Teen depression: Large study finds girls have the highest risk June 6, 2017 12:00 AM By Jill Daly / Pittsburgh Post-Gazette Reaching teenagers with depression and offering them help in a crisis is not easy. One young man whose anxiety led to depression says that adults don t always recognize the signs and teens don t know how to tell them. A huge obstacle is the fear of what other people will think. Also, there s a fear of telling a loved one a parent or guardian. It s a very difficult thing to do, said Eli, 25, of Squirrel Hill, who asked that his full name not be used. Eli said he always had an introspective nature and shyness. But at about 16, after trying to adjust to a big high school, he said he thought he might be depressed. There was an underlying feeling of emptiness and loneliness; a void; an overwhelming feeling of isolation, he said. He said many adults brushed aside his concerns while he was in high school. An underlying theme was I was doing something wrong, Eli said. He hid his feelings, but his emotional pain got worse and he finally told someone at school of suicidal thoughts and he sought emergency treatment. It s a shame there was no intervention that happened sooner. But he said intensive outpatient care made a difference: a very caring therapist, psychiatrist and individual and group therapy. That was really helpful. Teenagers experience more depression than previously believed and nearly three times as many girls as boys will have their first experience with depression between the ages of 12 and 17, according to a recent study led by Pittsburgh researchers. 1 of 5 6/6/17, 8:49 AM
We have known about the gender gap for years, said study senior author Elizabeth Miller, chief of adolescent and young adult medicine at Children s Hospital of Pittsburgh of UPMC. What s new is the gender gap appears earlier than previously anticipated. By asking 12-year-olds about their experience, even asking them to recall when they were 11 years old, cases of elementary-school-age depression were revealed as well. We should be attending to [the gender gap], Dr. Miller said. There s tons of theories about it: from socialization to hormonal changes, the impacts of girls hormonal changes and the risk for depression. Exposure to childhood trauma and abuse is a risk factor as well, she said. She said waiting for the depression to resolve itself without treatment isn t supported by the study, which also noted high rates of suicide attempts for both boys and girls with depression. The study used a large sample of U.S. teenagers drawn from multiple years, 2009-14, of the annual National Survey of Drug Use and Health (it includes a total of about 67,500 respondents of all ages each year). Interviewers asked the teens if they had a major depressive episode in their lives 14 percent said they did. When asked what age they were when first episode happened, it was the age of 12 for 5.7 percent of girls and 2 percent of boys. The gap got larger at each age upward until age 15, when the incidence rate was 13.2 percent for girls and 4.4 percent, boys. Recent-onset depression A study of young people from an annual national health survey showed a wide gender gap in cases of depression among boys and girls, ages 12-17. Based on the proportion of incidences according to age and sex, it's projected that nearly three times as many girls (36.1 percent) as boys (13.6 percent) will have their first onset of depression between 12 and 17 years of age. - Proportion of incidences of recent-onset depression, according to sex, for ages 12-17. 15% 10% 10.3 12.3 13.2 12.5 10.6 5% 2 5.7 2.6 3.7 4.4 4 4.9 0% 12 13 14 15 16 17 AGE Male Female Source: Joshua Breslau, et al., Translational Psychiatry (2017) - Post-Gazette 2 of 5 6/6/17, 8:49 AM
Projected cumulative incidences of recent-onset depression, according to sex, for ages 12-17. 40% 36.1 30% 31.2 25 20% 10% 0% 17.8 13.6 10.4 10.7 8.2 5.4 3.8 3 1.3 12 13 14 15 16 17 AGE Male Female Source: Joshua Breslau, et al., Translational Psychiatry (2017) - Post-Gazette The finding there was such a big gap at such a young age was pretty striking, said the study s lead author, Joshua Breslau, Ph.D., Sc.D., a researcher at the RAND Corporation. Published last week in the journal Translational Psychiatry, the research also involved the Intramural Research Program of the Eunice Kennedy Shriver National Institute of Child Health and Human Development. Dr. Miller said teens with depression have long periods of low mood or feeling unable to enjoy activities they usually enjoy. Other common symptoms are insomnia, irritability, weight gain or loss, and feelings of guilt or worthlessness. Signs of withdrawal and not engaging in usual activities we take that very seriously, Dr. Miller said. In the study, teens with depression experience were sorted into three groups: recent first onset (depressive episode within the past year); persistent (both within the past year and first episode more than one year earlier); and remitted (with no episode in past year, but with first episode more than a year ago). They were also asked about impairment, or how the episode caused limitations at home, school or work, with close relationships and with social life. They were asked if they had attempted suicide. 3 of 5 6/6/17, 8:49 AM
They were asked about conduct issues, such as getting into serious fights, carrying a handgun, selling illegal drugs and stealing. And they were asked about school experiences in the past year, such as whether their courses were meaningful or interesting, if teachers told them they were doing a good job and what their recent grades were. Among the girls, persistent cases of depression were tied to higher levels of impairment and higher rates of suicide attempts than recent-first-onset cases, the study said. Among boys, persistent and recent-onset cases had similar impairments. No significant difference among the male groups was found in prevalence of suicide attempts. No more waiting Dr. Miller said the practice of just waiting for children to get better on their own will have to change. We need to be much more intentional and get a more detailed mental health assessment and a more intentional plan for follow-up. We can say now that recent-onset depression is serious business and persistent cases need to be given access to treatment. Parents, teachers and others dealing with teens should be educated on the symptoms of depression, she said. Dr. Miller and RAND s Mr. Breslau both said they would like further research to find the warning signs of depression. The study was the largest featuring adolescents, Mr. Breslau said. Dr. Miller said protective factors could be discovered in future research: What are the things we can put into place to prevent these kids from getting depressed? Some skills-based treatments help teens learn to regulate their emotions and get better sleep, she said. It reduces the risk of suicide, but also puts them on a path for regulating their emotions. The practice of mindfulness is an example of a teachable skill, she said. Expanding ways to get treatment to teens is important, Mr. Breslau said. A recent Pittsburgh-San Diego study found benefits in a streamlined behavioral therapy for teens with anxiety and depression. One of its lead authors was David Brent, director of the Services for Teens at Risk suicide prevention program at the University of Pittsburgh and Western Psychiatric Institute and Clinic. 4 of 5 6/6/17, 8:49 AM
Eli encouraged young people to seek out a therapist and not give up even if the first therapist isn t the right match. Going to therapy is good, he said. I don t think the stigma or negative connotations are appropriate. I think we could all learn about ourselves and how to interact with others in a better way. For teens and families with a mental health crisis, the re:solve Crisis Network phone line offers help from a trained counselor around the clock (1-888-796-8226). Its walk-in location is 333 N. Braddock Ave., Point Breeze. Jill Daly: jdaly@post-gazette.com, 412-263-1596. 5 of 5 6/6/17, 8:49 AM