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Common risk factors associated with adolescent and young adult depression.

ABSTRACT

Depression is one of the leading causes of disability for all ages and genders in the United States. Historically, depression had been viewed as a condition that only affected older adults; however, in recent years health professionals have recognized depression as a serious condition also affecting adolescence and young adults. The purpose of this study was to identify whether gender was a risk factor of depression within the adolescent and young adult population as literature shows that depression can impact growth and development, school performance, peer or family relationship and at times can be fatal. Data from the 2005-2006 National Health and Nutrition Examination Survey was studied to gain understanding into the predictive relationship between adolescent depression and gender. The hypothesis that gender is a predictive factor for depression in this population was supported.

INTRODUCTION

Everyone experiences unhappiness at some point throughout his or her life. Most often these feelings are a result of change due to various events such as growing older, illness, the loss of a family member, or the breakup of a relationship. The painful thoughts and feelings that accompany these events are usually appropriate, needed, and temporary, and can even present an opportunity for personal growth. However, when these feelings continue and impair everyday life, it may be an indication of depression. Severity, extent, and the manifestation of symptoms are the factors that distinguish normal sadness from depression (Torpy, 2006).

Depression is a common psychological disorder that can alter a person's mood, physical functions and social interactions with several subtypes. Approximately 121 million citizens worldwide of all genders, ages, and backgrounds are affected with symptoms of depression (McMillian, 2011). People with depressive illnesses do not all experience the same symptoms but when untreated these problems can become chronic or recurrent and interfere with an individuals' everyday life. Depression is a medical illness that causes a persistent feeling of sadness and loss of interest. In fact, in the year 2012, WHO classified depression as the leading cause of disability for all ages and genders, which demonstrates the importance of understanding, diagnosing, and treatment of this illness (World Health Organization, 2012).

Historically, depression has been viewed as a condition that only affected older adults; however, in recent years health professionals have recognized depression as a serious condition also affecting adolescence and young adults. It is estimated that about 10 to 15 percent of adolescence and young adults are depressed at any given time. Research suggests that one of every five young people will experience an episode of major depression during high school with the average age of onset being 14 years and one out of every four college students or adults (Heller, 2012).

Five percent of those 9 to 17 years of age meet the criteria for major depressive disorder and 3 percent of adolescents have dysthymic disorder with the incidence of depressive disorders markedly increases after puberty (Bhatia & Bhatia, 2007).

Depression is one of the leading causes of morbidity and mortality in the world today and places a significant economic burden on society. It is among the most treatable mental disorders, yet it remains a chronic illness with 85% of people who experience a single episode of depression experiencing another episode within 15 years (Gladstone, Beardslee & Erin, 2012).

Most importantly, depression is known to increase the risk of suicide in adolescents. According to Halpern (2004), since the year 2000, suicide is the third leading cause of death for adolescents accounting for approximately 2,000 lives or 12% of the annual deaths in this age group annually. Furthermore, the number of adolescent deaths from suicide in the United States has drastically increased during the past few decades. While the rates of completed suicide are low (1.5 per 100,000 among 10- to 14-year-olds and 8.2 per 100,000 among 15- to 19-year olds), there are many more attempt and suicidal ideations (Gould et al, 2003). Learning the risk factors for depression and it's correlation and warning signs to suicide will go a long way toward prevention of both.

STATEMENT OF THE PROBLEM

Nevertheless, depression in adolescents and young adults are more often overlooked, misdiagnosed, or undetected in comparison to older adults, possibly due to the eminence of irritability and mood fluctuations within this age group. Various risk factors such as gender, psychosocial and family environment, or genetics disposition could increase the likelihood of adolescent or young adulthood depression (A.D.A.M Health Solutions, 2012). Since depression is under-diagnosed it is important for professionals and parents to pay attention to any signs of depression amongst adolescent and young adults. Understanding high risk factors and targeting those individuals for prevention, intervention, and lifestyle changes could be the difference between life and death for some (Pereira, 2010).

