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Adolescent Depression NEVADA KIDS COUNT Issue #1 Center for Business and Economic Research Depression Every year, approximately 50 in 1,000 adolescents experience the torment of major depression.1 Periods of anxiety or depression during adolescence are common and can be normal reactions to life events.2 But, there is a difference between simply feeling depressed over a life event and clinical depression. Clinical depression involves overwhelming feelings of being sad for weeks or longer.3 According to the Center for Mental Health Services, 12.5 percent of teens endure clinical depression.4 The mental-health ailments suffered by many adolescents are being overlooked by busy, distracted, or uninformed adults.5 Among adolescents, aged 12 to 17 who reported having suffered a major depressive episode (MDE) in 2004, only 40.3 percent received depression treatment within that time period.6 Depressed teenagers are often “misdiagnosed, underdiagnosed, and undertreated.”7 Population studies show that at any given instance between 10 and 15 percent of the child and adolescent population endures symptoms of depression.8 Predictions indicate that depression may be the second largest killer after heart disease by the year 2020, and Winter 2006 epidemiological studies show that depression is a contributory factor to fatal coronary disease.9 The mood disorders that are most often diagnosed in adolescents are major depressive disorder, dysthymic disorder, and bipolar disorder.10 The condition of major depressive disorder is a dire illness identified by at least one MDE.11 About 2.2 million adolescents ages 12 to 17 (9 percent) languished at least one MDE in 2004.12 A teen with at least five signs or symptoms of depression during a two-week period is having a MDE. The symptoms of a MDE include a depressed or irritable mood; diminished interest in almost all activities; sleep disturbance; appetite disturbance; decreased concentration; thoughts of suicide or death; psychomotor agitation or retardation; fatigue; and feelings of worthlessness or inappropriate guilt.13 Behaviors associated with a MDE include the following: substance abuse (self medicating), eating disorders (such as anorexia), self injury (such as cutting), and acting out (such as aggression).14 Once a young person has experienced a major depression, he or she is at risk of having a recurrence within five years.15 Dysthymic disorder is a mood disorder like major depressive disorder, but it has fewer symptoms and is more chronic.16 Bipolar disorder is a mood disorder in which episodes of mania alternate with episodes of depression. The disorder normally begins with depression and the first manic features may not occur for months or years after the first depressive episode.17 Manic symptoms include difficulty sleeping; incessant talking, often rapidly or loudly; and racing thoughts. Manic adolescents may start numerous projects without finishing them; engage in reckless or risky behavior; or become overconfident in their abilities.18 Twenty to 40 percent of adolescents with depression eventually develop bipolar disorder. Reactive depression is the most common mood problem in adolescents in reaction to minor adversities, which is not considered a mood disorder.19 Some of the core symptoms of depression, such as changes in appetite and sleep patterns are related to the functions of the hypothalamus. The hypothalamus is, in turn, closely tied to the pituitary gland. Abnormalities of pituitary function, such as increased rates of circulating cortisol and hypo- or hyperthyroidism, are well-established features of depression.20 The 2004 annual National Survey on Drug Use and Health showed that very depressed youth aged 12 to 17 were twice more likely to engage in substance abuse than those who were not depressed. About 28 percent of depressed teens used alcohol, 2 23 percent smoked cigarettes, and roughly, 21 percent used drugs.21 Strategies need to be instituted to reduce the stigma attributed to mental illness and obtain treatment for those