When angst turns to agony

GROWING up is hard to do, but these days mounting social pressures on young children are making the transition from childhood to adulthood harder than ever before. More than a million children in the UK could be suffering from anxiety or depression, according to a new survey of British parents.

Over three quarters of those quizzed by Norwich Union Healthcare in the Growing Pains study blamed peer pressure and school stresses, such as bullying and exams, for negative impacts on their child's emotional health.

Around a fifth of the 400 parents, all with children between the ages of five and 15, also cited added pressure over body image as another reason why youngsters are becoming increasingly prone to stress, panic attacks and depression - and five per cent of mothers and fathers worry that their child is at risk of developing an eating disorder. Almost a quarter of parents think that lack of communication in families could be contributing to problems among youngsters.

''Feeling depressed is part of living, of dealing with the uncertainties of life. For children and young people, it is part of finding out how to cope with the ups and downs of growing up,'' explains Dinah Morley, director of children's mental health charity YoungMinds.

''But if these feelings go on for months, to the point where they interfere a great deal with day-to-day living and take away from vitality and pleasure in life, then they become more of a problem. At the extreme, some may actually have a clinical depression. This is a disturbed state of mind that makes everyday living very difficult, and definitely needs specialist help.''

Dinah believes the results of the study clearly show that mental health problems are rising among adolescents in the UK. ''Many young people feel desperately anxious about how they are going to take their place in the adult world," she says.

Steve Harrison, a nurse consultant with the Tees and North East Yorkshire NHS mental health trust, works with many troubled children and teenagers. "Life today has a frantic, driven quality and this is as true for young people as it as for adults," says Steve, who is based at the Newberry Centre at West Lane Hospital in Middlesbrough. "The competitive element is very strong these days and while some children thrive on that, others struggle."

Children and teenagers who find life unbearable but find it difficult to communicate this to adults around them sometimes express their anguish by refusing to eat, cutting themselves or becoming very withdrawn.

"These forms of behaviour are often classic cries for help. Children and adolescents are still learning how to communicate verbally. Sometimes they communicate in other ways," says Steve.

A complicating factor can often be substance abuse, usually cannabis and alcohol. "There seems to be a greater availability of substances which can be abused, which adds to the mix and can cause side-effects," he says.

"Cannabis can make children feel paranoid and it can also cause problems with thinking and perception."

Adults who remember sharing a bottle of cider with friends in a bus shelter might be surprised to note that the drink of choice among some youngsters is cheap vodka. "There is a lot of cheap alcohol around and children are using spirits like vodka. It seems that many children are seeking a more extreme experience with alcohol," says Steve.

Although there is evidence that life is getting tougher for children, he believes that society is beginning to tackle child and adolescent mental health problems more effectively. "There are now more resources around and we are trying to do something about these problems instead of turning a blind eye," he says.

Around four or five teenagers in every 100 are depressed, while around two in every 100 children aged 12 suffer from clinical depression, according to statistics from YoungMinds.

Some of the key issues that young people may become depressed about are:

* Losing their parents - whether because of divorce or separation, or through death

* Not being loved or listened to, or feeling left out

* Losing their pets or favourite toys or possessions

* Changing school, moving home, losing friends

* Their parents arguing or becoming depressed

* Their bodies, getting ill, being abnormal

* Issues surrounding sex

* Not doing well in exams

* Being abused - physically, sexually or emotionally

School-age children who are very depressed can find it hard to concentrate, may lose interest in work and play, may become irritable and difficult to control, or may lose confidence. Some may even refuse to go to school, while others complain of feeling bored or lonely, even when they have friends.

''Many children blame themselves if things go wrong,'' Dinah points out. ''A child who is feeling bad may do things that lead to them being punished, for example, by being disruptive, stealing or playing truant from school. Teenagers are often moody and uncommunicative - this is part of normal adolescence, however, some teenagers get stuck. They seem to get overwhelmed by despair.''

The following are some of the signs that YoungMinds advises parents to watch out for:

* Being extremely moody and irritable

* Giving up interests or hobbies

* Losing interest or not doing well at school or work, and having difficulty concentrating

* Becoming withdrawn and losing touch with friends

* Not looking after themselves

* Not eating enough or eating too much

* Being very self-critical

* Sleeping badly or sleeping too much

Some teenagers may also express or escape from these feelings and thoughts by acting recklessly - such as by taking drugs, drinking too much or getting into dangerous situations. And teenagers who are very depressed can become preoccupied with thoughts of death. They may even attempt to kill or harm themselves, for example, by taking an overdose or cutting their arms.

''Children and young people can't make sense of feeling depressed on their own - they need a caring adult to help them understand and deal with their feelings over time. Otherwise their problems can become worse,'' Dinah says.

''There is a lot that can be done to help children and young people who show the signs of feeling very depressed - and if they don't want to talk to someone they know, telephone helplines offer confidential support. Different kinds of individual and family therapy can also be helpful, and medication is sometimes useful, but should only be given to those who are seriously depressed and only after other forms of help have been tried."

Steve Harrison argues that it is everybody's responsibility to help youngsters who may be struggling with anxiety and depression.

Parents face particular challenges and while the vast majority cope, a significant minority struggle. "Children need to have love and warmth, a safe place, recognised limits, education and learning. Some people love their kids but struggle to meet all the other requirements," he says.

* YoungMinds Parents' Information Service offers advice on where to find help. Visit www.youngminds.org.uk/infocentre. Norwich Union Healthcare and independent group Dr Foster have developed an online information guide to children's health services at www.personalhealthmanager.co.uk. Alternatively, telephone NHS Direct on 0845 46 47 (24hrs) or see your GP.