TGBP Anxiety and Depression Handout PDF

25/06/2021
DEPRESSION &
ANXIETY
in our children
RED FLAGS & MUST KNOWS
Teresita L. Martinez, MD
26 June 2021
THE GROWING BRAIN PROJECT
Disclosure/Disclaimer
• Residency Training in Adult Neurology and

Psychiatry (USTH)
• Fellowship Training in Child Neurology

(USTH)
• Advocate of Mental Health
• No other conflicts of interest to declare
1
25/06/2021
OBJECTIVES OF THIS TALK:
• To give an overview of how CHILDREN and ADOLESCENTS are coping

(struggling) with the on going pandemic and quarantine
• To present the different RED FLAGS to look for.
• To discuss the state of MENTAL HEALTH especially now during the

SOCIAL MEDIA ERA and during the QUARANTINE
• To provide possible solutions on strengthening RESILIENCE in

Children and Adolescents
Table of Contents
WHERE WE RED FLAGS

01 ARE NOW
02
The Pandemic, the Quarantine Anxiety and Depression in
and my Sanity Children and Adolescents
03 DIGITAL 04 LIFE HACKS

HEALTH
Mental Health and the Era of Promoting Resilience Amid
Social Media Adversity (aka Pandemic)
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WHERE WE
01 ARE NOW
The Pandemic, the Quarantine
and my Sanity
The Pandemic changed the way we do things.
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Psychological impact of COVID-19 pandemic in the Philippines
MODERATE TO SEVERE ANXIETY AND DEPRESSION AMONG FILIPINOS.
16.9% 28.8%
MODERATE 13.4%
MODERATE MODERATE
TO SEVERE
TO SEVERE TO SEVERE
EPRESSIODN
ANXIETY STRESS
LEVEL young age group of 12-21.4
Single, no children
Student Status
Journal of Affective Disorders 277 (2020) 379–391

The impact of COVID-19 pandemic on physical and mental health of

Asians: A study of seven middle-income countries in Asia (N = 4479)
<30 years single and separated status
high education background discrimination by other countries
contact with people with COVID-19
PLoS One . 2021 Feb 11;16(2):e0246824. doi: 10.1371/journal.pone.0246824. eCollection 2021.

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Impact of the COVID-19 Pandemic on Physical and Mental Health

in Lower and Upper Middle-Income Asian Countries: A
Comparison Between the Philippines and China
N: 849 participants from 71 cities in

the Philippines and 861 participants
from 159 cities in China
ORIGINALRESEARCH published:09February2021, doi:10.3389/fpsyt.2020.568929



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Filipino (LMIC) respondents reported

significantly higher levels of depression, anxiety,
and stress
Filipino respondents were more likely to

report physical symptoms resembling
COVID-19 infection, recent direct and
indirect contact with COVID , concerns about
family members contracting COVID-19 , Free image download via:
https://www.globalgiving.org/projects/covid-19-relief-
dissatisfaction with health information response/


Students were Students in PH

afraid that reported higher
confinement and levels of IES-R and
learning online depression scores
would hinder their Differences with no
progress in their STANDARD of mode
studies of delivery of
education
ORIGINALRESEARCH published:09February2021,
doi:10.3389/fpsyt.2020.568929
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ANXIETY AND DEPRESSION AMONG STUDENTS IN WUHAN CHINA

Association of Home Quarantine and Mental Health Among Teenagers
in Wuhan, China, During the COVID-19 Pandemic
▪ N= 10713
▪ Current residents of Wuhan
▪ 12-18 y/o, quarantined and on online
class 21.7%
ANXIETY
24.6%
DEPRESSION
JAMA Pediatr. 2021;175(3):313-316. doi:10.1001/jamapediatrics.
02 RED FLAGS
Anxiety and Depression in
Children and Adolescents
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Identifying the TELL-TALE SIGNS
• Focus on
developmental
psychopathology and
the child’s specific
vulnerabilities
Mental health considerations for children & adolescents in

COVID-19 Pandemic
• Children also feel
• Interventions need to focus on

nurturing resilience in children and
adolescents.
• Parents, Educators, Adults need to

look after their own mental health
too.
Pak J Med Sci May-2020 Vol. 36 No. COVID19-S4

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Children and their Vulnerabilities
• They have a limited

understanding of the
event
• They may not be able

to communicate their
feelings with their
parents
TEENS AND THEIR VULNERABILITIES
Adolescence is a time of
significant and rapid
biological, social, and
psychological changes
Hamilton et al. 2020 - COVID
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VULNERABI LITY
• Continuum from low to high

• Mediated by the dynamic interplay of risk and protective
factors
• Severity of stressors
• Thresholds vary according to an interaction of child
characteristics, contextual variables, and the type and
degree of perceived stressors
Anxiety and Depression in Children and Adolescents.

