- Teens and Depression: Diagnosis, Treatment, and Risks
- Symptoms of Teen Depression
- Suicide Warning Signs in Teens
- Treatment of Depression
- Provide Support at Home
- Adolescent mental health
- Mental health determinants
- Emotional disorders
- Childhood behavioural disorders
- Eating disorders
- Suicide and self-harm
- Risk-taking behaviours
- Promotion and prevention
- Early detection and treatment
- WHO response
Teens and Depression: Diagnosis, Treatment, and Risks
According to the US Department of Health and Human Services, approximately one five adolescents has a diagnosable mental health disorder, and nearly one-third show symptoms of depression.
Symptoms of depression in adolescents aren’t always easy to identify because they often appear as normal adolescent behavior. Early warning signs are ly to include: irritability, fatigue, changes in sleep patterns, changes in eating patterns, social withdrawal, and/or anger.
A study on trends in depression among adolescents and young adults showed a 37 percent increase in adolescent reports of major depressive episodes between 2005 and 2014. Given the rise in adolescent depression, it’s important for parents, caregivers, and educators to understand the symptoms of adolescent depression and how to help.
Symptoms of Teen Depression
The defining feature of a major depressive episode is a period of at least two weeks during which there is either depressed mood or loss of interest in nearly all activities. In adolescents, the mood may be irritable. The two-week period represents a change in functioning for the teen.
In addition to experiencing depressed or irritable mood or loss of interest or pleasure, four other symptoms must be present:
- Anger or hostility
- Changes in eating or sleeping habits
- Fatigue or lack of energy
- Feelings of guilt or worthlessness
- Poor school performance
- Lack of motivation
- Difficulty concentrating
- Tearfulness or frequent crying
- Unexplained aches or pains
- Thoughts of death or suicide (with or without a plan)
Suicide Warning Signs in Teens
The possibility of suicide exists at all times during a major depressive episode.
The latest statistics from the Centers for Disease Control (CDC) show that among students in grades 9-12 in the United States, 17% seriously considered attempting suicide in the previous 12 months, 13.
6% made a plan about how they would commit suicide, 8 percent attempted suicide one or more times, and 2.7% made an attempt that resulted in poisoning, overdose, or an injury that required medical attention.
Current data were collected in 2013.
Watch for the following signs of suicidal ideation among teens:
- Talking about committing suicide
- Writing poems or stories about suicide
- Giving away prized possessions
- Engaging in reckless behavior
- Romanticizing death
- Saying goodbye to friends and family members (in person, in notes, or on social media)
- Cryptic social media updates that reference death or the end
If you suspect that your teen (or your friend) is suicidal, take action right away. Call 1-800-273-TALK for 24-hour suicide prevention and help through the National Suicide Prevention Lifeline.
Treatment of Depression
A complete physical to rule out other medical conditions is always a good first step in you suspect that your teen is struggling with depression.
- Psychotherapy: Talk therapy and/or cognitive behavioral therapy are often good initial treatments for mild to moderate cases of depression.
- Group therapy: Therapy groups can be effective for teens. Through group work, teens connect with other teens that share and understand their struggles and create support networks beyond their immediate families and close friends.
- Medication management: Selective serotonin reuptake inhibitors (SSRI’s) are antidepressant medications that can be beneficial to adolescents diagnosed with major depressive disorder. An adolescent being treated for major depressive disorder should be carefully evaluated by a physician to determine whether or not medication is necessary. Antidepressant medication does come with risks. In 2004, the U.S. Food and Drug Administration issued a warning about SSRI medications for children and adolescent due to an increased risk of suicidal thoughts or behavior.
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Provide Support at Home
Depression is a serious condition that requires treatment. Do not take a wait and watch approach if you suspect depression–early intervention is best. In addition to professional treatment, there are some things you can do at home to help your teen.
- Focus on listening: You can’t fix this for your teen, and lectures won’t make depression go away, but active and empathic listening establishes rapport and provides emotional support.
- Make 1:1 time a priority: The simple of act of making time to talk each day helps your teen reconnect and seek help instead of internalizing feelings.
- Confront social isolation: Lack of motivation might make it difficult for your teen to connect with peers during this time. Encourage your teen to reach out to close friends and engage in activities of interest with other teens.
