Systematic Review of Depression among Adolescents

Population and Problem

Depression is a major mental health issue affecting many adolescents not only in the United States but all over the world. Studies on the adolescent population have observed that approximately 3.8 million adolescents from age 12 to 17 have encountered more than one major depressive episode (Orri et al., 2018). Research also shows that adolescent females reported higher rates of depression (23%) compared to adolescent males (8.8%). Factors such as grades, school performance, popularity, sexuality, abuse, bullying, cyberbullying, social media, and countless other reasons are the major causes of depression among adolescents (Zhu, Haegele & Healy, 2019). Also, popularity can make a teen’s self-esteem drop, and provoke a feeling of worthlessness. Bullying is also predominant, and could easily make a teen or child depressed, with over 20% reported being bullied in 2019. LGBTQ+ teens and youth are at a significantly larger risk of depression and suicide. With more adolescents engaging in suicide attempts and self-harm behavior and being diagnosed as having depression, it is critical to not only explore how to prevent their onset but also to treat those with symptoms.

Review of Articles

Current literature shows that depression is becoming rampant among adolescents. A study conducted by Orri et al. (2018) shows a declining rate of life satisfaction, happiness, and an increase in hospital admissions for self-harm behaviors and symptoms of depression among adolescents in the U.S. These mental health indicators are showing similar patterns with most cases indicating that poor mental health is more prevalent among girls than boys. In similar research, Evans & Erickson (2019) articulate that the increase in suicidal behaviors and depression among adolescents has remained concurrent due to the increase of digital media use. Increased smartphone and digital media use have influenced adolescents’ mental health through mechanisms such as disruptions and displacement of in-person social interactions, cyberbullying, sleep interference, and online information concerning self-harm. Other factors such as child abuse, trauma, and abandonment have also led to an increase in depression and suicide rates

In their research, Zhu, Haegele & Healy (2019) investigate the relationship between depression, academic achievement, and other problems related to mental health among adolescents. For the longest time, depression has been linked to mental health problems such as irritability, suicide risks, feelings of emptiness and sadness, severally hindered mental functioning, and learning problems. It is also related to low academic performance resulting from lack of concentration and impaired cognitive functioning.  Keles & Idsoe (2018) highlight students with a major depressive disorder are likely to experience problems in their school performance and higher levels of psychological distress. The authors also add that poor mental health resulting from depression is associated with irregular sleep patterns and academic pressure that have negative effects on school performance. This article comprehensively highlights the effects of depression on adolescents and provides recommendations. The information provided is significant to research on the effects of depression on adolescents.

Depression has led to significant effects that have negatively affected the lives of many young people. Fiorilli et al (2019) in their article offers an analysis of causes, effects, and interventions of depression among adolescents. The authors use data and statistics from case studies and government sources to provide comprehensive figures and facts of how the rates of depression have increased among young people in the country. According to the authors, the major depressive disorder has led to significant mortality and morbidity in the U.S and other nations. The main causes of depression and its effects can be viewed in terms of health, financial and social aspects. Less information has been provided concerning the causes of depression among adolescents. However, Clayborne, Varin & Colman (2019) examined some of the causes and found out that brain chemistry, childhood trauma, hormone, genetics and negative thinking patterns are among the leading causes of depression among adolescents. Socially, depressions make teenagers behave abnormally, use drugs, and isolate themselves. Financially, it makes people bankrupt. There are also many health problems related to depression including insomnia, tiredness, agitation, headaches, angry outbursts, and self-harm. Apart from providing significant remedies for depression, this article is significant since it provides generalized frameworks for researchers and health care activists.

Keles & Idsoe (2018) provide a significant look at the sensitive periods of adolescence and the prevalence of depression during this period. This article is significant for this research because it offers a broad analysis of the effects of depression on teenagers and how it can be prevented. According to the authors, depression throughout early adolescence tremendously rises the lifelong developmental risks including suicide and mental health problems, lower educational achivement, problems with social relationships, substance abuse risk and school dropouts. This is because adolescence is a sensitive period that puts teenagers at risk of many problems. The authors offer a comprehensive look into current theories that provides information on the risk aspects that increase the susceptibility of depression symptoms (Keles & Idsoe, 2018). This article also offers critical preventive measures for depression that can be used to distinct risk outlines and executed before the sensitive phase of adolescence as a way of minimizing the risks of depression. There the information offered in this article is vital for research on depression among adolescents.