afflicted.22 Upon diagnosis, there are various treatment options for the depressed individual. Medication was once the first treatment option, but is not currently the preferred method. Studies indicate that antidepressants only work in 35 to 45 percent of the population.23 The U.S. Food and Drug Administration (FDA) issued a public-health advisory in October of 2004 forcing manufacturers of antidepressant drugs to display a warning to alert medical professionals to the greater risk of suicidal thinking and behavior in children and adolescents being given these medications.24 Since medications are questionable, the most viable option would be to address the underlying causes of depression instead of just the symptoms.25 The other treatments for depression involve therapy. The therapeutic treatments include the following: cognitive-behavioral therapy, group therapy, family therapy, and psychodynamic psychotherapy. Cognitive-Behavioral therapy is based on the idea that emotions are a learned response, the psychological pain is due to a person’s perception of what events mean to him/her.26 The goal of cognitive-behavioral therapy is overturning pessimistic ways of thinking, creating social skills, and setting goals to pursue pleasurable activities via patient-therapist discussions. Group therapy involves breaking down the feeling of isolation in the depressed adolescent, which can alleviate some of the depressive symptoms by realizing they are not alone in their experiences.27 Family therapy addresses patterns of communication in the family and attempts to restructure the family in order to provide a better support base for the patient.28 Psychodynamic psychotherapy attempts to link symptoms of depression to childhood traumas or conflicts.29 Early traumatic experiences such as abuse or incest can manifest as depression; these suppressed memories can emerge in adolescence.30 The simplest method for alleviating depression may be physical exercise. Exercise causes the brain’s chemistry to create more endorphins and serotonin, which change mood.31 Suicide Suicide is a permanent solution to a temporary problem (Phil Donahue). Over 90 percent of adolescents with suicidal tendencies have a treatable psychiatric disorder.32 Mood disorders are major risk factors for suicide among children and adolescents.33 Up to 15 percent of individuals diagnosed with major depressive disorder die by suicide.34 An reported 11 in 100,000 youth between the ages 15 to 19 will attempt suicide each year and many more suicide attempts will go unreported.35 The third leading cause of death in 2002 was suicide in the 15 to 24 age group; the first and second leading causes of death were accidents and homicides, respectively.36 Some accidents may actually be suicides in disguise. Teen females attempt suicide more frequently (about nine times more often) than teen males, but males are about four times more likely to succeed when they are trying to kill themselves. This is because teen males tend to use more deadly methods (like guns or hanging) than females who try to hurt or kill themselves with less deadly methods (like overdoses of medications or cutting).37 In 2002, an estimated 124,409 visits to U.S. emergency departments were made after attempted suicides or other selfharm incidents among persons aged 10-24 years.38 The most frequent method of suicide in this age group was by firearm (49%), followed by suffocation (38%), and poisoning (7%).39 The suicide risk among people with depression is about 30 times higher than that of the general population.40 “Four psychosocial factors were found to be important for overall suicide risk: hopelessness, hostility, negative selfconcept, and isolation.”41 Suicide can emanate from a depressed person’s feeling that life is so intolerable that death appears to be the sole deliverance; the suicidal individual sees no opportunity for change or improvement.42 The suicidal individual cannot see beyond his/ her depressive state symptoms. “In suicidal individuals dysregulation of the serotenogenic system is common, making them impulsive, intense, and