Adolescence

According to Kevey (2022), adolescents makeup the largest part of the world’s population, they are estimated to be about 1.8 billion which is almost a third of the world population. Adolescence is a developmental stage characterised by rapid physical, intellectual and social changes from childhood into adulthood (Centre for Disease Control [CDC], 2019). Individuals reach this stage differently but it generally starts with the onset of puberty around the age of 10 years, and ends with the acquisition of adult roles and responsibilities at the age of 19 years (CDC, 2019). It is a period of challenges for many brought forth by accelerated changes in: physical appearance due to onset of puberty, psychological changes due to seeking independence and autonomy, cognitive changes signified by shifting from concrete to abstract way of thinking, emotional moodiness and social changes as they experience knew life influences (New South Wales Government NSW Health, 2019).

At this stage, adolescents are trying to discover their identities and build new relationships, their bodies and brain development changes so rapidly resulting in mood swings and impulsiveness (Backes & Bonnie, 2019). Due to these major shifts in their biological and social environment, adolescents are vulnerable to mental health problems such anxiety and depression (Australian Institute of Health and Welfare [AIHW], 2018). In 2021, WHO (2021a) estimated the prevalence of mental health problems among adolescents as 14% worldwide, with depression, anxiety and behavioural disorders among the leading disabilities.

Depression

Depression is one of the most common mental health problems in the world, it is characterised by an ongoing sadness and lack of interest in things which were previously enjoyable, leading to behavioural and physical challenges which affect one’s functionality (Cieza et al., 2020). The four common categories of depressive disorders include: major depressive disorder also known as ‘depression’, persistent depressive disorder, bipolar disorder, and seasonal affective disorder, with major depressive disorder being the most common of all (Harvard Health Publishing, 2018). According to The Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM–5; APA, 2013b), all of the depressive disorders are characterised by sadness, emptiness, or irritability, together with somatic and cognitive changes that are significant enough to interfere with an individual life, the only difference is the time and length of suffering. Depression is usually comorbid with other mental health disorders such as anxiety and drug dependence leading to increased negative outcomes in an individual’s life such as self-harm and suicide if not treated (Harvard Health Publishing, 2018).

To be diagnosed with depression, an adolescent has to experience five or more of the following symptoms for at least 2 weeks, inclusive of either depressed mood or loss of pleasure: unexplained weight loss or gain, insomnia or hypersomnia, fatigue, clouded thinking, worthlessness or guilt, suicidal thoughts, extreme distress and no physiological explanation of the symptoms (APA, 2013b).According to the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, depression is one of the most disabling psychopathological disorders and ranked third of burden of all diseases both worldwide and in Australia with 13% prevalence (AIHW, 2018).

Depression is common in adolescence especially girls, with an increasing prevalence after puberty, exceeding 4% rate per year (Cieza et al., 2020). During the year 2013 to 2014, 20% of Australian adolescents aged 11 to 17 years had depression:13% and 6.6%, respectively (AIHW, 2018). Depression often remains undiagnosed among adolescents, one of the reasons is that it is challenging to differentiate adolescent mood-swings from depressive illness and therefore leading to lack of diagnosis or misdiagnosis (AIHW, 2018). Besides the physical decline in health, depression also affect adolescent’s social wellbeing, manifesting through social withdrawal as the individual loses interest in things, lower academic achievement at school due to lack of motivation, involvement in risky and antisocial behaviours as a way of masking the depression and consequently becoming even more alienated due to their behaviours (Thapar et al., 2012).

Evidence of Symptoms 

Several different factors: biological, physiological and environmental may lead to depression in adolescents. When considering biological and physiological factors, blood samples have been used to measure hormonal levels in a patient’s body. For example, a study by Kraus et al. (2017) linked serotonin deficiency with the prevalence of depression, Serotonin is responsible for brain functions including mood and neural activities hence its deficiency increases the likelihood of depression in adolescents. The presence of endocrine dysfunction such as decreased growth hormone and hormonal shifts due to puberty in adolescents have been linked to depression (Clarke & Currie, 2009: Reinecke & Simons, 2005). Evidence gathered from high performance liquid chromatography showing defective and increased neurotransmitters from adolescents’ brains have been associated with major depressive disorders (Reinecke & Simons, 2005).

