Readings Wenar, C. & Kerig, P. (2000)“ Disorders in the depressive spectrum and child and adolescent suicide in Developmental Psychopathology (pp ). Singapore: McGraw-Hill Wenar, C. & Kerig, P. (2000)“ Disorders in the depressive spectrum and child and adolescent suicide in Developmental Psychopathology (pp ). Singapore: McGraw-Hill

Lecture Questions Where is the line between ‘normal’ adolescent depression and ‘abnormal’? Where is the line between ‘normal’ adolescent depression and ‘abnormal’? Why is adolescence a time of vulnerability to depression? Why is adolescence a time of vulnerability to depression? What does depression look like in adolescence? What does depression look like in adolescence? What are the risk and protective factors for adolescent depression and youth suicide? What are the risk and protective factors for adolescent depression and youth suicide?

What’s ‘normal’? Worrying Worrying ‘Moodiness’ ‘Moodiness’ ‘Puberty blues’ ‘Puberty blues’ Underdiagnosis related to ‘normal’ aspects of adolescence Underdiagnosis related to ‘normal’ aspects of adolescence

Adolescent vulnerability Cognitive factors Egocentricity Egocentricity Black and white thinking Black and white thinking Emotional reasoning Emotional reasoning Personal fable- uniqueness Personal fable- uniqueness Increased capacity for self awareness Increased capacity for self awareness

Adolescent vulnerability Adolescent ‘turmoil’ Adolescent ‘turmoil’ Changing bodies, changing parental relationships Changing bodies, changing parental relationships Sexual identities Sexual identities Relationships Relationships Academic pressures Academic pressures Peer pressures Peer pressures Balancing work and school Balancing work and school

How common is it? One of the three most common mental health problems in young people One of the three most common mental health problems in young people First onset of a major depression often occurs in mid-late adolescence (15 mean age) First onset of a major depression often occurs in mid-late adolescence (15 mean age) Rise in depression ages 13-15, peak ages , decline to adult levels Rise in depression ages 13-15, peak ages , decline to adult levels Depression is a significant problem for young people in custody or living on the streets Depression is a significant problem for young people in custody or living on the streets Episode in adolescence risk factor for episode in adulthood (Patton) Episode in adolescence risk factor for episode in adulthood (Patton)

NZ prevalence Fergusson & Horwood Fergusson & Horwood year old young women 30.2% rate year old young women 30.2% rate 18 plus 10.8% 18 plus 10.8% year old young men 13.7% year old young men 13.7% 18 plus 3.4% 18 plus 3.4%

Gender patterns Onset of menarche significant for girls (around age 12) Onset of menarche significant for girls (around age 12) Equal prevalence boys and girls til 15 then greater prevalence amongst girls (around twice as likely) Equal prevalence boys and girls til 15 then greater prevalence amongst girls (around twice as likely) Girls’ depression predictor of subsequent episodes Girls’ depression predictor of subsequent episodes Speculative differences in way depression differently expressed by girls and boys Speculative differences in way depression differently expressed by girls and boys Role of constructions of gender, pressures to conform with approach to adulthood Role of constructions of gender, pressures to conform with approach to adulthood

Adolescent presentation Depressed mood Fatigue Depressed mood Fatigue Decreased concentration Insomnia Decreased concentration Insomnia Social withdrawal Guilt Social withdrawal Guilt Negative self-image Anorexia Negative self-image Anorexia Anger/irritability Hopelessness Anger/irritability Hopelessness Suicidality Depression feels like falling out of a plane without a parachute There aren’t any words to express the confusion of feelings I was often impatient with my friends. They didn’t want to be around me any more

DSM Criteria Persistent depressed mood Persistent depressed mood Loss of pleasure or interest in activities Loss of pleasure or interest in activities Weight loss or gain Weight loss or gain Insomnia Insomnia Restlessness Restlessness Fatigue Fatigue Feelings of worthlessness Feelings of worthlessness Impairment in concentration, making decisions Impairment in concentration, making decisions Recurrent thoughts of death Recurrent thoughts of death 5 plus, two weeks at least 1 symptom (1) or (2) 5 plus, two weeks at least 1 symptom (1) or (2)

Comorbidity Substance abuse- Patton’s research on cannabis use Substance abuse- Patton’s research on cannabis use Anxiety disorders (60-70% in children) Anxiety disorders (60-70% in children) Conduct disorder (boys) Conduct disorder (boys) Age patterns- preschoolers separation anxiety, school age children conduct disorder and adolescents eating disorders or substance abuse Age patterns- preschoolers separation anxiety, school age children conduct disorder and adolescents eating disorders or substance abuse

Precipitating factors Relationship losses: Girl/boyfriend Girl/boyfriend Family member Family member Close friend Close friend Failure to achieve a goal Sports/leisure Sports/leisure Academic Academic

Risk factors- young person Biological changes Biological changes Physical illness Physical illness Poor nutrition Poor nutrition Alcohol or drug abuse Alcohol or drug abuse Negative self evaluation beliefs Negative self evaluation beliefs External locus of control External locus of control

Risk factors- family Family history of depression Family history of depression Early loss experiences Early loss experiences Exposure to non-optimal parenting experiences, especially focus on child’s failures or neglectful parenting Exposure to non-optimal parenting experiences, especially focus on child’s failures or neglectful parenting Lack of connectedness with family (Resnick et al.) Lack of connectedness with family (Resnick et al.)

Risk factors-social Stresses from e.g., sexuality issues, academic pressures, peer pressure, friendship/relationship problems, identitiy issues Stresses from e.g., sexuality issues, academic pressures, peer pressure, friendship/relationship problems, identitiy issues Lack of connectedness with school (Resnick et al.) Lack of connectedness with school (Resnick et al.)

Protective Factors Resnick et al. “Protecting adolescents from harm” Resnick et al. “Protecting adolescents from harm” Connectedness with family, other adults, or school Connectedness with family, other adults, or school Religiosity Religiosity Feeling safe at school Feeling safe at school Coping skills Coping skills Feelings of self-esteem and belonging Feelings of self-esteem and belonging Secure cultural identity Secure cultural identity

Help-seeking Most young people don’t seek help: Use informal versus formal help Use informal versus formal help Bullet proof-think they can handle it Bullet proof-think they can handle it Don’t know what’s available Don’t know what’s available Negative about what is available Negative about what is available Effects of depression itself Effects of depression itself Psychosocial- levels of stress, confidence and social support Psychosocial- levels of stress, confidence and social support

Youth Suicide 1995 NZ worst rate of 13 OECD countries 1995 NZ worst rate of 13 OECD countries deaths deaths deaths deaths deaths deaths Females attempt at twice the rate Females attempt at twice the rate Males higher ‘success’ Males higher ‘success’ Maori males highest rate (numbers of suicides divided by population that age) Maori males highest rate (numbers of suicides divided by population that age)

Key risk factors High emotional distress High emotional distress Previous attempts Previous attempts Family/friend suicide attempt Family/friend suicide attempt Involvement in violence perpetration Involvement in violence perpetration Victim of violence Victim of violence Substance abuse Substance abuse Easy access to suicide ‘tools’ Easy access to suicide ‘tools’

Protective factors As for depression As for depression Resnick et al study: No protective factors: 1 in 5 boys and 1 in 3 girls attempt No protective factors: 1 in 5 boys and 1 in 3 girls attempt 3 protective and 3 risk factors: probability 4% boys, 8% girls 3 protective and 3 risk factors: probability 4% boys, 8% girls No risk factors, probability < 1% No risk factors, probability < 1% Prevention + decrease risks and increae protective Prevention + decrease risks and increae protective