Depression has led to significant impacts, especially on the youth. Thus, people must come up with effective strategies to reduce the negative implications. In their research, Clayborne, Varin & Colman (2019) examine the strategies used by adolescents in minimizing the risks of depression in their local contexts. Many strategies can be used to reduce the impacts of depression. Cognitive-behavioral strategies provided by experts and physicians can significantly help reduce the depression symptoms of different teenagers within their respective spheres.  Evans & Erickson (2019) claim that the implementation and development of depression programs are needed to help in resonating with the youth. Harm reduction strategies will be significant in informing this strategy. Nonetheless, for effective harm reduction programs, there is a need for significant information from youth experiences and honesty. The authors also add that harm reduction in the framework of geographically, socially, and culturally normalization provides significant ways in which young people deal with depression (Evans & Erickson, 2019). This article is significant for research since it provides comprehensive information on how people can prevent depression.

I have learned many aspects concerning the prevalence of depression among adolescents from conducting this research. Before conducting the literature review, all I had is a general idea of the prevalence and effects of depression in society. I have learned that depression among adolescents is caused by many factors including brain chemistry, childhood traumatic experiences, hormones, genetics and negative thinking patterns. Also, depression causes major effects such as suicide and self-harm, poor academic performance, increased risk of drug use, and other health-related issues (Clayborne, Varin & Colman, 2019). My literature is also significant in my research since it includes identifying the gap in existing literature for placing the research within the context to explain its reason. It will also help to form the theoretical framework, develop the right methodology, and support the results.

Evidence-based Interventions

There are many evidence-based interventions for depression among adolescents. According to Fiorilli et al. (2019) for depression, evidence-based interventions can be split up into different categories including lifestyle, therapy, and medication. When it comes to lifestyle, exercise and other general interventions are effective. Some research has found that exercise can be just as good at helping depression compared to medication. This is because exercise helps in reducing negative thoughts, stress and relaxes the mind. Also, small amounts of research suggest that skipping a night of sleep can help, but unfortunately once the deprivation is gone the depression returns. General choices include smoking cessation, a good diet, and not taking drugs or excessive alcohol

Several therapeutic interventions can also help in reducing depression symptoms. One of them is through psychotherapy or counseling. This is more effective in teenagers and can be delivered in a group or a one-to-one session. There is also Cognitive Behavioral Therapy (CBT). It appears to be similar in effect to an antidepressant recent reviews suggest. Combined with medication it is used in severe depression and/or anxiety (Keles & Idsoe, 2018). Apart from lifestyle choices and therapy, medication also helps in reducing depression among adolescents. One of the most effective medications for depression is SSRIs (fluoxetine, citalopram). There is a relatively strong evidence base for the use of these medications, especially in teenagers and especially in those with more serious depression. Other medications such as Ketamine are probably the most promising potential antidepressant and have been very effective in a few trials (Orri et al., 2018). More evidence is needed, however. Modafinil, dextroamphetamine, and buprenorphine all have some very rare indications in the treatment of depression. They would only be used in someone with a complex disorder and most likely multi-morbidity.

Chosen Interventions

An evidence-based intervention I might choose to deal with the depression problem among adolescents is Cognitive Behavioral Therapy (CBT). This is because, through CBT, I can modify the thought patterns of an adolescent to change his or her behaviors and moods (Keles & Idsoe, 2018). This method can be applied to an adolescent who is facing major depressive symptoms. I can work with adolescents using CBT to identify their negative behavioral responses and thought patterns to stressful and challenging situations. Some risk factors presented by adolescents include increased negative behaviors, aggressive or impulsive tendencies, and childhood trauma.

Cognitive-behavioral therapy is one the best interventions that provides effective treament for depression and anxiety (Orri et al., 2018). CBT is an evidence-based practice and outperforms medication in terms of later relapse. Considering my expertise and the client’s values, we can work together to change aspects of the person’s environment, behavior, and cognition.

