impact people’s lives in a negative light, causing personal, educational and familial difficulties.
Here are some of the most common symptoms of depression that you should look out for (not exhaustive):
Extreme sadness and low mood
Lack of interest in activities once enjoyed
Lack of self-worth
Experiences sleep disturbances and loss of appetite
But how can we first better support troubled youths? When it comes to dealing with depression, individuals with mild depressive conditions could adopt self-help strategies such as trying to maintain a balanced diet, to pick up on relaxation techniques, embark on daily gratitude journaling exercises (e.g. 3 things I can be thankful for today) and get some exercise in, even if it’s just a stroll around the estate or exercises from ATHLEAN-X™ or Athlean-XX for Women. Try encouraging them to live a healthy lifestyle and maybe create a ‘Daily Wellness Plan’ – a list of little and big things they can accomplish on a daily basis to comfort and keep their moods up. However, it is key to take note that even though their depression may be perceived to be mild from a third person’s point of view, we should never make assumptions as to what they truly feel on the inside. We should never, under any circumstance, tell them to “snap out of it”. It is very important for us to be patient and listen to what they have to say if they do approach and confide in you. Stay empathetic and show your concern for the individual. Acknowledge and respect their feelings and worries. Listen actively by using active listening skills. Encourage them to join mental health support groups like those conducted by PSALTCare – journeying with others that are going through similar struggles can encourage social healing.
On the other hand, for those coping with moderate to severe conditions, we might need to encourage them to seek a multidisciplinary approach to recovery like psychiatric help and look to taking medications, with supporting psychotherapy or counselling sessions and support groups. They might also be afraid of the stigma attached to seeing a Psychiatrist or what would transpire in that session. Try to assure them that there is nothing to be ashamed of. In fact, it is a lot more common in Singapore now, and a trip to the Psychiatrist is as straightforward as seeing your family doctor. Alternatively, these youths can book appointments for psychotherapy first. With appropriate treatment and support, it is entirely possible for them to move on and lead a more productive and happier life. Here’s a questionnaire that is widely used by Psychiatrists to help determine depression to help you with next steps decisions: www.mdcalc.com/phq-9-patient-health-questionnaire-9
Bullying can be manifested in many forms, and children and youth can be involved in many ways in it. However, with 1 in 4 children in Singapore reporting that they have experienced bullying a few times a month, bullying might be closer to home than you think.
Bullying is done with the intent to hurt and is repeated or persistent. Often, the target of bullying finds it difficult to stop it or stand up for himself / herself. This is different from peer conflicts or quarrels which typically involve incidents where children mutually hurt each other. As parents and caregivers, how do we support our children as they navigate the complexities of relationship-building, and what are some warning signs that indicate that they are involved in bullying?
Broadly, there are three different types of bullying
Relational: When hurtful actions are made with the intention to shame a person and damage the forming of healthy relationships and friendships. This can take the form of leaving someone out of a group, teasing, name-calling, expressing negative thoughts or feelings about a person, and even intimidating them to do things against their will.
Physical: When harm has been inflicted on a person or their belongings. This can take the form of hitting, punching, kicking, inappropriate touching and persistent damaging or stealing of belongings.
Cyber-bullying: Occurs on the internet, through mobile phones, computers, video-game systems and other forms of technology. Both relational and physical bullying can occur on this platform. For example, digital technology can be used to gossip and spread rumours or hostile messages, or game accounts can be hacked and items stolen.
How do I identify if my child is involved in bullying?
Recognising these warning signs is the first step in stemming bullying.