- Prioritize exercise: Regular exercise plays a vital role in improving mental health. Aim for one hour of exercise a day. Offer to try new exercise classes with your teen to make it fun.
- Improve nutrition: A healthy, balanced diet helps combat fatigue and feed the brain.
- Talk about sleep: Insufficient sleep exacerbates symptoms of depression. Teens need 9-10 hours of sleep every night.
It’s important for parents to be open and honest with teens with everything from seeking a diagnosis to making healthy changes at home to seeking professional treatment. Involving your teen in the diagnosis and treatment process helps your teen take control of his or her mental health and learn to prevent or cope with potential relapses.
- US Department of Health and Human Services, Office of Adolescent Mental Health, March (2017). Available at: www.hhs.gov/ash/oah/adolescent-health-topics/mental-health/home.html. Accessed July 7, 2019.
- Ramin Mojtabai, Mark Olfson, Beth Han, “National Trends in the Prevalence and Treatment of Depression in Adolescents and Young Adults,” Pediatrics, November (2016).
- American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, American Psychiatric Publishing, Washington, D.C., 2013: Pages 160-168.
- Centers for Disease Control, “Suicide: Facts at a Glance”, 2015. Available at: https://www.cdc.gov/violenceprevention/pdf/suicide-datasheet-a.pdf. Accessed July 7, 2019
- National Institute of Mental Health, “Antidepressant Medications for Children and Adolescents: Information for Parents and Caregivers”, Retrieved from: https://www.nimh.nih.gov/health/topics/child-and-adolescent-mental-health/antidepressant-medications-for-children-and-adolescents-information-for-parents-and-caregivers.shtml.
Adolescent mental health
Adolescence (10-19 years) is a unique and formative time. Multiple physical, emotional and social changes, including exposure to poverty, abuse, or violence, can make adolescents vulnerable to mental health problems.
Promoting psychological well-being and protecting adolescents from adverse experiences and risk factors that may impact their potential to thrive are critical for their well-being during adolescence and for their physical and mental health in adulthood.
Mental health determinants
Adolescence is a crucial period for developing and maintaining social and emotional habits important for mental well-being.
These include adopting healthy sleep patterns; taking regular exercise; developing coping, problem-solving, and interpersonal skills; and learning to manage emotions. Supportive environments in the family, at school and in the wider community are also important.
An estimated 10-20% of adolescents globally experience mental health conditions, yet these remain underdiagnosed and undertreated(1).
Multiple factors determine mental health outcomes. The more risk factors adolescents are exposed to, the greater the potential impact on their mental health.
Factors that can contribute to stress during adolescence include a desire for greater autonomy, pressure to conform with peers, exploration of sexual identity, and increased access to and use of technology.
Media influence and gender norms can exacerbate the disparity between an adolescent’s lived reality and their perceptions or aspirations for the future. Other important determinants include the quality of their home life and relationships with peers.
Violence (including harsh parenting and bullying) and socioeconomic problems are recognized risks to mental health. Children and adolescents are especially vulnerable to sexual violence, which has a clear association with detrimental mental health.
Some adolescents are at greater risk of mental health conditions due to their living conditions, stigma, discrimination or exclusion, or lack of access to quality support and services.
These include adolescents living in humanitarian and fragile settings; adolescents with chronic illness, autism spectrum disorder, an intellectual disability or other neurological condition; pregnant adolescents, adolescent parents, or those in early and/or forced marriages; orphans; and adolescents from minority ethnic or sexual backgrounds or other discriminated groups.
Adolescents with mental health conditions are in turn particularly vulnerable to social exclusion, discrimination, stigma (affecting readiness to seek help), educational difficulties, risk-taking behaviours, physical ill-health and human rights violations.
Emotional disorders commonly emerge during adolescence. In addition to depression or anxiety, adolescents with emotional disorders can also experience excessive irritability, frustration or anger.
Symptoms can overlap across more than one emotional disorder with rapid and unexpected changes in mood and emotional outbursts.
Younger adolescents may additionally develop emotion-related physical symptoms such as stomach ache, headache or nausea.
Globally, depression is the fourth leading cause of illness and disability among adolescents aged 15-19 years and fifteenth for those aged 10-14 years.