Another intervention I might consider is Dialectical behavioral therapy (DBT) and exercise and mindfulness practices. DBT emphasizes accepting one’s unpleasant and distressing thoughts, behaviors, and feelings and teaches one to regulate them. Applying exercise and mindfulness is a part of DBT and it helps me to observe and learn what is happening within an adolescent such as thoughts, feelings, sensations, impulses at the moment (Evans & Erickson, 2019). It allows one to slow down and focus on coping at the moment. Medication will be administered depending on the intensity of the client’s depressive symptoms and how much it’s affecting his or her functioning in daily life

Application of Skills and Techniques

While using CBT, I will apply some specific techniques and skills. The paralyzation of willpower and lack of pleasure from previously enjoyed activities will be the first focus of the CBT. Adolescents with depression and anxiety will often find themselves not wanting to get out of bed and will forecast failure and catastrophic consequences upon any activity. Depression results in a vicious cycle where depression leads to a lack of energy/motivation, this leads to a lack of activity, which leads to increased feelings of worthlessness and guilt, thus leading back to depression (Bernaras, Jaureguizar & Garaigordobil, 2019). Along with the client, we will work collaboratively to increase activity at the client’s pace to help generate more energy and behaviorally test negative assumptions and expectations.

Next, we will work on identifying common negative styles of thought that aren’t accurate or functional. The client will adopt a judge-like approach, weighing the evidence to correct these automatic negative thoughts. Those with depression see the world through their lenses which pertain to negativity toward the self, their world, and their future. CBT is helpful to clients and all are about equal value- that is, none is better than any other (Keles & Idsoe, 2018). The most important factor contributing to the success of therapy is “the therapeutic relationship,” that is, the quality of the relationship between the patient and the therapist. Another important factor I will consider is whether the patient is hopeful that they can improve in the therapy. All other factors are of negligible significance including the type of therapy.

When it comes to skills, I will employ active listening, empathy, building rapport, and effective communication. During the CBT process, I will actively listen to the client by providing them with full attention to what they are doing and saying. I will also value them as worthy people. While actively listening, I will also employ silence to give control of the objective, pace, and content. This incorporates listening to their words and silence, observing them, and sitting with them. I will apply empathy by making them feel safe and letting them know that their problems are heard. Being compassionate to them enables me to build trust and make them open up regarding their problems. Building rapport during conversations will help establish connections with my clients. Effective communication establishes trust and helps me understand the feelings of the clients.

Measuring the Outcomes of Intervention

One of the most effective ways of measuring the outcomes of CBT is by monitoring the goals set by a client. CBT for adolescents with depression is effective when it is connected to the long-term goals for recovery (Orri et al., 2018). Short-term goals can be measured by breaking down the goals to recovery into smaller steps. It is also the responsibility of a therapist to provide clients with significant techniques for measuring the progress of CBT. One of the most effective tools is the Neuropsychological Educational Approach to Cognitive Remediation (NEAR) since it allows the therapist and client to monitor progress week by week (Evans & Erickson, 2019). Counselors also provide comprehensive testing that can measure the overall behavioral and emotional improvement throughout the entire process. Focusing on exercises, and tasks make it easier for clients and therapists to measure the results.

Cultural Considerations

Adolescent depression is prevalent in every community and clients come from different ethnicities or cultural backgrounds. While working with the adolescent population, it is critical to give weight to their cultural backgrounds. It is also an ethical standard for the American Counseling Association. I have to consider, their values, beliefs, and practice. For instance, I will keep in mind that Western culture tends to prize individuality and separation. Sometimes a counselor may not recognize they are forgetting other cultures do not, and they may mistake cultural factors for enmeshment (Zhu, Haegele & Healy, 2019). Ultimately as a therapist working with adolescents from different backgrounds, I must respect the choice of the client and act in the best interest clients. That means understanding the culture and respect for the individual choices of a client. Each client is still a person, and even people of the same background will have different cultures and beliefs. So while I do consider it important, I need to avoid stereotyping as best we can. I should not assume that because a teenager I am working with is Jewish, Black, Chinese, Hmong, Polish, Navajo, or Catholic they would all fit neatly into one background or another. It is better to allow the person to have a safe space to work with their issues. A therapist might think about their cultural considerations, address them openly, and/or incorporate them as part of therapy.