Cognition and emotion are related processes originating from the interaction within the brain neurons, and a dysfunction of these interactions leads to failure to regulate one’s mood and diminished cognition (Clarke & Currie, 2009). Evidence from reports of diminished executive functions such as planning, and executive control have been documented in adolescents with depression, and they also experience difficulties in memory retention which directly impacts their academic performance (Kraus et al., 2017).

Taking into consideration some environmental factors, an experience of traumatic childhood events such as neglect and abuse has been linked to depression in adolescence (APA, 2013b). Other genetic factors include family history of depression, heritability of neuroticism trait which increases the risk of developing depression during stressful events is approximately 40% (APA, 2013b), hence adolescents with family history of depression have higher prevalence.

There are several identified behavioural and social changes that may indicate that the adolescent has depression, these include: irritability-adolescents with depression tend to be more irritable and full of outbursts more than others age groups, they spend less time with their social groups as compared to those without depression (Reinecke & Simons, 2005). These behaviours also impact them at school, more often they are socially withdrawn which limits their interaction with others and exacerbating their loneliness (Reinecke & Simons, 2005).

Impact on the Individual and Interactions

Depression interferes with different aspects of an individual’s life. It affects their emotions, self-perception, way of thinking, relationships, functionality and overall happiness (Clarke & Currie, 2009). At an individual level, depression does not only manifest cognitively with diminished functionality which leads to low academic achievement or psychologically as lack of interest, low self-worth and self-mutilation, it can cause physical challenges such as headaches, lack of sleep and appetite, fatigue and general body weakness, and the most detrimental of all is suicide (Kraus et al., 2017).

Depression has a ripple effect, affecting not only the individual, but also their surrounding: peers, family and school. It disrupts family routines, create conflict within the family and peers because of the moodiness and outbursts (Victoria Government; Better Health Channel, 2012). If not isolating themselves, adolescents with depression may disrupt lessons or get into physical altercation at school in order to mask the depression, this negatively impact their academic performance peer relationships (Victoria Government; Better Health Channel, 2012). They have higher prevalence of school dropout and involvement in drugs, smoking and alcohol use, which put them at a higher risk of other long-term diseases such as heart disease, diabetes and lung cancer, impacting the community’s economy in the long run due to medical expenses (Better Health, 2012a).

Suggested Interventions

There are several evidence-based psychotherapeutic such as cognitive behaviour therapy (CBT) and pharmacological treatments proven to improve the symptoms of depression (Thapar et.al., 2012). A study of 439 American adolescents with depressive symptoms aged between 12-17 years on whether evidenced-based psychotherapeutic treatment or pharmacological treatment was more effective showed no difference between results of individual programmes but more efficacy on combined treatment: 73% combined, 62% pharmacological and 61%  CBT (Spirito et al., 2011). Adolescents with depression face many challenges including stigma, and this usually impedes them from seeking help (Thapar et.al., 2012). It is the responsibility of the Guidance Officer (GO), administration staff and teachers as they are the secondary carers, to devise a whole school approach as an initial intervention to teach about depression and target stigma associated with it hence encouraging students and families to seek help more (Thapar et.al., 2012).

For adolescents who have depressive symptom, the school guidance officer should adapt the use of Cognitive Behaviour Therapy (CBT), which has been proven to alleviate symptoms of depression in adolescents (Spirito et al., 2011). CBT is an evidence-based therapy which involves mood monitoring, social skills, relaxation training, thinking and problem-solving techniques which are needed for emotion regulation and interpersonal relations, for adolescents, the involvement of parents is critical as primary carers to enhance the support system (Spirito et al., 2011).

Telman et al. (2020) suggest a more individualised program which targets the individual’s personnel needs and strength. As the GO is limited when considering pharmacological treatment, they cannot use it as their intervention plan. Unless the adolescent is already on medication, it is advisable to consider a combination of CBT with Interpersonal Psychotherapy for Depressed Adolescents (IPT-A). IPT-A is described as a short-term therapy aimed at focusing on the individual’s current functioning challenges in order to reduce symptoms of depression by enhancing their interpersonal relationships (Mufson et al., 2004). It is focused on five main areas associated with depression: grief, conflicts, role changes, empathy and parental component. The aim of IPT-A is to identify interpersonal relationship challenges within the five areas above and focus on them treat the depression. Studies have shown that both CBT and IPT-A are beneficial towards adolescence depression (Telman et al., 2020: Mufson et al., 2004), with IPT being more efficacious than CBT (Mufson et al., 2004), and therefore it is reasonable to combine them as they target different areas of life.