When a parent is depressed: what children need

“Mummy, are you angry with me?”

An eight-year-old girl stands at the bedroom door. It is four in the afternoon, the curtains are drawn, and her mother is lying with her face to the wall. She is not angry. She has not been well for three weeks now, but she has no words for it even for herself, let alone for a child. So she says: “No, I’m just tired.” The girl nods, goes into the kitchen and spreads herself a slice of bread. The next day she tidies her room without anyone asking. And the day after that. Somewhere inside she has decided that if she is good enough, she may see her mother smile again.

This scene is composite, but many families know it in one version or another. Depression is not an illness that stays behind the bedroom door. It breathes through the whole house. And children, even very young ones, sense it long before they could give it a name.

This piece is for parents who are struggling with depression and worry about what it means for their children. It is also for the other parent, for grandparents, for everyone who stands alongside such a family. I will not write about what parents are doing wrong. I will write about what children need — and how you can give them that even when your own strength is running out.

What a child sees when a parent cannot get up

Children do not see depression. They see its consequences: a parent who does not get up, who no longer laughs at their jokes, who gets angry over small things, who does not come to the school performance. They see the silence at dinner and the tension between their parents. And because they are given no explanation, they make one up themselves.

That explanation is almost always the same: it’s my fault. Young children think as though the world is arranged around them. If Mum is sad, it is because I was naughty. If Dad is angry, I made him angry. In a sense these thoughts are even easier for a child than the truth — because if it is my fault, I can do something. I can try harder, be better behaved, quieter, more useful. The truth, that the parent is ill and the child cannot fix it, is far more frightening.

That is why children in such families often become very good, very quiet or very loud. Each of these is an attempt to set something right in a system they do not understand.

What the research shows

Research on the children of depressed parents goes back decades, and its findings need to be read carefully — because they matter, but they are easy to misunderstand.

Myrna Weissman and colleagues followed families for more than twenty years. Over that time, the children of parents with depression had roughly three times the risk of depression and anxiety disorders compared with the children of parents without it. A large meta-analysis by Sherryl Goodman and colleagues in 2011, which brought together almost two hundred studies, confirmed the link between maternal depression and difficulties in children — both those that turn inwards (sadness, anxiety) and those that turn outwards (behavioural problems). The link was consistent, but on average small.

That very word — small — is important. A higher risk does not mean the child will become ill. It means the child is more vulnerable. Most children of depressed parents do not develop depression in childhood. And research has shown fairly precisely what sets apart those who stay well.

Not destiny: what protects children

Perhaps the most encouraging finding comes from a study that followed mothers being treated for depression, together with their children. When the mother’s depression eased, the children’s difficulties also decreased over the following months. In mothers who did not recover, this did not happen. In other words: one of the best things you can do for your child is to look after yourself. That is not selfishness. It is caring for your child by a roundabout route.

Beyond that, a few protective factors keep recurring in the research:

• Understanding. Children who understand that their parent is ill and that it is not their fault cope better. Understanding in itself reduces anxiety.
• A relationship with at least one steady adult. The other parent, grandparents, an aunt, a teacher, a coach. Someone with whom the child can simply be a child.
• A life outside the home. Friends, sport, music, school — places where the child’s life does not revolve around the parent’s illness.
• The relationship between the parents. When the parents stay connected and support each other, children bear one parent’s depression more easily.

Interestingly, children do not need their parent to be cheerful all the time. Above all, they need the world to be predictable and their experience to be acknowledged. “I can see you’ve noticed I’ve been different lately” is worth more to a child than a forced smile.

How to tell a child what is happening

Many parents are afraid that the word “depression” would burden their child. Experience and research suggest the opposite: it is the silence that burdens them. The child already knows something is wrong. They just do not know what.

The explanation needs to fit the child’s age. A few guidelines:

• Pre-school children need a very simple, concrete explanation: “Mummy is ill. This illness makes her very tired and sad. It’s not because of you. The doctor is helping her.” And then, above all, routine and someone who is available.
• School-age children can understand that depression is an illness that affects how a person feels and what they can manage. They often have concrete questions: Will he die? Will I get ill too? Is it my fault? It is good to answer these questions honestly and calmly.
• Teenagers can hear more, including how depression is treated and that a vulnerability to it can sometimes run in families. It is important not to turn them into confidants or therapists. They can know — but they must not carry it.

At every age: say that it is not the child’s fault, that they cannot fix it and that it is not their job to look after the parent. And say who is looking after things. A child needs to know that someone is caring for the parent — that the adults have taken on that task.

A family conversation, Beardslee’s way

In the 1990s the American child psychiatrist William Beardslee developed an approach known today as Family Talk. It grew out of a simple observation: the children of depressed parents who were doing well had in common that they understood what was happening to their parent, and that they understood they were not to blame.

The approach is not therapy for the child but a guided family meeting. The professional first meets with the parents, then with the children separately, and then helps the parents prepare and lead a conversation with the children. In the study by Beardslee and colleagues, families who went through the programme reported a better understanding of the illness and more open conversation at home. The effects were still visible several years later.

In Slovenia this programme is not widely available as such, but any family therapist can use its principles — and in many respects parents can use them on their own too.

When a child becomes a parent to their parent

The girl from the opening, who spreads her own bread and tidies without a word, is on a path that has a name in family therapy: parentification. It means a child takes on a role that belongs to an adult — caring for younger siblings, for the household or, harder still, for the parent’s emotional state.