given to extreme reactions.”43 A hazardous period in depression occurs when an individual is coming out of the deepest part 3 of the experience and utilizes their newly acquired energy to take their own life.44 It is not uncommon for an individual to appear joyful prior to committing suicide. The following behaviors are common to someone who is suicidal: Preoccupation with death; Statements of low self esteem; A setting of affairs, such as possession of a will; Giving away cherished possessions; Suicidal ideation; Suicidal threats; or Suicidal-plan possession.45 Nevada According to the 2005 Youth Risk Behavior Survey (YRBS), 27.8 percent of Nevada high school students felt so sad or hopeless almost every day for 2 or more weeks in a row that they stopped doing some usual activities.46 In the past 12 months, 16.1 percent of Nevada high school students seriously considered attempting suicide.47 Close to nine percent of Nevada high school students attempted suicide one or more times.48 In 2004, 19 percent of teen violent deaths (ages 15-19) were by suicide. Accidents were 61 percent and homicides were 20 percent.49 Conclusion The condition of clinical depression involves overwhelming feelings of being sad for weeks or longer. Many adolescents who suffer from clinical depression are unable to escape their dark moods without treatment. The most often diagnosed mood 4 disorder among adolescent is major depressive disorder. Due to the suicide dangers associated with current medications, adolescents being treated by medication need to be monitored carefully. Therapy is preferred over medication, since the FDA warning in 2004. Since the majority of suicides occur among individuals with treatable psychiatric disorders, it is paramount to identify adolescents with these conditions before it is too late. With education and awareness, suicide occurences can be reduced and perhaps moved down the list of leading deaths. References 1. Bower, Bruce, August 2004, “Lifting the Mood,” Science News, Vol. 166, Issue 8. 2. Murphy, Kathryn, December 2005, “What Can You Do to Prevent Teen Suicide?” Nursing, Vol. 35, No. 12, pp. 43-45. 3. Wysong, Pippa, December 2005, “Dark Moods,” Current Health, Vol. 32, Issue 4. 4. Ibid. 5. Shellenbarger, Sue, April 17, 2003, “Hiding from Your Teen’s Depression: Parents Struggle Over How to Cope, Wall Street Journal, available online at: <http: //www. mdhealth notes.net/depression.htm> as of 1/23/06. 6. Centers for Disease Control and Prevention, June 11, 2004, “Morbidity and Mortality Weekly Report,” Vol. 53, No. 22, available online at: <http://www.cdc.gov/mmwr /PDF/wk/mm5322.pdf> as of 1/25/06. 7. Farmer, Terri J., 2002, “The Experience of Major Depression: Adolescents’ Perspectives,” Issues in Mental Health Nursing, Vol. 23, pp. 567-585. 8. Mental Health: A Report of the Surgeon General, “Depression and Suicide in Children and Adolescents,” Ch. 3, available online at: <http://www.surgeongeneral. gov/library/mentalhealth/chapter3/sec5.html> as of 2/1/06. 9. LeBan, Levon A., Gladys Barrett-Merrick, and Robert Romanski, 1996, “Combating Adolescent & Teen Suicide,” The Crisis Institute, Suicidology, available online at: < http://www.gnofn.org /~nocrisis/two.html> as of 1/20/06. 10. Mental Health: A Report of the Surgeon General, “Depression and Suicide in Children and Adolescents,” Ch. 3, available online at: <http://www.surgeongeneral. gov/library/mentalhealth/chapter3/sec5.html> as of 2/1/06. 11. Ibid. 12. U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, 2005, “9 Percent of Adolescents Experienced a Major Depressive Episode in the Past Year, Survey Finds,” available online at: <http://www.samhsa.gov /news/ newsreleases/051229_teens.htm> as of 1/20/06. 13. Murphy, Kathryn, December 2005, “What Can You Do to Prevent Teen Suicide?” Nursing, Vol. 35, No. 12, pp. 43-45. 14. Jaffe, Jaelline, Lisa Flores Dumke, and Jeanne Segal, July 2005, “Teen Depression: Signs, Symptoms, and Getting Help for Teenagers,” Helpguide.org, available online at: <http://www.helpguide.org/mental/depression_teen. htm> as of 1/20/06. 