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Assessment and Treatment of Depression in Adolescence

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Assessment and Treatment of Depression in Adolescence


Today's youth are faced with many challenges including depression, substance use and suicide. Depressive disorders in adolescence are a major health concern. Depression often disrupts normal development due to the negative impact it has on social and educational functioning. This paper focuses on adolescent depression, as well as its assessment and treatment. Additionally, an examination of both risk and protective factors of adolescent depression, and implications these relationships have for prevention and adolescent health behavior.

Adjusting to physical and hormonal changes, becoming more independent, an increase parent-child conflict, social and academic responsibilities, and a desire for intimacy with others are examples of stressors that may predispose an adolescent to experience depression. The challenges faced by youth today are reflected in a host of problems, including depression, substance use or abuse and suicide (Garland & Zigler, 1993). Whether depression is defined as a symptom, syndrome, or psychiatric disorder, affective disorders in adolescence are a major health concern. The presence of depression disrupts the young person's maturational development through the detrimental impact it has on social and educational functioning. For example, evidence indicates that major depression slows down some aspects of cognitive development and interferes with the acquisition of verbal skills; which can lead to dropping out of school, (Kovacs, 1989). Moreover, research indicates that in the long-term, depression that reoccurs leads to an increased risk for depressive disorder and dysfunction in adulthood, (Garber, Kriss, Koch, & Lindholm, 1988). Not only is adolescent depression the most significant predictor for adult depression; it also predicts increased risk among females of higher divorce rates and estrangement from parents, while among males there exists increased risk for higher rates of unemployment and car accidents. Both have increased risk for intimacy problems and legal activities (McFarlane, Atchison, Rafalowicz, & Papay, 1994). Thus, the study of adolescent depression and its predictors are of utmost importance.

Depression remains one of the most significant mental health problems throughout the life span as reflected in its high prevalence among adults, the debilitating effects to overall functioning, in its association with negative outcomes including substance abuse (Weissman, & Klerman, 1991). The term "depression" has been defined as a painful emotion or negative mood; as an aggregate of negative mood and associated complaints such as hopelessness worthlessness, suicidal ideation and lethargy; or depressive disorder with characteristic symptom patterns, and duration that impairs a person's functioning and meets the criteria for a Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) diagnosis.

High levels of depression or emotional distress may be particularly dangerous for adolescents. There is compelling evidence from diversity of studies that indicate that if depression is persistent it has numerous negative associated features and consequences; such as engaging in dangerous behaviors, hostility or anger, substance use and suicidal ideation and or attempts (Felix-Ortiz, Newcomb, & Myers (1994). Problems of adolescents are on the rise as research indicates that rates of the emotional and behavioral problems of adolescents have increased over the past ten years (Achenbach & Howell, 1993). The strongest support of the diagnosis of depressive disorders in youths are longitudinal data including that the disorder recurs and interferes with the ability to achieve and maintain competent function, (Kovacs, 1989).

Depressed, or dysphoric, mood refers to feeling sadness, unhappiness, the feelings, or feelings of worthlessness, which are exhibited occasionally or for a brief period of time (Davison & Neale, 1994). Other hallmark symptoms include feeling discouraged, and feelings of self-reproach. Depressed mood is viewed as a normal response to thwarted goals or to personal loss, as long as it does not become persistent or severely debilitating. For adolescents, a negative mood can occur in response to specific situation such as the loss of significant relationship or getting a poor grade on an exam (Garrison, Schluchter, Schoenbach, & Kaplan, 1989).

A depressive syndrome is defined by the constellation of symptoms, behaviors and emotions, which may include depressed mood, and a negative self-concept, self punitive wishes, vegetative changes, and/or a decrease in activity level (Beck, 1972). A depressive syndrome is described when the adolescent is (1) withdrawn, (2) complains of numerous somatic complaints, (3) exhibits social or attentional problems, or (4) in some



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