Adolescent Depression

Adolescent depression is a serious public health threat. The World Health Organization (2019), estimates that mental health problems affect 10-20% of the adolescent population worldwide. It is the number one cause of disability and illness. Adolescent depression is linked to suicide, the number 3 cause of adolescent death. There has been an under-diagnosis and treatment of adolescent depression. The identification of this disease will assist in decreasing the morbidity and mortality rate while increasing the quality of life. It is important to understand the epidemiology of this disease to assist in developing strategies to reduce the impact on the adolescent population. As the Advanced Practice Nurse Practitioner (APRN), the focus will be on accurate diagnosis, effective treatments, and careful follow-up.

Background

According to Lu (2019), adolescents are diagnosed with depression if they have had a depressed mood or had a loss of interest in daily activities for two weeks or more. They must also be experiencing four or more symptoms that reflects a change of functioning. Common symptoms can include feeling sad, decreased interest from activities, changes in appetite, changes in weight, changes in sleeping patterns, irritability, unable to concentrate, and feelings of hopelessness. Depression in adolescent may have varying and complex causes. While genetics factors are considered, depression is likely caused from a precipitating factor such as difficult life experiences with family, school, and relationships. Abuse, either physical, mental or sexual, can also be a risk factor. Adolescents who are experiencing depression are at an increased risk for suicide ideation, suicide attempts, and successful suicides (American Academy of Pediatrics, 2019).

The National Institute of Mental Health (2019), estimates the prevalence of depression among adolescents aged 12 to 17 years old to be 3.1 million in the United States. This represents 12.8% of the population. Depression rates were higher among the female adolescent population at 19.4% compared to the male adolescent population at 6.4%. Of the 3.1 million suffering with depression, 60% did not receive any treatment. Nationwide, 11.01% had serious thought of committing suicide. In Florida, it is estimated in 2016, 146,000 which is 10.5% of adolescents had a major depression episode. Of that, 9.38% had serious thought of committing suicide. Florida is in the top 10 of having the lowest prevalence of mental health and substance abuse issues in the country (US Department of Health and Human Services, 2019).

Make sure your essay is 100% unique

Our experts will write for you an essay on any topic, with any deadline and requirements from scratch

127 our experts are available
right now

Get custom essay

Surveillance and Reporting

Surveillance of adolescent depression is critical to understand the impact on the population. This assists in developing policies and programs for public health action. Agencies such as The National Institute of Mental Health and The Substance Abuse and Mental Health Services Administration partnered with The National Center for Health Statistics collect statistical data used to calculate national prevalence for federal surveillance systems (CDC, 2019).

The US Preventive Task Force (2019), recommends that all adolescents be screened for depression. There are also several risk factors noted that assist in identifying adolescent who are at a higher risk for depression. These risk factors include: being female, history of depression, other mental health disorders/illnesses, obesity, race and ethnicity. Psychosocial risk factors include neglect, abuse, traumatic events, conflicts, sexual orientation, and socioeconomic status.

There is not any current mandatory reporting for adolescent depression, however there is mandated reporting for factors that may be the cause of the depression. Chapter 39 of the Florida Statutes mandates that if abuse suspected that is reported to The Department of Children and Families via The Florida Abuse Hotline. Abuse is defined as any act or threatened act that causes the impairment of physical, mental, and emotional health. After a report has been made, the abuse hotline counselor determines if the information given meets legal requirements for investigation (Florida Department of Children and Families, 2019).

If the APRN suspects that depression in a patient is caused from abuse, then it needs to be reported to The Florida Abuse Hotline. If the APRN determines that an adolescent patient with depression has suicidal thoughts, that can initiate a Baker Act. The Baker Act is when an individual is taken into custody in Florida under the mental health law for an involuntary psychiatric exam. However, a person under the age of 17 can only be held for 12 hours after arriving at the facility. If inpatient services are deemed necessary a petition can be filed (Citizens Commission on Human Rights, 2019).

Analysis

Adolescent depression can be seen worldwide. It is important to address this early on because adolescence is a sensitive developmental period. This is the time where a person’s identity is formed, and the foundation is laid for later mental health. During this transition period, adolescents are faced with many of life stressors. Some may not be able to cope with such stressors. In a study conducted by Bademli, Canbaz, & Lok (2017), it was found that during the adolescent period, there was a higher incidence of mental health problems. Female adolescents are at a higher risk of depression due to self-esteem, body image, self-consciousness, and stressful events.

Adolescents whose mother worked full times jobs, had a higher risk of depression because of the lack of time spent with the adolescent. Low education levels of parents put adolescents at risk. Parents who are divorced or separated also impacted the adolescent. Living in inner cities as a minority is a high-risk factor. It is suggested that there is lack of evidence stating there is a genetic link; however, 20 % to 50 % of diagnosed adolescents have a family history of depression or other mental illness. While all adolescents need to be screened, it is important to address risk factors for depression.

When treating depression there is an increased financial cost due to general medical services, specialty services, mental health services, and pharmacy use. These cost not only go towards treating the depression, but also the comorbidities that may come with the depression. In a collaborative care model to treat depression in adolescents who had health insurance, there was an $883 increase above the usual care per year (Haaland et al., 2016). Adolescents face social cost as well. They may feel as though they are different or be ashamed, they have been diagnosed with a mental illness. Individuals who suffer from mental illness face self and public stigmas. They may be stereotyped by their illness. Individuals can feel as though they are being ostracized by their environment, such as teachers and peers (Kaushik, Kostaki, & Kyriakopulos, 2016).

