Rebuilding hope post-Covid: The signs of depression and despair

There was already something of a crisis in adolescent and child mental health in the UK, even before Covid-19 came on the scene.

Services were underfunded and overstretched. But the pandemic has made the situation worse, exacerbating existing mental health problems in some young people, triggering new ones – and help with such problems has been even harder to come by in the past year, through the inaccessibility of therapy during lockdowns, and the sheer volume of demand.

REBUILDING HOPE POST-COVID: To read other articles in this series, visit

1. The signs of depression and despair
2. Helping students to overcome despair
3. Understanding risk
4. Fostering hope and positivity

Depression

A particular problem is the rise in depression. A recent Office for National Statistics survey found that the number of people describing themselves as depressed has more than doubled through the pandemic to more than 20 per cent (ONS, 2021).

Even the quoted figures are very probably only the tip of the iceberg: many of those who put a brave face on it publicly will often admit privately that they have been depressed (and which of us has not had such feelings?).

Anecdotal reports from youth services suggest that this rise in depression has occurred across all age groups in the school population, including young children, but with teenagers being especially badly affected.

None of this is surprising: the situation we have all lived through has been intrinsically depressing.

For many, this depressive reaction is likely to be temporary. It may well lift as Covid-19 comes under better control and restrictions ease more and more. But for some, the problem may well be more entrenched and difficult to resolve: in some, the situation will have triggered the much more serious problem of despair.

Despair

Despair is not the same thing as depression. The two are closely connected, and may be co-morbid: despair is intrinsically depressing, and depression may involve an element of despair. The difference is one of focus and degree.

Depression can take many forms, have many levels, many triggers and causes. It is a wretched experience, but it is not necessarily all-encompassing: there may still be elements of hope. Despair is by definition more extreme, more all-consuming. The Oxford English Dictionary defines it as a complete loss of hope.

Despair is a serious matter: it can kill. It is strongly associated with suicide (Weishaar & Beck, 2009) and with deaths from substance abuse in adolescents and adults (Copeland et al, 2020; Shanahan et al, 2019). Very young children may be at less immediate risk of suicide or substance abuse, but despair in young children is a strong risk factor for substance abuse and other mental health problems as these individuals reach adolescence and adult life (Godwin, 2020).

There is some evidence that suicide and substance abuse – so-called “deaths of despair” (Case & Deaton, 2017) – have increased overall during the pandemic, in adults (Mulligan, 2020).

Reasons to be concerned?

Given the intrinsic frustrations and miseries of lockdowns, and the apocalyptic imagery of reporting of the pandemic in the 24/7 media, the public narrative of a generation of teenagers whose educations, career and lifetime earnings (and in the case of younger children, basic skills and social development, even language) will be materially, and perhaps permanently damaged (though there is generally very little substantive evidence to support these alarming media claims), there are strong reasons for predicting a rise in despair in the young (John, 2020).

In particular, many experts have predicted that such despair will drive a rise in suicide in teenagers (John, 2020). As yet, the evidence on this is equivocal. It may be too soon for any rise in adolescent suicide to emerge in the data in most societies (John, 2020).

However, a study from Japan (yet to be peer-reviewed) reports that while there was no rise in suicide in teenagers and young adults in the early months of the pandemic, there was a major rise (of 70 per cent to more than 90 per cent) as time went on (Ueda, 2020). Let us hope the same will not be true here.

Better news in the summer months may be enough to counter depression in the majority of individuals. But for those suffering the all-encompassing darkness of hopeless despair, even good news is unlikely to resolve the problem, given the continuing media narrative of potential threats from new variants and so on.

In any case, once it has set in, true despair can be hard for the individual to overcome, even at the best of times.

Urgent support

Those suffering despair need urgent support. In adolescents, early intervention may prevent suicide or substance abuse. Equally importantly, there is emerging research which suggests that identifying issues in children in primary school and intervening can have long-lasting effects in reducing despair and “deaths of despair” through subsequent adolescence and adult life (Godwin, 2020).

The first step in supporting the despairing is to identify them. But alas, identifying despair in the young can be difficult. There are as yet no clear universally agreed diagnostic criteria.

Finding effective ways to identify hopelessness and despair in the young is an urgent task (Shrank et al, 2008). All we can do for now is draw on common sense, and such insights as may come from research.

Behavioural cues of despair

Occasionally, a child or teenager will spontaneously make some comment that leads us to suspect despair. More often, the first cues are likely to come from the individual’s behaviour.

But what to look for? Unfortunately, there is as yet very little relevant research here. What we have is almost entirely based studies with animals, and mostly with mice. Such research tends to use the controversial “forced swim behavioural despair test” (Portsolt et al, 1977) in which mice were placed in water in a container from which they cannot escape.

The focus of such research is generally on testing anti-depressant drugs: will such drugs reduce the animal’s depression and hence despair?

Researchers have concluded that (at least in the case of some drugs) they do: mice on certain antidepressants continue to struggle to escape the container, while those who were not given the drugs are more likely to give up.

The suggestion is that it is giving up that is the behavioural marker for hopeless despair. Although this animal research is controversial at many levels, not least ethically, the conclusion makes an intuitive sense.

Some individuals facing severe frustrations will be angry with the world, “acting out”, (as, for example, in the case of a teenage girl who smashed up the family china, or the young child who deliberately broke his favourite toys, both apparently – by parental report – in frustration over the restrictions of lockdown).

