Readings

Wenar, C. & Kerig, P. (2000)“ Wenar, C. & Kerig, P. (2000)“ Disorders in the depressive Disorders in the depressive spectrum and child and adolescent spectrum and child and adolescent suicide in suicide in Developmental Developmental Psychopathology Psychopathology (pp. 143-159). (pp. 143-159). Singapore: McGraw-HillSingapore: McGraw-Hill

Lecture Questions

Where is the line between ‘normal’ Where is the line between ‘normal’ adolescent depression and adolescent depression and ‘abnormal’?‘abnormal’?

Why is adolescence a time of Why is adolescence a time of vulnerability to depression?vulnerability to depression?

What does depression look like in What does depression look like in adolescence?adolescence?

What are the risk and protective What are the risk and protective factors for adolescent depression factors for adolescent depression and youth suicide?and youth suicide?

What’s ‘normal’?

WorryingWorrying ‘‘Moodiness’Moodiness’ ‘‘Puberty blues’Puberty blues’ Underdiagnosis related Underdiagnosis related

to ‘normal’ aspects to ‘normal’ aspects of adolescence of adolescence

Adolescent vulnerability

Cognitive factorsCognitive factors EgocentricityEgocentricity Black and white Black and white

thinking thinking Emotional reasoningEmotional reasoning Personal fable- Personal fable-

uniquenessuniqueness Increased capacity for Increased capacity for

self awareness self awareness

Adolescent vulnerability

Adolescent ‘turmoil’Adolescent ‘turmoil’ Changing bodies, changing Changing bodies, changing

parental relationshipsparental relationships Sexual identitiesSexual identities RelationshipsRelationships Academic pressuresAcademic pressures Peer pressuresPeer pressures Balancing work and schoolBalancing work and school

How common is it? One of the three most common mental One of the three most common mental

health problems in young peoplehealth problems in young people First onset of a major depression often First onset of a major depression often

occurs in mid-late adolescence (15 mean occurs in mid-late adolescence (15 mean age)age)

Rise in depression ages 13-15, peak ages 17-Rise in depression ages 13-15, peak ages 17-18, decline to adult levels18, decline to adult levels

Depression is a significant problem for young Depression is a significant problem for young people in custody or living on the streetspeople in custody or living on the streets

Episode in adolescence risk factor for Episode in adolescence risk factor for episode in adulthood (Patton)episode in adulthood (Patton)

NZ prevalence

Fergusson & HorwoodFergusson & Horwood 16-18 year old young women 30.2% 16-18 year old young women 30.2%

raterate 18 plus 10.8%18 plus 10.8% 16-18 year old young men 13.7%16-18 year old young men 13.7% 18 plus 3.4%18 plus 3.4%

Gender patterns Onset of menarche significant for girls Onset of menarche significant for girls

(around age 12)(around age 12) Equal prevalence boys and girls til 15 then Equal prevalence boys and girls til 15 then

greater prevalence amongst girls (around greater prevalence amongst girls (around twice as likely)twice as likely)

Girls’ depression predictor of subsequent Girls’ depression predictor of subsequent episodesepisodes

Speculative differences in way depression Speculative differences in way depression differently expressed by girls and boysdifferently expressed by girls and boys

Role of constructions of gender, pressures to Role of constructions of gender, pressures to conform with approach to adulthoodconform with approach to adulthood

Adolescent presentation

Depressed mood Fatigue Depressed mood Fatigue Decreased concentration InsomniaDecreased concentration Insomnia Social withdrawal GuiltSocial withdrawal Guilt Negative self-image AnorexiaNegative self-image Anorexia Anger/irritability Hopelessness Anger/irritability Hopelessness

Suicidality Depression

feels like falling out of

a plane without a parachute

There aren’t any words to express the confusion of

feelings

I was often impatient with my friends. They didn’t want to be around me any more

DSM Criteria Persistent depressed moodPersistent depressed mood Loss of pleasure or interest in activitiesLoss of pleasure or interest in activities Weight loss or gainWeight loss or gain InsomniaInsomnia RestlessnessRestlessness FatigueFatigue Feelings of worthlessnessFeelings of worthlessness Impairment in concentration, making decisionsImpairment in concentration, making decisions Recurrent thoughts of deathRecurrent thoughts of death 5 plus, two weeks at least 1 symptom (1) or (2)5 plus, two weeks at least 1 symptom (1) or (2)

