Which are the main obstacles in the recognition and treatment of childhood depression and prevention of suicide in Hungary?
Sándor Kalmár, M.D., Ph.D.
According to the different assessments, the prevalence of the child and youths depression (below 19 year) are about 18-20%, namely about 385 928 children in Hungary. (2015) It is to be regretted that we do not have exact epidemiological data about the children depression. Number of registered patients by mood disorders at child and youth were 487 in the Child psychiatric dispensaries (2015). This is only 0.025% of the children under 19 year, and 0.13% of the affective disorders. The number of children below 19 year was 1 929 641 in Hungary. The number of suicides is high in Hungary.
Table 1. Number of suicides and number of suicide per 100 000 by gender. Hungary. 1980, 1990, 2000, 2005, 2010, 2015.
|Year||Number of suicides||Number of suicides per 100 000|
Table 2. Number of suicides per 100 000 people. Hungary. 2015.
Male: 29.6; female: 9.3; total: 19.0
Table 3. Number of suicides per 100 000 by age-groups. Hungary.1980, 1990, 2000, 2005, 2010, 2015.
Although the 64% of all suicides were older than 50 years, the number of 15-24 and 25-34 years old suicide people is also high.
Table 4. Average of the suicides (%) above 50 years old victims. Hungary.
Table 5. Number of suicides compared to mortality. 15-24 year old people (%) Hungary. 2000-2015.
Table 6. Number of suicides compared to mortality. 25-34 year old people (%) Hungary. 2000-2015.
In Kecskemét town the number of suicides per 100 000 are higher than in the country.
Table 7. Number of suicides and suicide rates by gender, Kecskemét town. 2000, 2005, 2010-2016.
There are several obstacles in the recognition, treatment and prevention of child-depression that causes a serious public health problem. 75% of the first manifestation of the psychiatric disorders manifest at the age of adolescence and young adult. Several deficiencies make the children growing healthy adults difficult in spite of the facts codified in laws.
The main contradictions, deficiency and obstacles:
- Insufficient responsibility of the institutions, and people dealing with society and children. Disinterest among the competent authorities.
- High incidence of Mental, Affective Disorders and suicide among adolescents and youths. (24.8% of the children and youths are suffering from mental and behavior disorders that need psychiatric treatment according to Professor Ágnes Vetró, Szeged.)
- The somatic, mental, cultural and spiritual ignorance/illiteracy occurrence among parents, teachers, health care workers, even the population formed due to the misses of the pedagogical society.
- The lack of the holistic approach of the children suffering from mental disorder or disease and their treatment. A lot of psychiatrists and psychologists – who are neither physician nor philosopher but someone who is trained in psychology and important and useful helper of every psychiatrist – consider themselves experts on the human mind, intellect and behavior, unfortunately do not possess with that knowledge that discover in the past decades about the connection between the central nervous system and the mind. The most of the General Practitioners and the General Pediatricians who should provide the basic health care services among the population do not possesses the required neuro-psychiatric and psychiatric knowledge and do not carry out mental prevention.
- The lack of remedy based on evidences of the supply of children and adolescent psychiatry whose basic condition is comprehension and accepting the relationship between the organic brain lesions and the mental functions.
- The most of the General Practitioners and the General Pediatricians who should provide the basic health care services among the population do not possesses the required neuro-psychiatric and psychiatric knowledge and do not carry out mental prevention.
- The lack of the inpatient and outpatient children and adolescent psychiatry services in the whole country. The role of the children and adolescent psychiatry has been appreciated, which is only formal, deficient today and cannot assure the optimal children’s mental supply according to the principles of remedy based on evidences. The low number of Child and Youth psychiatrists, the Child and Youth Dispensaries are also a serious problem in Hungary. The 24 Child-psychiatric Dispensaries are not able to provide optimal provision for every child who is suffering from Mental Disorders. There are not any Child Psychiatry Dispensaries in two counties. (Komárom-Esztergom county: 58 480 children 19>, & Bosod-Abauj-Zemplén county: 129 666 children 19>)
Table 8. Patients cared for in psychiatric institutions for children and juveniles
|No of patients||141 282||196 808||100 047||85 677||100 109|
|cared patients||77 591||126 181||40 000||48 345||51 988|
|Registered patients in care – boys||10 380||10 858||9 212||6 724||7 743|
|Registered patients in care girls||7 668||7 338||4 746||3 943||5 475|
|Registered patients in care total||18 048||18 196||13 958||10 667||13 218|
|new patients taken in care||9 585||8 916||4 434||3 968||3 952|
The number of Dispensaries between 2000 and 2015 decreased 38%; the number of patients decreased 29.0%; the number of cared patients decreased 33.0%; the number of new patients taken in care decreased 59.0%. The 3 952 new patients taken in care is only 0.2% of the children 19>.