Anxiety is the ninth leading cause for adolescents aged 15-19 years and sixth for those aged 10-14 years. Emotional disorders can profoundly affect areas schoolwork and school attendance.
Social withdrawal can exacerbate isolation and loneliness. At its worse, depression can lead to suicide.
Childhood behavioural disorders
Childhood behavioural disorders are the second leading cause of disease burden in young adolescents aged 10-14 years and the eleventh leading cause among older adolescents aged 15-19 years.
Childhood behavioural disorders include attention deficit hyperactivity disorder (characterized by difficulty paying attention, excessive activity and acting without regards to consequences, which are otherwise not appropriate for a person's age), and conduct disorder (with symptoms of destructive or challenging behaviour). Childhood behavioural disorders can affect adolescents’ education and may result in criminal behaviour.
Eating disorders commonly emerge during adolescence and young adulthood. Eating disorders affect females more commonly than males.
Conditions such as anorexia nervosa, bulimia nervosa and binge eating disorder are characterised by harmful eating behaviours such as restricting calories or binge eating.
Eating disorders are detrimental to health and often co-exist with depression, anxiety and/or substance misuse.
Conditions that include symptoms of psychosis most commonly emerge in late adolescence or early adulthood. Symptoms can include hallucinations or delusions. These experiences can impair an adolescent’s ability to participate in daily life and education and often lead to stigma or human rights violations.
Suicide and self-harm
An estimated 62 000 adolescents died in 2016 as a result of self-harm. Suicide is the third leading cause of death in older adolescents (15-19 years).
Nearly 90% of the world’s adolescents live in low-or middle-income countries and more than 90% of adolescent suicides are among adolescents living in those countries.
Risk factors for suicide are multifaceted, including harmful use of alcohol, abuse in childhood, stigma against help-seeking, barriers to accessing care and access to means. Communication through digital media about suicidal behaviour is an emerging concern for this age group.
Many risk-taking behaviours for health, such as substance use or sexual risk taking, start during adolescence. Risk-taking behaviours can be both an unhelpful strategy to cope with poor mental health and can severely impact an adolescent’s mental and physical well-being.
Worldwide, the prevalence of heavy episodic drinking among adolescents aged 15-19 years was 13.6% in 2016, with males most at risk.
The use of tobacco and cannabis are additional concerns. Cannabis is the most widely used drug among young people with about 4.7% of 15-16-years-olds using it at least once in 2018. Many adult smokers have their first cigarette prior to the age of 18 years.
Perpetration of violence is a risk-taking behaviour that can increase the lihood of low educational attainment, injury, involvement with crime or death. Interpersonal violence was ranked the second leading cause of death of older adolescent boys in 2016.
Promotion and prevention
Mental health promotion and prevention interventions aim tostrengthen an individual's capacity to regulate emotions, enhance alternatives to risk-taking behaviours, build resilience for difficult situations and adversities, and promote supportive social environments and social networks.
These programmes require a multilevel approach with varied delivery platforms –for example, digital media, health or social care settings, schools or the community, and varied strategies to reach adolescents, particularly the most vulnerable.
Early detection and treatment
It is crucial to address the needs of adolescents with defined mental health conditions.
Avoiding institutionalization and over-medicalization, prioritizing nonpharmacological approaches, and respecting the rights of children in line with the United Nations Convention on the Rights of the Child and other human rights instruments are key for adolescents.
WHO’s mental health Gap Action Programme (mhGAP) provides evidence-based guidelines for non-specialists to enable them to better identify and support priority mental health conditions in lower-resourced settings.
WHO works on strategies, programmes and tools to assist governments in responding to the health needs of adolescents. Key resources are:
- Global Strategy for Women’s, Children’s and Adolescents’ Health 2016–2030
- Mental Health Action Plan 2013–2020
- Mental Health Gap Action Programme (mhGAP)
In the context of emergencies, WHO has developed tools for:
all of which consider issues related to young people.
(1) Kessler RC, Angermeyer M, Anthony JC, et al. Lifetime prevalence and age-of-onset distributions of mental disorders in the World Health Organization’s World Mental Health Survey Initiative. World Psychiatry 2007; 6: 168–76