Adolescent Depression: Overview and Annotated Bibliography
Few periods in one's life are filled with more change or tumult than the stage known as adolescence. Defined by dramatic physical, hormonal, social and intellectual transition, adolescence is distinguished by the maturation of puberty. And perhaps more than at any other point in one's life, this maturation leads to a significant transformative period which finds the individual at a midway point between childhood and adulthood. Given the unique biological experiences and the encompassing sociological pressures that accompany this life cycle stage, it is not surprising that individuals experiencing this stage are particularly vulnerable to considerable emotional distress and for many, depression. This vulnerability is the focus of the discussion and the annotated bibliography contained hereafter. The account presented here is concerned with the symptoms, treatment and consequences of depression in adolescents with the intention of providing a useful resource for approaching what is a genuine public health issue.
A Brief Overview of the Adolescence Stage:
According to Harder (2002), Erik Erikson offers a valuable point of introduction to a discussion on adolescence. Erikson's Theory of Stages provides a basic timeline for the development and life-cycle of the individual centering on a distinctly western sociological contextualization. Erikson identifies Adolescence as the period directly following the stage known as Latency, or school age, and directly preceding young adulthood. Though it is sited as beginning around the age of 12 and leading up to the age of 18, these ages are subject to considerable variation, particularly with girls trending slightly younger than boys. According to Harder, Adolescence is defined by greater tendencies toward ego orientation and independent will. Harder indicates that "Up to this stage, according to Erikson, development mostly depends upon what is done to us. From here on out, development depends primarily upon what we do. And while adolescence is a stage at which we are neither a child nor an adult, life is definitely getting more complex as we attempt to find our own identity, struggle with social interactions, and grapple with moral issues." (Harder, p. 1)
This is a point in individual personal development in which we are able to observe the intrinsic value of actions and decisions rather than simply viewing them in terms of personal repercussions. This leads into a greater sense of the world as separate from ourselves. In the transitional period, we begin to develop impulses that are derived as much internally as from social, ethical and relational influences. Moreover, substantial physical changes will often lead the individual to draw connections for the first time between physical appearance and personal contentment. Indeed, KGI (2007) indicates, "dramatic physical changes are the hallmark of early adolescence and these physical changes are important to your adolescent. They signify that he or she is developing like his or her peers." (KGI, 1)
Individuals will notice significant changes in themselves in terms of physical alteration, emotional tumult and sexual awareness. This will tend to manifest most concertedly in one's relationship to such social contexts as school, family and neighborhood. And to the point, KGI reports, this adolescent period is an important time in terms of cultivating a loose but increasingly intimate social network. This conforms with general research on this stage of development, which is highlighted by a transition from a life dominated by home and family to one increasingly more divided to the pursuits of school, extra-curricular activity, athletic team membership and information social gathering. These tend to function as substitutes in certain areas where previously only the family fulfilled certain needs.
Symptoms and Diagnosis:
The conditions above define a period of unprecedented experience for the individual, and all of it contextualized by the enveloping social pressures produced in contexts such as schools and self-selected peer groups. For a great many young individuals enduring this period, distress, discontent and depression can be defining characteristics. And as the text by Young et al. (2010) reveals, this is a statistically significant problem. Accordingly, the research by Young et al. reports that "approximately 15% of adolescents will experience a major depressive episode. At any given point in time, 5% of adolescents will meet criteria for a depression diagnosis. The risk factors associated with depression in adolescence include a family history of depression, being female, subthreshold depression, having a nonaffective disorder, negative cognitions, interpersonal conflict, low social support, and stressful life events." (Young et al., p. 87)
The article by Young et al. goes on to report that a wide array of observable symptoms will emerge in those suffering from adolescent depression. Particularly, Young et al. indicate that depression is characterized by manic behavior, dramatic mood swings, erratic temperament, low energy, limited interest in social engagement, excessive or non-existent appetite, diminishing hygiene and possible anti-social behavior such as a propensity toward violence, self-abuse or other abnormality. These symptoms and a wide range of others will typically indicate that the individual is experiencing distress that may be classified as a situational and temporal depressive state or as a more chronic depressive condition. In spite of the fact that many of these symptoms can present quite detectably, Young et al. indicate that there remains a degree of limitation in how seriously adolescent depression is treated. Because the life cycle stage is marked by great emotional change, the symptoms of depression may often simply be dismissed as 'growing pains.' However, Young et al. report, "despite the availability of measures to identify depressed adolescents and efficacious interventions to treat these adolescents, a large number of depressed adolescents go undetected and untreated. Furthermore, when treatment is sought in the community, the services provided are often quite brief and do not involve evidence-based approaches." (Young et al., p. 87) This helps to provide a powerful imperative for the present research as well as for the subsequent section concerning treatment approaches.
