Adolescence

Adolescents make up almost 15% of the Australian population (Australian Institute of Health and Welfare [AIHW], 2020b). This is over 3.2 million young people, up from 2.3 million in 1971 (AIHW, 2021a). The proportion of adolescents in relation to the Australian population is expected to remain the same for the next 45 years, resulting in well over 5 million adolescents in 2066 (AIHW, 2021a).

Adolescence is a time for significant growth and development. The body grows in size, the brain rewires, the sexual and reproductive organs mature. Simultaneously, adolescents develop advanced reasoning skills and a stronger sense of self as they seek to create their own identities through forming attachments with people other than their parents (Lumen, n.d.). Within all these developmental changes the importance of good health, both mentally and physically is imperative. When adolescents have good overall health, they achieve better academic outcomes, transition successfully to full time employment, develop healthy adult lifestyles and engage in fewer adverse risky behaviours (AIHW, 2020c; Institute of Medicine (US) et al., 2011).

Fewer risky behaviours could reduce the injuries and deaths amongst adolescents as there is a significant increase of injury related deaths between ages 10 to 14 and 15 to 24 years (AIHW, 2020c). Additionally, mental health disorders of adolescents are on the rise with approximately one third of Australian youth reporting high to very high levels of psychological distress (AIHW, 2021b). Poor mental health is associated with suicidal ideation. Self-inflicted injury and suicide were the leading cause of burden of disease for people aged 15 to 24 in 2015 followed by anxiety and depression (AIHW, 2021b). One key challenge that adolescents face is the diagnoses of depression as typical adolescent behaviour is often indicated by increased irritability, mood negativity and instability which can mask depressive symptoms (Dietvorst et al., 2021)

Depression

Depression is a persistent state of sadness, loss of interest in pleasurable things and a general feeling of hopelessness that can interfere with relationships and one’s ability to participate in daily activities (Nelson & Kjos, 2008). The World Health Organisation (WHO) classifies depression into three categories; mild, moderate and severe and although many people may experience depression at some time major depressive episodes are distinguished by their severity, persistence and duration (Geldard et al., 2019). One out of every seven Australians will experience depression in their lifetime and globally approximately 5% of adults suffer from depression (Beyond Blue, 2021; WHO, 2021a).  Adolescents who become depressed and suffer depressive symptoms are at higher risk of developing depressive disorders as adults.

The predominant symptoms of depression are sadness, emptiness, feeling hopeless and having a negative focus on problems. People may also experience weight loss or gain, suffer from insomnia or hypersomnia, experience headaches and stomach problems, feel exhausted, drained of energy and sluggish (Nelson & Kjos, 2008). Depression can leave a person feeling tired, empty, angry, sad and irritable. They experience poor concentration, feelings of guilt, low self-worth and have suicidal thoughts. These symptoms often interfere with their everyday activities of work, school and family/social interactions.

The most severe outcome of depression is suicide, which is the leading cause of death in Australian adolescents (Healthdirect, 2018). Suicidal ideation and parasuicide becomes most common at approximately 15 years of age and should be taken very seriously, serving as a warning that an adolescent’s emotions are overwhelming (Lumen, 2012). When an adolescent descends into major depression their thinking becomes distorted and all normal, regular activities are disrupted as their thoughts become increasingly pessimistic, sad and hopeless (Nelson & Kjos, 2008).

There is no one cause for depression. Genetics and adverse childhood experiences, puberty, lack of self-esteem, lack of connection with others and unstable family environments may all contribute to depressive disorders.

Evidence of Symptoms 

Many adolescents experience some types of depressive moods with studies indicating that higher negative moods are shown in early adolescence and then growing out of them towards later adolescence (Dietvorst et al., 2021). However, this is not indicative of all adolescents with some negative moods escalating through to problematic depressive disorders affecting wellbeing. Adolescents displaying depressive symptoms experience persistent patterns of lower positive moods.

Adolescents who experience depression may also engage in high risk behaviours, such as unsafe sex, substance abuse, self-harm and aggression towards others (Geldard et al., 2019; Nelson & Kjos, 2008). Conflict with parents is also prevalent to adolescents with depression, consequently, they may run away from home to avoid confrontation and pressures. These adolescent behaviours often mask the depressive symptoms and can be a way for the adolescent to self-medicate and alleviate the pain of their depressive thoughts.