Purpose of the Study

Depression is a complex condition that has no single cause; however, a combination of genetics, biologic, and environmental risk factors may increase the probability of acquiring the condition. Therefore, the purpose of this study was to examine gender and whether or not it is a determinant of depression in adolescents and young adults.

Significance of the Study

Adolescents and young adults struggling with depression often go unidentified, untreated, or mistreated; however, depression can impacts growth and development, school performance, peer or family relationships and at times can be fatal. Suicide is the most devastating outcome of depressive symptoms during adolescence and due to the alarming statistics the importance of understanding the signs and symptoms of depression and focusing on prevention efforts has become crucial (Bulhoes et al., 2013). Therefore, it is hopeful that this study will help highlight whether gender is associated with depression in adolescence and young adults.

LITERATURE REVIEW

Adolescence is defined as the transitional stage of physical and mental development that occurs between childhood and adulthood. Adolescence is roughly considered to be the period between 13 and 18 years of age in which the youth experiences biological, social, and psychological changes. Whereas, young adulthood is roughly considered as the time from the end of adolescence at age 18 to age 21 in which an individual emerges into young adult responsibilities. Many adolescents and young adults develop depression during these years as they try to make sense of the numerous changes that are occurring in their lives. According to the National Institute of Mental Health, (2010), 1 in 12 or 8.3% of American adolescents or young adults are currently affected by symptoms of depression.

Depression in adolescents and young adults is often difficult to identify and diagnose, as it is common for this age group to alter their moods or emotions. (Bhardwaj & Goodyer, 2009) It is quite typical for a teenager or young adult to feel sad or overwhelmed by school, peers, or changes in their physical development. Although most teenagers or young adults may have some or all of these symptoms at some time or another, continued symptoms over long extended periods can be reason to believe they are suffering from depression.

Common Forms of Depression

Depression comes in many shapes and forms. In some, depression can persist at a low level for months and even years. In others, the symptoms are so severe that it can lead to suicide. Depression can be triggered or provoked by many factors including personal/ interpersonal events or hormonal changes (i.e. puberty). At any given time, up to 15 percent of adolescents and young adults have some symptoms of depression. Five percent of those, 9 to 17 years of age, meet the criteria for major depressive disorder and three percent of adolescents have dysthymic disorders, which are the two most common forms of depression in adolescents (Bhatia & Bhatia, 2007). Although both forms of depression have similar characteristics; the severity, frequency and duration of symptoms will vary depending on the individual and his or her particular illness. Healthcare professionals must distinguish between the two clinical forms of depression in order to diagnose and treat appropriately.

Major depression (clinical depression). Major depressive disorder is characterized by a combination of severe symptoms such as lack of interest in activities, strong feelings of worthlessness or guilt, and thoughts of suicide, that may disable or prevent a person from executing daily activities(A.D.A.M Health Solutions, 2012). Symptoms of depression must persist for over two weeks in order to be considered a major depressive episode. "Depression is one of the most prevalent mental disorders among adolescents and young adults, with approximately 20% experiencing an episode of major depressive disorder during adolescents." (Cates, Feldman & Passero, 2007). Some individuals have isolated episodes that are separated by many years without any depressive symptoms, whereas others have clusters of episodes, and still others have increasingly frequent episodes as they grow older. After the first episode of this disorder, there is a 60% chance of having a second episode. After the second episode, there is a 70% chance of having a third, and after the third episode, there is a 90% chance of having a fourth (Long, 2011).

Dysthymia (chronic/ mild depression). The Greek word dysthymia means "bad state of mind" or "ill humor." As one of the two chief forms of clinical depression, dysthymia disorder is characterized as a long-term (two years or greater) form of depression. An individual suffering from dysthymic disorder has fewer or less severe symptoms than major depressive disorder but experiences depressive symptoms more consistently and for longer periods of time. Although the symptoms are chronic, those who suffer from dysthymia are usually able to perform daily functions adequately but might consistently appear unhappy or unmotivated (Harvard Health Publications, 2005).

