Shireen Ahmed hopes that open communication, sports and positive role models will help ease daughter Rumaysa Khan's transition to her teenage years. Rumaysa is athletic and plays soccer but also loves trying on her mother's shoes.Galit Rodan/The Globe and Mail
'In Grade 6, I was happy-go-lucky," said Haifa about when her depression started. "It was in junior high that I started skipping school and smoking cigarettes."
Now 26, Haifa (a pseudonym) was depressed throughout her teenage years in Montreal. Just before Grade 7, her family moved neighbourhoods. The environment at her new school was intense – lots of competition for the attention of boys and popular girls, lots of pressure to have the right clothes and be daring enough to shoplift.
Haifa got in trouble for acting out at school, and then at home when her teachers called her parents. She got into bed and slept as often as she could – after school, after dinner and well into the afternoon on weekends.
"It was my family doctor who clued in," said Haifa. But her parents didn't push her to get treated for depression, attributing her behaviour to "teenage rebellion." And she resisted her doctor's advice because she was sick of adults telling her what to do.
Haifa's story isn't uncommon – at any given time, 5 per cent of adolescents are going through a depressive episode, says Rod Evans, director of clinical services at Kinark Child and Family Services based in Markham, Ont. Up until puberty, it's boys who are most at risk for mental health problems (their chance of developing Attention Deficit Hyperactivity Disorder (ADHD), for example, is much higher), but once hormones kick in, he says, it's girls who are more vulnerable. Dr. Evans says that exact figures are hard to pin down, but that adolescent girls are three or even four times as likely to experience depression as boys.
Girls' increased risk of depression dovetails with another, more recent, phenomenon: The onset of puberty is happening at younger ages – on average, girls are developing breasts a year and a half earlier than they did 15 years ago.
"Increased estrogen and the development of secondary sexual characteristics, like breast tissue, are quite closely correlated with mental health problems," said Dr. Evans, whose clinic treats 10,000 youth every year. "Mental illness has biological, psychological and social causes, and puberty contributes to all three."
Not all researchers believe that hormonal changes are to blame for girls' depression, but these changes contribute to how adolescents and pre-adolescents cope with the legion stresses of girlhood. Shireen Ahmed is the mother of a 10-year-old girl, and three boys aged six to 12, in Mississauga, Ont. She says her daughter, Rumaysa Khan, is excited to get her period – "she's very keen to join this club" – but both mom and daughter wish that one step to adulthood was not a huge leap. This summer, they drove to six stores before finding the one-piece bathing suit Rumaysa wanted.
She's noticed that Rumaysa is starting to become self-conscious about her body. The girl wears an undershirt at all times, even on the hottest summer days, and asked her mom for a bra to wear while playing basketball. "We found a tiny sports bra," said Ms. Ahmed. "It made her feel better." But she turned down Rumaysa's request to wax her arms. "There's an expectation for girls to look a certain way and gear up for that very quickly," said Ms. Ahmed.
A long-time soccer player herself, she's adamant her daughter continues to play sports, which she hopes will give her respect for bodily strength, not just size.
In her work as a pediatric endocrinologist at the B.C. Children's Hospital, Dr. Dina Panagiotopoulos meets with families whose daughters are experiencing early puberty. She sometimes prescribes hormone injections to halt the changes, but only in serious cases, like if a four-year-old girl is menstruating. But those are rare cases, and often a side effect of a more serious problem, such as a brain tumour. Last year, her clinic put only 10 girls on puberty-stalling shots.
Usually, families are told that slightly early breast buds aren't a big deal. Early development can be a side effect of being overweight. Most girls are sent home with a recommendation to improve their diets. Dr. Panagiotopoulos notes that despite earlier breasts, the age of girls' first periods has stayed fairly steady around 12.5 years old since the mid-20th century.
For her, a link between early puberty and depression is far from obvious. "I've never referred a single patient to a mental health worker for depression because of early puberty," she said. "Many mental health problems don't develop until a certain age, but that doesn't mean they're caused by puberty."
Figuring out the cause-and-effect is tricky. Sometimes, it's childhood stress that seems to kick-start early puberty. Several studies have shown that children who face significant stresses are more likely to reach puberty before their peers. These same stresses can then contribute to depression which manifests itself at the same time as a child is experiencing puberty, leading parents and doctors to blame hormones when childhood experiences might be the culprit.
Girls who have been adopted internationally, for example, were found to reach puberty before children from the same country who immigrated with their biological parents, perhaps because of poverty or parental strife in their early lives. And some studies have found that lesbian and bisexual girls develop faster, with researchers speculating that bullying and internalized homophobia are potential causes – as do girls who were abused.
"Sorting out which came first can be complicated," said Elizabeth Saewyc, a professor of nursing and adolescent medicine at the University of British Colombia. Abuse before or after puberty is an obvious, and serious, cause of depression. Dr. Saewyc also believes earlier puberty puts girls at risk for sexual abuse by older youth who assume that because a girl has a more adult body, she's ready for more adult behaviour.
"It's a feedback loop," said Dr. Saewyc. "Several studies show that early stress contributes to early puberty, which then creates a higher risk of being abused."
Regardless of the reasons, therapy for adolescents helps tweens and teens reduce negative thinking. If the mood problems seem stubborn, then doctors consider medications.
Parents keeping an eye on their daughters need to remember that depression isn't just about sadness – Drs. Saewyc and Dr. Evans both point out that anger and irritability are both warning signs, as is a decreased interest in friends.
This echoes Haifa's experience. "I didn't think it was actual depression so much as just being pissed off all the time, and no one understanding what I was going through," she said.
When Haifa left her family to go to university in Ottawa, she realized her moods weren't just a response to her environment. She became more open to therapy and antidepressants. Now she's stable, and doing a research job she really enjoys.
When asked what advice she'd give to parents of girls reaching puberty, Haifa remembers a specific pink sweater that her parents wouldn't buy for her in junior high. She was sure the sweater was her key to popularity, and her parents' refusal was devastating.
"I'm not saying they should have bought it, but don't act like it's trivial," she counsels. "It wasn't trivial to me. I hope I remember when I have kids."
Special to The Globe and Mail