Depression is more than just a low mood – it is a severe condition that affects the physical, cognitive, and psychosocial functioning of one in four young Australians. In 2015 the Australian Government published a report on the findings of the Australian Child and Adolescent Survey of mental health and well-being. Within the findings of the survey presented that 112,000 young Australians had been dealing with a major depressive disorder for over 12 months (Ainley, Haan, HafeKost, Johnson, Lawrence, Sawyer & Zubrick, 2015). This research paper is going to focus on adolescents suffering from depression from a human service, counseling practice context. It will first present a concise description of the characteristics of depression, its prevalence, and potential causes. It is followed by an evaluation of the impacts of depression on an individual's development and functioning, with some cultural and other relevant considerations. This paper will then provide a description of how depression disorder is assessed to form a diagnosis and how the impact of depression in adolescent's individual development and functioning is evaluated. It will then provide a description and analysis of specific intervention and support strategies to meet the learning and social needs of each adolescent suffering from depression.
Depression presents itself differently in all individuals. Depression can present itself in changes in an individual's behavior, like feeling a loss of interest in usual activities, becoming socially withdrawn from close friends and family, and losing the ability to concentrate, resulting in falling in performance at school or university. It changes that individuals' feelings to those of being overwhelmed, sad, empty, irritable, lacking in confidence, indecisiveness, and disappointment, leaving them with thoughts of "I am a worthless failure" and "nothing good ever happens to me, people would be better of without me." Depression in adolescents can also present itself in the form of physical issues like feeling tired all the time, sick and run down, loss or gain of weight even sleeping problems (Beyond Blue Ltd, 2019).
According to the Black Dog Institute (n.d), 9% of young people aged 16-24 experience high to very high levels of psychological distress, and adolescents aged 18-24 years have the highest prevalence of mental disorders like depression. In the report on the Australian child and adolescent survey of mental health and well-being in 2015, it was written that the number of adolescents' that suffered major depressive disorder for a 12-month time span was 112,000 young Australians (Ainley J et al., 2015). Beyond Blue reported the prevalence of around one in 35 young Australians aged 4-17 experience a depressive disorder (Beyond Blue, n.d)
There is no single known cause for adolescent depression. In the textbook Abnormal Child and Adolescent Psychology with DSM-V updates, they unpack the etiology of depression through integrated multiple determinants (Israel & Wick-Nelson, 2015). These determinants cover the biological influences like genetic influences, as research has suggested heritability in depression, links between the development of depression and an individual's temperament have been suggested. Brain functioning and neurochemistry have also been given mention as the "dysregulation of the neurochemical and neuroendocrine systems in the etiology of depression have received considerable attention" (Israel & Wick-Nelson, 2015, p.179). It covers social-psychological influences, as considerations of environmental factors that may contribute to the vulnerability of depression are of pivotal importance. Any history of sexual, physical, or family violence in their environment can have a considerable impact on adolescent's depression. In a controlled case study, an early aged environmental stressor like parental loss or separation significantly increases the likelihood of developing depression disorder (Agid, Bloch, Hanin, Heresco-Levy, Lerer, Murad, Shapira, Troudart & Zislin, 1999). It is also noted that cognitive-behavioral/interpersonal perspectives may contribute to the determination of depression. Influences like interpersonal skills, mood regulation, cognitive distortions, views of self, a learned sense of helplessness, and stress all contribute. However, it is unclear if these influences play a crucial role in the development of depression or as an underlying vulnerability associated with it. Peer relations and depression also seem to have an active link here in adolescents.
"Rejected girls were more than twice as likely to report high levels of depression than average, popular, and controversial girls. Furthermore, neglected girls were more than twice as likely as rejected girls and more than five times as likely as the average group of girls to report depression problems" (Israel & Wicks-Nelson, 2015, p.187).
The impacts depression has on adolescences' educational, physical, psychosocial developing, and functioning is different for everyone experiencing it. They are a time when adolescents develop their identity and sense of self values, beliefs, and norms. If depression occurs in this crucial developmental time, it may have education impacts because depression may lead the adolescent to miss school, reducing their academic performance, which can have a downstream effect on later career or study options. Adolescents with depression are significantly more likely to experience substance abuse. They are at a higher risk of involvement with the juvenile justice system due to risky behavior, and there is also a suggestion that adolescent depression affects susceptibility to infectious disease (Glied & Pine, 2002). The most significant impact depression can have holistically on an adolescent is the statistic that individuals dealing with depression will typically experience other diagnosable problems as well. "Reports suggest 40 to 70% of youths diagnosed with Depression disorder also meet the criteria for another disorder" (Israel & Wicks-Nelson, 2015, p.177).
