How to diagnose and deal with depression in adolescents

Depression, anxiety and behavioral disturbances are among the main causes of pain and disabilities among adolescents. Throughout the world, one in seven young people between the ages of 10 and 19 face some mental disorder, according to the World Health Organization (WHO).

The period of rapid growth and development makes childhood and adolescence become critical phases for mental health. The cognitive, social and emotional skills acquired in this phase of life can shape the mental health of two individuals in the adult phase.

In the absence of attention and care with mental conditions of age, it can lead to future prejudices, including limitations to a full life. According to the WHO, the quality of the environment where children and adolescents grow determines their well-being and development. Also, early negative experiences at home, in the school environment or digital spaces, such as exposure to violence, bullying and poverty, increase the risk of mental disorders.

Impacts of depression for adolescents

Emotional disturbances, such as depression and anxiety, are common among adolescents. Anxiety disorders are more prevalent in this age group and are more common among older adolescents. It is estimated that 3.6% two young people from 10 to 14 years old and 4.6% two from 15 to 19 years old are suffering from an anxiety disorder.

Já depression affects about 1.1% two adolescents between 10 and 14 years old and 2.8% those between 15 and 19 years old. Depression and anxiety share some of the same symptoms, including rapid and unexpected changes in mood, which can be confused with common behaviors of this phase of life.

Not so, differently from typical reactions to life, anxieties and depressive disorders can profoundly affect school activities, relationships and family life.

Doctors consistently report a lack of confidence in their ability to care for adolescents with depression. In this context, researchers from Canada will carry out a review study on the diagnosis and care of depression at age groups.

According to the research, the prevalence of depression among adolescents increases with age. Before the Covid-19 pandemic, the prevalence of major depressive disorder among adolescents was about 13% to 15%.

A recent analysis found that about 1 in 4 young people presented clinically significant depressive symptoms during the pandemic, with higher rates associated with advanced age and the female sex.

The onset of depression before adulthood is associated with a higher severity of childhood in adulthood, with an increase in the number of depressive episodes, hospital admissions, and risk of self-harm and suicide, worse physical health outcomes (including obesity, diabetes, and cardiovascular disease). ), in social and occupational relations.

Multifactorial factors of depression

Due to two depressive and multifactorial disorders, including genetic, environmental factors and the own organism of each person.

First-grade relatives of individuals with major depressive disorder have a 2 to 4 times higher risk of development for children than for the general population, according to the Brazilian Pediatric Society (SBP).

In the environmental context, adverse childhood experiences are considered as a potential risk factor. Negative emotional experiences also increase the likelihood of depressive episodes.

Stigma and bullying experiences have been associated with increased rates of depression among LGBTQIA+ adolescents. Given two United States we suggest that the intersectionality between race and gender exacerbates depression.

How is depression diagnosed in children and adolescents?

The Brazilian Pediatric Society (SBP) recommends that pediatricians investigate questions related to the behavioral and emotional picture of children and adolescents. The consultations should include conversations about mood and feelings, in addition to the observation of possible inappropriate routines or indicative of toxic stress.

The diagnosis of depression must be carried out by specialized professionals. In general, they are considered criteria present in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (called DSM-5).

In this context, doctors should consider five or more symptoms (go down), present for at least two weeks and representing changes in the life of the adolescent. Among the manifestations is depressed mood and loss of interest or pleasure. The depressed mood can be defined by intense and permanent sadness, most or all days, with a feeling of emptiness and lack of hope.

The following symptoms are also considered for the diagnosis of depression in adolescents, when they are intense or manifest every day:

• Lose or gain weight markedly unrelated to diets;
• insônia or excessive drowsiness;
• motor agitation or slowness;
• fatigue and loss of energy;
• feeling of uselessness or excessive or inappropriate guilt;
• decreased ability to think or concentrate, other than indecisiveness;
• recurring thoughts of death; suicidal ideation (thinking or planning one’s own death).

Although I am not Canadian, the researchers highlight that, in comparison with adults with depression, children and adolescents may be more likely to present irritability and unstable mood, rather than depressed, in addition to sociability difficulties. Compared with newer children, adolescents are less likely to present anxiety, physical symptoms, psychomotor agitation, and hallucinations.

The specialists defend that the risk assessment is a critical component of the diagnosis of depression. and included a review of suicidal intent and plane, in addition to criteria such as recent hopelessness, perceived overload and impulsivity, previous suicide attempts and self-mutilation and stress factors.

study

The Canadian study conducted a review based on the most recent evidence and clinical practice guidelines from Canada, the United States, the United Kingdom, Australia, and New Zealand. Among the main topics are points on diagnosis, triage and care.

Diagnosis: Irritability and sad or depressed mood, fatigue, sound disturbances, decreased pleasure in activities and difficulty concentrating may indicate the diagnosis of depression in adolescents.

Triage: However, more research is needed on universal triage for adolescent depression in primary care, it may be appropriate in some cases. Physicians must use a validated triage tool and recognize that triage is not a substitute for diagnostic evaluation.

Careful: A multifaceted approach is necessary, which may include psychotherapy and medication, as well as an approach to two stress factors.

“Depression is an increasingly common condition, more treatable among adolescents. Primary care physicians and pediatricians are well positioned to support the evaluation and treatment of the first line of depression in this group, helping patients to recover their health and function”, write the authors.

They state that future research is needed to address unanswered questions, including the effects of the Covid-19 pandemic on depression, whether universal triage is best for results, and how to best customize depression treatment to optimize effectiveness.

Sources: Depression in childhood and adolescence, scientific document of the Brazilian Pediatric Society (SBP); Diagnosis and management of depression in adolescents, from the Canadian Medical Association Journal.