Download Special Issues for Adolescents with HIV

Special Issues for Adolescents with HIV:
Depression
A single risk factor rarely results in depressive outcomes. Instead, biological, psychological, and social
systems are considered within a larger framework for explaining the etiology of depression. A
developmental perspective suggests: 1) the manifestation of depression varies with age; 2) how individuals
experience depression internally varies greatly from one individual to the next; and 3) the context of
ongoing development changes should be taken into account when assessing for depression in
adolescents. With this in mind, aspects unique to adolescents should also be considered within a
developmental perspective in order to understand depression in this client category.
Diagnostic Criteria
A major depressive disorder is diagnosed when there is a
history of one or more major depressive episodes without a
history of manic, mixed (manic – depressed), or hypomanic
episodes. There must also be at least two weeks of pervasive
change in mood, manifested by either depressed or irritable
mood and/or a loss of interest and pleasure. Additionally,
several signs and symptoms must be present before a
diagnosis of major depression is indicated.
Clinical Resource Guide
Condition
Adolescent
Depression
Signs = “objective”
indication(s) of a medical
fact or quality that can be
detected by a clinician
Symptoms = “subjective”
experiences that a patient
might report to a clinician
* = directly associated
with adolescents
Etiology
Depression may be
the result of many
factors, either
individually or acting in
concert.
These may include
environmental factors,
which may be
reactions to events,
such as a loss. A
depressed mood may
also be related to or
triggered by psychological factors
including a lack of selfesteem or a
pessimistic view of life.
Other factors that are
physiological in
nature, such as
serotonin deficiencies,
could also lead to
depression.
Risk Factors
Signs
• Family history of depression or
previous episode(s) of
depression*
• Frequent absences from
school or poor
performance in school*
• Dropping out of school or
unattainment of a significant
goal*
• Talks about or tries to run
away from home*
Symptoms
• Persistent sad or irritable
mood*
• Family counseling
and individual
psychotherapy
• Loss of interest in activities
he/she once enjoyed,
becomes apathetic*
• Medications
• Difficulty sleeping or
excessive sleeping patterns
• Diagnosis of an illness, disease
progression or hospitalization
• Outbursts of shouting,
complaining or
unexplained crying
• Disclosure of a diagnosed
illness to family and friends
• Alcohol or substance
abuse
• Low self-esteem, feelings of
hopelessness or
inappropriate guilt*
•Low satisfaction with assistance
received from support network*
• Reckless behavior
• Difficulty concentrating
• Obsessed with poetry or
music with morbid
themes*
• Recurrent thoughts of death
or suicide
• Low adaptive/coping ability*
• Family financial difficulties,
neglect/abuse, parental
alcohol or substance abuse*
• Stress or trauma (including
natural disasters)
• Attentional, conduct, anxiety or
learning disorders*
• Questioning sexual orientation*
• Previous suicide attempt
• Loss of a parent or loved one,
divorce of parents or other
losses*
• Only child or living with
adoptive parents*
• Significant changes in
eating and sleeping
patterns*
• Significant weight gain or
loss*
• Frequent displays of
misconduct
• Self-destructiveness (e.g.,
high risk sexual behavior*
• Talks of self injury or prior
episode(s)
• Prior attempts or expressions of suicide
Treatment
• Increased irritability, anger,
or hostility*
• Frequent somatic
complaints (e.g.,
reoccurring stomachaches,
headaches and muscle
aches)*
• Unstable moods and
potential for violence*
• Extreme sensitivity to
rejection, criticism, or
failure*
• Withdrawn or social
isolation, poor
communication*
• Diet, exercise and
sleep modifications
with family involvement to increase
compliance
• Targeted
interventions for
problem resolution
involving the home
or school
environment
• Combination of
psychotherapy
and medications
References
1. Depression in Children and Adolescents. (1996). Retrieved June 26, 2006, from
www.athealth.com/consumer/disorders/ChildDepression.html.
2. Huebner A., Morgan E. (2001). Adolescent Depression. Retrieved June 27, 2006, from http://www.ext.vt.edu/pubs/family/350-851/350851.html.
3. Depression: REACH Study Addresses Adolescents with HIV. (2001). Available from http://www.newsrx.com.
4. Gaynes, B., Lohr, K., Mills Burchell, C., Mulrow, C., Orleans, C., Pignone, M., & Rushton, J. (2002). Screening for Depression:
Recommendations and Rationale. Annals of Internal Medicine, 136, 760-764.
5. Teen Depression: Warning Signs, Information, Getting Help. (2000). Retrieved June 26, 2006, from www.focusas.com/Depression.html.
6. Frisch, L., & Frisch, N. (2002). (2nd Ed.,), Psychiatric Mental Health Nursing. The Adolescent (p. 533). Albany, N.Y: Delmar.
7. Medical Sign. (2006). Retrieved June 27, 2006, from http://en.wikipedia.org/wiki/medical_sign.
8. Brown, A. (2002): Patient Care for the Nurse Practitioner. Available from http://find.galegroup.com.
Credits
This tool was developed by the Mental Health subset (Chair: Linda Frank, PhD,
MSN, ACRN, PA/MA AETC) of the AIDS Education and Training Centers (AETC)
National Resource Center, Adolescent HIV/AIDS Workgroup (Chair: Marion
Donohoe, RN, MSN, CPNP, St. Jude Children’s Research Hospital, ANAC and
Ronald Wilcox, MD, FAAP, Delta Region AETC). Collaborating members include
Elizabeth Cabrera, MEd (TX/OK AETC), Verita Ingram, MBA (TX/OK AETC), Elise
Johnson, MSW (Bickerstaff Pediatric Family Center), Jennifer Scanlon, FNP (The
Children's Hospital, Denver), and Ronald Wilcox. The workgroup efforts were
coordinated by the AETC National Resource Center (Managing Editor: Megan
Vanneman, MPH).