There have also been links made between socioeconomic, ethnic, and cultural considerations made when looking into adolescent depression. Low socioeconomic status (SES) disadvantages children, and increasing evidence supports the link between lower SES and adverse psychological health outcomes, a variety of negative health outcomes at birth, and throughout the lifespan. There is also evidence that supports the link that low SES and exposure to adversity are linked to decreased educational success (American Psychological Association, 2019) because of things like fewer quality schools' opportunities and reduced motivation for learning. Risks of Depression may also be notably higher for adolescents whose ethnic or cultural background is other than mainstream. Early experience with prejudice, racism, and discrimination can have a negative impact on an adolescent's self-concept and emotional well-being. Disappointedly minority group members also often experience disadvantages in seeking and receiving appropriate treatment for depression and behavioral problems.
Assessment of Selected Condition:
Assessment of Depression in Adolescents requires multifaceted and empirically supportive approaches and includes integrating data from several different observational strategies, contextual analysis, case formulation, and treatment planning strategies. If an adolescent is depressed the first step is to take them to the doctor, where they can conduct an assessment or refer the adolescent to a youth psychiatrist, counselor, or mental health worker. In the professional context of a Human service counselor, they are trained to assess an individual's mental health and use therapeutic techniques based on specific training programs. These specific training programs are commonly conducted through extensive clinical interviews with the use of a broad assessment instrument like the Child Behavior Checklist. Assessment can also be in the form of the Self-report checklists, that assess the ideas directly relevant to the adolescents presenting problems, the Children's Depression Inventory (CDI) is commonly employed here. More self-report checklists are The State trait inventory for children, The revised children's manifest anxiety scale, The multidimensional anxiety scale, and The negative effect self-statement questionnaire. There are also forms of behavior observation assessments and intellectual-educational tests that can be useful also, as co-occurring difficulties are common. In the case of adolescences' dealing with depression, it is also helpful to take on a more family approach, if called for. If the child is experiencing stressors in their home life that are adding to their depressive state, it can help to get the parents more interactive and informed on how their child is feeling and the unnoticed added stressors that could be avoided. These assessment tests and checklists are trying to determine the causal factors that are going on. Causal factors can include the direct cause, indirect causes, mediating factors, moderating factors, fundamental causes, sufficient factors, and contributing factors.
The Diagnostic and Statistical Manual of Mental Disorders (DSM) assesses the individual through structured interviews. These structured interviews will find out if any of the following is bothering the individual:
Depressed or irritable mood
Loss of interest or pleasure
Change in weight or appetite
Sleep problems
Motor agitation or retardation
Fatigue or loss of energy
Feelings of worthlessness or guilt
Difficulty thinking, concentrating or making decisions
Thoughts of death or suicidal thoughts/behaviors
For an adolescent to be diagnosed with depression through the DSM, they are required to present five or more of the symptoms listed above. One of the required symptoms must be depressed (or irritable) mood or loss of interest or pleasure. Also, the symptoms must be present for two weeks, and the symptoms must cause clinically significant distress or impairment in critical areas of youths' function (Israel & Wicks-Nelson, 2015, p.174)
The presence or absence and various combinations of protective and risk factors contribute to depression in youth. Protective factors can occur on a Mirco level with positive physical development or academic achievement/intellectual development. It can occur on a Meso level within a family that provides structure and predictability with supporting relationships or clear expectations for behavior and values. Protective factors can also occur within the Macro level for an adolescent who has opportunities for engagement within school and community activities or the presence of mentors and support for the development of skills and interests. Some risks that occur at a Micro level are insecure attachments, low self-esteem, perceived incompetence, or a negative explanatory style, alcohol or drug abuse, coping with sexual identity in an unsupportive environment. Risk factors that can occur at a Meso level are child abuse or maltreatment, divorce, or parental depression. Risks that can occur at a Macro level for an adolescent could be peer rejection, poverty, community violence, or experiencing a traumatic event. All of the potential Risk and Protective factors just listed either in a Micro, Meso, or Macro level are all interrelated, and by identifying these factors in youth, it helps guide prevention and intervention strategies to pursue (Youth.Gov, n.d).
Description and analysis of specific intervention/support strategies:
There are so many kinds of support and intervention strategies for adolescents suffering from depression. Support strategies can come in the form of self-care education programs that teach the value of things like nutrition, physical exercise, how to accentuate the positive, breathing exercises, and prevention techniques for procrastination. Resilience in adolescents is another fantastic supportive strategy to teach, teaching them the tools to successfully adapt despite adversity is the overall goal. So teaching techniques like problem-solving skills, skills in self-regulation, positive views of self, achievement motivation, active coping skills, perceived self-efficacy and control, and spirituality will give them long-term control over their lives.
