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Major Depressive Disorder in Young Adults

Kaitlyn Rutigliano
Nursing 616 C: Living with Mental Illness
University of New Hampshire
December 4, 2013

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Major Depressive Disorder (MDD) is one of the leading psychological illnesses among teens
and young adults. Over the past ten years, MDD has significantly increased in individuals ages
19-24. Although this is a common mental health disorder, researchers are beginning to take a
closer look as to why this MDD has become such a phenomenon in the younger population.
Many studies have been conducted to identify potential causes of rising MDD rates in young
adults. Researchers are investigating many factors that may be contributing to this increase such
as environmental toxins, extreme life stressors and neurological imbalances (Zarate, 2010). In
addition, researchers are also looking into the onset of depressive symptoms and the etiology of
this disorder. This paper will discuss the major concerns with MDD and how young adults are
the most at risk.
Identifying Decision
Mental health is a critical area of health care that is often neglected in hospitals and out-
patient facilities. Due to economical hardships, budget cuts are implemented in these care
settings; unfortunately, mental health units are often the first to be terminated. Without
professional help, many individuals with mental illnesses suffer tremendously, especially young
adults. Young adults, ages 19-24, are highly vulnerable to mental disorders due to the maturation
of the brain. The neurological transition between adolescence to adulthood puts both physical
and mental stress on the body. Brain development is occurring rapidly during this stage of life
and researchers are noticing neurotransmitter imbalances as one of the major playmakers in
major depressive disorder in young adults. In addition to neurological imbalances, researchers
are also paying close attention to environmental and lifestyle stressors in relation to MDD.
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This topic tends to be over looked; meanwhile it is one of the leading mental disorders in
young individuals. Major Depressive Disorder is a debilitating mental illness that can lead to
death, most commonly through suicide, if left untreated for an extensive period of time (Chueng,
2007). Health care professionals need to be aware of the importance of early diagnosis and
proper treatment. This disorder can manifest as early as childhood and health care professionals
should be held accountable for recognizing major objective and subjective symptoms patients
may be experiencing.
Assessing the Research
The resources gathered for this research paper were found through the University of New
Hampshires interlibrary databases. Databases used included CINAHL and PsycINFO and
provided the student with the most helpful articles to support the topic of young adults and major
depressive disorder. During the initial stages of research, the student was mainly focused on the
broad topic of MDD rather than a specific population. This propelled the student to look into
areas where MDD was most problematic: young adults. Using Boolean search terms such as
and and or, allowed the student to find the most scholarly articles related to the topic of
interest. Key words used included young adult(s) and depression, college student(s) and
depression, mental health and young adult(s). In addition to using Boolean search terms and
categorical keywords, the student narrowed the search further to articles that were less than 10
years old and provided full-text studies. These limitations enhanced the students ability to find
more evidence-based resources.
Logical Argument
As discussed earlier in this paper, major depressive disorder (MDD) is one of the most
common mental health illnesses seen in young adults. However, the issue that revolves around
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this population is that health care professionals are failing to recognize and treat the signs and
symptoms of MDD. The first article entitled, Mental Health Service Use Among Adolescents and
Young Adults with Major Depressive Disorder and Suicidality was a quantitative study that addresses
the need for mental health services and how physicians are not considering the signs and
symptoms of MDD in their young adult patients. In this study, researchers found that 42% of
young adults (out of 619 participants with depression, between the ages of 15 24) did not use
any mental health services. In addition out of the participants, aged 19-24 with suicidal ideations,
48% could not access mental services (Chueng,2007). Depending on health care plans, many
individuals require referrals from primary care physicians to seek out-patient treatment, mainly
psychiatric care. However, if physicians are not taking the necessary action to help their patients
and recognizing major depressive symptoms, than conditions persistently become worse.
Another component related to MDD is the biochemical neurotransmitter receptor function in
the hypothalamus. Psychological Stress and Vulnerability for Major Depressive Disorder:
Cortisol, Brain Structure, Function, and Cognitive Processing in Young Adults is a quantitative
study that discusses how the stress can lead to hypothalamic changes within the cerebral cortex
leading to MDD. The hypothalamic-pituitary-adrenal (HPA) axis is a major site in the brain that
controls and regulates stress. When stress levels exceed the capabilities of the body to naturally
regulate, neurological imbalances result. Researchers conducted a study on healthy young adults
who did not have significant indicators of MDD (Dedovic, 2013). The participants of the study
were exposed to stressful situations and brain activity was monitored. The researchers discovered
that young adults were more susceptible to depressive-like symptoms when presented with
extreme cases of stress compared to other age groups. The HPA function decreased in these
participants which allowed for the researchers to conclude that stress directly relates to MDD.