Symptoms of Depression

Recognizing the symptoms of depression is often the biggest hurdle to the diagnosis and treatment of any form of depression. Unfortunately, many people who experience symptoms never do get diagnosed or treated for their illness, which in many cases has led to suicidal thoughts or life-ending events. According to Cates, Feldman & Passero (2007) symptoms that are generally associated with major depressive disorder and dysthmia disorder include but are not limited to the following: loss of interest in activities, insomnia or excessive sleeping, poor appetite, impaired concentration, irritability/restlessness, persistent sadness or hopelessness, significant weight loss or gain, withdrawal from friends and family, fatigue or decreased energy, tearfulness or frequent crying, persistent aches or pains, feeling of worthlessness and guilt, or thoughts of death or suicide.

Common Risk Factors Associated with Depression

Gender. Epidemiological findings suggest that increases in depressive disorders are greater for girls than for boys during adolescence and young adulthood (Lewinsohn, Rohde & Seeley, 1998). Generally, the incidence of depressive disorders noticeably increases as adolescence reach puberty. Puberty refers to the process in which a boy or girls sexual and physical characteristics mature. It is initiated by hormone signals from the brain, which stimulate the growth, function and transformation of variance body parts including the reproductive organs. By 14 years of age, depressive disorders are more than twice as common in girls as in boys possibly because of differences in coping styles during puberty (Bhatia & Bhatia, 2007).

Girls are more likely than boys to begin going through puberty before or during the transition to secondary school making it a more stressful transitional period. At puberty, girls' attitudes regarding their physical appearance often become more negative, as it is difficult to adjust to a new body image. Body image is closely linked to self-esteem in women and body dissatisfaction is a risk factor for depression. Girls who enter puberty prior to their peers must also face additional stress of coping with the reaction of other to her development. They often turn to older woman for support and guidance which may isolate her from her own peers who are not experiencing the same social, psychological, and physical changes (Stice, Hayward, Cameron, Killen & Taylor, 2000).

Hormonal changes that accompany women's developmental and reproductive processes may also play a role in depression. For some girls, the simple changeability of estrogen levels during puberty in adolescent years and possible pregnancy in young adulthood is sufficient to lead to depression (Studd & Panay, 2004). Hormone fluctuations related to the menstrual cycles can also profoundly influence mood changes for many women. The symptoms associated with the menstrual cycle such as bloating, irritability, and fatigue might make some women feel distressed and lead to depression. For most adolescence, this transitional period is uncomfortable and often embarrassing. As they learn about their sexuality and experience the physical changes occurring to their bodies' adolescent girls avoid discussing their feelings with others, which results in separation or division from their everyday lives (Keenan & Hipwell, 2005).

On the other hand, for adolescent boys the development experienced during puberty such as the deepening of the voice, development of facial hair, and refinement of muscles is welcomed by society. Adolescent boys embrace their self-image unlike girls and create a social network that supports the changes they are experiencing which often continues on into young adulthood. However, this is not always the case for all, as some do not develop as quickly as their peers or have distorted body image which may be linked with elevated risk of depression (Blashill & Wilhelm, 2013). Even though depression rates for adolescent girls are twice as high as those in adolescent boys, many boys are still affected by the condition. Unfortunately, depression in men can often be overlooked as many find it difficult to talk about their feelings or fear a falling of masculinity (Branney & White, 2008).

Moreover, in Western societies, the mass media is typically regarded as the single strongest transmitter of unrealistic beauty ideals, and often held responsible for the high proportion of body dissatisfaction of young adolescents (Hargreaves & Tiggemann, 2003). The media plays an enormous role in defining modern day beauty and manhood; however, for young adults and adolescents these messages can often convolute their understanding of reality. Due to the influence of the media, adolescence has been targeted as the most likely time for the emergence of body dissatisfaction. Body dissatisfaction, in the form of wishing to be thinner has now been demonstrated in girls as young as six years of age and is generally found to be greater for girls than boys. (Clark & Tiggemann, 2006). As one enters into adolescent years and begins experiencing changes with their bodies may lead to less satisfaction with body image and physical appearance leading to depression.

