Adolescence

The adolescent population in Australia increased to 3.2 million in 2020, with statistics predicting that by 2066, the proportion of young people in the community will reach 5.1 million (Australian Institute of Health and Welfare, 2022).  Developmentally, the goal of adolescence is to transition from childhood to adulthood; leaving behind a life of dependence, arriving at adulthood as mature, autonomous and independent individuals, with a refined sense of identity and purpose (Gerald et al., 2019).  As a result, this stage of life is undisputedly an influential period of time in a young person’s life; multifaceted and complex in nature and demarcated with changes that extend across the biological, psychological, cognitive, physical and behavioural developmental domains (Gerald et al., 2019; Quas, 2014).  Changes in these areas of functioning impact how young people feel, interact, look, think and make decisions about their future (Torres, 2020a).  Therefore, adolescence can be described as a particularly vulnerable and risky stage of life, with developmental challenges more likely to occur at this lifespan stage.  For example, adolescents may experience mood disruptions; conflict with adults and authority; episodes of risk-taking behaviour; peer pressure; difficulties with abstract and egocentric thinking; challenges with parental and community expectations, self-image, as well as, ethnic, sexual, career, self and spiritual identity, and physical illness (Gerald et al., 2019).  These stressors collectively or alone, have the capacity to perpetuate the onset of more serious mental health illnesses, such as social phobias, anxiety, panic disorders and depression which may result in teens requiring professional support and intervention (Black Dog Institute, 2022; Bowyer, 2022).

Depression

Depression is a mental health disorder that affects the way people think, feel and act (Torres, 2020a).  It is characterised by overwhelming sadness, impaired mood, loss of interest in once enjoyable activities and can result in emotional and physical problems that impact an individual’s ability to function within their home, school, work and community environments (Black Dog Institute, 2022; Healthdirect, 2020d; Torres, 2020a; WHO,  2022b; Youth.gov, n.d.).  Globally, depression is one of the leading causes of disability, affecting 6.7% of people each year (Torres, 2020a; WHO, 2022b).  The onset of depression can occur at any lifespan phase, however, it typically presents during the period of adolescence and may characteristically be the combined result of childhood adversity, poverty, grief, unemployment, genetics, biochemical factors, illness, gender, stress and/or personality type (Black Dog Institute, 2022; Krans & Faris, 2021; WHO, 2022b).   Depression ranges in severity and can be mild, moderate or severe depending on the duration, persistence and degree of symptoms, with women statistically more likely than men to experience a depressive episode (Krans & Faris, 2021; WHO, 2022b).  An individual with mild depression may experience low mood, energy and self-esteem; poor concentration, memory, diet and sleep; guilt; anger; mood swings (irritability, despair, inadequacy) and withdrawal from social activities (Gerald et al., 2019).  These symptoms often interfere with one’s ability to perform daily tasks and consequently, can reduce their capacity to function within their home, work and social settings (Gerald et al., 2019).  Depression in its severest form can involve symptoms of psychosis, hallucinations, delusions, thoughts of death and suicidal ideation and behaviours (Krans & Faris, 2021).  However, with the correct diagnosis and treatment, the prognosis for depression sufferers is positive, with 80-90% of people going on to experience relief of their symptoms, making depression one of the most curable mental health disorders (Torres, 2020a).

Evidence of Symptoms 

Depression in adolescence is synonymous with depression in adults, with statistics highlighting that more than half of all adult mental health disorders begin during the period of adolescence (Bowyer, 2022; Klein, 2021; Krans & Faris, 2021).  Nevertheless, depression during this stage of life remains serious, with youth suicide identified as the leading cause of death among young people (Black Dog Institute, 2022; Healthdirect, 2020d). Various factors contribute to the cause of depression in young people and include differences in brain structure, genetics, learned patterns of behaviour, substance misuse, stress of puberty and adverse childhood trauma (Black Dog Institute 2022a; Klein, 2021; Krans & Faris, 2021; WHO, 2022b).  The risk of developing depression is amplified when adolescents become exposed to family crisis, domestic violence, bullying, harassment, illness and social exclusion (Klein, 2021; Krans & Faris, 2021).  Subsequently, the signs and symptoms of depression among teens often manifest differently to adults due to the cognitive, social, behavioural and environmental changes and challenges they are exposed to, making depression difficult for parents and caregivers to identify; with warning signs often confused with stereotypical adolescent behaviour (Black Dog Institute, 2022; Klein, 2021; Krans & Faris, 2021).

