Alarming increase of rates of teenage depression – causes, effects, and mitigating strategies

Approximately 3.2 million or 13% of teenagers in the US reported experiencing at least

one major depressive episode according to the 2017 National Survey on Drug Use and Health,

which more than a 50% rise from 2007 when 2 million or 8% of teenagers reported similar

experiences (Geiger & Davis, 2019, para 2). This is indeed a very alarming statistic, and the

medical community is waking up to mental health crisis among teenagers - one that they had

neglected for so long among this age group. As Dr. Gurinder Dabhia, MD, a pediatrician at

Scripps Clinic Rancho Bernardo says, “Whether there are more teens experiencing depression

and anxiety, or we’re just becoming more aware of them, the fact is that depression and anxiety

afflict our teenagers more often than we thought”. This paper aims to highlight important

statistics about teen depression, and show that mental health issues amongst teens is on the rise

in the US. It aims to explore the root causes of such increase in depression by correlating it to

changes in societal factors in recent times, such as the advent of the age of social media and its

effect on teens, and also discuss symptoms of depression amongst teens. Finally, the paper

highlights particularly vulnerable sub-groups among teens, and discuss broad strategies and

outlook changes that mental health professional aim to introduce to combat teen depression. The

main objective of the paper is to highlight that teens are vulnerable to depression which is being

exacerbated by modern social environment, teenage depression has the potential to cause the

maximum amount of damage compared to depression in other age group. It is especially difficult

to diagnose depression amongst teens as the symptoms may be viewed as normal teenage

behavior, which is why it is especially important for parents and pediatricians to closely monitor

teens and screen for depression periodically.

Causes of depression amongst teens

The modern day environment and socio-economic circumstances are insidious but direct

causes of depression amongst teens and adolescents. Also, the recent focus of psychiatrists and

counsellors on the teenage depressed have increased the diagnosis of depression amongst teens,

whereas previously in till the 1980s, mental health professionals were hesitant to certify a

teenager with a developing mind as depressed (Lohmann, 2019, para 7). It is now being

recognized by pediatricians that the prevalence of depression amongst teenagers have previously

been underestimated by the medical community, in other words, depression affects teenagers a

lot more than previously estimated. With over 90% of teens possessing smartphones and out of

that almost 45% being online almost all day times of the day and well into the night, social

media use among teenagers have shot up rapidly, which has been identified as a leading cause of

inducing depression amongst teens due to over stimulus of the brain which has been known to

cause dopamine imbalances, hyper connectivity and desensitization and the constant comparison

of oneself with others online (Lohmann, 2019, para 7). Another cause identified, one of the

primary causes of which is excessive smartphone use, is lack of sleep, sleep disturbance and

insomnia, which is known to be a major factor to induce depression, mood swings, lack of focus

and performance, and irritability. (Lohmann, 2019, para 9). Sleep is even more essential for

teenagers as it is during this time that the body and brain are undergoing “maturational and

psychological changes” (Lohmann, 2019, para 10). Most parents now live a fast paced live given

today’s corporate culture, which combined with the prevalence of nuclear families in western

society, leaves very little time for social activity or community interaction, resulting in today’s

children growing up to be more isolated and with lesser support systems, than earlier

generations. This rushed life style combined with the fact that kids today face a lot more
competition in entry to University and the job market (where there is a legitimate crisis at the

moment) puts them at a constant state of feeling pressure to succeed, and ultimately leads to the

formation of the early signs of depresseion (Lohmann, 2019, para 11-13). Teenage depression

also appears to affect girls much more than boys.

Why teenage girls are affected worse by depression than boys

It has been found that teenage girls are three times more likely to suffer from depression

than boys of the same age (Geiger & Davis, 2019, para 1) and therefore pediatricians and child

psychiatrists need to take cognizance of the fact and modify treatment accordingly. As per data

from the Pew Research Centre, in 2017 whereas 845,000 teenage boys, comprising 7%, reported

at least one major depressive episode, for girls that number stood at nearly 2.4 million or 20%

(Geiger & Davis, 2019, para 3). Whereas teenage depression rates for boys increased at a rate of

44% for teenage boys between 2007 and 2017, that number stands at 66% for girls during the

same time period (Geiger & Davis, 2019, para 4). The year 2015 say three times more girls aged

10-14 being admitted in the hospital for causing deliberate harm to themselves because of major

depression than boys of the same age (Twenge, 2020). Surprisingly, as per data from the Pew

