Adolescence

Adolescence is a significant developmental period that extends beyond the linear progression of change from childhood to adulthood (Wicks-Nelson & Israel, 2015). It encompasses the dynamic change to physiological, psychological, emotional, behavioural and cognitive development (Golombek et al., 1977; Crosnoe & Johnson, 2011). Along with these changes comes many challenges and risks, threatening each layer of environment, having significant impact well into adulthood. Adolescents have a higher rate of mental health issues, risk-taking behaviours, loss in self-worth and self-esteem, and self-isolating behaviours which all have significant adverse effects on the individual during an already tumultuous time of identity formation, search for autonomy and finding a place within society (Geldard et al., 2016). Each of these factors of adolescence can result in complexities during their current developmental period and later in life.

Depression

Depression, according to the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; APA, 2013b) is a mood disorder which affects feelings of worthlessness or guilt, behavioural symptoms, cognitive functions and physical functions (Wicks-Nelson & Israel, 2015). This mental health disorder is common among adolescents, with rates between 0.4 to 8.3%, and poses as a major risk factor for suicide and social and educational impairments (Wicks-Nelson & Israel, 2015; Thapar et al., 2012). There are three different classifications of adolescent depression. First, depressed mood being periods of sadness either in response to a situation or failure. Second, depressive symptoms, being a collection of behaviours and emotions whether anxious or depressive and third, clinical depression being the categorisation of mental disorders (Petersen et al., 1992).

Symptoms of depression are consistent among children, adolescents and adults, consisting of depressed or irritable mood, loss of interest or pleasure, change in weight or appetite, insomnia, agitation, fatigue, feelings of worthlessness or guilt, cognitive difficulty or suicidal ideation (Wicks-Nelson & Israel, 2015). Wicks-Nelson & Israel (2015) states that factors such as low socio-economic status has a significant relationship with higher rates of depression in adolescents, due to family stressors of income, limited parental education, family disruption, environmental adversities and racial or ethnic discrimination (Wicks-Nelson & Israel, 2015). The DSM-5 (APA, 2013b) states that in order to assess for depression, information from parents, family and social environments as well as a clinical interview accompanied with an assessment instrument, such as the Child Behaviour Checklist is required (Wicks-Nelson & Israel, 2015). Depression in adolescence manifests in a similar way to that of children, however, during adolescent development and the shift in cognitive, social and biological factors, symptoms of depression begin to resemble that of their adult counterparts (Wicks-Nelson & Israel, 2015). Nevertheless, adolescent depression is often missed in comparison to adults due to the already prominent behaviours of mood reactivity and irritability that occurs during the adolescent time period (Thapar et al., 2012). During an already tumultuous time where adolescents are searching for their place in the world, this poses a significant threat.

Evidence of Symptoms 

Determining the cause of adolescent depression is challenging due to the range of family, social and individual risk factors that can occur (Thapar et al., 2012). Inherited factors and adversity early in life can impact the structure and functioning of the brain, increasing the risk of depression symptoms. Additionally, research into genetics suggest that parents who have depression are three to four times more likely to have children with depression (Thapar et al., 2012). Beyond inherited factors, psychosocial risk factors should be considered when assessing cause. Environmental factors such as exposure to stressful events, chronic adversity and severe stressors on relationships such as, family discord, bullying by peers, poverty, illness and negative family relationships can each add to the compounding risk for adolescents who have already genetic predisposition to depression (Thapar et al., 2012).

Depression in adolescence can appear in many forms ranging from periods of sadness, inability to problem solve, feelings of hopelessness, disengagement from school and from social settings to reoccurring feelings of worthlessness and suicidal ideation (Wicks-Nelson & Israel, 2015). In order to best assess depression in adolescents it is important to involve a number of strategies and gather as much information, from as many stakeholders as possible (Wicks-Nelson & Israel, 2015). As depression can manifest in a number of ways, such as declines in academic outcomes, behavioural problems and withdrawal from peers and family (Wicks-Nelson & Israel, 2015). Collecting information from parents, teachers, guidance officers and social environments are all effective avenues for assessing the presence of depression. However, among the most commonly used practices is self-reported measures, in particular the Children’s Depression Inventory which asks the adolescent a series of questions that best describes them for two weeks prior (Wicks-Nelson & Israel, 2015). This inventory tool is then rephrased to be used by parents and other stakeholders in order to assess different aspects of the adolescent’s behaviour (Wicks-Nelson & Israel, 2015).

Impact on the Individual and Interactions

Adolescence is already a stressful period and poses great risks to an individual’s physical, cognitive and psychological state. The added complexity of depression in adolescence increases these risks immensely in regards to negative outcomes for education, family and social aspects. The increase in an adolescent feeling less self-worth, feeling displaced and disengaged, feeling chronic sadness and fatigue and at worst case, suicidal ideation, is detrimental to their health, wellbeing and future success. Within and beyond the educational context this can have lasting impacts well into adulthood which ultimately could exacerbate the individual’s mental health, unless support and intervention is provided at many levels.

Suggested Interventions

Identifying mental health issues and providing support and intervention is essential when considering individuals of all ages. However, it is more detrimental when working with adolescents. Both self-reported assessment, information gathering from parents, family, environment and educational contexts, in conjunction with clinical assessment are recommended for best outcomes of interventions and support. In an educational context it is important for adolescents to be linked with the appropriate support services in order to provide appropriate support. Guidance officers are vital to first level assessment, where students engage on a daily basis. Furthermore, guidance officers have direct access to extra information from teachers and parents which can help aid in developing such things as an individual support plan. Adolescents that are dealing with depression require many levels of support. Firstly, depending on the depressive symptoms, adolescents may require a safety plan as well as an individual support plan, which is to be implemented in classroom contexts and within the overall school environment to ensure that teachers are aware of required support. However, considerations should be made when developing these methods of support. Knowledge of the students’ background, past adversities, home life and current risk and protective factors are necessary for the most effective support and intervention when dealing with adolescent depression (Petersen, et al., 1992).