ISBN 978-1-4614-3108-4 e-ISBN 978-1-4614-3110-7
DOI 10.1007/978-1-4614-3110-7
ANXIETY AND DEPRESSION are two of the most

prevalent mental health problems of childhood and
adolescence, affecting up to as many as one-third of
children and youth over their lifetimes.
UNDER-IDENTIFIED
MISDIAGNOSED
COMORBID WITH
EACH OTHER
Anxiety and Depression in Children and Adolescents.

ISBN 978-1-4614-3108-4 e-ISBN 978-1-4614-3110-7
DOI 10.1007/978-1-4614-3110-7
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GENETIC
3.53M (9%)
Out of School Youth
(PSA, 2017)
CULTURAL BIOLOGICAL
DEVELOPMENT 4M+ not able to

enroll in August 2020
27.7M (2019)→ 23M (2020)
(DepEd, 2020)
SOCIAL FAMILY
https://www.pna.gov.ph/articles/1129909 07 FEB 2021

SCHOOL
ANXIETY
• an anticipatory
• cognitive process involving
repetitive thoughts
• related to possible threatening
WORRY outcomes and their potential
consequences
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Developmental Anxiety
STRANGER ANXIETY SEPARATION ANXIETY

(7-8 months of age) (12-15 months of age)
PHOTOS courtesy of https://www.123rf.com/
The Essential Companion to the Diagnostic and Statistical Manual

of Mental Disorders, Fifth Edition. 2014.
Childhood Anxiety
COGNITIVELY BEHAVIORALLY
PHYSIOLOGICALLY

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Childhood Anxiety
S E PA R AT I O N A N X I E T Y SELECTIVE MUTISM
Developmentally Consistent failure to

inappropriate and speak in specific
excessive fear or social situations in
anxiety concerning which there is an
separation from expectation for
those to whom the speaking despite
individual is speaking in other
attached situations.
PHOTO courtesy of https://www.123rf.com/

Childhood Anxiety
GENERALIZED ANXIETY SELECTIVE MUTISM
Uncontrollable worry Extreme self-

about general daily consciousness and
functioning, the future, social discomfort;
social, and academic socially avoidant
competence; physiological
overestimate likelihood
of negative outcomes;
reactions
underestimate ability in social settings;
to cope low self esteem

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Childhood Anxiety
POST TRAUMATIC STRESS DISORDER PA N I C AT TAC K D
Reexperiencing Physiological, cognitive,

traumatic events affective symptoms
through dreaming and including heart
thinking; extreme palpitations, sweating,
stress; sleep problems; trembling or shaking,
hypervigilance; chest pain or
concentration discomfort, dizziness;
problems fear of dying, loss of
control, etc

DEPRESSION
• depressed children do
worry about many
aspects of their lives
including social and
academic spheres

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Childhood Depression
COGNITIVELY BEHAVIORALLY
PHYSIOLOGICALLY

RED Flags
• Sad and irritable

• Loss of interest in activities
they once enjoy
• decline in self care or
personal appearance,
• Changes in weight
• Shift in sleep patterns
• Sluggishness
• Harsh self-assessment
• Feelings of worthlessness,
hopelessness
• Suicidal thoughts
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What has been the effect of covid-19 on

suicide rates?
• No change: Australia, Canada, New
Zealand, Norway, Peru, Sweden, and the
Suicide rates haven’t risen, but we US—high income countries
should be cautious! (March 2021) • JAPAN - where there has been a fall, then a rise,
most marked in women and young people. The
causes are uncertain, but economic factors and
celebrity suicide may have played a part
• PROTECTIVE FACTORS:
• We may have been more careful in lockdown
to stay in touch, more alert to warning signs.
• In the face of a crisis, there may have been a
greater sense of community, of getting
through it together.
• Perhaps a belief too that it would soon be
over, so that the distress that many felt did
not become that most dangerous of moods,
despair.
BMJ 2021;372:n834
BMJ 2021; 372 doi: https://doi.org/10.1136/bmj.n834 (Published 29 March 2021)
2808 3529
(PSA, 2019) (PSA, 2020)
25.7%
https://www.rappler.com/nation/suicide-rises-
philippines-pandemic-drags-on-2021
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MARTINEZ ©2021. No part of this presentation can be copied and used without the permission of the owner.
LANGUISHING
A sense of
stagnation
and
emptiness.
https://www.nytimes.com/2021/04/19/well/mind/covid-mental-health-languishing.html
03 DIGITAL
HEALTH
Mental Health and the Era of
Social Media
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Teens, the Internet and the Pandemic
Access to school or Fake news and misinformation