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An article entitled Predictors of First Lifetime Onset of Major Depressive Disorder in Young
Adulthood was a mixed-method study that addressed how MDD is most frequently detected in
young adulthood. The study goes on to explain that many individuals who exhibit depressive
tendencies experience their first onset in their 20s. Researchers discovered that young adults
were most at risk for developing MDD due to genetics, past abuse history that resurfaced and
psychosocial variable (Klein, 2013). Findings were conducted through self-evaluation surveys
which addressed indicative measures of potential MDD.
Prefrontal White Matter Abnormalities in Young Adult with Major Depressive Disorder: A
Diffusion Tensor Imaging Study was a quantitative study that discussed how neurological
malformations directly correlated with MDD seen in young adults. Researchers compared the
measurements of prefrontal matter of healthy young adults against individuals with MDD. The
study concluded that those participants with MDD had significantly lower fractional anisotropy
(FA) values in prefrontal white matter (Li, 2007). With a decreased FA, the brain does not work
at an optimal level and produces neurological imbalances such as MDD, which was seen in these
participants. This study provided a scientific approach to how MDD can be dependent on the
functionality of major sectors of the brain.
The fifth article reviewed was entitled Does Emotion Predict the Course of Major
Depressive Disorder? was a qualitative study that addressed the etiological components of
MDD. Researchers wanted to gain a better understanding of whether or not emotions played a
significant role in the manifestation of MDD. The results showed that a persons mindset and
attitude toward life was a profound indicator of MDD severity. Participants who showed a
positive regard toward oneself was less likely to experience severe cases of depression.
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However, those who had a negative attitude towards self were more likely to exhibit worse cases
of depression. The researchers concluded that many of the participants who experienced more
severe cases of depression exhibited behaviors such as neuroticism and social isolation (Morris,
2009). This study focused more on participants outlook and behavior rather than the
neurological aspect of MDD.
The sixth article that was used, Prevention of Recurrence of Major Depression Among
Emerging Adults by a Group Cognitive-Behavioral/Interpersonal Intervention, discussed the
increasing prevalence of depression relapse and the importance of relapse prevention. This
qualitative study directed research towards the young adult population. Studies have shown that
individuals who experience depression in adolescence were 50% more likely to experience
recurrence of with first two years of adulthood. Researchers conducted this study on college
students who had a history of adolescent depression. In order to find the most effective method
of prevention, the researchers tested the use of cognitive-behavioral and interpersonal therapy
over a two year span. The result showed that students who received these therapeutic modalities
cut their risk for depression relapse in half compared to those who did not receive the treatment
(Sheets, 2013). The study helped support the effectiveness of cognitive therapy and the treatment
of MDD.
The Course of Depressive Symptoms in Men From Early Adolescence to Young Adulthood:
Identifying Latent Trajectories and Early Predictors was the seventh article reviewed for this
research paper. The study looked at the MDD trajectory and how it changed from adolescence to
adulthood. Males from ages 15-24 were interviewed and researchers found that the psychiatric
trajectory of MDD was based on specific effects of childhood, parental, provisional, and
individual risk factor (Stoolmiller, 2005). This study demonstrated that the male pattern of MDD
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was not dependent on one sole purpose, but rather a collection of factors. In addition, symptoms
that presented in adolescent appeared to stay consistent as the individual entered young
Psychiatric Disorders in Young Adults: Depression Assessment and Treatment was the final
article that was reviewed. This study discussed the rise in MDD prevalence in young adults and
the causes of this significant increase. Researchers found that young adults who participated in
their study were more likely to experience high rates of relapse, vestigial symptoms, cognitive
and functional declination, psychosocial disability, and an overall decrease in personal well-
being (Zarate, 2010). The study was directed towards understanding the pathophysiology of
MDD and ways to decrease the need for lifelong medication. The study concluded that factors
such as brain chemistry, social factors and genetics were major triggers for MDD onset and
Critical Approach
All of the studies used in this research paper were peer-reviewed and evidence-based cases.
However, each article has different strengths and weaknesses. The first article used, Mental
Health Service Use Among Adolescents and Young Adults with Major Depressive Disorder and
Suicidality, was a concise and systematic study that provided statistical evidence of the consequences of
not seeking psychiatric treatment. One of the limitations to this article was that it did not demonstrate
specific mental health treatment that would be most beneficial for patients with MDD. The second article,
Psychological Stress and Vulnerability for Major Depressive Disorder: Cortisol, Brain
Structure, Function, and Cognitive Processing in Young Adults was informative and brought
forth a different approach to MDD. The main limitation to this study was that it was difficult to
interpret due to the science-heavy vocabulary. An advanced reading level would be necessary to
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fully comprehend the literature used. The third article used, Predictors of First Lifetime Onset of
Major Depressive Disorder in Young Adulthood was a very interesting article that demonstrated
how adult onset was not the only indicators of MDD. The researchers showed that MDD patients
exhibit various depressive-symptoms that physicians and family members often overlook. The
research was methodical and easy to understand. The fourth study, Prefrontal White Matter
Abnormalities in Young Adult with Major Depressive Disorder: A Diffusion Tensor Imaging
Study was a profound study that greatly supported the neurological imbalances associated with
MDD. The main limitation for this article was that it was taken from a small sample; therefore
not accounting for the general population.