How Code of Ethics Applies

The code of ethics needs to be applied effectively when working with adolescents with depression. According to the code of ethics, counselors need to know what is expected of them professionally as well as to the clients. When working with adolescents, therapists have to use their expertise and ensure that they follow the code of ethics and work to meet the interests of the clients (NASW, 2017). Confidentiality and privacy are critical despite their age. Adolescents can report to the therapist if they feel their confidentiality has been breached. The counselor can also report if they feel that the adolescent is at risk of harming others or him or herself. A code sets boundaries between both parties that ultimately protects both from the professional’s deviant behaviors that could harm the person seeking their expertise. In a personal sense, it protects the patient from the exploitations with which they may have grown up. It is also critical to provide the clients with an informed consent form to sign for confidentiality (Orri et al., 2018). Counselors must also practice competence and integrity to establish effective therapeutic practices and ensure that depression is reduced among the clients.

Applying Trauma-informed Lens

One of the major causes of depression among adolescents is childhood trauma. In this case, a trauma-informed lens would be effective when working with adolescents presenting depression symptoms. A Trauma-informed lens works from a framework of understanding that trauma is subjective and has the potential to damage an adolescent’s emotional health (Orri et al., 2018). The question in TIC is “what happened to this person rather than what’s wrong with this person”. When using a trauma-informed lens, I will start with an assessment that would assess for events that have occurred in an adolescent’s life that point to trauma-related events. I will also assure the client of physical, emotional, spiritual, and cultural safety and have awareness of a person’s unease in a situation. Then, I can offer choices for their life and care. it would be effective to ensure trustworthiness by providing a client with clear information about the conditions, treatment, risks, etc. This also goes into explaining to them what exactly is going to happen or is happening next with full transparency. The trauma-informed lens also builds on strengths recognizing the adolescent’s strengths and using them to begin the healing process (Evans & Erickson, 2019). Also, collaboration and teamwork would help by recognizing that true healing happens with the relationship and teamwork of the patient, care team, and their support system, rather than simply a treatment or process.

References

Bernaras, E., Jaureguizar, J., & Garaigordobil, M. (2019). Child and adolescent depression: a review of theories, evaluation instruments, prevention programs, and treatments. Frontiers in Psychology, 10(1), 543. https://doi.org/10.3389/fpsyg.2019.00543

Clayborne, Z. M., Varin, M., & Colman, I. (2019). Systematic review and meta-analysis: adolescent depression and long-term psychosocial outcomes. Journal of the American Academy of Child & Adolescent Psychiatry, 58(1), 72-79. https://doi.org/10.1016/j.jaac.2018.07.896

Evans, C. R., & Erickson, N. (2019). Intersectionality and depression in adolescence and early adulthood: a MAIHDA analysis of the national longitudinal study of adolescent to adult health, 1995–2008. Social Science & Medicine, 220(1), 1-11. https://doi.org/10.1016/j.socscimed.2018.10.019

Fiorilli, C., Grimaldi Capitello, T., Barni, D., Buonomo, I., & Gentile, S. (2019). Predicting adolescent depression: The interrelated roles of self-esteem and interpersonal stressors. Frontiers in Psychology, 10(1), 565.  https://doi.org/10.3389/fpsyg.2019.00565

Keles, S., & Idsoe, T. (2018). A meta-analysis of group cognitive-behavioral therapy (CBT) interventions for adolescents with depression. Journal of adolescence, 67(1), 129-139. https://doi.org/10.1016/j.adolescence.2018.05.011

National Association of Social Workers (NASW). (2017). Read the Code of Ethics. https://www.socialworkers.org/About/Ethics/Code-of-Ethics/Code-of-Ethics-English

Orri, M., Galera, C., Turecki, G., Forte, A., Renaud, J., Boivin, M., … & Geoffroy, M. C. (2018). Association of childhood irritability and depressive/anxious mood profiles with adolescent suicidal ideation and attempts. JAMA Psychiatry, 75(5), 465-473. doi:10.1001/jamapsychiatry.2018.0174

Zhu, X., Haegele, J. A., & Healy, S. (2019). Movement and mental health: Behavioral correlates of anxiety and depression among children of 6–17 years old in the US. Mental Health and Physical Activity, 16, 60-65.