educational materials, covid Self presentation and body
19 resources image
Diversion Mood, anxiety, depression
Social Interactions Sleep and Circadian Rhythm
Identity Development and Self
expression
Hamilton et al. 2020 - COVID
ONLINE CLASS
How are we adjusting so far?
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ONLINE BURNOUT
• Burn-out is a syndrome conceptualized as resulting from

chronic workplace stress that has not been successfully
managed.
DEPERSONA-
ENERGY LIZATION
REDUCED
DEPLETION OR MENTAL PROFESSIONAL
DISTANCE FROM EFFICACY
EXHAUSTION JOB OR
OCCUPATION
European Journal of Open, Distance and E-Learning. European Journal

of Open, Distance and E-Learning (ed.gov)
Online learning increases student fatigue and

burnout
46% increase in depressive states
and symptoms
Social isolation
Lack of productive emotional and

physical outlets
Limited engagement in school
ART BY Amorah Schultze

Confined Quarantining
https://thedispatchonline.net/13980/commentary/online-learning-increases-
student-fatigue-and-burnout/
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04 LIFE HACKS
Promoting Resilience
Amid Adversity (aka
Pandemic)
Preparing them to PROTECT
THEMSELVES
• Equipping them with

the necessary
RESILIENCE to make it
through.
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RESILIENCE
▪ The process of adapting

well in the face of
adversity, trauma, tragedy,
threats, or significant
sources of stress.
▪ Bouncing Back
https://www.apa.org/topics/resilience
Psychological Resilience and the

effects of Pandemic
People with high resilience

are less likely to show
emotional symptoms during
quarantine and pandemic.
Social Science & Medicine 262 (2020) 113261
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Characteristics of Resilient Children

SUPPORT
GROUP
GOOD
EASY
THINKING
GOING
SKILLS
RESILIENCE
RELIGIOUS
TALENTED
SPIRITUAL
CULTIVATING PSYCHOLOGICAL
RESILIENCE
Protective factors
Sensitive, responsive caregiving
Meeting basic needs
Emotional support for children
Support for caregiver well-being
Social connectedness
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•GENETICS •PERSONALITY
•NERVOUS SYSTEM •SELF
(BRAIN)
•NEURONAL PLASTICITY
•IMMUNE SYSTEM
PYSCHOLO-
BIOLOGICAL
GICAL
SOCIAL SPIRITUAL
•SOCIAL RELATIONSHIPS •RELIGION

•SOCIAL INSTITUTIONS •MEANING AND PURPOSE
•SOCIAL SUFFERING,
SOCIAL ATTRIBUTES
How do we cultivate resilience in school?

3 SCHOOL QUALITIES THAT
PROMOTE RESILIENCE (PRE
PANDEMIC)
Caring relationships between pupils

and teachers
High expectations for pupils to do

well through teacher practices
which are child-centered.
https://doi.org/10.1080/01587919.20
21.1885092
https://www.parentmap.com/article/r
emote-resilience-building- Pupils’ meaningful involvement and
community-during-distance-learning responsibility, with opportunities to
express opinions, make choices,
solve problems and work with and
help others
PHOTO CREDITS: https://www.123rf.com/
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Building resilience in education systems during the pandemic
SENSE OF BELONGINGNESS SENSE OF PURPOSE

https://doi.org/10.1080/01587919.2021.1885092
https://www.parentmap.com/article/remote-resilience-building-community-during-distance-learning
Building resilience in education systems post pandemic
BUILDING A
VIRTUAL
CO MMUNITY

https://doi.org/10.1080/01587919.2021.1885092
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A SENSE OF
PURPOSE

https://doi.org/10.1080/01587919.2021.1885092
BUILDING
RESILIENCE
AT H O M E

https://doi.org/10.1080/01587919.2021.1885092
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25/06/2021
“ Time spent with family is invaluable to creating

resilience. It’s also a good time to celebrate past
successes. Talking about difficulties your family has
faced together and challenges your child has
overcome themselves generates something we all
need right now — HOPE.”
Gemma Alexander, Parent Map, 2021
https://doi.org/10.1080/01587919.2021.1885092
How do we build resilience at home?
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How do we build resilience at home?

