The suicide rate for adolescents has increased more than 200% over the last decade. Recent studies have shown that greater than 20% of adolescents in the general population have emotional problems and one-third of adolescents attending psychiatric clinics suffer from depression. The majority of teenage depressions can be managed successfully by the primary care physician with the support of the family, says Maurice Blackman MB, FRCPC.
Depression has been considered to be the major psychiatric disease of the 20th century, affecting approximately eight million people in North America. Adults with psychiatric illness are 20 times more likely to die from accidents or suicide than adults without psychiatric disorder. Major depression, including bipolar affective disorder, often appears for the first time during the teenage years, and early recognition of these conditions will have profound effects on later morbidity and mortality.
Is depression in adolescents a significant problem?
The suicide rate for adolescents has increased more than 200% over the last decade. Adolescent suicide is now responsible for more deaths in youths aged 15 to 19 than cardiovascular disease or cancer. Recent studies have shown that greater than 20% of adolescents in the general population have emotional problems and one-third of adolescents attending psychiatric clinics suffer from depression. Despite this, depression in this age group is greatly underdiagnosed, leading to serious difficulties in school, work and personal adjustment which often continue into adulthood.
Why is depression in this age group often missed?
Adolescence is a time of emotional turmoil, mood lability, gloomy introspection, great drama and heightened sensitivity. It is a time of rebellion and behavioral experimentation. The physician's challenge is to identify depressive symptomatology which may be superimposed on the backdrop of a more transient, but expected, developmental storm.
Diagnosis, therefore, must rely not only on a formal clinical interview but on information provided by collaterals, including parents, teachers and community advisors. The patient's premorbid personality must be taken into account, as well as any obvious or subtle stress or trauma that may have preceded the clinical state. The therapeutic alliance is very important since the adolescent will not usually readily share his/her feelings with an adult stranger unless trust and rapport are established.
Confidentiality must be assured, but not to the point that the parents - who are often essential allies in treatment - are wholly excluded. Diagnosis may require more than one interview and is not a process that can be rushed. Inquire directly about possible suicidal ideation.
What are the common symptoms of adolescent depression?
Depression presents in adolescents with essentially the same symptoms as in adults; however, some clinical shrewdness may be required...