Additionally, adolescents may lack concentration and focus, have failing grades at school, be irritable, have feelings of guilt and self-hatred (Nelson & Kjos, 2008). Due to the depressive symptoms of sadness, disruption in sleeping patterns, loss of interest in regular activities, isolation and anger are characterised as typical adolescent behaviours, depression can often be undiagnosed or go unnoticed. However, when an adolescent begins to isolate themselves and is displaying self-destructive behaviours further investigation and testing must be done to uncover their state of mind and motivation.

Due to adolescents trying to mask their feelings parents are often unaware of their self-damaging behaviour and thought patterns of loneliness, fear, shame, self-loathing and despair. It is a positive sign if an adolescent informs a parent or adult about their depressive symptoms as this shows they have a belief that others can help. Unfortunately, the most self-destructive and damaging behaviours are kept private by the adolescent believing that others would not help and they are not worthy of help anyway (Wise, 2004).

As acknowledged, identifying depression in adolescents can be difficult unless they present themselves and request help. Symptoms can often be masked as delinquent behaviours or mistaken as a typical moody adolescent. It has been recognised that completing real-life or context-mood questionnaires could assist in detecting adolescents who are at risk of developing depressive disorders (Wise, 2004).

Impact on the Individual and Interactions

Depressed adolescents risk problems in varied aspects of their lives. Even though adolescents often report feeling happier and having a more positive mood when around their friends they may begin to withdraw from social situations such as school as they have the inability to adapt their moods to different contexts (Dietvorst et al., 2021). Thus, poor school attendance results in poor academic results perpetuating the isolation of an adolescent as they refuse to attend due to failing as well as their depressive mood. This can lead to further at-risk situations such as unemployment as an adult.

Literature confirms that parents and adolescents rarely discuss the personal issues of adolescence thus many parents are unaware that their child may be suffering (Wise, 2004). Additionally, they may not recognise signs and symptoms specific to a depressive disorder and dismiss their adolescent child’s emotions as moody, telling them to ‘snap out of it’. These types of statements and beliefs can reinforce the adolescent’s negative feelings and further distance them for seeking support within the family.

Adverse childhood trauma, family hardships and parental psychopathology contribute to the troubled social, behavioural and emotional behaviours displayed during adolescence. Adolescents who have not learned successful socialisation skills such as conflict resolution, communication and problem-solving techniques are at risk of developing stress in their friendships and selecting maladaptive social contexts (Lumen, 2012). This can generate a scenario of depressed adolescents congregating together exacerbating negative social and depressive contexts and feelings within one another leading to more sinister individualised and internalised depressive thoughts

Suggested Interventions

Depression is a complex condition with such varied symptoms and reasons to why one would become depressed. Although there are medications used to treat some people with depression they are not the preferred option as many antidepressant medications do have adverse side effects. Psychological treatments are a more favourable option when treating depression. In Queensland, the government supports those in need to obtain a mental health plan. By visiting a local GP, a mental health plan can be created assisting access and affordability to allied health professionals. To assist in diagnosing anxiety and depression a K10 checklist can be used and when a student presents with persistent depressive symptoms the Guidance Officer (GO) will refer the adolescent to their GP for a mental health plan so they have further assistance and more protective factors on offer.

Additional to the GP referral a GO can work with the adolescent in the school environment and offer support. Modified cognitive behavioural therapy (CBT) can be useful for assisting adolescents with depression. Rather than allowing the adolescent to continually reflect on their feelings (as this can be counter-productive) GO’s can reflect back their beliefs, support them in becoming aware of their self-talk, assist them to set short term goals, encourage activity and use a priming approach to help them understand that others have different responses and beliefs (Geldard & Geldard, 2012; Scanlan & Francey, 2017). Similarly, to children, adolescents like things to be fun; GO’s can tap into this part of the adolescent by being playful and creative with their CBT techniques including using games, role-plays, simple and relatable language such as metaphors, cartoons and props. These things can help the adolescent make sense of what is going on for them and remember the session. There are also a range of outside agencies that work with schools, such as Headspace, that can assist adolescents to deal with their feelings and connect with clinicians.