Warning signs of being a target of bullying:
has unexplainable cuts, bruises, scratches or other injuries
comes home with lost, torn, damaged, or destroyed clothing, books, stationeries or other belongings
is unusually hungry after returning from school
seems fearful of going to school, walking to and from school, riding the school bus, or taking part in organized activities with peers, and often finds or makes up excuses (e.g. faking illness) as to why he/she cannot go to school
has declining grades, lost interest in school work or suddenly begins to do poorly in school
experiences a loss of appetite, or has changes in eating habits like skipping meals or binge eating
reports sleeping difficulty (e.g. trouble falling and staying asleep, frequent bad dreams, etc)
complains frequently of headaches, stomachaches or other physical ailments
suddenly stops talking about friends and has few, if any, friends, with whom he or she spends time with during recess or after school
is withdrawn and stammers
continually ‘loses’ money or starts stealing
appears anxious, sad, moody, teary, or depressed when he or she comes home and suffers from low self-esteem
self-harms or talks about suicide
becomes aggressive and unreasonable
refuses to talk about what is wrong
begins to target siblings
Emotional and Behavioural signs
Warning signs of engaging in bullying:
gets into verbal or physical fights
suddenly possesses unexplained extra money or new belongings
often reacts aggressively towards others
has friends who bully others
may be excessively worried about their popularity and reputation
can be competitive
has received many disciplinary warnings and actions
refuses to accept responsibility for their actions
What should I do if I think my child is involved in bullying?
It is important to talk with children who show signs of being bullied or bullying others. The safety and mental health of our children should remain an utmost concern. It’s painful to think of your child receiving or inflicting harm on other kids, but bullying is a serious issue for both the targeted and the aggressor. According to research, a vast majority of bullies have also been the targets of bullying, and less than 1% of primary school children are “true bullies” – those who were not bullied by their peers.
Bear these three C’s in mind when relating with your child: Communicate, Consult and Connect
Communicate If you hear from a teacher or another parent that your child involved in a bullying situation, the first thing you should do is talk to your child about the situation. Be direct about the issue, but make it clear that you are open to hearing your child’s side of the story. Stay calm and say something like, “Your teacher called to tell me that you were involved in some bullying. I’m really concerned about this, and we need to talk about it. Please tell me what happened.”Avoid prejudging the situation and reacting based on emotions. It can be tempting to immediately blame the other party, criticise parenting, or condemn the school system, but it is also worth taking time to look inward and reflect on whether your own actions may be influencing your child’s. Some children may be modelling their interpersonal style based on the behaviour they have observed. If so, it is important to start fostering a positive home environment, where members of the family treat one another with kindness and respect, creating a safe space for children to share their worries and failures.
Consult Talking through the situation with your child can help you understand why the bullying is happening, and what steps need to be taken in order to stop it. For example, you may find that your child has incredibly low self-esteem and bullying helped him/her feel powerful and able to control something. He/she might prefer being known as ‘the worst kid in school’ and interacting with other children in the process, rather than not being noticed at all and having no friends. Or perhaps your child might accept being the target of bullying with the mistaken belief that such behaviours are acceptable between friends. Some children may not be able to articulate their feelings. This is especially true of children who are struggling with anxiety, trauma, or another mental health issue. If you are having trouble, consider consulting a child psychologist or psychiatrist who has a lot of experience evaluating kids’ behaviours. Your child might need a therapist’s help to work through underlying issues, investigate the root of the problem and guide you and your child in tackling the specific challenges that your child faces in his/her social interactions.
Connect Ultimately, it is about building a close and lasting connection with your child. Connecting with your child about his/her day-to-day life will put you in a better position to recognise signs of bullying and trouble. Start with asking your child a few open-ended questions on a daily basis. For example, ask him/her to share about one really great thing that happened that day, and one not-so-great thing. It can be tough to get started, but children who are regularly encouraged to share details of their lives with their parents tend to be more comfortable with continuing to do so when they are in their adolescence. Listening to your child in a supportive, non-judgmental way helps them feel connected to your presence and love in their lives, and makes them more receptive to opening up to you about their problems as well as accepting the advice that you give to them. It is always better to handle challenging issues like bullying together so that your child will be able to walk out of the shadow of the bullying with confidence and courage.
