RISING RATES OF DEPRESSION AMONG TEENAGERS AND ITS CONTRIBUTING FACTORS

By: MEHRUN NISA

OBJECTIVE 

To determine the prevalence, risk factors, and risk behaviors associated with depressive symptoms in a nationally representative, cross-sectional sample of young adolescents. 

INTRODUCTION 

Depression is the most significant mental health problem of adolescence (Whiting, 1981; Petersen et al., 1993; Hamrin and Pachler, 2005; Dopheide, 2006;). The prevalence of depression in this period is reported to vary from 5% to 20% (Lewinsohn et al., 2000; Mel-nyk et al., 2003; Saluja et al., 2004). In contrast to its rare prevalence in childhood, the prevalence of depression rises markedly in adolescence. While the prevalence of depression is lower than 3% in childhood, this rate reaches 14% in adolescence (Lewinsohn et al., 1998). Adolescent depression brings about similar consequences as adult depression. Depression both causes disability and constitutes a risk factor for suicidal behaviors in adolescents (Gröholt et al., 2000; Sourander et al., 2001; Liu and Tein, 2005; Eskin et al., 2007). Depression during adolescence is associated with numerous negative psychosocial consequences. Depression seriously interferes with effective functioning. Because of their suffering and impairment, depressed adolescents require help especially during, but also before and after the episode. In terms of life phases, there is a difference between genders. While there seems to be no difference between girls and boys in terms of depression before adolescence (Garber and Horowitz, 2002), in adolescence however, depression becomes more prevalent among girls than boys (Nolen-Hoeksema and Girgus, 1994). As expected, the present study found that the proportion of females with CDI scores indicative of depression was higher than that of males and that the mean CDI score of the females was significantly higher. Differences between genders observed in the present study are in agreement with previous findings (Lewinsohn and Essau, 2002; Nolen-Hoeksema, 2002). Depression is associated with an increased risk of suicide. Those who experience depression at an early age often struggle with depression throughout their lives, and in many cases, early onset of depression predicts more severe depression during adulthood. Depression is associated with poor health behaviors and social challenges. In addition to an increased risk of suicide, youths who are depressed are at a higher risk for mental disorders such as anxiety, conduct disorders, and substance abuse. They are also more likely than other youths to engage in unsafe sexual practices and other risky behaviors. Further, youths who are depressed tend to experience difficulty relating to peers and are more likely than others to be involved in physical fights with peers. The difficulties they face in their peer relationships and their tendency toward violent behavior are not well understood; however, there is some overlap between the issues faced by youths who are depressed and those faced by youths involved in aggressive behaviors such as bullying. 

PREVALENCE AND CAUSES 

One of the most distinctive features of adolescence is 

the rise in the significance of peers (Muus, 1982). The level of support an adolescent perceives from his/her relationships with friends may affect whether he/she will suffer from depression. The results of the present study support this idea. For both male and female participants, low levels of perceived social support from peers were related to high

depression scores. This finding is similar to the results of previous studies, which suggest that problems in peer relationships constitute a risk factor for adolescent depression (Prinstein et al., 2005; Afifi et al., 2006; Allen et al., 2006). Even though peers gain significance during adolescence, the family also remains important (Muus, 1982). Family is still the fundamental source of confidence in this period; therefore, qualitative characteristics of family relationships are expected to affect the psychological state of adolescents. The findings of the present study confirm this view. We found that low levels of perceived social support from family were predictive of depression, which is in agreement with Meadows et al. 's (2006) report on the significance of parental social support to the mental health of both male and female adolescents. 

Per the related literature (Lewinsohn et al., 1997; Guillon et al., 2003; Burwell and Shirk, 2006), low self-esteem was the strongest predictive factor for high depression scores. For both males and females, the self-esteem scores of those who scored above the CDI cut-off point were lower than those who scored below the cut-off point. For an adolescent in high school, academic success is of considerable importance. Academic failure is reported to affect adolescents in 2 ways (Undheim and Sund, 2005): First, failure has negative effects on the adolescent as it prevents him/her from attaining the personal developmental and educational objectives he/she has 

set for him/herself. Second, disappointment caused by failing to attain the standards that parents have set affects the adolescent negatively. In cases of failure, some teenagers create false report cards or even attempt suicide. In this context, we can predict that academic failure negatively affects student mental health. As was reported by Lewin-sohn et al. (1994) and Roeser et al. (1998), the findings of the present study also suggest that low GPA is related to high depression scores in adolescent males and females. Unipolar depressive disorder in adolescence is common worldwide but often unrecognized. The incidence, notably in girls, rises sharply after puberty, and, by the end of adolescence, the 1 year prevalence rate exceeds 4%. The burden is highest in low-income and middle-income countries. Depression is associated with substantial present and future morbidity and heightens suicide risk. The strongest risk factors for depression in adolescents are a family history of depression and exposure to psychosocial stress. Inherited risks, developmental factors, sex hormones, and psychosocial adversity interact to increase risk through hormonal factors and associated perturbed neural pathways. Although many similarities between depression in adolescence and depression in adulthood exist, in adolescents, the use of antidepressants is of concern, and opinions about clinical management are divided. 