15. National Mental Health Association, September 1998, “Clinical Depression and Children/Adolescents,” available online at: <http://www.nncc.org/Child.Dev/depress. html> as of 1/24/06. 16. Mental Health: A Report of the Surgeon General, “Depression and Suicide in Children and Adolescents,” Ch. 3, available online at: <http://www.surgeongeneral.gov/ library/mentalhealth/chapter3/sec5.html> as of 2/1/06. 17. Ibid. 18. Ibid. 29. Murphy, Kathryn, December 2005, “What Can You Do to Prevent Teen Suicide?” Nursing, Vol. 35, No. 12, pp. 43-45. 30. Ibid. 31. Jaffe, Jaelline, Lisa Flores Dumke, and Jeanne Segal, July 2005, “Teen Depression: Signs, Symptoms, and Getting Help for Teenagers,” Helpguide.org, available online at: <http://www.helpguide.org/mental/depression_teen. htm> as of 1/20/06. 32. Murphy, Kathryn, December 2005, “What Can You Do to Prevent Teen Suicide?” Nursing, Vol. 35, No. 12, pp. 43-45. 33. Child Trends DataBank, 2003, “Teen Homicide, Suicide, and Firearm Death,” available online at: <http://www. childtrendsdatabank.org/indicators/70ViolentDeath.cfm> as of 1/11/06. 34. LeBan, Levon A., Gladys Barrett-Merrick, and Robert Romanski, 1996, “Combating Adolescent & Teen Suicide,” The Crisis Institute, Suicidology, available online at: < http:// www.gnofn.org /~nocrisis/two.html> as of 1/20/06. 35. Ibid. 36. Child Trends DataBank, 2003, “Teen Homicide, Suicide, and Firearm Death,” available online at: <http://www. childtrendsdatabank.org/indicators/70ViolentDeath.cfm> as of 1/11/06. 20. Ibid. 37. Nemours Foundation, May 2002, “Suicide,” available online at: <http://www.kids health.org/teen/your_mind/ mental_health/suicide.html> as of 1/20/06. 21. CNN.com, December 29, 2005, “Study: Major depression strikes 2.2 million U.S. teens,” available online at: <http://www.cnn.com/2005/HEALTH/conditions/12/29/ health.depres sion.reut/?eref=yahoo> as of 1/20/06. 38. Centers for Disease Control and Prevention, June 11, 2004, “Morbidity and Mortality Weekly Report,” Vol. 53, No. 22, available online at: <http://www.cdc.gov/mmwr /PDF/wk/mm5322.pdf> as of 1/25/06. 19. Ibid. 22. Hyde, Toni, John Kirkland, David Bimler, and Pia Pechtel, August 2005, “An Empirical Taxonomy of SocialPsychological Risk Indicators in Youth Suicide,” Suicide and Life-Threatening Behavior, Vol. 34, No. 4, pp. 436-447. 23. Murray, Bob and Alicia Fortinberry, January 15, 2005, “Depression Facts and Stats,” Uplift Program, available online at: <http://www.upliftprogram.com/depression_stats .html> as of 1/20/06. 24. Bridge, Jeffrey A., Rémy P. Barbe, Boris Birmaher, David J. Kolko, and David A. Brent, 2005, “Emergent Suicidality in a Clinical Psychotherapy Trial for Adolescent Depression,” American Journal of Psychiatry, Vol. 162, pp. 2173-2175. 25. Murray, Bob and Alicia Fortinberry, January 15, 2005, “Depression Facts and Stats,” Uplift Program, available online at: <http://www.upliftprogram.com/depression_stats .html> as of 1/20/06. 26. Murphy, Kathryn, December 2005, “What Can You Do to Prevent Teen Suicide?” Nursing, Vol. 35, No. 12, pp. 43-45. 27. Jaffe, Jaelline, Lisa Flores Dumke, and Jeanne Segal, July 2005, “Teen Depression: Signs, Symptoms, and Getting Help for Teenagers,” Helpguide.org, available online at: <http://www.helpguide.org/mental/depression_teen. htm> as of 1/20/06. 28. Ibid. 39. Ibid. 40. National Mental Health Association, September 1998, “Clinical Depression and Children/Adolescents,” available online at: <http://www.nncc.org/Child.Dev/depress. html> as of 1/24/06. 41. Rutter, Philip A. and Andrew E. Behrendt, Summer 2004, “Adolescent Suicide Risk Four Psychosocial Factors,” Adolescence, Vol. 39, No. 154, pp. 295-302. 42. Hyde, Toni, John Kirkland, David Bimler, and Pia Pechtel, August 2005, “An Empirical Taxonomy of SocialPsychological Risk Indicators in Youth Suicide,” Suicide and Life-Threatening Behavior, Vol. 34, No. 4, pp. 436-447. 43. Mental Health: A Report of the Surgeon General, “Depression and Suicide in Children and Adolescents,” Ch. 3, available online at: <http://www.surgeongeneral.gov/ library/mentalhealth/chapter3/sec5.html> as of 2/1/06. 