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Adolescent

Depression

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Depression…

Is a condition of mental disturbance. Depression is one of the most frequent characteristic or adolescents referred for psychological treatment.

Depression

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Life changes Mental illness Acceptance Appearance (low self esteem) Lack of parental support Being in a two parent family structure School failure Stressful peer relationship, conflict and

rejection Hormonal changes (Especially for girls))

Depression

Why do Adolescents get depressed?

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Major Depressive Disorder

An individual experiences a major depressive episode and depressed characteristics

Felling lethargy meaning a lack of energy

Feeling hopelessness Lasts two weeks or longer Impairs daily function and activities

Depression

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9 Symptoms to Determine Depressive Episodes

Feeling of depressed mood daily Reduced interest of pleasure Weight lose or gain Increase or decrease in appetite Troubles sleeping Loss of energy Feeling worthless or guilty Problems thinking, concentrating, and

decision making1. Recurrent

Depression

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Pervasive depressive symptoms

Lack of interest in pleasant activities Withdrawal from other (Family and

friends) Eating disorder Drug abuse and conduct disorders

Depression

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Patros, G. Philip. Shamoo, K. Tonia. Depression and Suicide in Children and Adolescents: Prevention, Intervention, and Postvention. aren’t feeling sad or hopeless, they are irritable. Sleeping and eating patterns are drastically altered, and they will exhibit fidgety and restless behavior. Education, which is very important is affected also in adolescents who are depressed. It is difficult for them to focus, so their grades could very likely drop. Some, but not all my have thoughts of death or suicide. It is also documented that “4 of these symptoms must be present nearly every day for at least two week, and for those children under age six, at least 3 of the first four criteria will be exhibited”, for them to be considered “depressed.”

Symptoms in adolescents

Lose interests in activities that they normally enjoy

Sad, lonely, irritable Sleeping and eating patterns are drastically

altered Grades are very likely to drop Some, but not all may have thoughts of suicide 4 of these symptoms must be present nearly

every day or for at least 2 weeks to be considered depressed

Depression

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Prevalence of Depression

Rates of depression is higher in girls than it is in boys

An episode of clinical depression during adolescence sets the ground for an increased risk for reoccurrence

“The prevalence rate of major depression changes with age from about 1% prepubertally to levels of between 5%-8% by age 19, with lower rates for boys compared to girls postpubertally.

Depression

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Family Factors More criticizing than praising Families have high levels of expressed

emotion-hostility, conflict, and over involvement

Marital problems/sibling rivalry

Depression

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Family Factors (cont.)

Depressed mother often display inadequate parenting

Disengages from children Depressed mothers may withdraw or ignore child-

rearing situations Depressed fathers are withdrawn, indecisive, cynical High levels of expressed emotion, or hostility, conflict Family members often fight but remain deeply

involved in the details of one another’s lives??? May cause adolescents to develop cognitive

distortions and poor social skill, problem solving, and assertiveness

Depression

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Girls Frequently discuss

depression Lower Depression Rates

Depression rates

equalize

by late adolescence

Feelings of fatigue

Increased depression

Increased hormonal levels

Crying spells

Girls vs. BoysBoys

Rarely discuss depression

Higher depression rates??

Have the idea that real men don’t get depressed

Feelings of agitation

Crying spells

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Research on Depression

Scientists and research rely on family and twin studies to evaluate depression.

A family study assess family members of a person with a mood disorder and indicated if depression runs in family.

First degree relatives of people with family with depression often have depression 15 to 25% of the time Depression

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Twin Studies Twin Study in which identical twins and

fraternal twins are compared 1dentical(monozygotic) twins: Share 100% of

genes Fraternal(dizygotic) twins: Share 50% of genes

The twin study produces a concordance rates which is percentage of cases where each twin has the disorder

Depression is higher amongst identical twins than fraternal twins

Depression

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Biological Factors Genetics account for 39 to 50 percent of

depression symptoms Help produce brain, neurochemical, and

hormonal changes that lead to do depression

Environmental interaction can trigger depression

Genetic predisposition toward depression Naturally predisposed to depression, born

with low serotonin and norepinephrine

Depression

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Structural Changes of Brain

The hippocampus, a small part of the brain that is vital to the storage of memories, appear to be smaller in people with a history of depression

A smaller hippocampus has fewer serotonin receptors Decreased activity and size in the prefrontal area of the

brain Amygdala, caudate nucleus, and anterior cingulate

cortex are damage as well Reduced goal-directed behaviors and inhibition of

negative mood Reoccurring negative thoughts Damage to white matter, basal ganglia and pons can

impair the regulation of attention, motor behavior and emotions

Depression

Neurotransmitters Serotonin is a neurotransmitter that

allows communication between nerves in the brain and body

Norepinephrine, serotonin, and dopamine influences motivation and emotional state

Antidepressant medication boost serotonin levels in the brain

Adolescents suffering from depression have memory problems and increased levels of cortisol Depression

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Effects of Depression Can Affect Growth and Development Abstract thinking skills and concentration

decrease Depressed adolescents may have social skill

deficits, communication problems, and relationship conflict

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Depression

Treatments

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Assessment The assessment is a very important

step and it should be done before assigning any form of treatment to an adolescent.

