Last week I discussed what depression was within the context of social cognition as well as some of the theories behind it. This week I wanted to focus on the prevalence/frequency of symptoms, some of the risk factors associated with depression, and the psychosocial characteristics of an individual becoming/being/been depressed. I found a great article that summarized the current understanding of depression in older adolescents (14-18 years old) based out of Oregon.
Since 1985, the researchers conducted a large, prospective, epidemiologic study entitled the Oregon Adolescent Depression Project (OADP). The OADP consisted of a representative sample of 1,709 high school students who completed a diagnostic interview and a wide array of psychosocial measures when they were 14 to 18 years of age (Time 1, or T1). Approximately 1 year later (T2), 1,507 (88%) of the participants returned for a second diagnostic interview and questionnaire assessment. Participants were assessed on a comprehensive array of psychosocial constructs either known to be associated with depression in adults or hypothesized to be important with respect to depression in adolescents. The researchers are currently in the process of conducting a third diagnostic assessment (T3) with the OADP participants near the time of their 24th birthday, which will provide important information regarding the impact of psychopathology during the transition from adolescence to young adulthood (Lewinsohn, 1998).
Frequency/ Prevalence of Symptoms:
Researchers previously thought that children and adolescents, when depressed, would exhibit different symptoms than adults (e.g., “masked” depression). However, the trend over the past 20 years has been increasing toward viewing major depressive disorder (MDD) in children, adolescents, and adults as similar, as reflected in the DSM-III-R and DSM-IV, which emphasize the commonalities in MDD across the age span. To examine the manifestation of an episode of MDD in adolescence, the researchers calculated the relative frequency of DSM-III-R depressive symptoms for adolescents in an episode of MDD, for noncases, and for the total sample at T1. Results are shown in Table 1. As can be seen, in addition to depressed mood, the most frequent symptoms are thinking difficulties and sleep and weight/appetite disturbances. The least frequent symptom is thoughts of death/suicide, which, nonetheless, was reported by over half of the MDD cases (Lewinsohn, 1998).
What I feel must be noted is that even though this study is quite comprehensive, the beginning of the research comes from the information in the DSM-III-R which is two versions behind our current one. But, we wouldn’t have research that stems back over thirty years if they didn’t start with what they had then.
The next question they addressed was whether patterns of MDD symptoms in boys and girls differ. Among OADP participants with MDD (269 girls and 123 boys), prevalence rates of two of the nine symptoms were significantly different. Compared to depressed boys, depressed girls more often reported weight/appetite disturbance (77.0% vs. 58.5%) and worthlessness/guilt (82.5% vs. 67.5%). These differences may indicate a slightly different focus for treatment of depressed adolescent girls versus boys (Lewinsohn, 1998).
I also think that the different symptoms between genders have a lot to do with the social dynamic they immerse themselves in. Young females in my perspective, looks towards their image as the main reflection of who they are. When a little girl looks to her role models and the media, she sees all the distorted fantasies of perfection society has laid out for them, it doesn’t surprise me that appetite disturbance is more prevalent in girls over boys.
Age and Gender:
The researchers described that their initial hypothesis was that the gender difference in depression would emerge during the high school years (between 14 and 18 years of age). They found a significant gender difference which is shown in Figure 1, with females being twice as likely as males to be depressed. The effect of age and the interaction of age and gender, however, were nonsignificant. Comparing our results with other studies suggests that gender difference in MDD levels probably emerges in the relatively small window between the ages of 12 and 14.
I feel like the reason that they didn’t find a significant interaction was because of environment. Family, work, school, and other co-curricular activities that involve social interactions have a lot to do with an individual’s mood. Parents divorcing are becoming a more common occurrence and I can speak from experience that it can throw anyone off their mental health.
Interest in the co-occurrence, or comorbidity, of psychiatric disorders is a rather recent phenomenon. Comorbidity refers to the fact that patients with one disorder may be at elevated risk for a second disorder and this co-occurrence may affect the course of the two disorders. Comorbidity is said to exist either when persons with a current disorder have an elevated prevalence of other current disorders (concurrent comorbidity), or when persons with a history of a disorder have an elevated prevalence of other disorders (lifetime comorbidity). While empirical knowledge regarding the comorbidity of mental disorders in adults has rapidly increased in the last decade, much less is known regarding psychiatric comorbidity in adolescents.
Comorbidity of MDD with Other Mental Disorders Is Substantial:
Almost half (43%) of adolescents with MDD also have the lifetime occurrence of another mental disorder. Rates of comorbidity in depressed adults are roughly comparable or slightly higher, estimated to be 56–60%. The following table shows the probability of various disorders and other types of pathology within the OADP, given MDD and conversely, the probably of MDD given other diagnoses and pathology. Depression is significantly comorbid with almost all of the examined conditions. When there is a comorbid disorder, the MDD episode develops after the other disorder in 80% of cases (Lewinsohn, 1998).