From a counselor's perspective a specific strategy for the intervention and support of adolescents suffering from Depression is Cognitive Behavioral Therapy (CBT). CBT is a psychotherapeutic treatment that helps patients understand their thoughts and feelings that are influencing their behaviors and teaches how to identify and change destructive or disturbing thought patterns that have a negative influence on their behaviors and emotions. The program is delivered through 5 to 20 counseling sessions one on one sessions. The overarching concept behind CBT is that our thoughts and feelings play a fundamental role in our behavior, the goal is to teach patients that while they cannot control every aspect of the world around them, they can take control of how they interpret and deal with things in their environment. So the aim is to teach the adolescent that when an automatic negative thought occurs, that exacerbates emotional difficulties and depression, patients instead examine these thoughts and are encouraged to look at evidence from reality that either supports or refutes these thoughts. By doing this, the adolescent will begin to take a more realistic and objective look at the thoughts that contribute to their depression and will become more aware of how unrealistic they are and will begin to start engaging in healthier thinking patterns. The second part of CBT focuses on the actual behaviors that are contributing to adverse outcomes, the patient learns and practices new skills that can be put in to use in the real-world situations (Cherry, 2019). Brent and Weersing (2006) suggest four standard techniques and the typical sequence for cognitive-behavioral therapy for adolescents with depression. The first technique is Psychoeducation and mood monitoring. This is achieved by working collaboratively with youths and parents to describe the characteristics of depression and the CBT process of treatment, and by teaching youths to monitor their moods, thoughts, and behaviors to begin to see patterns. The second technique is Please activity scheduling and behavioral activation. By promoting the engagement in activities that provide opportunities for mastery or pleasure for mood regulation, which also promotes a long-term focus on creating a rewarding, non-stressful, mood-elevating environment. The third technique is Cognitive Restructuring, which teaches youths to examine their core schemas and change the negative ones to engage in rational thinking about themselves, the world, and future possibilities. The last technique used is Additional CBT skill-building; this is the teachings of relaxation techniques, providing social skills and conflict resolution training, and teaching general problem-solving skills.
The challenges associated with CBT are that for it to be effective, the patient must be ready and willing to spend time and effort analyzing their thoughts and feelings, this may not always be an easy task. However, self-analysis is crucial for CBT to work. Criticisms of CBT have also been that by simply becoming aware of your negative thoughts does not make them easy to alter
Positive Psychology interventions are a new branch in clinical intervention. With the concept of counseling changing from 'a place where only troubles are discussed' to know 'a place where strengths are discovered, positive emotions are cultivation and gratitude and optimism are fostered' (Freire, Matias, Silva & Teixeira, 2015). Positive psychology interventions aim at enhancing well-being and promoting positive development and optimal functioning in youth.
School settings have found that Well-being therapy (WBT) is ideal in youth interventions. WBT is a psychotherapeutic strategy for increasing psychological well-being and resilience. It is comprised of six dimensions: environmental mastery, personal growth, purpose in life, autonomy, self-acceptance, and positive relations with others. It uses techniques of self-observation, a structured diary, and interaction between adolescents and counselors to increase well-being. It is said to be most effective when used with CBT as well.
Over the years, several authors have highlighted the importance of applying the principles of positive psychology to the CBT in clinical practice. Based on this overlapping integrative perspective, Teixeira and Freire (n.d) developed a manualized 14-week individual intervention. This intervention is called Optimal Functioning therapy for adolescents (OFTA). This therapy uses CBT strategies to reduce depressive symptoms while incorporating positive psychology issues to promote happiness and well-being. It is broken up into three main modules. The first modules help promote positive experiences in daily life, positive ways of thinking, a more positive interpretation of reality, and the enhancement of secondary control over uncontrollable adverse events and problems. In the second module, the adolescent focuses on identifying and recognizing their strengths of character, the advantages of those strengths, and discusses ways of using those strengths to solve problems. In the last module, module number three focuses on identifying activities that induce a state of flow and encourages adolescents to incorporate these activities into their daily life routines, fostering hope and optimism through the development of future life goals and steps to achieve them.
References:
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Agid O., Bloch M., Hanin B., Heresco-Levy U., Lerer B., Murad H., Shapira B., Troudart T & Zislin J, 1999, Environment and vulnerability to major psychiatric illness: a case control study of early parental loss in major depression, bipolar disorder and schizophrenia. Viewed on the 8th October 2019, Retrieved from < https://www.researchgate.net/profile/Michael_Ritsner2/publication/13090722_Environm ent_and_vulnerability_to_major_psychiatric_illness_A_case_control_study_of_early_par ental_loss_in_major_depression_bipolar_disorder_and_schizophrenia/links/02e7e53bd4a 018ca6d000000.pdf>
American Psychological Association, 2019, Children, youth, families and socioeconomic status. Viewed on 10th October 2019, retrieved from https://www.apa.org/pi/ses/resources/publications/children-families
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Weersing V & Weisz J, 2002. Community clinic treatment of depressed youth: benchmarking usual care against CBT clinical trials, Journal of consulting and clinical psychology, viewed on the 10th October 2019, Retrieved from http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.925.5784&rep=rep1&type=pdf
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