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Major Depressive Disorder
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Major Depressive Disorder and Societies Youth
Lisa Somerville
Argosy University- Nashville Campus
December 13, 2007
Abstract
In an attempt to better understand depression in today’s youth, I have chosen to explore the depths of Major Depressive Disorder and how it affects the young people in our society. Depression amongst school age children and adolescents are the primary focus. The prevalence, adversities, and treatment of the depression are discussed as well. After exploring these few facets of the disorder, I will talk briefly about the Ecological Model developed by Urie Bronfenbrenner and Morris in 1998 that is used by counselors to help evaluate and assess the children who are referred by teachers or medical physicians.
Major Depressive Disorder and Societies Youth
Major Depressive Disorder in the DSM IV is determined by depressive episodes that last at least 2 weeks at which time a depressed mood is present or there is a loss of interest and or pleasure in the day to day activities. For society’s children, the mood may appear to be one of irritability rather than a look of sadness. Symptoms of a depressed individual are: feelings of worthlessness, hopelessness, agitation, guilt, difficulty thinking and focusing, fatigue, loss of appetite, recurrent thoughts of suicide or death, withdrawal and insomnia. Major Depressive Disorder is a mood disorder that is hard to detect in children. Children tend to lack the abilities at such young ages to express their emotional and cognitive state of mind. A child’s developmental progress or lack of may affect the process of diagnosis because the child is either unable to articulate their emotional state or are possibly exaggerating, maybe even misunderstanding what they are feeling. School age children illustrate behavioral problems, lack of interest and troubles with academia. Adolescent children tend to be withdrawn, lethargic and fatigued while having loss of appetite, and later in the teen years may contemplate suicide. There may be a comorbid condition present at the time of assessment that may alter the diagnosis, and allow the depression to go undetected by professionals (Journal of the American Academy of Physicians, Sept. 2004).
Depression is prevalent in youth who have at least one primary family member who suffer or have suffered from acute or chronic depressive episodes. There is a close relationship and proven correlation with biological attributes that contribute to youth depression. 70% of children who have depression also have at least one other psychiatric comorbidity. (Journal of the American Academy of Physicians, Sept. 2004, para.14). The onset of Major Depressive Disorder affects approximately 4% to 8% of the adolescent youth in our society. (Patient
Care for the Nurse Practitioner, Oct. 2002. para. 2). There has been a lifetime risk factor attached to children of parents who are depressed. It states that 15-60% of children who come from depressive parents will suffer some time in their lives. During the adolescent years, girls are more likely to develop depressive moods because of the peer pressure and image concerns that plague our societies. Girl’s reach puberty faster and develop sooner emotionally and physically, therefore; research has shown a huge correlation between life situations and the affects of environment on depression in youth. Girls are socially more dependent on peers observations and opinions. Gender amongst youth plays a large role in the prevalence during adolescent years. Boys, unless affected by home life, environment, socioeconomic concern or abandonment issues tend not to be as affected during these crucial years by depression. Although not as prevalent in boys, research doesn’t exclude their side of the spectrum.
Exploration of this topic requires that the discussion on adversities be a topic of interest. As stated prior, environment plays a constructive role in the development of mood disorders. Being that Major Depressive Disorder is the most common of the many mood disorders, I think that the adversities that will be mentioned are prevalent to most people. The adversities that I researched and that showed up most often are: Parental drinking, economic hardship, parental mental illness, violence in the family, parent’s marital problems, death of mother or father, or the absence of a loved one. These earlier childhood adversities can be predictors for what may arise in later years. These situations cause anxiety in children and for this reason children should not be exposed to these adversities. Anxiety tends to be a precursor for depression. (Journal of Abnormal Child Psychology 33.1. pg. 13)(Feb. 2005).
Today schools are taking a much more effective role in detection of depression in the younger generations. Because school is like work for adults and is where children spend most of their days, I thought it would be appropriate to discuss a model developed by Urie Bronfenbrenner and Morris in 1979, which addresses the totality of the child’s life up to the present moment. This model gave school counselors a tool to work from while assessing the children. This model puts every aspect of the disorder on a continuum that professionals can use as a guide during questioning and diagnosis. Due to the fact that depression is hard to detect in young children, this process allows the counselor to see all symptoms present even if they don’t fit the DSM IV criteria to comprise a diagnosis. The Ecological Model takes a look at the child as a whole. This includes, home, school, family and community involvement. From this point the Ecological Model will help to explain how these areas in the child’s life are affected by depressed moods or whether or not they are possibly causing the depressive episodes. The Ecological Model helps professionals determine the what, when, where, who and why the depression is occurring. The biggest question is usually the “WHO”. Who should really be the focus of the intervention process? This helps counselors know whether they should be targeting the source of the problem that has influenced the depressed child. An important factor to the intervention is where the intervention occurs. The atmosphere should always be non-threatening. For those who use the model, they should be creative and adaptable to the process. Professionals should remember that the client is still the main focus of treatment. Family and play time are some of the most essential aspects of a child’s life, and the two areas should be explored fully during evaluation. (Professional School Counseling 8.3, Feb. 2005 pg. 284.)