Research, girls receive treatment for depression more than boys – 45% of teenage girls with

depressive episodes received treatment compared to 33% of teenage boys (Geiger & Davis,

2019, para 5), which begs the question then, as to why, in spite of such, rates of teenage

depression amongst teenage girls far outnumber that amongst teenage boys? The answer it seems

lies in the use of social media, an environment which establishes a hierarchical order based on

popularity and can be a harsh environment for people lower on the hierarchical ladder constantly

comparing their lives to that of more glamorous and popular people on social platforms
(Twenge, 2020, page 2 para 3). It was found that whereas boys spend more of their digital time

playing games which involves real-time communication and even verbal communication, girls

mainly spend most of their digital time on social media, which causes severe anxiety because of

a delay in getting a reply, or low number of likes compared to others; further, since smartphones

are much more portable than gaming consoles and PCs, girls on social media continued to be

engaged for a longer time, even during bed-time which has a much more severe detrimental

effect (Twenge, 2020, page 2-3). Whereas 26% of girls who spent about 6 hours a day on social

media reported major feelings of unhappiness, with boys in similar situations that number drops

to 18% (Twenge, 2020, page 2, para 6). This difference has been attributed to that fact that girls

are more prone to concerns about popularity and are more severely affected by negative or

positive interactions is social media compared to boys (Twenge, 2020, page 2, para 7). The law

already knows that children are the most vulnerable groups in online interactions, and it is

already unlawful for a child to have a personal social media account before they turn 13, but this

law is rarely ever enforced (Twenge, 2020, page 2, para 8). Therefore, it is important that parents

themselves take cognizance and focus on monitoring or supervising their child’s social media

use, and set strict limits to minimize long-term harm. So what are some signs of depression that

parents should be aware of?

How to spot depression amongst teens

There are several signs, indicators and precursors to depression in teenagers which are

not very different from depression in adults, however spotting depression amongst teenagers is

quite a bit harder, as symptoms may be confused with natural teenage behavior. A whopping 3.2

million adolescents have reportedly suffered from at least one major depressive episode in the
US according to data from 2017 from the National Institute of Mental Health (Scripps, 2019,

para 3). A precursor to depression is anxiety, the symptoms of which amongst teenagers are a

noticeable display of excessive worry, difficulty in falling sleep at night and consequent

sleepiness during the waking hours of the day, difficult in concentrating generally and

specifically in studies resulting in falling academic performance at school, constant feeling of

restlessness, persistent sense of fatigue and prolonged irritability (Scripps, 2019, para 7). Signs

of depression in teenagers can include symptoms like diminished interest in social activities on a

constant basis, diminishing social circle and deliberately pulling away from friends, especially

family, sporadic bursts of anger and irritability, constant negative or pessimistic thinking which

becomes the general outlook altogether, a consistent decline in academic performance, difficulty

in focusing or concentrating on one thing for an extended period of time, unexplained headaches,

a dramatic change in eating habits – eating more or less from usual (Scripps, 2019, para 6).

However, all these signs maybe quite ‘normal’ for a large majority of teenagers and parents,

family members and teachers have a hard time distinguishing signs of depression from normal

behavior, and thus in spite of spotting these symptoms, they are often chalked up to teenage

angst, hormonal changes, or just a phase that teenagers go through. "For teenagers, because they

tend to stay at home, stay in their bed or their bedroom, they don't want to move, they look lazy,"

as per Dr. Johanne Renaud, medical director of the child psychiatry program at the Douglas

Institute (Breummer, 2018, page 1, para 1). "But depressed teenagers are not lazy. They are sad,

they don't feel like doing anything, they have low motivation." For instant, as Johanne Renaud,

medical director of the child psychiatry program at the Douglas Institute puts it, teenager are

often perceived to be inherently lazy, as they tend to stay at home and not venture out of their

bed room; however, it is a wrong notion as teenagers aren’t inherently lazy, and depressed
teenagers act this way as they feel a severe lack of motivation (Breummer, 2018, page 1, para 2).

As per Dr. Gary Maslow, an assistant professor of pediatrics and psychiatry and behavioral

sciences at Duke University “The biggest challenge is identifying adolescents”….“without

screening they fall thru the cracks and don't come to attention until the symptoms get worse,”

(Storss, 2016, page 2, para 6). Therefore it is especially important that proper treatment protocols

are initiated for treatment of teen depression.

