Download Adolescent Depression - Nevada KIDS COUNT

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