Family history of depression and traumatic childhood events. Children are a product of their environment. Many children are at high-risk for depression due to familial predisposition and exposure to adversity throughout their childhood. Those who are brought up in loving, caring, and supportive environments are more likely to behave that way as adults. Just as children who were brought up in abusive, un-stable, or negative environments tend to have behavioral or substance abuse problems.

Approximately 15 million children in the United States grow up in a household where a parent has experienced one or more episodes of a major depressive disorder. (Parent, Forehand & Compas, 2013). Research has proven that children of depressed parents are at greater risk to experience depression and have emotional and behavioral problems during their adolescent and young adult years (Diego, Sanders & Field, 2001). Though parents often feel that their child's behavior is the source of their distress, in fact the child is actually often reacting to the patient's depression. Depressed parents experience difficulties in their parenting role and struggle to remain responsive to their children (O'Conner, 2006). Parents who are depressed are often overwhelmed with their own lives and do not have the patience to help their children develop structure in theirs. Children without structured lives and responsibilities often feel lost or useless. They are unable to establish or accomplish goals and are unsure of the future. Depressed parents often expect their child to do well but never spend the time to develop a bond and partake in the establishment of a stable and structure environment to allow their child to prosper. Lack of support, disengagement, and minimal communication create negativity and an adverse relationship between parents and their children (O'Conner, 2006).

Furthermore, according to O'Conner (2006), depressed parents have been found to be more tolerant, inconsistent and more likely to avoid confrontation, which impairs there parenting responsibilities. They engage in negative habits such as tobacco-use or alcohol-use and have a difficult time maintaining stable friendships or relationships. Furthermore, compared to non-depressed individuals, depressed individuals raise more negative topics in conversation and are more likely to provoke negative emotions in others. Depressed parents spend their days with negative thoughts or emotions which are regularly passed on to their children. These interactions and outlooks during childhood are the foundation for adult life. Children begin to feel and portray the same characteristics as their parents, which increase their likelihood to experience depression as well (Davila, Stroud & Starr, 2010).

Even the best of parents are unable to completely shield their children from events as they happen. There are many factors that may increase the chance of depression including traumatic events during childhood such as the loss of a loved one, exposure to violence, physical/sexual/emotion abuse, divorce, and many more. Children who experience traumatic events such as these tend to show signs and symptoms of depression during their adolescent and young adult age (Goodyer, Herbert & Tamplin, 1997). Children absorb and process events just as adults do, though they may not be able to express their feelings as easy. The healing process after a traumatic event takes time; however, children are often powerless when they experience these events at a young age and begin to re-live them when they reach an older age increasing their vulnerability to develop depression.

With high percentages of marriages ending in divorce in the United States, this has become one of the most common traumatic events children are experiencing. After nearly 30 years of research, there is a consensus in literature regarding the impact of parental divorce on depression in adolescence. From a child's perspective a single event is not what leads to divorce but rather a series of negative events or stressors such persistent family conflict, economic hardship, or family disorganization. These episodes often instill adverse feelings towards on parent and create an unstructured and chaotic environment for the child. Children often feel responsible for the yelling or arguments their parents have about them, which lead to feelings of hopelessness or depression (Aseltine, 1996).

