When Cheryl Cobb’s daughter Mary was a teenager, she started simply refusing to go to school or church. Family friends advised Cobb to force Mary to do what was expected, saying that the young woman was being defiant. It didn’t work out well.
“I would literally be pulling on her arm to make her get out of the car,” Cobb said. “I would walk her into the office to sign in, walk her to her locker and then to class. Leaving her there in tears was so traumatic, for both of us.”
After a few years of trying the “tough love” technique, Cobb realized that something more serious than teenage rebellion was going on.
She took Mary to see a psychiatrist, where the young woman was diagnosed with depression.
Like Mary, adolescents around the world experience depressive symptoms in their teenage years, and the number of cases is growing. A survey released by the World Health Organization in May found depression to be the No. 1 cause of illness and disability in adolescents worldwide. Mental health experts have identified a number of reasons for the rise, ranging from media to genetics, but the rise and severity of adolescent depression requires a response.
“The world has not paid enough attention to the health of adolescents,” says Dr. Flavia Bustreo, assistant director-general for Family, Women and Children’s Health, part of WHO, in a press release that says "if adolescents with mental health problems get the care they need, this can prevent deaths and avoid suffering throughout life."
Young people at risk
The World Mental Health Survey, which was supported by WHO, found that half of those who suffered from mental health problems, including depression, first experience symptoms at age 14. In high-income countries, like the United States, fewer than half of adolescents with a mental health problem receive treatment.
The Centers for Disease Control reported that a survey of students in grades 9-12 at schools in the United States revealed “16 percent of students reported seriously considering suicide, 13 percent reported creating a plan, and 8 percent reported trying to take their own life in the 12 months preceding the survey.”
In America today, high school and college students are five to eight times as likely to suffer from depressive symptoms as were teenagers 50 or 60 years ago, according to Psychology Today.
Depression rates for adolescents are on the rise for a variety of reasons, according to Manpreet K. Singh, director of the Pediatric Mood Disorders Clinic and an assistant professor of psychiatry and behavioral sciences at Lucile Packard Children’s Hospital at Stanford.
“Some suggest it’s because children are more exposed to stress and childhood adversity, which has significant implications for how a child develops over time and can increase vulnerability for anxiety and depression and other problems down the line,” Singh said. “Other people suggest the role of family and media."
Media in particular has come under scrutiny as the entertainment industry becomes more pervasive. A study from the National Institutes of Health found that media portrayals of body image and the “ideal” life create unrealistic expectations for teenagers, disrupting their “normal identity development” and leading to depression.
In addition, the NIH study found that violent or graphic media augments depressive tendencies by creating an idea that the world is worse than it is.
Boys are less likely than girls to develop symptoms of depression, and a report from the Substance Abuse and Mental Health Services Administration found that girls at age 15 are three times as likely to suffer a “major depressive episode” as girls at age 12. In 2011, 1.4 million girls ages 12-17 in the United States experienced an episode of depression.
A family history of depression or anxiety, childhood trauma or abuse and chronic medical illness are all risk factors for depression, according to a report published by British Columbia Medical Journal.
“Another factor could be that we’re recognizing it more,” Singh said. As more parents and doctors understand the symptoms of adolescent depression, they are better able to differentiate between teenage moodiness and severe medical issues.
Signs and symptoms
The first step to treating depression is recognizing the symptoms, which are sometimes difficult to distinguish from the normal anxiety that accompanies puberty and adolescence, according to an article about teen depression from the Mayo Clinic.
Chelsea Bown, a recent college graduate, was a senior in high school when she started experiencing depressive symptoms. She stopped caring about school, and her grades dropped. Her relationships with her friends disintegrated. Although she recognized that something was wrong with her, she didn’t believe it was anything that could be fixed.
“I thought I was a freak, because I was super upset and I hated life and I just felt so alone with everything. I didn’t want to tell anyone because I was embarrassed,” she said, emphasizing the insecurity, self-loathing and loneliness that are common to those suffering from depression.
Other signs of depression in adolescents are fatigue, sleeping too much or too little, eating too much or not enough, engaging in riskier behavior, irritability, and a loss of pleasure in things they used to enjoy.
Separation anxiety is present in about 50 percent of the cases of adolescent depression, according to a National Institutes of Mental Health report.
Depressive symptoms also last longer than typical examples of teenage angst, according to an NIMH report about identifying and treating adolescent depression. Rather than coming and going, the negative emotions and change in behavior continue for weeks or months at a time.
Despite the prevalence of depression among youths, only 38.9 percent of those experiencing depression received treatment in 2007, according to the NIHCM report.
Since the symptoms of depression are so similar to normal teenage anxiety, it’s important to talk to a doctor rather than self-diagnosing. The symptoms could also be a sign of a physical medical condition, such as thyroid disease, that will need to be ruled out through a physical examination and blood tests, according to the NIMH report. Once a doctor conclusively diagnoses depression, treatment can then move forward and further negative effects can be avoided.
“Early recognition can potentially prevent the onset and progression of depression into adulthood,” Singh said.
Depression has a tangible effect on brain function and development, meaning that the longer the mental illness goes untreated, the greater the chance of serious, irreparable harm to the teenager’s brain, according to Singh.
Teenagers are also more likely to harm themselves when depressed, according to a report from the National Institute for Health Care Management, and engage in self-destructive behaviors.
“Studies indicate that 90 percent of teens who die by suicide were suffering from an identifiable mental disorder at their time of death, typically depression,” the report states.
Depression can be an indication that the teenager is struggling with other mental health concerns, according to the 1990-92 National Comorbidity Survey. The NIHCM report referenced the findings, which showed that “77 percent of 15 to 24 year olds diagnosed with major depression had at least one other psychiatric diagnosis as well.”
“Among those with multiple diagnoses, 40 percent had anxiety disorders, 12 percent had addictive disorders, and 25 percent had conduct disorders."
What parents can do
A study at the Stanford School of Medicine found genetics to be a factor in about 50 percent of depression cases.
The disease’s genetic nature is one of the reasons why more incidents of depression are being reported, according to Singh, and is actually a benefit for suffering teenagers.
“Sometimes kids are being recognized sooner than perhaps they otherwise would have because they have a family member who is affected by the disorder, who understands it and may have gone through a similar process,” she explains.
Cobb, who has suffered from depression throughout her life, found that her own experiences made her more willing to seek out help for her daughter, rather than punish the young woman for being moody and obstinate.
“If I hadn't finally understood my own experiences with it, I would have never known how to find help for her.”
Singh advises parents to open up a safe dialogue with their children to encourage them to discuss their emotional health.
“The hardest thing about depression is the lack of understanding that it is a condition that a person cannot control. It's the stigma that if a person just tried harder, they could overcome it,” Cobb said.
This stigma makes it hard for sufferers to express how they feel. They fear that they will be ostracized because of a condition they can’t control.
According to Singh, viewing depression as shameful can make children and parents unwilling to address the problem, which delays treatment and puts the teens at higher risk. The only way to reduce the stigma is to recognize and understand depression.
“Parents and children need to be informed consumers,” she said. “I encourage families to be patient and persevere in engaging with a primary care physician. The consequences of not treating depression are too great.”
If you suspect your child or teenager may be suffering from depression, visit their personal physician immediately.
To find a child psychiatrist in your area, visit the American Academy of Child and Adolescent Psychiatry website and select the “Child and Adolescent Psychiatrist Finder” link.
If someone you know is in danger of suicide, call 1-800-273-TALK, a national hotline that will direct you to a trained crisis counselor in your area.