The single most common factor for children who develop resilience is at least one
stable and committed relationship with a supportive parent, caregiver, or other adult.
Resilience is the result of a combination of protective factors.
FACILITATING SUPPORTIVE ADULT-

CHILD RELATIONSHIPS
BUILDING A SENSE OF SELF-EFFICACY

AND PERCEIVED CONTROL
PROVIDING OPPORTUNITIES TO
STRENGTHEN ADAPTIVE SKILLS
MOBILIZING SOURCES OF FAITH, HOPE, “Over time, the cumulative impact of positive
AND CULTURAL TRADITIONS life experiences and coping skills can shift the
fulcrum’s position, making it easier to achieve
positive outcomes. “
https://developingchild.harvard.edu/science/key-concepts/resilience/
Addressing Online Burnout
• Promoting Awareness on stress

and burnout.
• Increase the frequency of

breaks between online lectures
or during teleconferences
• Directing wellness campaigns at

students to increase their
awareness on the physical and
emotional consequences of
increased online time
REVIEW
published:11November2020
doi:10.3389/fpubh.2020.574969
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25/06/2021
Addressing Online Burnout
• Introducing podcast-based (audio

recordings) as substitute to online
visual encounters.
• Implementing healthy exercises

during long online sessions.
• Providing online participants with

the opportunity to share their
feelings and mental struggles
• Cutting down on unhealthy habits

(smoking, coffee)
REVIEW
published:11November2020
doi:10.3389/fpubh.2020.574969
be kind
laugh
pray
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thank
you!
tlmartinez@ust.edu.ph
teremartinezmd@gmail.com
Teresita L. Martinez, MD
29

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25/06/2021

THE GROWING BRAIN PROJECT

• Residency Training in Adult Neurology and

• Fellowship Training in Child Neurology

• Advocate of Mental Health

• No other conflicts of interest to declare

THE GROWING BRAIN PROJECT

OBJECTIVES OF THIS TALK:

• To give an overview of how CHILDREN and ADOLESCENTS are coping

• To present the different RED FLAGS to look for.

• To discuss the state of MENTAL HEALTH especially now during the

• To provide possible solutions on strengthening RESILIENCE in

THE GROWING BRAIN PROJECT

WHERE WE RED FLAGS

03 DIGITAL 04 LIFE HACKS

THE GROWING BRAIN PROJECT

The Pandemic changed the way we do things.

THE GROWING BRAIN PROJECT

Psychological impact of COVID-19 pandemic in the Philippines

MODERATE TO SEVERE ANXIETY AND DEPRESSION AMONG FILIPINOS.

Journal of Affective Disorders 277 (2020) 379–391

The impact of COVID-19 pandemic on physical and mental health of

<30 years single and separated status

high education background discrimination by other countries

contact with people with COVID-19

PLoS One . 2021 Feb 11;16(2):e0246824. doi: 10.1371/journal.pone.0246824. eCollection 2021.

Impact of the COVID-19 Pandemic on Physical and Mental Health

N: 849 participants from 71 cities in

ORIGINALRESEARCH published:09February2021, doi:10.3389/fpsyt.2020.568929

Impact of the COVID-19 Pandemic on Physical and Mental Health

ORIGINALRESEARCH published:09February2021, doi:10.3389/fpsyt.2020.568929

Impact of the COVID-19 Pandemic on Physical and Mental Health

Filipino (LMIC) respondents reported

Filipino respondents were more likely to

ORIGINALRESEARCH published:09February2021, doi:10.3389/fpsyt.2020.568929

Impact of the COVID-19 Pandemic on Physical and Mental Health

Students were Students in PH

ANXIETY AND DEPRESSION AMONG STUDENTS IN WUHAN CHINA

JAMA Pediatr. 2021;175(3):313-316. doi:10.1001/jamapediatrics.

THE GROWING BRAIN PROJECT

Identifying the TELL-TALE SIGNS

THE GROWING BRAIN PROJECT

Mental health considerations for children & adolescents in

• Children also feel

• Interventions need to focus on

• Parents, Educators, Adults need to

Pak J Med Sci May-2020 Vol. 36 No. COVID19-S4

Children and their Vulnerabilities

• They have a limited

• They may not be able

THE GROWING BRAIN PROJECT

TEENS AND THEIR VULNERABILITIES

Hamilton et al. 2020 - COVID

THE GROWING BRAIN PROJECT

• Continuum from low to high

Anxiety and Depression in Children and Adolescents.

THE GROWING BRAIN PROJECT

ANXIETY AND DEPRESSION are two of the most

Anxiety and Depression in Children and Adolescents.

DEVELOPMENT 4M+ not able to

https://www.pna.gov.ph/articles/1129909 07 FEB 2021

THE GROWING BRAIN PROJECT