Substance abuse. According to Williams (2011), substance abuse by adolescents remains a major public health problem in the United States. Teenagers and young adults who suffer from depression are at greater probability of self-medicating by initiating substance use including: cigarette smoking, utilization of alcohol, and utilization of illicit drugs such as marijuana. The National Survey on Drug Use and Health, in an annual survey of approximately 45,000 participants aged 12 years or older, revealed that young adults often begin smoking cigarettes or engage in marijuana use within a year of their depression diagnosis and "that too often people turn to cigarettes or other substances to try to deal with their depression." (Substance Abuse and Mental Health Services Administration, 2007). Furthermore, according to Goldstein (2009), substance use is twice as common among adolescents with depression (29.2%) compared with those without depression (14.5%). For adolescents, the simultaneous presence of depression and substance use can create a health-related disadvantage that persists into young adulthood and that last through their lifetime.

Chronic illness. A chronic illness or medical condition is a health problem that lasts for a prolonged period of time, is often incurable, and requires frequent medical interventions. (Compas & Jaser, 2012). These conditions can vary in severity from asthma, to diabetes, to cancer; however, any of these conditions can present children and their families with significant challenges and stressors. About 2 million adolescents (6% of persons aged 10-18 years) in the United States have a chronic health condition that results in limitation of daily activities or disability (Neinstein, 2001). Adolescents or young adults who have a chronic disease more likely than not are depressed and it is not difficult to understand why. The risk of chronic illness and depression increase with the severity of the illness and the level of life disruption it causes. People with chronic illnesses and depression often overlook the symptoms of depression and assume it is normal to feel sad due to the incurable condition.

The symptoms that are caused by these chronic illnesses such as side effects of medication or pain due to surgical intervention create stressors such as limited activities or changes in physical appearance. Coping with these lifestyle changes are difficult for anyone; however, the risk of depression increases during adolescents and young adulthood since it is considered to be the healthiest time of life. Many adolescents and young adults begin feeling anger followed by feelings of depression. They try to comprehend why they have this chronic illness; often times making it difficult to pursue enjoyable activities, undermines self-confidence, and a sense of hope for the future.

METHODOLOGY

This study uses secondary data from the 2005-2006 National Health and Nutrition Examination Survey (NHANES) to analyze the relationship between these two variables. The NHANES program is designed to assess the health and nutritional status of adults and children in the United States with depression as one of the health topics examined annually.

The National Health and Nutrition Examination Survey (NHANES) is a major program of the National Center for Health Statistics (NCHS), under the direction of the Centers for Disease Control and Prevention (CDC), and has the responsibility for producing vital and health statistics for the Nation. The NHANES program began in early 1960s and has been conducted as a series of surveys focusing on different population groups or health topics. In 1999, the survey became a continuous program that has a changing focus on a variety of health and nutrition measurements to meet emerging needs (National Health and Nutrition Examination Survey, n.d.).

The Data

The survey examines a nationally representative sample of about 5,000 persons each year from the ages of 12- 100 years old. The questions are asked by computer-assisted personal interviews and approximately 5% of the interviews are recorded and reviewed for quality control purposes. For the purpose of this study, the target population was adolescents and young adults; therefore, data from the NHANES depression screener survey was extracted only for participants from the ages of 13-21 years old resulting in a sample population of 2,199 participants.

Furthermore, as part of the NHANES annual examination these participants were provided with a Depression Screener and asked to answer a series of symptom questions that are used most often in primary care settings to identify signs of depression. Findings from the depression screener survey outlined below in combination with the demographic and socioeconomic questionnaires will be used to determine the prevalence of depression in adolescent and young adults by gender.

As part of the depression screener, responders were asked to rate each question utilizing the following scoring system: "0"- not at all, "1"- several days, "2"- more than half the days, or "3" - nearly every day. The questions that were asked during the depression screener interview are listed below.

Over the last 2 weeks, how often have you been bothered by the following problems:

1. Little interest or pleasure in doing things?

2. Feeling down, depressed, or hopeless?

3. Trouble falling or staying asleep, or sleeping too much?

4. Feeling tired or having little energy?

5. Poor appetite or overeating?

6. Feeling bad about yourself--or that you are a failure or have let yourself or your family down?

7. Trouble concentrating on things, such as reading the newspaper or watching TV?

8. Moving or speaking so slowly that other people could have noticed? Or the opposite--being so fidgety or restless that you have been moving around a lot more than usual?