The 2nd Singapore Mental Health Study (SMHS) which began in 2016 (reported in December 2018) was initiated by the Institute of Mental Health (IMH) in collaboration with the Ministry of Health (MOH) and Nanyang Technological University (NTU). The study focused only on those 18 years old and above. The findings show that 13.9% or 1 in 7 Singaporeans have experienced a mood (major or bipolar depression), anxiety (obsessive compulsive disorder and generalised anxiety disorder) or alcohol use disorder (alcohol abuse and alcohol dependence) in their lifetime. These are the top 3 mental disorders in Singapore among the conditions assessed in the study. The study also reported that more than three-quarters of those with a mental disorder in their lifetime did not seek professional help. In the first SMHS study in 2010, the lifetime prevalence rate of mental disorders in the Singapore population was 12% or 1 in 8 persons.
In a 2012 publication on Depression by the Ministry of Health, it was reported that depression affects between 2.5% to 18% of youth*. Depression among youths in Singapore is considered common. But it is a serious mental health symptom because of it what it reflects of children’s experiences in their environment. In particular, it is a serious reflection of what they may experience in the family or relational environment. If not adequately treated, the depressed child is likely to bring their depression into adulthood. This means that the emotionally wounded or damaged child is likely to carry their wounds forward as adults. This is a likely scenario because it is estimated that an initial episode of depression increases the likelihood of a second episode by 50%. A second major episode of depression increases the likelihood of a 3rd episode of depression by 75%. A third major episode of depression increases the likelihood of a 4th episode by 100%. Not surprisingly, depression has been found to affect brain structures and functioning. It is this recurrent tendency of depression that the suicide risk often increases over time within the same individual with a history of depression.
The risk of depression in childhood needs to be a major consideration for all those concerned with the development of children. Depression among children is a serious health problem because it can impair the emotional development of the child. It can seriously affect identity formation which is foundational to how the emerging adolescent learns to relate to themselves, to others and to the world at large. Later as adults, depression can impair psycho-social as well as occupational functioning. Depression is associated with significant morbidity and mortality. Also, depression can be triggered by, or lead to, other mental health conditions such as substance abuse, anxiety, schizophrenia or personality disorders.
Signs to watch for in children who may be depressed:
Continuous feelings of sadness and hopelessness
Irritability or anger
Increased sensitivity to rejection
Changes in appetite — either increased or decreased
Changes in sleep — sleeplessness or excessive sleep
Vocal outbursts or crying
Fatigue and low energy
Physical complaints such as stomachaches, headaches that do not respond to treatment
Reduced ability to function during events and activities at home or with friends, in school, extracurricular activities, and in other hobbies or interests
Feelings of worthlessness or guilt
Impaired thinking or concentration
Thoughts of death or suicide
Not all depressed children display these symptoms. They are more likely to display different symptoms at different times at different settings. When depression is significant, there are often noticeable changes in social activities, loss of interest in school and poor academic performance, or a change in appearance.
The young child is most vulnerable to depression due to the quality of relationships with his or her caregivers. This vulnerability increases when the family environment is also accompanied by marital conflict, abuse, violence, illness and/or low socioeconomic status. However, it is in the quality of relationships with caregivers that is crucial because of what it can offer as a buffer or protection from other external events or causes. Therefore, the mental health of children begins with thoughtful parents who genuinely understand and care about their child’s emotional needs and development.
Parenting Practices that promote Good Mental Health in Children:
1. Love your child unconditionally
A genuine attitude to decide in the best interests of your child, and not in the parent’s convenience. Children thrive under certain physical and emotional conditions. The long-term view is needed. Parenting must understand the healthy outcome effective parenting can produce. This helps to plan to optimise the emotional development of the child. Loving well in the best interests of the child provides the best head start towards orienting the child to relate to themselves and others in a healthy way. Children’s need to establish a healthy identity, to uncover and stretch their potential, and learn to self-actualise will require parents to stretch their own emotional ‘ceiling.’ This means parents who desire to raise emotionally healthy children have to face their own insecurities so as not to impose them on their own children. Parenting with the best interests of the child will often be at the inconvenience of parents especially if parents do not appreciate the value of nurturing relationships which children thrive on.
