Depression and Anxiety in Children with Chronic Health Conditions

Some children and teenagers with chronic health conditions react to the worries and disruptions the condition presents by becoming depressed or overly anxious. The term for this is “internalizing problems.” The child responds to the condition with internal mental turmoil — excessive sadness or worry.

It’s important to note that some degree of sadness or worry is normal when a child is dealing with a serious condition. For example, it’s typical for a child to be unhappy when they can’t be as active as they would like to be, or when they can’t spend time with friends. And it’s normal to worry when dealing with a life-threatening condition.

Sadness and worry cross the line into depression or anxiety disorder when they interfere with the child’s ability to function — when the downhearted spirit or excessive worry keeps a child from engaging in everyday activities or participating fully in their treatment plan.

Causes

Children and adolescents with chronic health conditions face a special set of physical and emotional challenges. They may be scared that their condition will get worse, and they may be dealing with pain, either from their condition or from its treatment. In some cases, treatments or procedures associated with managing the condition can be very demanding. Children may also feel “different” from their peers, and their schedules for family, school and social life may be disrupted.

These emotional strains and practical obstacles, combined with the pushes and pulls of growing through the normal stages of childhood development, can lead some children and adolescents to become depressed or overly anxious.

A family history of depression or anxiety disorder may be a factor, as may a child’s personality. Some children are more prone to negative thinking or to worrying than others, while some children are naturally more optimistic or generally calm. A child with an inclination to think about worst-case outcomes may be prone to depression or anxiety disorder when faced with the very real challenges of a chronic medical condition.

Signs and symptoms

Depression and anxiety problems are separate conditions, with their own signs as symptoms. These are described more fully on the following pages:

Testing and diagnosis

If your child’s low mood or worry is interfering with school, friendships, family life or their medical treatment plan, talk with your child’s doctor. The medical team working with you and your child to treat the medical condition can be expanded to include a child and adolescent psychiatrist.

Treatment

Treatment for depression or anxiety problems will depend on the age of the child and the nature of the problem. Treatment may include:

Individual therapy

  • Training in stress management techniques and coping skills
  • Cognitive behavior therapy to learn to recognize irrational and negative thought patterns and to replace them with positive ones through repeated practice

Family education and therapy

  • Education and therapy for parents and other family members to learn effective ways to support the child’s treatment

Medication

  • Antidepressant medication
  • Medication to help reduce anxious feelings and physical symptoms of anxiety

Outlook

Depression and anxiety are treatable conditions. With appropriate care and support, most children who are dealing with depression or anxiety along with a chronic medical condition are able to experience relief from these symptoms.

Follow-up care

If long-term treatment is needed for the chronic condition, ongoing attention to the child’s emotional health is important. Parents should take steps to help the child remain actively engaged in school and with friends and to find rewarding activities that are within the range of the child’s abilities.

Why choose CHOP?

Children’s Hospital of Philadelphia (CHOP) has a skilled team of child and adolescent psychiatrists, psychologists, neuropsychologists, nurse practitioners, social workers and more, who work in collaboration to recognize and help a child or adolescent deal with emotional problems that may occur alongside a chronic health condition. CHOP has helpful information for parents of children with different chronic conditions to help them navigate the emotional and practical issues they may face from initial diagnosis through treatment and follow-up.