9. Thoughts that you would be better off dead or of hurting yourself in some way?

10. How difficult have these problems made it for you to do your work, take care of things at home, or get along with people? (Not at all difficult, Somewhat difficult, Very difficult, Extremely difficult)

Statistical Analysis

SPSS was used to analyze and determine correlation between gender and adolescent and young adult depression using the 2005-2006 NHANES data. The methodology used for this study was through secondary data analysis. Data was derived from multiple surveys; a combination of interview and physical examinations, conducted by NHANES. The measures used to analyze the data include descriptive statistics such as frequencies, percentages, and means.

Dependent and Independent Variables

The dependent variable in this study is depression. Data is based on the ten questions from the Depression Screener Questionnaire in NHANES assessing the signs and symptoms of depression. The independent variable in this study is gender (male/female).

Research Hypothesis

As mentioned above, rates of depression are greater for girls than for boys during adolescence and young adulthood, (Lewinsohn, Rohde & Seeley, 1998). This could be due to increased stressors throughout the stages of puberty, scrutiny and self-doubt due to changing body image, and different coping styles with these changes. Therefore, the researcher hypothesized based on the ten questions about is as follow:

Hypothesis: Gender is a risk factor for adolescent depression with rates of depression greater for girls than boys.

RESULT AND DISCUSSION

The Statistical Package for Social Sciences (SPSS) was utilized for this result. Of the 2,199 adolescent and young adults responders, males comprised of 1,068 participants (48.6%) and females comprised of 1,131 (51.4%) from the age of 13-21. Additionally, of the male and female responders at the time of the survey, 1,375 (62.5%) were enrolled in school, 317 (14.4%) were in between grades, 300 (13.6%) were not enrolled in school, and 207 (9.5%) did not respond to this question. Table 2 below showed the frequency of participant and Table 3 demonstrated current enrollment status among gender enrolled in school.

Depression Scoring in Correlation to Gender

Among the 2,199 participants who responded to the ten questions on the depression screener on whether they had signs/symptoms of depression on several days, more than half the days, or nearly every day within the last 2 weeks of when the survey was conducted; 1,572 questions were answered by both adolescent and young adult male and female participants as having experiences some thoughts of depression. Table 4 below is the mean differences of the responses to all the questions.

Both genders reported having signs and symptoms of depression; however, as a percentage of total females reported feeling depressed more often than males. About 16.52% of males in comparison to 19.60% of females reported that they had several days of depression, 3.29% of males in comparison to 3.46% of females reported that they felt depressed more than half the days, and 2.03% of males compared to 2.14% of females had symptoms of depression nearly every day over the 2 week period that was in question.

The first hypothesis predicts that gender is a risk factor for adolescent depression with rates of depression greater for girls than boys. A Chi-Squared test was run to determine the relationship between the variables. It was determined that there was significant differences among girls and boys. The Pearson's chi-squared value of 515, df of 21, and p=.000 is statistically significant. The analysis supports Hypothesis 1 that depression is greater for girls than boys. Feeling little interest or pleasure in doing things, the Pearson chi-squared value 686, df of 4 and p=.812 is not statistically significant, for question about trouble falling or staying asleep, or sleeping too much, the Pearson chi-squared value of 686, df of 9 and p=.189 is not statistically significant. Only the question about moving or speaking so slowly that other people could have noticed or the opposite - being so fidgety or restless that you have been moving around a lot more than usual proved to be significant. The Pearson chi-squared value of 515, df of 12 and p=.000 is statistically significant. There are no major differences in response to other questions.

