Depression from Bullying: A Pediatrician’s Perspective

Written By Michael G Madanat, MD, MBA, MS, FAAP

Dr. Madanat practices general pediatrics in San Dimas, CA and is the president of Foothill Pediatric and Adolescent Clinic. He completed his Bachelor’s Degree in Psychology at UC San Diego and his Master’s Degree in Physiology and Biophysics at Georgetown University in Washington, DC. He then went on to earn his MD and his MBA from Tufts University School of Medicine in Boston, MA. Dr. Madanat completed his internship and residency training in pediatrics at UCLA Medical Center. In addition to his role in his private practice, Dr. Madanat has served in multiple leadership capacities including Chairman of Pediatrics at Foothill Presbyterian Hospital, Pediatric Subject Matter Expert for the new Martin Luther King Hospital, and founding Board Member for Heal, a start-up physician-on-demand company. He is currently a Pod Lead for HealthCare Partners Medical Group, a Physician Coach for Citrus Valley Health Partners, and serves on the National Speaker Panel for Mead Johnson. Outside of his professional life, Dr. Madanat enjoys spending most of his time with his wife and two young sons.

We live in a beautiful world, but beneath this beauty lurks cruelty and sin. A recent patient encounter reminded me of this. As a pediatrician I am honored to have the opportunity to help my adolescent patients manage and cope with crisis. At the same time, I have the misfortune of seeing the world’s cruelty through their eyes.

A 15 year old male presents to my office for his annual wellness exam. He is accompanied by his mother, Lucy. She is tearful. He does not make eye contact with me as I greet him. His name is Matt and I have known him for many years. I previously saw him last year for his routine physical. He seems different now.

Matt appears less well groomed than usual. He has gained weight. He appears withdrawn. I quickly recognize the situation and I respectfully ask his mother to leave us alone to speak. I learn that he nearly failed 9th grade. In years past, he had always been a stellar student. He no longer plays soccer. He was once considered one of the finest defensive midfielders in his league. Matt spends most of his time alone now.

I bluntly ask him if he is getting high on any substances. He denies this. I then ask him if he has had any inclination of self-harm. After a pause, he says “No”, but endorses that he questions the value of his life. He says that he feels worthless and that his future is hopeless. My heart hurts listening to him. I reflect on my own young boys and ponder how I can prevent them from becoming like Matt.

With Matt’s permission, I ask for his mother to join us. Matt accepts this proposal. I immediately ask how John, his father, is doing. Lucy tells me that he has not been around as much recently due to work-related travel and regular evening meetings. Matt’s older siblings are grown and have moved out of the home. I acknowledge that I sense her concern and I ask her how long Matt has felt this way. Lucy answers “two or three weeks.” Matt is initially quiet, then responds “four or five months.” His mother appears shocked. She has no clue. Dad has been unavailable. Matt then opens up about his experience in his first year of high school. Lucy and I learn that he
is being bullied – daily! The harassment started during orientation and has persisted. He has not been physically harmed, but the intimidation is always there. A familiar story unfolds – a group of older kids picking on a kid for being “different.” To make matters worse, Matt has not sought help from anybody until today.

This story conveys one of the most serious problems amongst adolescents. Bullying is virtually ubiquitous in middle schools and high schools. While it is well known that school bullying is associated with depression and suicidality among adolescents, the risk has been seemingly compounded by the digital age. With social media, the bullying follows our children home and pervades their life. Matt was a victim of bullying and was certainly starting to show classic signs of depression.

While physicians should routinely screen their adolescent patients for depression, the onus is on us as parents to detect problems and to initiate the evaluation. Parents should be vigilant for rapid changes in their adolescent’s appearance, interests, academic performance, friends and acquaintances, diet and behavior. The treatment ultimately involves close collaboration with the physician, the parents, the school, and sometimes the whole community.

So, how do we as parents intervene both to prevent bullying and to manage the consequences? At every phase of the crisis that Lucy, John and Matt face together, the following are some parenting fundamentals that I believe address both sides. Please feel free to rank these according to your discretion.

1. Be loving, teach loving. It is never cliche or cheesy to openly express your love for your
   children. Nor is there anything wrong with teaching your children that kindness to others
   is love. Beyond words, we, as parents, can show love by routinely asking our children
   how they are doing and being prepared to listen empathetically. Often, adolescents just
   want to vent. We want them to approach us when there is a problem outside of the
   home. Being loving also means being prepared to set your son or daughter in the right
   direction if they are wrong, even if you believe they will not be receptive to your
   feedback. A little tough love can go a long way. They know deep inside that you always
   have their back.
2. Be present with your children. On the surface this certainly means physically spending
   time together. I always encourage my patients to have at least one meal together as a
   family every day and to take at least one vacation together every year. Obviously, as in
   John’s case, professional obligations can occasionally interfere with this plan. But, make
   the commitment whenever you can. Studies show that families that spend time together
   in this way have significantly better future quality of life outcomes for their children than
   those who do not (better academic success, better jobs, less mood disorders, less
   trouble with the law, etc.). Spending time together provides a forum for communication,
   which is essential to identify potential problems in the first place. Being present,
   however, also means being mindful of each other – not just being physically there, but
   also mentally. It is not just about being together, but about having meaningful time
   together.
3. Instill faith. I believe that this is an important point, especially considering the target
   audience of this article. Do not be afraid to remind them that God is looking down on
   them and that they can connect to Him through prayer. Have you ever heard the quote,
   “worry about nothing, pray about everything.” Often adolescents need this reminder.
   Faith will help realign them. It will help them value themselves. It will help create
   resilience. Bullying may seem overwhelming, but they should feel confident that they are
   thoroughly supported and can persevere through adversity.
4. Instill optimism. Much of this comes through faith. But, remember that adolescents may
   feel the way they do because they lose perspective on what they should value most in
   their life. Problems are minimized and perceived happiness is maximized via the lens
   that social media provides. Address their hopelessness by reminding them that
   everybody faces challenges in their life. And every problem is an opportunity to discover
   a unique solution.
5. Be thankful. Not just when times are good, but when times are not so good. Few things
   will boost an adolescent boy or girl’s self-esteem more than having them feel valued and
   appreciated. An attitude of gratitude can be contagious in a household and can result in
   good vibrations for all.
6. Know your child’s life outside of the home. Know their friends, even their friends’ parents.
   Establish good relationships with their teachers.
7. Limit/monitor screen time, including smart phone use. Whenever possible encourage
   participation in activities that teach teamwork, sportsmanship and help build self-esteem.

We obtained help for Matt. We spoke to his school principal. We connected him with a counselor and a therapist. We set up a meeting with the bullies’ parents. We even hard wired family dinners whenever John was at home and planned a weekend getaway for his whole family. I followed up with Matt three months later and I was relieved to see his improvement. He physically looked better, projected a healthier attitude, and had a more positive outlook. John came with Lucy to this office visit. Through a team-based approach, we averted disaster. Perhaps some kids are not so lucky. I know many of you have heard the stories about young teens taking their own lives due to the effects of psychosocial stress, particularly cyber-bullying. Matt was fortunate to have great resources and positive forces all around him. He and his family just needed direction. Through early identification and management we brought back the beauty to his life. I hope we as a community can keep Matt’s story in mind as we collectively seek the best for the younger generations.

Disclosure: While John, Lucy and Matt represent real life characters, their names and the exact details of the events have been modified to protect patient privacy.

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