Treatment of depression amongst teens

Diagnosing depressive behavior amongst teenagers is especially important, even more

than adults, because depression can bring much more deadly consequences for teenagers due to

their relative inexperience with life. According to data from the Center of Disease Control and

Prevention (CDC), suicide has been found to be the second leading cause of death amongst pre-

teens, teens, and young adults from 10 to 24 years of age (Scripps, 2019, para 2), the first being

road accidents. "Suicide attempts and completed suicides are a concern with depression in

adolescents and and they were considered in the recommendation (of the U.S. Preventative

Services Task Force) " according to Dr .Alex H. Krist, associate professor of family medicine at

Virginia Commonwealth University. Almost 17% of teenage high school students in the USA

have seriously considered suicide at one point or another, and 8% have actually attempted it

(Storrs, 2016, page 3, para 4). As per Breummer (2018, page 1, para 3), a whopping 70% of

those teenage suicides are linked to depression, and approximately one out of every five

teenagers will experience depression in one form or another during their teenage years, which is

twice that of the general population. Teenagers with severe depression and borderline suicidal

tendencies can indulge in self-harming practices such as cutting themselves (Breummer, 2018,
page 2, para 2). One of the areas to look out for teenagers who may exceptionally susceptible to

depression are teenager with a family history of depression and suicide, who it has been found

are three to five times more likely to susceptible to clinical depression themselves (Breummer,

2018, page 2, para 2). Previously, the Task Force had recommended screening for depression

amongst teenagers only when they showed preliminary signs and also only when the doctor had

in place systems which could enable individuals to get follow-up treatment and care, however in

response to the growing number of instances of suicide amongst teens, these old

recommendations have been judged as inadequate and new the recommendations of the

commission is that every medical practitioner should endeavor to put in place such care systems

and everybody from the teen age group must be examined for depression (Storrs, 2016, page 2,

para 1). The Task Force does not provide specific recommendations, but there are many possible

avenues by which medical care and screen for teenagers could be arranged, such as employing in

house mental health providers in primary care or pediatric facilities or referring patients to

therapists practicing elsewhere (Storrs, 2016, Page 2, para 4). As per Dr. Krist, a member of the

Task Force, the latest recommendations of the Task Force for teating teen depression "very much

parallel the recommendations for adults (18 and older)," (Storrs, 2016, Page 1, para 3), which is

why Dr. Gary Maslow, recommends utilizing screening questionnaires such as PHQ-A

consisting of nine questions, previously thought to be appropriate for adult only (Storrs, 2016,

Page 2, para 4). "Childhood depression is important. If families are concerned their child is

depressed we want them to talk with their clinician, or if a clinician is concerned we want them

to do further evaluation and treatment as needed," Dr. Krist says. As per Dr. Gurinder Dabhia.

“Most people think these conditions are difficult to treat, but there are a variety of options that
can help, including talk therapy. Early treatment can shorten the period of illness and help your

teen cope.”

Conclusion

Summing up, the rates of teenage depression have shot to an alarming degree since the 2010s,

which has now prompted the U.S. Preventative Services Task Force to recommend screen every

teenager for depression regardless of whether they show signs or not. This is a dramatic change

in attitude from just less than a decade ago, when depression was not considered as an issue for

teens and screen was not recommended until the candidate showed severe signs. This is

especially significant considering that the early signs of depression correspond with what is

considered normal teenage angst which makes it difficult to ascertain whether the child is

actually depressed or going through the drawbacks of a developmental period in their life, which

leads to a lot of teenage depression cases falling through the cracks without medical scrutiny.

The rigors of fast paced modern life, combined with the rampant use of social media among

teens seem to be the main culprit, especially among teenage girls, who have been found to be a

lot more vulnerable to depression than teenage boys. Even though the law disallows social media

accounts for children less than 13, it is rarely enforced. Therefore parents now have to take an

increasingly participatory role to monitor the use of social media amongst their teenage children.

The effect of depression amongst teenagers prove to be more severe than adults, as teenagers

have not had the time to develop coping abilities like adults with life experience, and are more
prone to devastating reactions like physical self-harm and even suicide because of the inability to

cope with depression. The topic of teenage depression is one of paramount concern and priority

as the health of the future generation should be at the top of every nation’s long-term

sustainability strategy, and therefore proper diagnosis and treatment of teen depression is an

extremely important concern for the medical community, which it seems to have taken with

significant seriousness in recent years.

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