Diagnosis of Adolescent Depression

The Institute for Clinical Systems Improvement (2018), state that clinicians should use the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) to diagnose depression. Depression involves changes in cognition, affect and neuro-vegetative functions for at least 2 weeks in duration. There may be different levels of impairment and intensity. Five or more of the symptoms along with depressed mood need to be present. The symptoms include: daily depressed mood, diminished interest, weight changes, sleep pattern changes, restlessness, daily fatigue, feeling worthless, unable to concentrate, and recurrent thoughts of death.

The US Preventive Services Task Force (2019), as previously stated, recommends that all adolescents be screened for depression. It is also recommended that adequate system is in place to ensure an accurate diagnosis, appropriate treatments, and follow-up. The Patient Health Questionnaire-9 (PHQ) is recommended by The National Institute for Health and Clinical Excellence to assess the severity of depressive symptoms. It is composed of 9 questions that correspond with the 9 criteria of the DSM 5 diagnosis of depression disorder. The PHQ has a high predictive value as a screening instrument. It is reported to have a sensitivity of 73% and specificity of 94%. This screening tool is easy to understand, brief, simple to score, and free to use (Doi, et al., 2018).

APRN

As a part of Healthy People 2020, the goal is to improve the mental health of adolescents through prevention and screening. This is done by through ensuring appropriate access to mental health services (Office of Disease Prevention and Health Promotion, 2019). The APRN is in a prime position to be able to identify and treat adolescent depression. This is a major point of contact, where the APRN can screen all adolescents using the PHQ-9 questionnaire. Screening for adolescent depression is the first step in the identification and diagnosis. If living in a rural area, where there is a lack of psychiatric specialist, the APRN needs to be able to feel comfortable in diagnosing and starting treatment for adolescent depression.

After initial screening, and following a diagnosis of adolescent depression, there needs to be initiation of appropriate treatment and a referral for follow-up care. Treatment options include psychotherapy or medication. If severe, the adolescent may need a combination. If it is concluded that the depression is caused from abuse, the APRN needs to contact the abuse hotline and report it. If the APRN determines that the adolescent is suicidal, they need to be placed under a Baker Act.

After treatment is initiated, there needs to be follow-up and reassessments to evaluate the adolescent’s response to treatment. It needs to be determined if the plan of care is being followed. Are the symptoms improving or worsening? If symptoms are worsening, the treatment needs to adjust. Does the adolescent need addition referrals for cognitive behavior therapy or inpatient treatment?

Conclusion

Adolescent depression is a significant public health concern affecting approximately 3.1 million in the United States. Depression interferes with all daily functions. It impairs the adolescent socially and academically. The diagnosis of depression in adolescence can increase the chance of developing major depression later in life. As the APRN, it is important to be able to recognize and treat depression in adolescence. The best strategy to being is to screen all adolescents, regardless if the risk factors associated with the illness are present or not.

Risk factors can include coming from a broken home, sexual orientation, socioeconomic status, obesity, and having a past history of depression. There is a higher risk of having depression for the female adolescent population. It is important to begin interventions as soon as possible. This can be in the form or education, therapy, medication, and referrals. It is important to educate the adolescent and the parent about depression to knock down any potential barriers such as stigmas associated with it.

References

1. American Academy of Pediatrics. (2019). History, observation, and surveillance. Retrieved from: https://www.aap.org
2. Bademli, K., Canbaz, M., Lok, N. (2017). Factors affecting adolescent mental health. Journal of Depression and Anxiety, 6(4), 1-3. doi:10.4172/2167-1044.1000283
3. Centers for Disease Control and Prevention (CDC). (2019). Mental health surveillance among children. Retrieved from: https://www.cdc.gov
4. Citizens Commission on Human Rights. (2019). Questions and answers: Baker act rights. Retrieved from: https://www.cchrflorida.org
5. Doi, S., Horikoshi, M., Murasmatsu, K., Takebayashi, M. (2018). Factorial validity and invariance of the patient health questionnaire among clinical and non-clinical populations. PLOS ONE, 13(7), 1-9. doi:10.1371/journal.pone.0199235
6. Florida Department of Children and Families. (2019). Florida abuse hotline. Retrieved from: https://www.dcf.state.fl.us
7. Haaland, W., Lindenbaum, J., Ludman, E., McCauley, E., Richardson, L., Wright, D. (2016). The costs and cost-effectiveness of collaborative care for adolescents with depression in primary care settings. JAMA Pediatrics, 170(11), 1048-1054. doi:10.1001/jamapediatrics.2016.1721
8. Institute for Clinical Systems Improvement. (2018). Diagnose and characterize major depression/ persistant depressive disorder with clinical interview. Retrieved from: https://www.icsi.org
9. Kaushik, A., Kostaki, E., Kyriakopulos, M. (2016). The stigma of mental illness in children and adolescents: A systematic review. Psychiatry Research, 243(30), 469-494. doi:10.1016/j.psychres.2016.04.042
10. Lu, W. (2019). Adolescent depression: National trends, risk factors, and healthcare disparities. American Journal of Health Behavior,43(1), 181-194. doi: 10.5993/AJHB.43.1.15
11. National Institute of Mental Health. (2019). Major depression. Retrieved from: https://www.nimhh.gov
12. Office of Disease Prevention and Health Promotion. (2019). Healthy people 2020. Retrieved from: https://www.healthypeople.gov
13. US Department of Health and Human Services. (2019). 2016 nsduh state prevalence estimates. Retrieved from: https://www.samhsa.gov
14. US Preventive Services Task Force. (2019). Depression in children and adolescents: Screening. Retrieved from: https://www.uspreventiveservicestaskforce.org