Dr. Busman said she works with children who may say, "I don't want to kill myself, but I feel so bad that I don't know what else to do and say."
When a child talks about wanting to die, ask what that child means and seek help from a therapist if you are concerned. Such a statement can be a real signal that a child is in need. So don't fire them or write them down as something the child says just for attention, she said.
How can treatment help?
"Parents should take children's symptoms very seriously," said Jonathan Comer, professor of psychology and psychiatry at Florida International University. "In serious forms, the balls will snow over time, and starting earlier is associated with poorer lifespan outcomes."
In a longitudinal study from 2016, Dr. Kovacs and her colleagues traced the course of depression from childhood and found recurring episodes later in life.
So, if you notice changes such as withdrawal from activity, irritability or sadness, fatigue or difficulty sleeping that last two weeks, you should consider having the child examined by someone who is familiar with mental health problems in children of this age. Start with your pediatrician who is aware of the resources available in your area.
Parents should insist on a comprehensive mental health assessment, said Dr. Busman, including capturing parent's history, time with child, and conversations with school. An assessment should include questions about symptoms of depression, as well as looking for other problems, such as attention deficit hyperactivity disorder or anxiety, that may be causing the child's distress.
Early treatment is effective, said Dr. Comer: "There is excellent evidence of family-centered treatment for depression in children – it focuses on family interactions and their effects on mood." Children aged 3 to 7, he said, are often used versions of parent-child interaction therapy known as PCIT, which is essentially coaching parents and helping them emphasize and praise the positive about their children's behavior.