The assessment is the way in which the healthcare provider determines why the adolescent feels depressed and the severity of their depression.

treatments

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TreatmentsCognitive Behavioral Therapy

Used to determine the relationship between the adolescent’s emotion, behavior, and cognition.

This technique is based on the social learning theory.

This technique has been tested on many severally depressed adolescents and it has shown to have significant effects in the improvement of depression.

treatments

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Treatments

Family Therapy This form of therapy is used to determine:

the adolescent’s relationship with their families

any problems that may be going on in the family

things that could be causing the depression of the adolescent

ways of improving family issues that could or have lead to depression

This technique has been shown as a great way to help prevent adolescent depression

treatments

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Treatments Interpersonal Therapy

This therapy emphasis the effect of relationships and attachment on an adolescent’s mental health and ways of coping.

It concentrates on the 4 main categories of relationship difficulty:

Grief Role disputes Role transitions Interpersonal deficits

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Treatments Pharmacotherapy

This is the use of medications to treat depression in adolescence.

There are many different types of medications that can be used, some which have shown to be useful and some which have shown not to be useful.

The combination of pharmacotherapy and cognitive behavioral therapy have shown to have the greatest improvements in depressed adolescents.

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Treatments

Other known forms of treatments include:

Electroconvulsive therapy Repetitive Transcranial Magnetic

Stimulation Light Therapy Behavioral Activation Cognitive Therapy Self-control Therapy Social Skills Training

treatments

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Medication For Depression

Antidepressants used in the treatment of mood

disorders characterized by various manic or

depressive affects.

Medications

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Selective serotonin reuptake inhibitors (SSRIs)

Are the most commonly prescribed antidepressants. They can ease symptoms of moderate to severe depression, are relatively safe and generally cause fewer side effects than other types.

Medications

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Types of (SSRIs)

fluoxetine (Prozac) citalopram (Celexa) escitalopram (Lexapro) . fluvoxamine (Luvox) .

Medications

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Side Effects of (SSRIs) Nausea Dry mouth Headache Diarrhea Nervousness, agitation or restlessness Reduced sexual desire or difficulty reaching orgasm Inability to maintain an erection (erectile dysfunction) Rash Increased sweating Weight gain Drowsiness Insomnia

Medications

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Prevalence

suicide

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Approximately 5% of children at any one time may suffer from serious depression.

It is estimated that 4.7% of the teenage population suffers from depression.

There is no related difference in the prevalence of depression among pre-adolescent children, but it increases to a 2:1 female to male ratio in adolescents.

prevalence

Prevalence

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The prevalence of depression may be higher in children with other psychiatric disorders, those with general medical conditions, and children with developmental disorders and mental retardation.

Prevalence of depression appears to be increasing in successive generations of children, with onset at earlier ages.

Adolescents who develop depression often have recurrences in adulthood and a more severe case.

prevalence

Prevalence

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Self-injury

Adolescent

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The intentional cutting, burning, or otherwise wounding without the intent to die.

Direct, deliberate destruction of one’s own body tissue in the absence of suicidal intent.

Self-injury

Self-Injury…

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Signs of self injuryBecause self injury is often kept a secret it is hard to spot signs and symptoms: Scratches (whether they may be from cuts or

burns) Fresh wounds such as cuts, scrapes, or bruises Claims of frequent accidents or mishaps (which

may explain the marks) Broken bones Low self esteem (just because someone has low

self esteem does not necessarily mean they self injure, however research shows that low self esteem is a factor related self injury)

Self-injury

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Common methods of self injury Cuts- often made with a blade or glass shard; a cut is usually classed as

an incision if its length is greater than its depth. Cuts are often described incorrectly as lacerations, which strictly speaking, are tears arising from blunt force injury

Puncture injuries- made by a pointed object inserted at right angles to the surface and then withdrawn, or inserted at an angle and then left under the skin. An injury is usually classified as puncture if its depth is greater than its length.

