Adolescence

Adolescence is defined as the stage between childhood and adulthood in which the young person moves from dependency to independence (Geldard et al., 2019). During this stage of development, many challenges are presented. Biological challenges occur as the adolescent goes through puberty where physiological and sexual changes take place. The increased hormone levels impact on the adolescent’s emotional state when impacted with social relationship changes (Geldard et al., 2019). Difficulties at school may arise as adolescents develop self – image concerns, partake in risk-taking behaviours and as conflicts occur. With all these changes happening, the adolescent is at increased risk of developing mental illnesses.

The World Health Organisation (WHO, 2021b) states people ages 10 to 19 years of age make up one in six of the population and globally. One in seven or 13% experience a mental disorder such as depression (WHO, 2021b). It is important adolescents are supported socially and emotionally by their family and friends, within the school environment and by the wider community. By protecting adolescents from adversity, promoting socio-emotional well-being and with access to mental health care, improvements with young people experiencing depression can be made as they progress through to adulthood (WHO, 2021b).

Depression

According to Black Dog Institute (2022) depression has high prevalence in Australia as one of the most common illnesses. Depression can be defined as having feelings of sadness and irritability lasting longer than two weeks and impacting daily life and participation in enjoyable activities (Headspace, 2022d). It can be difficult to distinguish depression from adolescent turmoil as it is common for young people to have mood swings and become irritable at times. However, having a reduced interest and enjoyment in participating in events or activities the adolescent used to enjoy doing, is what sets depression apart from just being adolescent turmoil (Black Dog Institute, 2022; Headspace, 2022d). From their interactions together, family and friends of the adolescent may notice other signs that depression is developing for the young person.

The obvious signs of depression may not always be evident as the young person’s independence grows. Lower self-esteem, emotion regulation difficulties, sleep patterns and diet changes, low energy and social withdrawal are signs that depression could be affecting the adolescent (Black Dog Institute, 2022; Be you, 2022b). Events or issues may have occurred that impacted greatly on the young person’s feelings, thoughts and behaviours. They may have experienced symptoms of depression in response to stressful events (Headspace, 2022d). These symptoms can vary in severity and frequency for adolescents.

Depression can be categorised into two main types of major and mild depression. Major depression involves the young person experiencing ‘episodes’ with symptoms building up over a period of time and lasting for a few weeks or longer. The low mood and loss of interest in activities may cause difficulties for young persons to complete their school work, go to work and even with getting out of bed (Headspace, 2022d).  A young person who has mild depression has longer lasting symptoms but can participate in most daily activities.  However, they require more effort and the activities are often less enjoyable for them.

Evidence of Symptoms 

Depression in adolescents is caused by a variety of events and experiences that trigger the young person into developing symptoms. Cognitive–interpersonal theories relating to depression highlight young people seek negative information about themselves as they believe they are unworthy of positive social attention, instead having negative expectations of interpersonal situations (Rudolph & Clark, 2001). These cognitive changes influence how they critically think of others. It also impacts on how young people interact with others, particularly their peers.

Adolescence involves growth biologically and cognitively which impacts on their interactions and self-belief systems. As young people develop their cognitive skills, their new-found confidence is likely to be tried out in unfamiliar situations, which are not always successful (Geldard et al., 2019). Negative events or influences combining with other triggers or may be the trigger itself, can result in depression developing. This has further implications for the adolescent with added cognitive challenges occurring.

Cognitive changes occur as the adolescent grows and also as they develop depression. Major depression can cause impaired cognitive function including memory loss, inattention and reduced executive function (Wen et al., 2021). This impacts the young person’s ability to make decisions while developing a low self-esteem with possibly suicidal thoughts occurring. The influences on their emotions may mean the adolescent will have difficulties self-regulating their feelings and responses. This in turn impacts greatly on their behavioural and social choices.

Depression impacts how adolescents behave and interact with others. During adolescence, peers are spending more time together with the quality of their interactions changing. A greater reliance on each other for social support is occurring with social stress from maladaptive behavioural patterns leading to the development of depressive behaviours (Burke et al., 2017). The adolescent may engage in risk taking behaviours with their peers or withdraw away from them and their family. Their self-care may deteriorate and they lose interest in activities that were particularly important to them (Headspace, 2022d).  As they are disengaging from their family and friends, impacts are inevitable.

Impact on the Individual and Interactions

Depression impacts the individual and the interactions they have with others. An impaired functioning is linked to depression as the adolescent demonstrates diminished competence in completing daily living tasks, maintaining family and friend relationships, and their ability in school and work environments (McDermott, 2010). As their mood and behaviours change, experiences they had enjoyed previously do not have the same impact when depressed. Their depressed behaviours negatively impact relationships at home and at school while having significant consequences for their mental health and wellbeing.

Having depression is a significant risk factor for suicidal thoughts or actions. Depression is linked to suicide by being one of its strongest risk factors with suicide accounting for one-fifth of all deaths of young people in 2005 (McDermott, 2010). Not only does this have significant impacts on the individual, the effects are also experienced by interactions with their family, friends and into their schooling and the wider community. Support services are required to be put into place to support the individual as well as their family and friends.

Suggested Interventions

Prompt support through the use of a school guidance officer (GO) can be provided to adolescents showing symptoms of having depression or developing this mental illness.  To assist in addressing the wellbeing needs of these students, cognitive behaviour therapy (CBT) can be utilised. CBT is a thoroughly researched psychotherapy that is considered to be one of the most effective treatments for young people who have depression (Hetrick, 2015). The GO can assist adolescents in exploring their current negative thinking and modifying their thoughts. There is a focus on changing the young person’s behaviours which in turn will trigger changes in their thoughts and emotions (Hetrick, 2015). CBT is considered for reducing symptoms in the short-term for young persons who do not meet the diagnostic criteria for having a major depressive disorder (McDermott, 2010). For those adolescents who are showing symptoms of major depression, expertise clinical care is required which a guidance officer does not have the skill set or qualifications to do.

A clinical interview can be used to identify depression in adolescents. It involves a general practitioner or psychiatrist assisting the young person to make sense of their feelings and reactions, as well as identifying symptoms or severity of a disorder. The HEADSS tool (Home, Education, Activities, Drugs, Sexuality and Suicide and Depression) is a psychosocial assessment used by health professionals in a clinical encounter with young people (McDermott, 2010). Engagement is promoted by addressing confidentiality and through the structuring of questions. The assessment is in a slowly escalating level beginning with relatively ‘safe’ issues to more sensitive ones (McDermott, 2010). The information gathered from the assessment can be used to inform a care plan for the adolescent. This care plan may be shared with the school so they can put further supports in place.

The school in which the adolescent who has a diagnosis of depression attends, should have an individual support plan for the student. Schools have a duty of care which includes maintaining student wellbeing and engaging in learning safely by enabling the health support needs of their students (Department of Education, 2022). Any suggestions from the care plan created by the adolescent’s clinical care support team should be added to the student’s individual support plan at school. This school’s plan would contain current interventions such as regular counselling sessions incorporating CBT. The guidance officer will provide this intervention to further assist the adolescent with managing their mental illness of depression.