Comorbidity

Substance abuse- Patton’s research on Substance abuse- Patton’s research on cannabis usecannabis use

Anxiety disorders (60-70% in children)Anxiety disorders (60-70% in children) Conduct disorder (boys)Conduct disorder (boys) Age patterns- preschoolers separation Age patterns- preschoolers separation

anxiety, school age children conduct anxiety, school age children conduct disorder and adolescents eating disorder and adolescents eating disorders or substance abusedisorders or substance abuse

Precipitating factors

Relationship losses:Relationship losses: Girl/boyfriendGirl/boyfriend Family member Family member Close friendClose friend

Failure to achieve a goalFailure to achieve a goal Sports/leisureSports/leisure AcademicAcademic

Risk factors- young person

Biological changesBiological changes Physical illnessPhysical illness Poor nutritionPoor nutrition Alcohol or drug abuseAlcohol or drug abuse Negative self evaluation beliefsNegative self evaluation beliefs External locus of controlExternal locus of control

Risk factors- family

Family history of depressionFamily history of depression Early loss experiencesEarly loss experiences Exposure to non-optimal parenting Exposure to non-optimal parenting

experiences, especially focus on experiences, especially focus on child’s failures or neglectful child’s failures or neglectful parentingparenting

Lack of connectedness with family Lack of connectedness with family (Resnick et al.)(Resnick et al.)

Risk factors-social

Stresses from e.g., sexuality Stresses from e.g., sexuality issues, academic pressures, peer issues, academic pressures, peer pressure, friendship/relationship pressure, friendship/relationship problems, identitiy issuesproblems, identitiy issues

Lack of connectedness with school Lack of connectedness with school (Resnick et al.)(Resnick et al.)

Protective Factors Resnick et al. “Protecting adolescents from Resnick et al. “Protecting adolescents from

harm”harm” Connectedness with family, other adults, Connectedness with family, other adults,

or school or school ReligiosityReligiosity Feeling safe at schoolFeeling safe at school Coping skillsCoping skills Feelings of self-esteem Feelings of self-esteem

and belongingand belonging Secure cultural identitySecure cultural identity

Help-seeking

Most young people don’t seek help:Most young people don’t seek help: Use informal versus formal helpUse informal versus formal help Bullet proof-think they can handle itBullet proof-think they can handle it Don’t know what’s availableDon’t know what’s available Negative about what is availableNegative about what is available Effects of depression itselfEffects of depression itself Psychosocial- levels of stress, Psychosocial- levels of stress,

confidence and social supportconfidence and social support

Youth Suicide 1995 NZ worst rate of 13 OECD countries1995 NZ worst rate of 13 OECD countries 1998-140 deaths1998-140 deaths 1999-120 deaths1999-120 deaths 2000-96 deaths2000-96 deaths Females attempt at twice the rateFemales attempt at twice the rate Males higher ‘success’ Males higher ‘success’ Maori males highest rate (numbers of Maori males highest rate (numbers of

suicides divided by population that age)suicides divided by population that age)

Key risk factors High emotional distressHigh emotional distress Previous attemptsPrevious attempts Family/friend suicide attemptFamily/friend suicide attempt Involvement in violence Involvement in violence

perpetrationperpetration Victim of violenceVictim of violence Substance abuseSubstance abuse Easy access to suicide ‘tools’Easy access to suicide ‘tools’

Protective factors

As for depressionAs for depressionResnick et al study:Resnick et al study: No protective factors: 1 in 5 boys and 1 No protective factors: 1 in 5 boys and 1

in 3 girls attemptin 3 girls attempt 3 protective and 3 risk factors: 3 protective and 3 risk factors:

probability 4% boys, 8% girlsprobability 4% boys, 8% girls No risk factors, probability < 1%No risk factors, probability < 1% Prevention + decrease risks and increae Prevention + decrease risks and increae

protectiveprotective