Symptomatically, adolescents with depression tend to have problems with declining academic performance, concentration, memory and are likely to disengage from school and work (Black Dog Institute, 2022; Klein, 2021; Krans & Faris, 2021).  Socially, they may withdraw from peer groups and activities that were once pleasurable and become irritable and/or melancholic most of the time (Black Dog Institute, 2022; Klein, 2021; Torres, 2020a).  The once active teen may also become uncharacteristically lethargic, lacking in energy and adopt an apathetic attitude towards the world around them, choosing to sit and internalise feelings of worthlessness, inadequacy and helplessness over opportunities to connect and engage with others (Black Dog Institute, 2022; Klein, 2021; Krans & Faris, 2021; Torres, 2020a). Physically, depressed teens may lose their appetite, refuse to eat and perform necessary hygiene routines; and experience prolonged episodes of insomnia which can result in physical ailments such as unexplained aches, pains and illnesses (Healthdirect, 2020d).  Teens who develop depression may also start to experiment with illicit substances, sexual promiscuity and engage in other risk-taking behaviours like irresponsible driving and property misconduct (Krans & Faris, 2021; Youth.gov, n.d.).  Additionally, youths suffering from a severe depression episode may engage in self-harm behaviours, think deeply about death and develop suicide ideation behaviours and devastatingly, in some cases attempt suicide with success (Youth.gov, n.d).

Distinguishing between typical adolescent broodiness and depression can be challenging, however, when these signs and symptoms persist beyond 2 weeks, increase in frequency and intensity, negatively impact the daily functioning of the young person and present as uncharacteristic changes in behaviour it is recommended that they are supported to seek help (Healthdirect, 2020d; Torres, 2020a).  The first step to seeking support for adolescents involves visiting a general practitioner who may assess the young person, which may include a physical examination, lab tests and psychological evaluation using interview techniques, questionnaires and basic facts template (Black Dog Institute, 2022; Healthdirect, 2020; Klein, 2021; Torres, 2020a).  Based on the analysis and interpretation of the assessment, the practitioner may suggest lifestyle changes and/or refer the teen to a psychologist or psychiatrist who specialises in young people (Gerald et al., 2019; Healthdirect, 2020d).  They may also contact and recommend that the adolescent reaches out to the school guidance counsellor and/or community health services to access support contextualised to their surrounding environments (Healthdirect, 2020; Klein, 2021).  Unfortunately, some young people refuse offers of assistance, however, they should be encouraged and supported to access reading materials and websites to learn more about depression and its prevalence, to fully understand that help can be and is available (Black Dog Institute, 2022; Gerald et al., 2019; Healthdirect 2020d).  However, when help is declined and a young person becomes suicidal, it is imperative that an adult act protectively and immediately access mental health support on behalf of the adolescent (Black Dog Institute, 2022).

Impact on the Individual and Interactions

Depression can significantly impact all aspects of an adolescent’s life, with difficulties that extend beyond the individual and transcend into their home, school and community environments (Krans & Faris, 2021). Depressed teens typically withdraw and isolate themselves away from family and friends and choose to engage in various behaviours that can pose many challenges for the them and those around them (Krans & Faris, 2021).  As a result of these behaviours, it is common for family members to feel helpless, which can lead to strained relationships within the home that mirror sibling, parent and marital conflict (Bowyer, 2022; Youth.gov, n.d.).  Fractured family relationships are often blamed on mentally unwell teens, and affect how families connects with relatives and members of the wider community; which may isolate the individual and family from community support and/or place them all at risk of social isolation (Youth.gov, n.d).

Teens suffering from depression also find it challenging to engage in the school setting successfully.  Young people with mental health illnesses are more likely to engage in school refusal, experience poor academic success and consequently drop out, or engage in risky, anti-social behaviours that may sever peer relationships and potentially lead to increased levels of school disciplinary absences (Youth.gov, n.d.). These same behaviours also place them at risk of peer isolation, bullying and harassment, which when combined, can negatively impact their future life trajectory with later life challenges such as career and tertiary study opportunities (Youth.gov, n.d.).

Suggested Interventions

Of all mental health disorders, depression is one of the most treatable, however, it is vital for this common mental health disorder to be identified and diagnosed early (Black Dog Institute, 2022; Torres, 2020a).  Medication, psychotherapy and self-help coping strategies are all outlined as effective treatment options for adolescent depression sufferers (Klein, 2021; Krans & Faris, 2021; Torres, 2020a).  However, as part of a young person’s treatment plan, a young person’s doctor, psychologist, psychiatrist or social worker may reach out to or recommended that they seek the support of the school guidance counsellor, as they too can provide a range of psycho-educational strategies to teens that may be beneficial to overcoming mental illness (Black Dog Institute, 2022; Gerald et al., 2019).  One strategy that may be effective is the Problem-Solving Framework, a strategy used to support self-discovery, whilst helping young people make decisions and change behaviours (Gerald et al., 2019).  This strategy recognises that teens are at a stage of development that involves a new-found level of independence, that requires them to make decisions for themselves. The problem-solving framework encourages counsellors to work with teens to; identify the problem; list all the possible solutions; made a list of pros and cons; decide on the best solution; outline the steps they will take to achieve the result and revise their progress to inform future decisions and outcomes (Gerald et al., 2019).  As a strategy, it can guide and support teens to understand the root cause of their depressive behaviours and look to find solutions to these problems, with emphasis on changing patterns of behaviour that may be perpetuating depression symptoms (Gerald et al., 2019). Based on the outcomes and success of the solutions explored in the framework, depressed teens and school counsellors may then work together to develop and document an individual support plan that includes effective self-help and coping strategies experienced as part of the problem-solving framework.