Dry burns- by contact with a flame or hot object includes electrical burns

Scalds- by contact with hot liquid or steam; external or internal (e.g. over-hot drinks)

Chemical burns- by contact with caustic substances Other presentations- re-opened injuries; bruising (potential for

fractures) following wall punching, head banging or self hitting; tissue damage arising from ligature an appendage; injuries caused by abrading or scouring the skin; internal damage for reversible insertions ; injecting contaminants into the skin or deliberately contaminating wounds.

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Types of self injuryDirect Direct

Direct Embodied through the

phenomenon of self injury”

Ex: Cutting Scratching Burning skin Picking wounds Inserting objects into

the body Banging ones head

Indirect “normal” ways

adolescents struggle to find their place in the world”

Ex: Excessive drinking Substance abuse Acting out sexually Developing eating

disorders Or engaging in other

high risk behaviors”Self-injury

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Target areas for self injury

Arms and wrists (74%) Legs (44%) Abdomen (25%) Head (23%) Chest (18%) Genital area (8%)

Self-injury

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Biological and Physical Causes

Biological “ Dysregulation of serotonergic

neurotransmission has been proposed to play a role in the expression of self injury”

“ Biological studies implicate reduced serotonergic neurotransmission in both inwardly and outwardly directed aggressive behaviors, especially impulsive ones pertains to patients with a history of attempted suicide. Individuals with personality disorders who cut or burn themselves”

Physical

Physical Stressful event in an

adolescents life Feeling like they have

lost control of a situation or situations

Having no where else to turn

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Statistics It has been estimated that as many one teenager in ten self

harm. A revealing study 6020 adolescents found that 6.9 % had

harmed themselves in the previous year and 13.2% reported at least once.

People who injure themselves are more likely to have an eating disorder and vice versa, self cutting has been reported in 40% of bulimics and 35% of anorexics

A study of the 2828 individuals who sought hospital treatment in Oxford for self harm between 1988 and 1996 found rates much higher in those from lower social groups.

In Arnold’s (1995) survey or 76 UK women , 30% reported they began self injuring around the age of 12. Similarly, Favazza and Conterio (1989) found 14 years old to be the most common age of onset in a study of 240 U.S. residents

Self-injury

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Other disorders associated with self injury: Myths and facts about cutting and

Borderline personality disorder Mood disorders Obsessive Compulsive disorder Post traumatic stress disorder (PTSD) Dissociative disorders

• ting and other means of self-harm tend to be taboo subjects, the people

Self-injury

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Possible maintenance factors for self injury

Persistence of original circumstances that led to initiation of self injury- such as an abusive relationship , social isolation, or repeated rejection

Conviction about self injury- believing that survival is impossible unless one remains in a injured state, that one deserves punishment, that cutting is the only way to reduce unpleasant feelings and that overt action is always necessary to communicate feelings to others

Emotional response from others- such as concern about injuries expressed by friends and family. Reinforcement is external and positive when self injury becomes associated with some welcome response.

Social aspects- as with “secondary gain” from having friends who cut or from acquisition of social status

Self-injury

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Treatment and Prevention

Treatment options:Self injury of any type needs to be treated whether that is through counseling and medication or a combination of both. It needs to be treated. Prevention: Identify those who are the most at risk: help to teach them resilience and

healthy coping skills that they can call in a time of distress Expand the social network: People who self injure often feel lonely if someone

who does self injure can form a relationship with someone who doesn’t it can improve the self injurers relationship and communication skills

Raise awareness: Parents, Adults, and even other adolescents should be educated about the warning signs of self injury and know what to do should the situation arise.

Promote programs that will encourage peers to seek help: Peers tend to be loyal to a friend when they know that friend is in crisis. Programs that encourage youth to reach out to adults

Offer education on the media influences of the world: The media has a huge impact on adolescence encouraging them to experiment. Teach critical thinking skills about these influences and this may help reduce the impact.

Self-injury

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suicide

Adolescent

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The cause of suicide… Studies show that suicide attempts among young people may be

based on long-standing problems triggered by a specific event. Suicidal adolescents may view a temporary situation as a permanent condition. Feelings of anger and resentment combined with exaggerated guilt can lead to impulsive, self-destructive acts.

Untreated depression is the number one cause for suicide Depression is triggered by several negative life experience and can

harm the person if they do not get it treated Some examples of how suicide can be triggered: Relationship problems Not feeling loved or wanted Moving to a new environment and not being accepted Loss of a loved one, or someone close to them Also a mental disorder can trigger suicide, such as bipolar and

Schizophrenia

suicide

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Top Three Methods of Suicide

Firearms-50%

Suffocation-24%

Poisoning-18%

Suicide Methods

FirearmsSuffocationPoisioning

suicide

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Suicide Rate

suicide

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How can adolescent suicide be treated/prevented?