TREATMENT 

While depression is highly treatable, low rates of recognition and diagnosis worsen the problem. Recognizing depression as early as possible could be a critical step to reducing the prevalence of depression among older individuals, managing depression more effectively, and preventing negative outcomes. Several important issues need further investigation to aid early diagnosis. Because most studies on adolescent depression have focused on high school students, the prevalence of depressive symptoms in younger adolescents (ie, middle school children) is not well established. Few studies have included middle school youths, and each has had methodological limitations, ranging from small sample sizes and the inability to study certain ethnic groups to varied indicators of depression. Thus, to recognize depression among youths as early as possible, further research is needed. Effective

treatments are available, but choices are dependent on depression severity and available resources. Prevention strategies targeted at high-risk groups are promoted. 

A) PSYCHOLOGICAL 

1. Individual approaches 

a) Cognitive behavioral psychotherapy 

This approach has come to be recognized as the most useful practical psychotherapy in depressed adults and is adaptable to many adolescents, although it does require quite a commitment and a basic level of understanding on the part of the patient. The focus is on systematically identifying, analyzing, and changing the maladaptive (negative) cognitions 

that so commonly underlie the depressed mood. The elements are: self-monitoring of mood, negative cognitions automatically triggered by external events and leading to low mood, then cognitive restructuring (working at substituting corrective. ie more balanced, cognitions). Weekly sessions with the therapist draw upon diary-keeping and homework tasks. b) Social skills training 

This is often best conducted in small groups of young people with similar problems and incorporates modeling (by therapists), role-play, performance feedback, and positive reinforcement of improvement. Again, homework tasks are often provided. c) Interpersonal psychotherapy 

This is a standardized approach focussing on relationships and life problems - in young people, these may include developmental tasks. There is a major disadvantage of a grave shortage of appropriately trained and experienced therapists using this approach. 2. Family work and family therapy 

Most young people remain involved with a family to some extent. It therefore makes sense to expect to involve the family in the treatment process in one way or another. It is acknowledged that this may not always be acceptable to either the young person or the family, and may need to be worked towards at a later stage in therapy rather than embarked upon immediately. 

B) DRUGS 

1. Tricyclic antidepressants 

The efficacy of these long-established antidepressant drugs in an adult population has been well-researched and estimated to be around 70% positive response. Equivalent studies in children/young people have been fraught with methodological differences, making them difficult to evaluate but a recent meta-analysis suggests a much less convincing response of no better than 40%. 

2. Monoamine oxidase inhibitors (antidepressants) 

This group of antidepressants seems to have a place in 

treating 'atypical' cases of depression in adults, i.e., where there is excessive anxiety, even phobic states, somatization, and a reverse pattern of diurnal variation. 

3. Lithium 

The use of lithium as a treatment (alongside major 

tranquilizers) in acute mania or as a preventative treatment for both depressive and manic episodes in bipolar disorder is well-established in adult patients and has a similar place in young people with this disorder. 

C) INPATIENT TREATMENT 

This may become necessary when the depression is 

particularly severe or resistant to outpatient management, or where there is a threat to physical safety, such as persistent suicidal ideation or self-harming behaviors, or damage to

health such as eating or drinking inadequately. Such a course of action may also be indicated where a supportive network is lacking or the family is not coping. 

CONCLUSION 

Adolescents and children constitute a section of the population whose mental health problems are studied relatively less than those of adults. In addition, treatment options for such problems are insufficient, both in quality and quantity. Studying the prevalence of mental health problems in adolescents and its associated factors is of vital importance for the planning and implementation of mental health services to be offered to this group. Depression is a substantial and largely unrecognized problem among young adolescents that warrants an increased need and opportunity for identification and intervention at the middle school level. Understanding differences in prevalence between males and females and among racial/ethnic groups may be important to the recognition and treatment of depression among youths. Depression is prevalent in high school students. Low self-esteem, low perceived social support from peers and family, and inefficient problem-solving skills appear to be risk factors for adolescent depression. Low GPA for boys and low paternal education for girls were gender-specific risk factors. Psychosocial interventions geared toward increasing self-esteem, social support, and problem-solving skills may be effective in the prevention and treatment of adolescent depression. 

REFERENCES 

Saluja, G., Iachan, R., Scheidt, P. C., Overpeck, M. D., Sun, W., & Giedd, J. N. (2004). Prevalence of and risk factors for depressive symptoms among young adolescents. Archives of Pediatrics & Adolescent Medicine, 158(8), 760-765. 

Thapar, A., Collishaw, S., Pine, D. S., & Thapar, A. K. (2012). Depression in adolescence. The Lancet, 379 (9820), 1056-1067. 

Eskin, M., Ertekin, K., Harlak, H., & Dereboy, C. (2008). Prevalence of and factors related to depression in high school students. Turkish Journal of Psychiatry, 19(4). Ainsworth, P., & Placzek, M. (2004). Treating depression in teenagers. Morecambe Bay Medical Journal, 4(9), 248-250.