Loving your child well answers the deep longing for the child to later ask, “Am I worthwhile?” The need for children to recognise their own personal importance, value and worth prepares them to find that their later life will amount to significance. The child at risk of depression commonly struggle with this sense of self regard. Loving the child unconditionally is not based on the social or academic performance that society may hold out for children. Instead, mistakes are accepted as a natural part of their learning. If the parents placed their importance on their children only in reaching their own ambitions, or social or academic accomplishments, these indicate conditional expectations for them to find approval or acceptance. The will view their worth based on what they do instead of who they are.
2. Ensure safe and secure physical and emotional surroundings
Secure attachment, which is offering an ongoing, consistent, soothing, accepting presence to the infant is the important beginning in the parent-child relationship that helps the infant to learn to feel safe and secure in the world. This is a foundational need for positive mental health in infants and children and later adulthood. Emotional safety from the secure bond offered by a secure parent helps young children to trust the caregiver and to experience their world as safe and predictable. Through this quality of care, a child is encouraged to first accept themselves as as lovable, as important. It also prepares them next to want to explore their world as they mature physically. This means parents who wish the best for their children have to prepare them to become independent over time.
Punitive, harsh or neglectful parents, especially when physical punishment is employed, leads to children questioning their worth or value and increases the risk for later depression. Parents who frequently employ shame, threats, insults or convey other derogatory messages to their children tend to raise a child who view themselves as defective. This is particularly damaging to children. Indeed, the DSM-V lists the sense of hopelessness or worthlessness as a common symptom of depression. Children can be raised to view themselves as defective, and that their life as meaningless.
Promoting a safe emotional environment emphasises listening and empathy as skills, and being age-appropriate supportive as an attitude. Being emotionally present and listening well will foster the child’s wish to share their experiences. It builds on the bond already started from providing a secure attachment. It encourages children to view the parent and other people as a safe resource they can count on later if needed. It answers the important question that children ask, “Is it OK to be me?” This also fosters familiarity with emotional intimacy that better prepare children for friendships and significant relationships later. Familiarity with close and supportive relationships also mean that the child is less likely to isolate themselves socially when they face problems later on. It is a wise parent who value interactional activities with their young children early on rather than let them become overly attached to computer games and the internet to amuse themselves. Excessive computer use at the detriment of other activities has been linked to increased loneliness, poor social development and depression.
3. Nurture Self-confidence and High Self-esteem
Self-confidence is most easily found when children grow up feeling loved unconditionally.
The foundation provided when the child feels loved should be supported by the child’s search for mastery in the world when they are ready to explore. Starting with simple activities, their need for autonomy and mastery over their environment allows them to gain confidence over the tasks they wish to take on. It is important for parents to support this rather than to over-protect them from exploration. Parents who are over-protective of their children and anxious about possible mishaps will find it difficult to foster the autonomy and independence their children need. To build their self-confidence and nurture high self-esteem, parents should be ready to praise their children’s exploratory efforts, be honest with them about their own mistakes, participate in the children’s activities, encourage them in activities where their interests match their ambitions and allow them to be tested by the tasks they take on.
The child’s ability to overcome, which allows them to be exposed to the frustrations and disappointments along the way, is something they have to face as well. Children should be encouraged to enjoy the process in the process of becoming. Learning to face their own frustrations, disappointments and failures will also serve to build self-confidence. Avoiding frustrations or disappointments or learning through determined effort and even failure tends to undermine self-confidence. The opportunities for children to grow through tasks and responsibilities is the beginning from which they can discover and establish their personal power and resilience.
Looking for ways to nurture your child’s self-confidence and develop high esteem answers the child need to know “Can I do it?” It requires that parents focus on building strength or resilience through the children’s autonomy –their learning to exercise control over their environment– rather than emphasize ease or comfort through avoidance.