Some responsibility is good for a child. A child who helps with tidying or sometimes looks after a younger brother is learning to cooperate. The problem arises when the responsibility is too great, lasts too long and nobody sees or acknowledges it. When the child feels that whether the parent gets through the day depends on them. When they become Mum’s confidant, Dad’s comforter or the go-between for their parents.

Research links long-lasting emotional parentification with greater vulnerability in adulthood — with depression, anxiety and relationship difficulties. Adults who were such children often do not know how to ask for help, feel responsible for the wellbeing of everyone around them and find it hard to believe they are worthy of love without being useful. I wrote about the roles children take on in burdened families in Roles in the family: the hero, the scapegoat, the invisible child. Which was yours?

The dialogue below is composite, not a real person:

“How is it for you when Mum doesn’t get up?”
“It’s fine. I make breakfast for my brother and take him to nursery.”
“How old are you?”
“Eleven.”
“That’s a lot for an eleven-year-old.”
He shrugs. “Someone has to.”
“And who looks after you?”
A long silence. “I don’t know. I don’t need it.”

That “I don’t need it” is a sentence I often hear twenty years later from adults. That is why it matters so much that the adults in a child’s life notice when the child is carrying too much — and take the load back.

Exercise: preparing to talk with your child

If you are a parent with depression — or the partner of someone who has it — and you have not yet talked about it with your child, this exercise can help you prepare. It is best done together with the other parent.

1. Write down what you think your child has noticed. Not what you know, but what they have seen: “That I lie down a lot. That I cried at dinner the other day.”
2. Write down what they may have explained to themselves. Most often: that it is their fault, that the parent is angry with them, that something terrible is going to happen.
3. Write three short sentences that answer these explanations, in language the child understands. For example: “I have an illness called depression. It’s not because of you. I go to a doctor who is helping me.”
4. Add a sentence about who is looking after things — after you and after them: “Dad and Granny will be with you more for a while. You can still play with your friends.”
5. Choose a calm moment and tell them. Then invite questions — and accept it if there are none. Children often come back with questions a few days later, once they have thought things over.

The conversation will not be perfect. It does not have to be. Your child will not remember every word, but they will remember that they were allowed to know and that they did not have to be afraid to ask.

The other parent and the family around

When one parent is depressed, the other often carries a double load: caring for their partner, the children, the household and work, while having nobody to care for them. This parent is enormously important for the children — they are exactly the steady adult the research talks about. But they have limits too.

I wrote about what depression does to the relationship between partners in Depression in a relationship: what happens to the couple, and what you can do, and about how to stand by someone without wearing yourself out in How to support someone with depression without burning yourself out. Here I would only add: the other parent must not become the only pillar. Help from grandparents, friends and professionals is not a sign that you cannot cope — it is a way of giving the children a safe environment.

The other parent can also make sure the three messages I described above reach the children. Sometimes it is even easier if they start the conversation — or if both parents lead it together.

Without blame: a depressed parent is not a bad parent

Parents with depression often carry an enormous amount of guilt. When they read about the risks for children, they feel even worse. “I’m ruining them.” “They don’t deserve a mother like me.” “They’d be better off without me.”

I want to be clear: depression is an illness, not a flaw of character. A parent with depression is not a bad parent, just as a parent with diabetes is not a bad parent. What harms children is not that the parent is ill, but that nobody talks about it, that the children are left alone with their own explanations and that the illness goes untreated. All of that can be changed.

If the thought that your children would be better off without you will not leave you, that is a sign of depression, not the truth. Such thoughts are a reason to seek help straight away. In Slovenia, call the crisis line Klic v duševni stiski on 01 520 99 00 (every day from 7 pm to 7 am) or the Samaritans helpline (Zaupni telefon Samarijan) on 116 123 (24 hours a day), and in an emergency, 112. Children and young people in Slovenia who are worried about a parent can call the TOM helpline on 116 111.

I have described which forms of psychotherapy help with depression in Which psychotherapy helps with depression. For your children, your treatment is one of the most important things you can do.

Where this does not apply

A few things that are only fair to say.

Talking is not enough when a child already has difficulties. If a child has been sleeping badly for a long time, is withdrawing, struggling at school, talking about being worthless or self-harming, they need help of their own — from a paediatrician, the school counselling service or a child psychologist. I have described how to tell depression apart from ordinary mood swings in older children in Teenage depression: telling it apart from ordinary mood swings.

Safety comes before everything else. When a parent’s illness is so severe that the child is not safe — because of neglect, violence, substance misuse or suicidal behaviour — it is no longer just about a conversation, but about protection. Then social services or other help need to be involved. That is not a betrayal of the parent. It is care for the child.

The research is mostly about mothers. We know less about fathers with depression, although the link appears to be similar. Most of the research also comes from other cultural settings. The figures do not tell you what will happen to your own child.

Not every difficulty a child has is a result of a parent’s depression. Children have their own temperaments, their own experiences and their own struggles. If we put everything down to the parent’s illness, we may miss what is really happening to the child — and burden the parent with guilt that is not theirs.

What to remember

• The children of depressed parents are more vulnerable, but most do not become ill. Risk is not destiny.
• Children explain silence to themselves — most often by deciding they are to blame. An honest, age-appropriate explanation lifts that weight.
• Three messages: your parent is ill and getting treatment; it is not your fault; you may live your own life.
• Watch out for parentification — a child can help, but must not carry the parent’s load.
• A parent’s treatment is one of the best things you can do for a child. A depressed parent is not a bad parent.