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Article Excerpt
Adolescent depression is a serious disorder marked by a prevalence rate of approximately 5% along with significant rates of relapse and mortality (Brent & Birmaher, 2002). This qualitative study involved semistructured interviews of nine young adults who were diagnosed with and treated for major depressive disorder between the ages of 15 and 18. Five themes emerged from the interviews: (a) talking to a counselor about their depression was helpful; (b) participants obtained relief in their counseling and expressed respect for their professional helpers; (c) parental (and adult) partnerships are important; (d) friends of the adolescent clients were usually helpful to them; and (e) the adolescents possessed a realistic optimism concerning a possible subsequent depressive episode. Implications for mental health counselors are also discussed
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Concerns over adolescents' mental health, particularly related to depression, are becoming increasingly apparent. According to an Annenberg Public Policy Center survey ("School officials identify," 2004) of 1400 mental health professionals working in public high schools, depression and substance abuse issues were cited as the most serious challenges, receiving ratings even higher than various forms of violence. Over two-thirds of the responding professionals identified depression as either a great or moderate problem. Furthermore, only 34% of survey participants indicated that their school had a clear process for identifying students with mental health issues. Of those students in need of counseling, the majority of professionals expressed a belief that only half or fewer receive the needed mental health services.
Adolescent depression potentially affects youths' overall well-being, interpersonal relationships and academic performance, as well as family and support systems. More importantly, adolescent depression is often related to suicide, the third leading cause of death for those aged 15-24. In 2002, 1531 youth between the ages of 15 and 19 committed suicide (Centers for Disease Control and Prevention [CDC], 2005). According to the CDC Web site, "Adolescents and young adults often experience stress, confusion, and depression from situations occurring in their families, schools, and communities. Such feelings can overwhelm young people and lead them to consider suicide as a 'solution'" (CDC, n.d.). Mental health counselors working with adolescent students and clients are encouraged to have a strong knowledge base on this problem, as the rate of such depression and suicide "constitutes a crisis in our society" (Stanard, 2000, p. 10). Finally, Evans, Van Velsor, and Schumacher (2002) called adolescent depression "one of the most overlooked and undertreated psychological disorders" within this period of development (p. 211).
Brent and Birmaher (2002) described adolescent depression as "a chronic, recurrent, and serious illness associated with substantial morbidity and mortality," yet also as an "eminently treatable condition" with medication and specific types of therapy (p. 670). At any given time, about 5% of adolescents are depressed, and, without professional help, a major depressive episode lasts approximately eight months. Furthermore, the risk of recurrence is significant. Within two years, about 40% of individuals will have another major depressive episode. Within five years, this statistic increases to 72% (Brent & Birmaher).
Signs and symptoms of adolescent depression can be consistent with those found in adult depression. The Diagnostic and Statistical Manual of Mental Health Disorders (4th ed., text revised) (DSM-IV-TR) (American Psychiatric Association, 2000) does not differentiate between adolescent and adult depression; in both cases, five or more symptoms must be present during the same two-week period and mark a change from the level of previous functioning. Of the nine DSM-IV-TR symptoms, only one criterion specifically mentions adolescents: Under "depressed mood most of the day," a subsequent note indicates that this can appear as an irritable mood in the adolescent population.
Brent and Birmaher (2002) noted that depression in both children and adolescents is not always featured by sadness, but rather takes the form of irritability, boredom, and the inability to find pleasure. Symptoms of depression may also vary depending upon the stage of adolescence. Younger adolescents may show more anxiety-related symptoms--clinging behaviors, unexplained fears, and physical symptoms--while older adolescents may experience a greater loss of interest and pleasure and also have more morbid thinking (Mondimore, 2002). Lewinsohn, Rhode, and Seeley (1998) found that nearly 89% of depressed adolescents reported disturbances in sleep. Other symptoms that were frequently reported included a disturbance in weight/appetite (79.5%) and anhedonia (77.3%).
Though the signs of depression are fairly clear, identifying an adolescent with depression can be difficult. Though only using the word "child" in discussing child and adolescent depression, the National Institute of Mental Health (n.d.) noted that the challenge lies in determining whether the youth is experiencing a temporary phase or truly suffering from depression. Two factors can enter this determination, the first of which separates an adolescent who is dispirited from an adolescent who is demoralized. Being dispirited could surface from an adolescent's not being allowed to go to a movie or on a date, while demoralization could result from rejection from a romantic partner. In the case of demoralization, the adolescent could show signs of rising above the feelings and thoughts of rejection, though only momentarily and temporarily. The second point focuses on the time element, as the change in mood must be significant and last for weeks rather than days (Koplewicz, 2002a).
Though much research has been conducted on adolescent depression in the past two decades, a significant amount is still unknown. For instance, as Koplewicz (2002) indicated, "The truth is that while we know what works best for adults, we're still addressing that question for adolescents" (p. 7). Much of the existing research on adolescent depression has been quantitative in nature, though some qualitative studies have also been conducted either on or related to the topic in the past five years.
Among the qualitative explorations, three of them approximated the present study. Wisdom and Green (2004) sought to better understand the experiences of teens given a depressive diagnosis. Because they could not identify any previous qualitative work on teens' experience of depression, they initially conducted a focus group of seven 15-year-old youths as a way to formulate preliminary queries before interviewing 15 adolescents with diagnoses of depression. They found that adolescents reacted to their diagnosis in one of three manners: "Identity Infusers" accepted it as a part of their personality that could not be changed; "Labelers" utilized it as a label that benefited their attempts to recover; and "Medicalizers" took on a patient role consistent with the medical perspective of depression (pp. 1230, 1231). The process by which teens experienced depression was also similar to adults: a gradual increase in distress, a period of being in a "funk," and a time of examination as to whether they were truly depressed (p. 1227).
Second, Farmer (2002) conducted in-depth interviews of five teens diagnosed with depression and found eight themes, including a "dispirited weariness" characterized by continuous fatigue, distressing physical symptoms, a decrease in grades, and a "loss of academic self-esteem" (p. 572). "Unrelenting anger" represented another theme--the most frequently mentioned aspect of participants' experience--that was marked by "an incredibly strong and persistent experience" and described by Farmer as "constant, easily triggered, and explosive" (p. 576). It was also this anger that participants used to measure their depth of depression and led to impulsive behaviors with grave consequences....
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