Adolescence

Adolescence is a dynamic maturation period in which an individual’s life can rapidly pivot in both negative and positive directions (Dahl et al., 2018). Characterised by a number of developmental changes and associated biological, cognitive, psychological, and social challenges the purpose of adolescence is to achieve independence. Current research indicates that an age range of 10 to 25 years corresponds significantly to the developmental structures of the brain and patterns of behaviour seen during adolescence (Arnone, 2014; Sawyer et al., 2018; Wise 2018). The World Health Organisation (WHO; 2022a) estimates that there are approximately 1.2 billion adolescents globally making up one sixth of the population with numbers expected to rise through to 2050.  Adolescence marks the peak onset of mental health conditions with global estimates indicating 14% of adolescents are experiencing mental health conditions (WHO, 2022b). Due to the developmental changes occurring at this time adolescents are increasingly vulnerable to societal stressors often resulting in risk taking or rebellious behaviours. These behaviours unfortunately increase the risk of poor mental health and the development of mental health conditions for which many are left untreated. Mental health literacies and promotion, prevention and early interventions should be integrated across educational and medical fields expending into the community in order to support adolescents as they transition to adulthood. In comparison to the general population individuals with mental health conditions have a decreased life expectancy of 10- 15 years, but with early interventions at the first onset, typically during adolescents can improve several outcomes (Solmi et al., 2021).

Depression

WHO (2022b) defines depression as a persistent sadness and lack of interest in previously enjoyable activities.  A statistical review of literature highlights numerous findings associating adolescent depression with numerous negative psychosocial outcomes throughout adulthood (Clayborne et al., 2019).  Racine et al.’s (2021) meta-analysis identifies that globally 25.2% of adolescents are displaying clinically elevated symptoms of depression. Bodden at al. (2018) further highlights global that prevalence rates in regards to adolescent depression in different countries, noting differences of between 1.3 to 18.2% with an estimated global prevalent rate indicating five percent of adolescents meeting diagnosis criteria in alignment to the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; APA, 2013b). This aligns to national data, suggesting that 5% of Australian adolescents aged between twelve and seventeen experienced major depressive disorder meeting DSM-5 diagnostic criteria (Lawrence et al., 2016). Lawrence et al. (2016) also indicates prevalence differences specific to gender identifying females (5.8%) were 1.5% higher than males (4.3%) in experiencing major depressive disorder.  These findings corroborate with international studies identifying that prevalence rates are higher amongst females than males in regards to both subthreshold depression and major depressive disorders (Crockett et al., 2020).

Depression is a multi-factorial mood disorder that prevents people from reaching their full potential impeding on behavioural, cognitive, and social aspect of life (Bernard, 2018). The DSM-5 identifies three levels of depression mild, moderate, and severe affecting an individual’s ability to function in different capacities. At mild levels of depression, daily tasks require some effort while moderate depression involves occupational and social impairments, with progressions including psychotic episodes in severe cases. Singh et al. (2019) systematic review highlighted two critical findings 1) that adolescents were poor at recognising the symptoms of depression, and 2) that adolescents tended to attach stigma to depression making them more inclined to seek help from informal sources.  Therefore, in order to minimise lifelong impacts of adolescent depression, strategies to improve adolescent mental health literacies and remove associated help-seeking negative stigma. Depression is the leading cause of mental health related disease burden globally (Herrman et al., 2019) with the average onset being mid to late adolescence. Subthreshold depressive symptoms in adolescence poses a significant indicator of early adulthood depressive disorders, psychosocial impairments, and substance abuse (Aalto-Setälä, 2002). Concerningly, less than two-thirds of adolescents with mental health problems access professional help due to a number of factors including poor mental health literacies and understandings of depression, stigma associated with both mental health problems and help seeking behaviour and a lack of trust in regards to confidentiality (Radez et al., 2021).