Prevention Methods Prevention Programs such as therapy Cognitive therapy is basically talk therapy where you talk out why you

would want to commit suicide. What exactly can fix your problem? Cognitive therapy reduced the rate of repeated suicide attempts by

50%. Dialectical behavior therapy-helps with borderline personality disorder. Medication: Clozapine-approved by Food and Drug Administration for

suicide prevention in people with Schizophrenia Schools can come up with prevention programs which some

researchers suggest start in the 7th grade. Suicide.org Some may check in to a psychiatric hospital When adolescents are depressed, they have a tough time believing

that their outlook can improve. But professional treatment can have a dramatic impact on their lives. It can put them back on track and bring them hope for the future.

suicide

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Signs of suicide,thoughts,feelings,and

attempts… Many factors are associated with suicidal attempts:

Parent absence, bullying, rejection, alcohol abuse, drug abuse, depression, sexual abuse, rape, physical abuse, unhappiness, parents pushing adolescents to overachieve, having friends who engage in suicidal behavior, and a family history of suicidal behavior just to name a few of many factors.

After some of these factors come into play, Suicidal thoughts begin to arise. As research shows, some actual attempts include self injury, poisoning, drug

overdose, knife marks, bruises, and overdose of pills. Since 1991, attempts have declined. In emerging adulthood, males are 6 times more likely to commit suicide

than females. Males use more lethal ways of attempting suicide such as using guns, but females take less lethal ways such as overdosing on sleeping pills and cutting their wrist.

15 – 19 year old Females were more likely to attempt suicide than males but males were more likely to succeed in suicide.

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Signs of suicide,thoughts,feelings,and attempts…cont.

• Four out of five teens who attempt suicide have given clear warnings. Pay attention to these warning signs: Suicide threats, direct and indirect Obsession with death Poems, essays and drawings that refer to death Giving away belongings Dramatic change in personality or appearance Irrational, bizarre behavior Overwhelming sense of guilt, shame or rejection Changed eating or sleeping patterns Severe drop in school performance Giving away belongings suicide

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Percentage of U.S. adolescents that seriously consider attempting suicide….

Sometimes teens feel so depressed that they consider ending their lives. Each year, almost 5,000 young people, ages 15 to 24, kill themselves.

The rate of suicide for this age group has nearly tripled since 1960, making it the third leading cause of death in adolescents and the second leading cause of death among college-age youth.

suicide

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Percentage of U.S. adolescents that seriously consider attempting suicide….

suicide

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Suicide attempt by U.S. adolescents from different

races…. Cultural contexts also are related to suicide

attempts, and adolescents suicide attempts vary across ethnics groups in the United States. More than 20 percent of Native American/Alaska native adolescents reported that they had attempted suicide, and suicide accounts for 20 percent of deaths in 15-19 year olds.

Both early and late experiences may be involved in suicide attempts. The adolescent might have a long-standing history of family instability and unhappiness.

suicide

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Suicide attempt by U.S. adolescents from different

races….

suicide

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Psychological profile of a suicidal adolescent….

Suicidal adolescents often have depressive symptoms. Although not all depressed adolescents are suicidal, depression is the most frequently cited factor associated with adolescent suicide.

A sense of hopelessness, low self-esteem, and high self-blame also are associated with adolescent suicide.

A recent study found that a perception of being a burden on others and thwarted belongingness were linked to suicidal thoughts.

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What to do and what not to do when you suspect someone is

considering suicide…What to do:

Ask direct, straightforward questions in a calm manner: “Are you thinking about hurting yourself?”

Asses the seriousness of the suicidal intent by asking questions about feelings, important relationships, who else the person has talked with, and the amount of thought given to the means to be used. If a gun, pills, a rope, or other means have been obtained and a precise plan has been developed, clearly the situation is dangerous. Stay with the person until help arrives.

Be a good listener and be very supportive without being falsely reassuring.

Try to persuade the person to obtain professional help and assist him or her in getting this help.

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What to do and what not to do when you suspect someone is

considering suicide…cont.

• What not to do: Do not ignore the warnings signs. Do not refuse to talk about suicide if a person

approaches you about it. Do not react with humor, disapproval, or

repulsion. Do not give false reassurances by saying such

things as “Everything is going to be ok.’ Also do not give out simple answers or platitudes, such as “you have everything to be thankful for.”

Do not abandon the individual after the crisis has passed or after professional help has commenced

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Questions? suicide

Self-injury

Depression

treatments

prevalence