44. Soreff, Stephen, March 2005, “Suicide,” eMedicine, available online at: <http://www.em edicine.com/med/ topic3004.htm> as of 1/20/06. 45. LeBan, Levon A., Gladys Barrett-Merrick, and Robert Romanski, 1996, “Combating Adolescent & Teen Suicide,” The Crisis Institute, Suicidology, available online at: < http:// www.gnofn.org /~nocrisis/two.html> as of 1/20/06. 46. Nevada State Department of Education, Office of Child Nutrition and School Health, Nevada Youth Risk Behavior Survey, 2003, 2005. 5 47. Ibid. Coping Strategies and Help-Seeking Behavior for Suicidality,” Journal of the American Academy of Child and Adolescent Psychiatry, Vol. 43, No. 9, pp. 1124-1133. 48. Ibid. 49. Center for Business and Economic Research, University of Nevada, Las Vegas, Nevada KIDS COUNT Data Book: 2006, by Rennae Daneshvary, R. Keith Schwer, William Cope, Juliette Tennert, Robert Potts, and Freda Klein. 57. Macgowan, Mark J., May 2004, “Psychosocial Treatment of Youth Suicide: A Systematic Review of the Research,” Research on Social Work Practice, Vol. 14, No. 3, pp. 147-162. 50. Slattery, Ryan, January 20, 2005, “Report Card Gives Nevada Failing Grade in Several Child Welfare Categories,” Las Vegas City Life, available online at: <http://www. lasvegascitylife.com/articles/2005/01/20/local_news/ news01.txt> as of 1/11/06. 58. Barbe, Remy P., Jeffrey Bridge, Boris Birmaher, David Kolko, and David A. Brent, Spring 2004, “Suicidality and Its Relationship to Treatment Outcome in Depressed Adolescents,” Suicide and Life-Threatening Behavior, Vol. 34, No. 1, pp. 44-55. 51. Young, Jami F., Kathy Berenson, Patricia Cohen, and Jesenia Garcia, 2005, “The Role of Parent and Peer Support in Predicting Adolescent Depression: A Longitudinal Community Study,” Journal of Research on Adolescence, Vol. 15, No. 4, pp. 407-423. 59. Fristad, Mary A. and Amy E. Shaver, 2001, “Psychosocial Interventions For Suicidal Children and Adolescents,” Depression and Anxiety, Vol. 14, pp. 192-197. 60. U.S. Department of Health & Human Services, Office of Applied Statistics, December 30, 2005, “Depression among Adolescents,” The NSDUH Report, available online at: <http://oas.samhsa.gov/2k5/youthDepression/ youthDepression.htm> as of 1/20/06. 52. Sourander, Andre, Antti Haavisto, John A. Ronning, Petteri Multimaki, Kai Parkkola, Paivi Santalahti, Georgios Nikolakaros, Hans Helenius, Irma Moilanen, Tuula Tamminen, Jorma Piha, Kirsti Kumpulainen, and Fredrik Almqvist, 2005, “Recognition of Psychiatric Disorders, and Self-Perceived Problems. A Follow-Up Study from Age 8 to Age 18,” Journal of Child Psychology and Psychiatry, Vol. 46, No. 10, pp. 1124–1134. 61. Child Trends, 2003, “Adolescents Who Feel Sad or Hopeless,” available online at: <http://www. childtrendsdatabank.org/indicators/30FeelSadorHopeless. cfm> as of 1/20/06. 53. Sankey, Melissa and Ruth Lawrence, April 2005, “Brief Report: Classification of Adolescent Suicide and RiskTaking Deaths,” Journal of Adolescence, Vol. 28, Issue 6, pp. 781-785. 54. Scherff, Andrew R., Tanya L. Eckert, and David N. Miller, April 2005, “Youth Suicide Prevention: A Survey of Public School Superintendents’ Acceptability of School-Based Programs,” Suicide and Life-Threatening Behavior, Vol. 35, No. 2, pp. 154-169. 55. Gutierrez, Peter M., Robin Watkins, and Dale Collura, Winter 2004, “Suicide Risk Screening in an Urban High School,” Suicide and Life-Threatening Behavior, Vol. 34, No. 2, pp. 421-428. By 56. Gould, Madelyn S., Drew Velting, Marjorie Kleinman, Christopher Lucas, John Graham Thomas, and Michelle Chung, September 2004, “Teenagers’ Attitudes about Faculty Consultant Center for Business and Economic Research University of Nevada Las Vegas William Cope, MS, MBA If you need more specific information about the children and youth in your local area, contact Nevada KIDS COUNT, Keith Schwer, PhD, Director CBER or Rennae Daneshvary, PhD, Interim Nevada KIDS COUNT Coordinator, Assistant Director CBER Phone: (702) 895-3191 Fax: (702) 895-3606 E-mail: [email protected] The Center for Business and Economic Research 4505 Maryland Parkway, Box 456002 6