Such behaviour may be difficult to manage, but is probably less worrying than a more passive response. The angry are still engaged, still trying. It is plausible to suggest that it is the individuals who become profoundly withdrawn and apathetic, who abandon activities that they had previously enjoyed, who stop engaging with peers or school – in sum who give up trying – who we should worry about the most.

These are certainly manifestations of severe depression, and possibly despair. Such withdrawal always needs investigation, particularly where it is persistent, or escalating. Anyone may become withdrawn for a while, after some problem or disappointment, but where a child is resilient and has hope, such reactions are likely to be self-limiting and relatively brief. More persistent and profound withdrawal may well indicate hopelessness and despair. If you observe such withdrawal, it is worth trying to talk to the individual.

Talking about feelings

Despair is an emotional reaction, not a state of the world, though this is not always apparent to the sufferer. One individual faced with a particular challenge may cope resiliently where another in the same situation succumbs to hopelessness and despair.

A key element in assessing despair is to explore the individual’s outlook. Providing a safe, non-judgemental context and a sympathetic ear, encouraging the individual to talk about their feelings, is a good first step. Not every depressed or despairing individual will be willing – or able – to discuss their feelings, and in that case, where there is profound withdrawal, the best may be to try to get immediate professional help. Even where there is a willingness to talk, such conversations require delicacy and finesse.

Asking directly about despair is unlikely to be useful. Despair is not a familiar concept for the young, who are unlikely to conceptualise their feelings in those terms. Even adolescents may not be able to identify and articulate despair as such, or to answer a direct question about despair.

With individuals of any age, it may be more productive to first ask more general questions about how the individual is feeling, and to listen for comments indicating depression and stress. How deep is that depression? How bad is the stress?

Where you suspect that there may be real despair, it may be useful to ask about hopes: what hopes does the individual have for the immediate future, or for the longer-term? Difficulty in offering any answer to such questions may be a clue suggesting hopeless despair. Equally, answers that indicate only impossible hopes may also indicate hopelessness – particularly where the individual recognises or fears that his or her hopes are forlorn.

Responding to despair

If a child or teenager can talk about feelings, you may have a way in to help. The crucial thing is to respect whatever feelings a child or teenager expresses: do not be too hasty in offering suggestions countering or dismissing the individual’s feelings, or trying to fix the problem, however tempting that may be.

As the Samaritans train their volunteers, offering someone in despair glib solutions (and if one is in despair, all solutions can easily seem glib) is undermining. It all too easily makes the sufferer feel that he or she is not understood, or not being taken seriously.

What is needed first in such conversations, before exploring practical solutions, is to offer a warm, non-judgemental sympathy for the woe. Sometimes such sympathy can be enough to take the edge off despair, though that effect is likely to be temporary. More support, emotional and practical, is almost certainly going to be necessary.

Supporting the despairing

Every child or teenager whose behaviour, or whose comments express feelings suggestive of despair, needs support, and in an ideal world, expert intervention. Alas, despite the intrinsically noxious, damaging and potentially lethal effects of despair, the mental health services are presently too stretched to provide support for all who need it.

As is the case with many emotional and mental health problems, the burden of providing “front-line” support for individuals in despair will fall on schools. But how are we to offer effective support to the young?

Ideally, every school should have a team of staff with whom such challenges can be discussed and shared. Many do, and that is obviously the first port of call. Depending on the family, it may also be useful to involve the parents, though that may need careful judgement as sometimes it may be counter-productive.

But what should we be aiming to offer, in supporting those in despair? Ultimately, what the hopeless need most is, obviously, to find hope again. There is no short answer to how that can be achieved – possible ways of rebuilding hope will be explored in the next articles in this series.

• Dr Stephanie Thornton is a chartered psychologist, author and lecturer in psychology and child development. She is the co-author of Understanding Developmental Psychology (Macmillan International/Red Globe, 2021). The second article in this series is due out next week. To read all her articles in SecEd including in this series, go to http://bit.ly/seced-thornton

Further information & references

• Case & Deaton: Mortality and morbidity in the 21st century, Brookings Papers on Economic Activity (1), 2017.
• Copeland et al: Associations of despair with suicidality and substance misuse among young adults, June 2020: https://bit.ly/3bHav70
• Godwin: The fast track intervention’s impact on behaviors of despair in adolescents and young adulthood, PNAS, December 2020: https://bit.ly/3wre60O
• John: Trends in suicide during the Covid-19 pandemic, BMJ ( 371), November 2020: https://bit.ly/3oA3j1X
• Mulligan: Deaths of despair and the incidence of excess mortality in 2020, NBER working paper 28303, 2020.
• ONS: Coronavirus and depression in adults, Great Britain, May 2021: https://bit.ly/3fzaWSb
• Porsolt et al: Behavioural despair in mice: A preliminary screening test for antidepressants, Archives Internationales de Pharmacodynamie et Thérapie (229), 1977.
• Shanahan et al: Does despair really kill? A roadmap for an evidence-based answer. American Journal of Public Health (109), 2019
• Schrank et al: Hope in psychiatry: A review of the literature, Acta Psychiatrica Scandinavia (118), 2008.
• Ueda et al: Suicide and mental health during the Covid-19 pandemic in Japan, December 2020: https://bit.ly/3yorDbD
• Weishaar & Beck: Hopelessness and suicide, International Review of Psychiatry (4), 2009.