Following diagnosis, there is a particular imperative to begin treatment. Depression is a condition which requires immediate support and attention as stagnant emotional distress can manifest in a state of deepening cognitive dissonance. Thus, monitoring and counseling are particularly recommended as the first steps in classifying the nature of the subject's depression. The text by Cheung et al. (2007) provides the basic template for placing an individual on the proper treatment course. Accordingly, Cheung et al. tell that "1) active monitoring of mildly depressed youth, (2) details for the specific application of evidence-based medication and psychotherapeutic approaches in cases of moderate-to-severe depression, (3) careful monitoring of adverse effects, (4) consultation and coordination of care with mental health specialists, (5) ongoing tracking of outcomes, and (6) specific steps to be taken in instances of partial or no improvement after an initial treatment has begun." (Cheung et al., p. 1313) These strategies for treatment are intended to work in coordination, though in modern treatment strategies, pharmaceutical treatment is a method frequently invoked.
The potential consequences of adolescent depression are numerous and troubling. The text by Bhatia & Bhatia (2007) makes clear that diagnosis is essential to prevent the worsening of this condition. Adolescents with depression that goes untreated can experience these formative years as a highly traumatic phase that can leave imprints well through adulthood. According to Bhatia & Bhatia "Depression impacts growth and development, school performance, and peer or family relationships, and it can be fatal. Major depressive disorder is a leading cause of youth suicidal behavior and suicide." (Bhatia & Bhatia, p. 73)
Bhatia, S.K. & Bhatia, S.C. (2007). Childhood and Adolescent Depression. American Family Physician, 75(1).
Bhatia & Bhatia (2007) provide the research with its core imperative by identifying the dangers associated with the presence of adolescent depression and most especially with a failure to treat said condition. Here, Bhatia & Bhatia confirm adolescent depression as a highly present public health condition and one that can be drawn to both biomedial and psychosocial risk factors. Bhatia & Bhatia also point out that 2/3rds of all individuals suffering with adolescent depression will also present some additional emotional or mental disorders. In addition to demonstrating the importance of the present research, Bhatia & Bhatia also warn of the dangers associates with untreated adolescent depression such as long-term developmental stagnation, negatively impacted personal relationships and suicide.
Cheung, A.H.; Zuckerbrot, R.A.; Jensen, P.S; Ghalib, K.; Laraque, D. & Stein, R.E.K. (2007). Guidelines for Adolescent Depression in Primary Care (GLAD-PC): II. Treatment for Ongoing Management. Pediatrics, 120(5).
The document composed by Cheung et al. (2007) is offered as a handbook for assisting mental health and pediatric psychology professionals in the diagnosis, treatment and ongoing management of adolescent depression. As such, this source is particularly instructive to the present discussion for its clear explication of the steps most commonly taken in addressing adolescent depression. The research conducted by Cheung et al. reveals an exhaustive process by which consensus was established on the best practices in treatment, referring to current scientific evidence and gathering data through focus groups, surveys and expert workshops. This thorough process would help the present research to identify the…