The American Family Physician journal states that the ultimate treatment plan for children and adolescents should include a multidisciplinary approach, which incorporates psychotherapy, education of family, education of the patient and pharmacotherapy.
Depression among youth can last for several months and tends to reoccur in young adulthood. Depression shouldn’t be ignored or written off as moodiness. Parents with depressed children usually are suffering from life’s changes and transfer their mental state on to the children without recognition of the behaviors taking place. Following puberty the ratio among boys and girls who are depressed children changes because gender differences take a separate road. A good majority of adolescents who become withdrawn around the onset of puberty suffer with psychosocial interactions. Major Depression in youth seems to be affected by environmental and genetic attributes which leads to the variety of treatment plans that are available. Today most treatment centers or therapist use a multidisciplinary plan that allows the patient to explore their options for a new quality of life. This is done by therapy sessions, medication, a medical doctor if needed and a case manager if warranted as well. Two psychotherapeutic approaches that are widely used are Cognitive-Behavioral Therapy and Interpersonal Therapy. Both therapies help to alter any dysfunctional thinking patterns and assist in bettering interpersonal skills while teaching coping strategies. Several anti-depressants are being used as well. Although suicide is the third cause of adolescent deaths, the rate has declined over the last few years. The Lancet journal states that, “Suicide rates are decreasing overall in adolescents, and there seems to be a correlation between the use of selective serotonin reuptake inhibitors and a decrease in completed suicides.” (Sept.2005, pg.933). Fluoxetine (Prozac) is the only approved anti-depressant for pediatrics. Approved by the FDA, Prozac is generally well received. The reported side effects are mild GI disturbances, sedation, and headaches. Some appetite and sleep disturbances have been reported as well. This is usually due to dosage and is adjusted by the physician.
Most treatment plans for adolescents are based on acute treatment plans. The extension
of treatment depends on the severity of depressed episodes and risk factors that would constitute the client bringing harm to themselves or others or impairment in daily functioning.
As treatments evolve and we look closer at the methods being used to treat depression, we should be conscious of the changing world around us. Major Depressive Disorder in children and adolescents is a constant problem due to the environments we live in and the established mental states of those who are opting to have children. Depression is genetically linked to family members and stressors around our everyday lives. Suicide among adolescents can be prevented with the help of professionals and good parenting skills. I think that parents need to take a more active role in understanding what depression is and if needed address their own presenting issues. Although this is my opinion, the research seems to point the blame at dysfunctional home lives and the environment to which we engage. Depression is a state of mind, not a way of life.
References
Abrams, Karen (Feb.2005). Children and adolescents who are depressed: an ecological approach.
8.3, 284. Retrieved December 1, 2007, from Journal of Professional School Counseling.
Louters, L. Lauren (Sept.2004). Don’t overlook childhood depression: an effective approach to
childhood depression requires that you maintain a high index of suspicion and understand the disorder’s full spectrum of manifestations. 17.9, 18. Retrieved December 1, 2007, from the Journal of the American Academy of Physicians.
Phillips K., Nicole, Hammen L., Constance, Brennan A., Patricia, Najman M., Jake, Bor,
William (Feb.2005). Early adversity and the prospective prediction of depressive and anxiety disorders in adolescents. 33.1, 13. Retreived December 1, 2007 from Journal of Abnormal Child Psychology.
Ryan, Neal (Sept. 10, 2005). Treatment of depression in children and adolescents. 366.9489,
933. Retrieved December 1, 2007 from The Lancet.
Son E. Sung, Kirchner T., Jeffrey (Nov. 15,2000). Depression in Children and
Adolescents.62.10, 2297. Retrieved December 1, 2007 from American Family Physician.
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References: Abrams, Karen (Feb.2005). Children and adolescents who are depressed: an ecological approach. 8.3, 284 Louters, L. Lauren (Sept.2004). Don’t overlook childhood depression: an effective approach to childhood depression requires that you maintain a high index of suspicion and understand the disorder’s full spectrum of manifestations Phillips K., Nicole, Hammen L., Constance, Brennan A., Patricia, Najman M., Jake, Bor, William (Feb.2005) Ryan, Neal (Sept. 10, 2005). Treatment of depression in children and adolescents. 366.9489, 933 Son E. Sung, Kirchner T., Jeffrey (Nov. 15,2000). Depression in Children and Adolescents.62.10, 2297
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