Diagnosis of depression in adolescents can be difficult due to problems differentiating between the normal, transient difficulties and developmental issues that occur in this age group and depressive symptoms. However accurate and timely diagnosis is critical because of the far reaching effects of depressive disorder on the functioning and adjustment of the adolescent. Depressive disorders may lead to serious consequences, including increased risk for illness, interpersonal and psychosocial difficulties, substance abuse, and suicide. This article reviews the adolescent depression and suicide research literature and discusses risk factors, unique symptom presentation, and effective treatment strategies. It also examines gender differences in the expression of symptoms and recommends gender-specific assessment and treatment strategies.
The accurate and early diagnosis and treatment of depression in adolescents is essential. The incidence of depression among youth age 9-17 has been estimated at 5% and only a minority are treated (Shaffer et al., 1996). Studies suggest that the 1-year prevalence in adolescents is as high as 8.3% (U.S. Department of Health & Human Services [HHS], 1999). Depression persists, or only partially remits, in more than half of them (Oldehinkel, Wittchen, & Schuster, 1999).
Depression in adolescents may lead to serious consequences including suicidal behaviors. The Center for Disease Control (CDC, 2000) reports that from 1980 to 1997, the rate of suicide among 15- to 19-year-old adolescents increased by 11% and among those aged 10 to 14 by 109%. Suicide is responsible for more deaths in youths age 15 to 19 than any disease. In 1996, suicide was the third leading cause of death (behind unintentional injury and homicide) in 15 to 24 year olds and the fourth leading cause of death in 10 to 14 year olds. There are gender and racial differences in the suicide rates. Boys are four times more likely to complete suicide than girls while girls are twice as likely to attempt suicide (HHS, 1999). The risk for suicide is highest among young white males, but suicide rates have increased most rapidly for young black males (CDC, 2000). Hispanic high school students are more likely than any other student to attempt suicide (HHS, 1999). The highest rate of completed suicide in the United States is among Native American male adolescents and young adults (HHS, 1999).
The presence of adolescent depression predicts continued risk for recurrences and persistence of depressive episodes, negative consequences, and suicidal risk into adulthood (Rao et al., 1995; Weissman et al., 1999). Successful treatment in adolescence is crucial, because adults with psychiatric illnesses are 20 times more likely to die from accidents or suicide than those without a mental disorder (Murphy, Monson, & Olivier, 1987). Depressed adolescents are more likely to experience stressful life events as young adults (Lewinsohn & Clarke, 1999). They are at higher risk for developing substance abuse and becoming an unwed parent. They are also less likely to complete college and earn as much money as those who were not depressed as adolescents (Lewinsohn & Clarke, 1999). These negative consequences during adolescence and young adulthood make early recognition and treatment essential.
SYMPTOMS OF DEPRESSION
The diagnosis of a major depressive episode in the Diagnostic and Statistical Manual of Mental Disorders, (4th ed.), (American Psychiatric Association, 1994) requires the presence of five or more of the following symptoms for a period of 2 weeks: (a) depressed mood, (b) loss of interest or pleasure, (c) significant weight or appetite change, (d) insomnia or hypersomnia, (e) psychomotor agitation or retardation, (f) fatigue/loss of energy, (g) feelings of worthlessness or inappropriate guilt, (h) diminished ability to think or concentrate, and/or (i) recurrent thoughts of death or suicidal ideation/plan/attempts. …