With this information I feel like we can pull from other treatment schemas to ‘stream-line’ new versions that are more efficient and effective.
The psychosocial characteristics which characterize adolescents before they become depressed (i.e., the antecedents for depression) enable us to identify teenagers who are at elevated risk for becoming depressed and provide an opportunity for preventive interventions. The 19 variables marked in the “before” column of the table below are psychosocial risk factors for becoming depressed in this age group. The greater the number of risk factors on which an individual is elevated, the greater the probability that they will become depressed in the future. Variables that are especially influential were internalizing problems, the presence of a non-affective disorder, past history of depression/suicide attempt, subsyndromal depression, and the presence of a non-affective disorder.
The 22 variables in the “during” column of the table highlight the types of psychosocial problems experienced by teenagers while they are depressed. The large number of correlates documents the pervasiveness of the psychosocial difficulties associated with being depressed. Being depressed clearly puts the teenager at a disadvantage in situations requiring adaptive functioning. The psychosocial impairments associated with depression in adolescence are very similar to those that have been observed in adults.
Having Been Depressed:
The 21 variables on which formerly depressed adolescents differ from never-depressed controls are important for at least two reasons. First, they tell us that formerly depressed teenagers continue to manifest some of the depression-related psychosocial impairments. And, formerly depressed adolescents may continue to experience some depression symptoms, internalizing problems, pessimism, depressotypic attributions (negative, stable and internal attributions for failure), excessive interpersonal dependency, and a greater number of major life stressors. The characteristics of having been depressed are also important because they provide a possible explanation of why formerly depressed teenagers are at high risk for recurrence. This knowledge can guide the course of preventative interventions offered to formerly depressed teenagers, and suggests that some degree of maintenance treatment needs to be offered after recovery from the acute episode.
Conclusions and Recommendations:
The magnitude of adolescent depression (prevalence but especially incidence) is much larger than had been thought. Depression in the adolescent population is clearly a major mental health problem that is often under-recognized. Depression during adolescence is associated with numerous negative psychosocial consequences and seriously interferes with effective functioning. Because of their suffering and impairment, depressed adolescents are in need of help especially during, but also before and after the episode. One has to have a systematic way of probing for the occurrence of other mental disorders, and for the occurrence of physical pathologies. The researchers results indicate that a number of psychosocial factors significantly contribute to the etiology of adolescent depression. While genetic and biological factors may also be implicated in this disorder, current research firmly establishes the importance of psychosocial factors in adolescent depression. The high recurrence rate makes it incumbent upon clinicians to help their adolescent patients learn prevention strategies for future use. In addition to providing current symptom relief, effective treatment should provide individuals with tools for reducing the risk of future depressive episodes. Ongoing research to develop and test effective treatments should keep in mind that matching patients to appropriate levels of care is incumbent to success. Different kinds of treatments may be adequate for different levels of depression severity and for different combinations of comorbid conditions. The most costly interventions should be reserved for the most severely depressed. Lesser levels of depression severity may respond well to less intensive (and less expensive) treatments. Which leads me into my final topic before my synopsis: treatments for depression and how can we make them better?
The bottom line of what the researchers are saying is that psychologists can make major contributions to this problem. Will it happen? We know that considerable energy and effort will be needed to implement some of the findings we cite. In her presidential address to the Association for the Advancement of Behavior Therapy in 1995, Linda Sobell (1996) emphasized that we must learn how to “bridge the gap” between scientists and practitioners by developing effective strategies for disseminating empirically-based treatments. The development and diffusion of science-based practices is at the heart of the scientist-practitioner model developed as long ago as 1949 at the Boulder Conference.
At least I’m not the only one out there that feels like there should be more of a ‘melding’ of the fields of science instead of ‘distinction’ especially when it comes to mental disorders. I feel like this article was a great fit for the information I wanted to convey about the risk factors associated with depression. It also gave me a sense of hope that there have been people out there that genuinely care about the mental well-being of young individuals and made it their jobs to continue their understanding of the illness so that maybe one day we won’t have to worry about it..
*all tables and citations came from the one research article
- Lewinsohn, P. (1998). Major depressive disorder in older adolescents: prevalence, risk factors, and clinical implications. Clinical Psychology Review, 18(7), 765-794. doi:10.1016/s0272-7358(98)00010-5
- The Truth About Exam Stress [Overwhelmed Student]. (n.d.). Retrieved March 16, 2017, from https://www.sudocrem.co.uk/skin-care-cream/blog/wp-content/uploads/2016/07/image003.jpg