Evidence of Symptoms

Depression is associated with broad deficits in cognitive functioning characterised by negative cognitive biases and maladaptive emotional regulation strategies evident by a lack of ability to plan, problem solve, as well as inhibiting the processing of information (LeMoult & Gotlib, 2019).  In addition to this, depressed individuals fail to show positive cognitive biases and adaptive emotional regulation strategies that are likely to serve as protective factors (LeMoult & Gotlib, 2019). Within adolescents this can be observed as trouble concentrating and remembering information, disengagement in school and extra-curricular activities, extreme sensitivities and fixation with personal failures, low self-esteem, mood swings, and feelings of hopelessness. Adolescents who are depressed may not show obvious signs of depression but may begin to behave uncharacteristically engaging with a number of risk-taking behaviours such as drug and alcohol abuse, school refusal, inappropriate sexual involvements. Sleep and eating patterns may also drastically alter during this period characterised by constant fatigue and significant weight loss or gain (Beyond Blue, 2022f). Adolescents will typically begin withdrawing from close friends, family and activities they had previously found engaging with the effects of social isolation again impacting on negative cognitive bias and emotional regulation.

Impact on the Individual and Interactions

The prevalence, recurrence and incidence of depression in adolescents is substantial, impacting negatively not only the individual but the relationships they hold in their personal, social, and educational lives. Depression influences individuals’ physical and mental wellbeing often leading adolescents to risk-taking behaviours and social isolation, which hold significant consequences on an adolescents’ cognitive and social-emotional development. Depression impacts on daily life and although a mental health disorder impacts your physical health and wellbeing as individuals no longer find pleasure in a number of activities they generally revert to a sedentary lifestyle in which finding the motivation to shower daily can be difficult. Such behaviour may lead to: poor hygiene, insomnia, headaches, fatigue, chronic pain, weight loss or gain increasing the risk of heart disease. As a result of these conditions, social isolation from peers and family may occur over time consequently increasing feelings of emptiness and increase the adolescent’s vulnerability to substance abuse and suicidal ideation (Butler et al., 2016). Depression often increases a student absence impacting on learning and when present at either school inhibits their ability to perform adequately (Johnston et al., 2019). This is of concern for a number of academic, social and emotional reasons as students enter a cycle of learning gaps which may lead to further feelings of failure and potentially bullying. Extended absenteeism from school or placement in an alternate setting due to mental health is also identified as a key risk factor in the for suicidal ideation and attempts, inappropriate sexual behaviour, teenage pregnancy, substance abuse and violence (Kearney, 2008).

Suggested Interventions

Guidance Counsellors (GC) have many responsibilities across the schooling section in providing prevention, intervention and postvention support to students, families and teachers in regards to an array of challenges that adolescents may face. Although GC do not diagnose mental health conditions such as depression, awareness of the symptoms and co-occurring conditions and behaviours allows for early identification of students with higher vulnerability to the condition for referral and to provide bases for initiation of school-based prevention and intervention programs (Evans et al., 2002).  Due to the high prevalence rates of adolescents with depressive symptoms globally, interventions within a school context have been heavily reviewed due to their unique position to influence adolescent learning. It has been identified that universal strategies beginning with prevention and the expansion of mental health literacies are needed in reducing adolescent poor mental health. Prevention programs are associated with a number of advantages with research suggesting that it is possible to prevent 22% of new depression cases annually (Werner-Seidler et al., 2017). School based mental health promotion need to focus on adaptive coping skills, help seeking behaviours and related competencies which can be delivered through social and emotional learning and targeted areas of the health curriculum. Cognitive-behavioural therapy CBT are designed to teach the use of positive self-talk to regulate negative thoughts, emotions and behaviours (Caldwell et al., 2019). Programs such as SPARK Resilience (Boniwell & Ryan, 2009) have been effectively implemented as universal school preventions that builds on CBT with positive psychology concepts such as resilience and post-traumatic growth to foster emotional resilience acting as a protective factor in adolescent mental health concerns.

For students who have been diagnosed or are experiencing symptoms of depression, individual and small group CBT interventions and daily check ins may be required (Paulus et al., 2016). The integration of CBT and mindfulness has also shown positive results for people with recurrent depression. Johnson et al. (2016) suggest that adolescents may receive particular benefits from mindfulness-based interventions in conjunction with CBT in providing support to students suffering from depression and anxiety.  In providing interventions to students who are suffering from depressive symptoms there are a number of CBT and mindfulness-based approaches designed for school-based universal and targeted intervention. This is the responsibility of the GC to ensure appropriate facilitation of the delivery of these programs in best supporting students. For students experiencing diagnosed depression, it is in the best interest of the student that the school and their external adult support group work together in developing a holistic approach to intervention processes. The GC in this instance is available for support during the school day in alignment with the student’s mental health plan which allows for closer monitoring of the student and their conditions progression or regression.