4. Promote opportunities to Play with other children and self
Play is an integral part of emotional development of children. It is the primary means in which children learn to explore, to discover themselves in their world, and socially to cooperate, take turns and help in friendships. Studies have even suggested that inadequate play time for preschool children lead to more disruptive behaviour. Besides social interactions, play allows for the development of emotional awareness and fosters empathy where children learn about their own emotions as well as the emotions of others. Play also allows children to enjoy the process of becoming one self. This is important in a goal-oriented world that emphasises only winning or success or grades. Indeed they can discover the truth that frustrations and disappointments are often the price we all pay to achieve success. In so doing, play allows children to learn how to emotionally regulate their feelings when they are presented with opportunities to learn to express thoughts, feeling and behaviours in socially appropriate ways.
Play is an important part of the child’s need to learn and experiment. Participation in play individually or in a group is an integral part of this learning process. Parents who are open to social interactions offer their children important advantages because they can facilitate their children’s emotional regulation and social learning when they play with their children on a regular basis. Children are more likely to enjoy other people contact when they already enjoy warm relationships with and have fun with their parents. TV or computer use should be monitored so that children are encouraged to engage more in active learning through participation. Computer games designers have made it easier for children, especially children who are neglected or are alone a lot, to be addicted to computer games. Excessive computer use has been found to be linked to depression in children.
Play offers the opportunity to address the questions that children ask, “Am I OK and is it good to be me?
5. Provide appropriate guidance and discipline
While children need to explore, develop new skills and become more independent and responsible, they also need to learn that certain behaviours are not acceptable. They need to be offered guidance and discipline that is fair and consistent from the family unit. They tend to take these social rules to their school and eventually to the workplace. Expectations may be expressed firmly but they need to be kind and realistic. Again, children learn best within encouraging and nurturing relationships. Parents need to be aware of their own maturity and growth and emotional status as they seek to help their children develop self-control, self-discipline or become kind. Their children cannot be expected to growth in those areas which parents have not grown themselves.
Explain “why” the child is being disciplined and the consequences of their actions. Criticism should be focused on the behaviour and not the person. Threats, nagging and the use of threats should be avoided. The power that the parent wields should emphasise guidance and instruction in the best interests of the child that allow for children to learn from their mistakes. Those parents who practice excessive domination or coercion should understand that it is not helpful in the long run if children are forced to accept a place of surrender in order for them to survive in the relationship. They need to be encouraged to exercise their own power when appropriate. What has been described as authoritarian parenting, characterised by high demands with poor feedback or nurturance has also been found associated with a higher incidence of depression in children. This is in sharp contrast to authoritative parenting which is characterised by high demands accompanied by responsiveness to the child’s emotional needs. This approach is found to produce children who are responsible, they can regulate themselves, they can make good decisions on their own, and they are respectful to others and to rules.
Parenting is primarily a personal and emotional project in raising one’s children. It is foundationally an emotional process to secure the child before a young child eventually matures to believe in themselves. This is crucial before they begin to actively learn to navigate themselves in an increasingly complex world. It is widely understood as a parent’s most important life task since the emotional outcome show up in emotionally healthy or unhealthy individuals even before adulthood beckons. There is an emotional ‘birthing’ process where the Self of a child arrives at a healthy place in their identity formation. Or the opposite will happen. Quality parenting in this ‘birthing’ process create the foundation in which the next generation of children find the basis for their own survival, happiness and fulfilment. As such, parents learning to parent with optimal outcomes will do well to emotionally mature and be healthy themselves so that their children have the best chance to establish themselves in a healthy place in preparation to thrive in life.
The Ministry of Health, Depression: MOH Clinical Practice Guidelines, 2011.
Woo BSC, Chang WC, Fung DSS, Koh JBK, Leong JSF, Kee CHY, et al. Development and validation of a depression scale for Asian adolescents. J Adolesc. 2004 Dec; 27(6):677-89.
Woo BSC, Ng TP, Fung DSS, Chan YH, Lee YP, Koh JBK, et al. Emotional and behavioral problems in Singaporean children based on parent, teacher and child reports. Singapore Med J. 2007 Dec; 48(12):1100-6.