There is increasing evidence that female adolescents and adults are more likely than their male peers to become depressed. Previous research identified the fact that by the age of 14 years old, depressive disorders are more than twice as common in girls as in boys (Bhatia & Bhatia, 2007). During the literature reviewed for this study, it was noted that the incidence of depressive disorders noticeably increases as adolescence reach puberty (Studd & Panay, 2004). Physical transformations during adolescents such as hormonal variations or body image changes could contribute to adolescent girls' increased vulnerability to depression. Therefore, gender was explored in this research to examine whether the findings in previous research could be supported by this study. The study found a statically significant relationship between gender and adolescent depression. In this study, both genders reported having signs and symptoms of depression; however, females reported feeling depressed more often than males. These results are comparable to findings in previous research; therefore, further research exploring the relationship between gender and depression is unnecessary. However, research regarding contributing factors that increase female susceptibility of depression would be warrantied.

CONCLUSION AND RECOMMENDATION

Extensive research has shown that depression is a complex condition that has no single cause; however, a combination of genetics, biologic, and environmental risk factors may increase the probability of acquiring the condition. Furthermore, depression is no longer a condition that is limited to adults but one that is acknowledged to be affecting approximately 10 to 15 percent of adolescents and young adults at any given time (Heller, 2012). Although there are common misconceptions about adolescent depression, if depression is unnoticed and untreated, it has been known to increase the risk of suicide. Understanding the signs, symptoms, and common risk factors of depression can assist parents and healthcare providers find the resources to treat the disorder.

The purpose of the current study was to investigate whether gender was a predictor of depression in adolescents and young adults. Gender was found to have a significant relationship with adolescent depression with rates of depression greater for adolescent girls than boys. Understanding the increased rate of depression in adolescents and the higher likelihood for adolescent girls to become depressed makes it a significant health care problem that is worthy of the efforts required to investigate causes, diagnosis, and opportunities for prevention and intervention. For parents and healthcare professionals, it is important to note that, depression is often overlooked, misdiagnosed, or undetected in adolescents. It is suggested that in the field of adolescent depression, further studies are to be conducted to assist primary care clinicians in identifying and initiating management of depressed adolescents while researching contributing factors that increase female adolescent predisposition to having depression.

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SWENDA MOREH

HENRY O'LAWRENCE

California State University, Long Beach, CA
TABLE 2
Participants by Age Group and Gender

Age                   Female
         Male
13 Years Old          144 (12.7%)
         131 (12.3%)
14 Years Old          136 (12.0%)
         126 (11.8%)
15 Years Old          156 (13.8%)
         142 (13.3%)
16 Years Old          142 (12.6%)
         157 (14.7%)
17 Years Old          143 (12.6%)
         134 (12.5%)
18 Years Old          164 (14.5%)
         152 (14.2%)
19 Years Old          132 (11.7%)
         136 (12.7%)
20 Years Old           56  (5.0%)
46 (4.3%)
21 Years Old           58  (5.1%)
44 (4.1%)

TABLE 3
Participants by Current Enrollment Status in School and Gender

School Enrollment Status  Female          Male
In School                      721(63.8%)
        654 (61.2%)
Between Grades              150 (13.2%)     167
(15.6%)
Not in School                  145 (12.8%)
        155 (14.5%)
Missing Response               115 (10.2%)
92 (8.6%)

TABLE 4
Mean Responses for NHANES 2005-2006 Depression Screener

Questions                Mean  Standard Deviation
Feeling down,
depressed, or hopeless    .31   .625
Trouble sleeping
or sleeping too much      .54   .820
Feeling tired or
having little energy      .67   .782
Poor appetite or
overeating                .35   .706
Feeling bad
about yourself            .21   .528
Trouble
concentrating on things   .25   .568
Moving or speaking
slowly or too fast        .14   .471
Thought you would be
better off dead           .05   .308
Difficulty these
problems have caused      .28   .489
Ever been told you
have asthma              1.85   .437
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Author:Moreh, Swenda; O'Lawrence, Henry
Publication:Journal of Health and Human Services Administration
Date:Sep 22, 2016
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