When teens are exposed to overwhelming internal and external struggles with little or no coping skills, they can become withdrawn, isolated and seriously depressed. Teens are going through hormonal changes and puberty, social stressors and anxiety, school and work pressure, and parental pressures. A stressor is any change in the teens life that disrupts the balance of their life and causes them to make necessary adjustments.
Stress manifests as physical or mental tension as a result of stressors in the teens life and the more stressors the teen experiences, the greater the risk for depression and thoughts of suicide. Teens with absentee parent(s), financial stress, little coping mechanisms, abuse, no support person and self esteem issues can be overwhelmed and feel as though there is no hope. Depression can arise from low self esteem, body image problems, bullying, abuse, trauma, trouble with friends, having a sexual orientation that they feel is not understood, or the loss of a loved one.
Sadly, even in solid, stable families teen depression is a serious problem. Teen depression is very serious and is more than just feeling sad. When teens are depressed, they have intense feelings of sadness, anger and hopelessness that make it difficult to function, enjoy life or even just get through the day. An estimated 3.2 million adolescents aged 12 to 17 in the United States had at least one major depressive episode. This number represented 13.3% of the U.S. population aged 12 to 17. The prevalence of major depressive episode was higher among adolescent females (20.0%) compared to males (6.8%).The prevalence of major depressive episode was highest among adolescents reporting two or more races (16.9%). In 2017, an estimated 2.3 million adolescents aged 12 to 17 in the United States had at least one major depressive episode with severe impairment. This number represented 9.4% of the U.S. population aged 12 to 17. (The National Institute of Mental Health, 2019)
Suicide is the second leading cause of death in U.S. teens and studies have shown that approximately 90% of people of die of suicide deaths have a diagnosable and treatable mental illness. These statistics show that teen depression rates are growing, especially in girls. By the time teens reach adulthood, approximately 20% will have experienced depression. At a time when parents feel the biggest concern should be to get their teens to be less defiant, be more responsible or eat better, the idea of helping a teen with depressive disorder can feel overwhelming and daunting. Depression assessment strategies An Institute of Medicine report states that the first symptoms of depression or other mental health illnesses generally present two to four years before a complete onset of the disorder (National Research Council and Institute of Medicine, 2009). Only half of teens with depression are diagnosed and then only half of those teens received treatment. Early detection is imperative. Healthcare must do better in routinely screening all teens for depression.
The latest recommendation from the American Academy of Pediatrics is that all “adolescent patients ages12 years and older should be screened annually for depression (MDD or depressive disorders) with a formal self-report screening tool either on paper or electronically (universal screening).”(American Academy of Pediatrics, 2015). There are a number of self-report screening tools including: PHQ-9 modified for Adolescents (PHQ-A), Mood and Feelings Questionnaire, Columbia Depression Scale, Pediatric Symptom Checklist, and Screen for child and Anxiety Related Disorders (SCARED). Results of the screening should be shared with the teen and parents and they should be assured that the depression has biological bases, is not their fault and can be treated successfully.
In addition to yearly depression screening, the guideline addresses the need to establish treatment plans and safety plans for teens who are depressed. Teen depression is treatable, but it is extremely important that the teen gets help so that it does not lead to further issues, or possibly end in an attempt to take their life. Some risk factors to assess for include: family history of mental illness, family conflict, learning problems, problems with friends including bullying, low self esteem, poor coping skills, childhood trauma, sexual orientation that is viewed by themselves, society or family as unacceptable. Conditions such as substance abuse, eating disorders, sudden weight lose or weight gain or anxiety should also be assessed.
Screening should include changes in moods and behaviors such as becoming withdrawn, changes in sleep (trouble falling asleep/staying asleep or sleeping much more than usual), poor school performance and lost interest in activities. When teens exhibit one or all of these symptoms, there must be immediate intervention. Symptoms of depression can cause mood swings, anger outbursts, anxiety and, at times, a complete breakdown. With some exceptions, in most states, teens under 18 require a parent’s permission to receive treatment for depression.
A teen generally cannot get treatment for depression without their parents help and healthcare providers should always be up to date on their state laws on providing treatment for mental health concerns and substance use in minors with and without parental consent. It is difficult to treat an illness that cannot always be seen. The Practice Parameter for Treating Depression by the American Academy of Child and Adolescent Psychiatry (AACAP) acknowledges that families “may not wish to participate in psychotherapy or may object to taking any medications.” Getting support Not only are there stressors that lead to depression, there are many stressors surrounding treatment for depression.
One barrier is when parents ignore obvious signs of depression or will not get help for their teen because of their personal biases and lack of education around mental health. Between 12-26% of parents report not wanting or needing help, or being unwilling to seek help for a child’s depression (Reardon, T., Harvey, K., Baranowska, 2017). It is crucial that teens feel validated in their feelings and thoughts about depression and that it is an illness that must be treated. Healthcare providers must provide education to teens and parents carefully and in a nonjudgmental way to help them understand that it is an unseen illness which is real, can be very serious, and needs treatment. Access to care and a severe shortage of child psychiatrists in the U.S. is another stressor. Teens should be given hotline numbers that they can call to get immediate help from people who understand what they are going through.
Referrals to mental health expects should be made at the time of assessment and not delayed when depression or mental health issues are identified. Teens should understand that most hotlines available 24/7 are confidential and that they can connect teens with agencies that can help them. Being sure that teens understand that with one phone call they can receive emotional support and information empowers teens to take steps to help themselves and that they are worthy of help. Instruct teens to text to TXT 4 HELP which allows the teens to text live with a healthcare professional (www.nationalsafeplace.org/txt-4-help). Many resources and hotlines can be accessed at https://www.nimh.nih.gov/ (search words: children and adolescents) that can help both teens and support people.
While assessing teens for depression is critical that healthcare professionals educated the public that mental health is an illness and to let teens know that if they have symptoms of depression they need to get help right away. There can be embarrassment or feelings of inadequacy from both the teen and families when talking about mental health. If teens open up and want to express their feelings, they need to be allowed to express their feelings without interrupting the conversation. Fear of failure, anxiety and lack of education in mental health issues are one of the biggest reasons teens do not reach out for help. Teens must know that you care and that there is help available to them and be given tangible resources to help them.
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