The fifth study, Does Emotion Predict the Course of Major Depressive Disorder? had many
limitations such as the findings not taking into account the course of MDD, lack of measurement
of MDD trajectory and only using published articles that supported researchers theory causing
bias. The sixth article, Prevention of Recurrence of Major Depression Among Emerging Adults
by a Group Cognitive-Behavioral/Interpersonal Intervention provided a thorough analysis of
how MDD can resurface in individuals who had previous episodes. The most significant
limitation was that all the participants were aware of their psychiatric history and were self-
selected samples. The seventh article, The Course of Depressive Symptoms in Men From Early
Adolescence to Young Adulthood: Identifying Latent Trajectories and Early Predictors was one
of the weaker articles because it was solely focused on males and did not take into consideration
the severity of symptoms and how long the participant had been suffering from MDD. Looking
back, the student may have rejected this article due to its strict population. The eighth article
used, Psychiatric Disorders in Young Adults: Depression Assessment and Treatment was the
most beneficial article that provided imperative information regarding MDD. The only limitation
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was that range of assessment and treatment mechanisms were focused on traditional methods of
Implication for Nursing Practice
After reviewing all eight articles, major depressive disorder in young adults is a complicated
psychiatric illness. Each article identified and discussed the many factors that determine the
etiology and trajectory of MDD. Young adults are most vulnerable due to the neurological
transition from adolescence to adulthood due to the stress that the body is under chemically.
There is a major deficient in health care knowledge of adult onset of MDD as one can tell from
the articles above. Nurses and physicians need to be more aware of this mental disorder and
advocate for their patients. Educational courses and seminars should be implemented in health
care settings; this is issue is not being taken serious and more individuals are suffering each year
due to the lack of help and understanding.
Health care professionals, especially nurses, should know the most common signs and
symptoms of depression as well as the not so common ones such as waking up earlier than
normal or body rashes similar to eczema. In addition, treatment options need to be re-evaluated
for effectiveness in clinical practice. For example researchers have found Wellbutrin, a
commonly used anti-depressant medication, to actually be a very poor remedy for MDD patients.
The health care system is grossly infatuated with medicinal methods of treatment; however,
alternative methods need to be considered. Holistic healing such as restorative yoga, light
therapy, acupuncture, consuming foods high in Vitamin D, Folate and Omega 3 fatty acids, and
herbal supplements such as St. Johns Wort have all been proven methods of treating MDD.
Although these methods are available, patients rarely know about alternative mechanisms.
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Nurses must promote both alternative and traditional treatment option; ultimately, it is the
patients choice of which avenue they wish to take.

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Cheung, A. H., & Dewa, C. S. (2007). Mental health service use among adolescents and young
adults with major depressive disorder and suicidality. The Canadian Journal Of
Psychiatry / La Revue Canadienne De Psychiatrie, 52(4), 228-232.
Dedovic, K. (2012). Psychological stress and vulnerability for major depressive disorder:
Cortisol, brain structure, function, and cognitive processing in young adults. Dissertation
Abstracts International, 72,
Klein, D. N., Glenn, C. R., Kosty, D. B., Seeley, J. R., Rohde, P., & Lewinsohn, P. M. (2013).
Predictors of first lifetime onset of major depressive disorder in young adulthood. Journal
Of Abnormal Psychology, 122(1), 1-6. doi:10.1037/a0029567
Li, L., Ma, N., Li, Z., Tan, L., Liu, J., Gong, G., & ... Xu, L. (2007). Prefrontal white matter
abnormalities in young adult with major depressive disorder: A diffusion tensor imaging
study. Brain Research, 1168124-128. doi:10.1016/j.brainres.2007.06.094
Morris, B. H., Bylsma, L. M., & Rottenberg, J. (2009). Does emotion predict the course of major
depressive disorder? A review of prospective studies. British Journal Of Clinical
Psychology, 48(3), 255-273. doi:10.1348/014466508X396549
Sheets, E. S., Craighead, L., Brosse, A. L., Hauser, M., Madsen, J. W., & Craighead, W. (2013).
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Prevention of recurrence of major depression among emerging adults by a group
cognitive-behavioral/interpersonal intervention. Journal Of Affective Disorders,147(1-3),
425-430. doi:10.1016/j.jad.2012.08.036
Stoolmiller, M., Kim, H. K., & Capaldi, D. M. (2005). The Course of Depressive Symptoms in
Men From Early Adolescence to Young Adulthood: Identifying Latent Trajectories and
Early Predictors. Journal Of Abnormal Psychology, 114(3), 331-345. doi:10.1037/0021-
Zarate, C. r. (2010). Psychiatric disorders in young adults: Depression assessment and treatment.
In J. E. Grant, M. N. Potenza (Eds.) , Young adult mental health (pp. 206-230). New
York, NY US: Oxford University Press.