- The lack of paradigm shift in the children psychiatry.
- Insufficient, complicated and difficult children-psychiatry examination.
- Lack of Children and Youths Psychiatry Textbooks and Handbooks. The last Hungarian ”Child and Youths Psychiatric Handbook” was published in Szeged, in 1996 by the ”Szent Györgyi Albert Medical University”. (Vetró Ágnes, William LI. Parry-Jones: Gyermek és Ifjúságpszichiátria. Handbook for university students and candidate for child-psychiatrists)
- The almost complete lack of the permanent and systematic health education, mental prevention. The Hungarian educational system is in crisis and cannot ensure that all children go on to become healthy adults and develop with them the characteristics necessary for the healthy personality. Serious problem is the lack of mental health education, with the essential consistent eternal values. A pivotal question of the mental aspect of teacher’s profession is (1) life orientation, (2) value orientation and (3) an expectable value system. Investigating value selection among teachers we find poor results. About 75% of teachers agree that sense of responsibility and sincerity are the most important, but for many teachers these are just words. Half of them consider tolerance, good manners and politeness important, but there are, many intolerant teachers! More 50% of the teachers do not consider independence, autonomy, self-control, steadiness, persistent effort & imagination important values. Only 20% of the teachers consider selflessness, religious faith, sparing, patience, good behavior & loyalty important values, while they don’t consider leadership skills & obedience values at all. Transgression of norms and the lack of respect for rules contribute to considerable chaos, divide the pedagogue society and create a huge gap between the teachers and the parents. In this case the protective role of good schools would be significant. (Paksi, Schmidt, 2006)
The following educational activities are pushed to the background in schools
- developing emotional processing skills of students
- helping students to cope with current biological-psychological- and social crises
- improving conflict solving skills
- increasing frustration tolerance
- teaching positive problem orientation to students
- improving communication skills
- improving decision making skills
- shaping the future perspective of students
- improving mental-cultural and spiritual level
- transferring of elementary cultural techniques to students
- The ignorance of the possible and achievable opportunities.
The prevention and treatment of child-depression and prevention of suicides are unimaginable without (1) the better knowledge and understand of central nervous system, (2) adequate, exact psychopathologic symptom list (3) a new, evidence based diagnostic system, (4) well-trained primary health care General Practitioners and the General Pediatricians (5) complete Child and Youth Dispensaries-network which based on the Evidence Based Medicine and (6) paramount mental health education with the essential consistent eternal values in every school.
Overcoming the barrier of children psychiatry can only be improved by the competent authorities, a coordinated action of dedicated child- psychiatrists, child-psychologists, clever parents, well-trained general practitioners and pediatricians, district nurses, excellent teachers and other committed key persons.
- Kalmár S. (2016) Unmet needs in the recognition and treatment of childhood Depression (Neuropsychopharmacol Hung 2016; 18(3): 147–161)
- Kalmár S. Major obstacles in the development of child and adolescent psychiatry in Hungary (Neuropsychopharmacol Hung 2016; 18(2): 093–109)
- Kalmár S. (2017) Necessity of paradigma-shift in psychiatry. http://www.internetandpsychiatry.com
- Kalmár S. A nevelés szerepe az egészséges magatartás kialakításában és az önpusztító magatartás megelőzésében. Medicina Könyvkiadó, 2017.
- Statistical Yearbook of Hungary. 2015. Hungarian Central Statistical Office. 2016.
- Yearbook of Health Statistics. Hungary. 2015. Hungarian Central Statistical Office. 2016.