Recognizing and Responding to Adolescent Depression

122 Presentation RECOGNIZING AND RESPONDING TO ADOLESCENT DEPRESSION STEPHEN R. KING, Ph.D. Department of Pediatrics St. Francis Hospital and Medical Center 114 Woodland Street Hartford, Connecticut 06105-1299 Over the past twenty years or so, mental health researchers have begun to pay increasing attention to the emotional status of adolescents. The work of Offer and others, which has focused on the self-image and adjustment of adolescents in many cultures, has provided empirical support for the hypothesis that adolescence is for the most part a relatively stable period of development and that most adolescents are well-adjusted .w On the other hand, research into psychopathology and emotional dysfunction suggests that many of the afflictions once thought to be largely limited to the adult population are found in significant numbers in the adolescent population as well. One area of research which has received a great deal of attention is depression. Interest in this area has been spurred in part by the recognition that suicide, which has markedly increased in adolescents, is often preceded by depression.3 The effect of depression on the development of alcohol and drug abuse, as well as school failure, is also being recognized.4'5 A number of studies have examined the prevalence of depressive symptoms in adolescent populations. In one widely cited early study, Albert and Beck found 33 percent of a sample of seventh- and eighth-grade students to be at least moderately depressed as measured by scores on the Beck Depression Inventory.6 Teri, also using the Beck as her measure of depression, studied a white, middle-class sample of adolescents and found that 49 percent scored above the cut-off for mild depression.7 Although prevalence rates for depression vary widely because of different measures and definitions of depressive disorder, it is generally agreed that depression in adolescents is more widespread than previously believed, that it tends to affect girls more than boys, and Journal of Health Care for the Poor and Underserved, Vol. 2, No. 1, Summer 1991 _____________________________King___________________________123 that it is more prevalent in older than younger adolescents.8 What are the risk factors for the development of depression in adolescents ? One of the strongest predictive factors is depression in one or both parents. A child has a one in four chance of becoming depressed if one parent is depressed, but a three in four chance if both are depressed. The relative contributions of genetics and environment to this equation are not fully known, although in cases where the parental depression is manifested in bipolar illness, the genetic influence is very high. Another is loss of a parent through death or separation.' This may be the result of various factors, including biological vulnerability, environmental determinants such as violence, as well as complex psychosocial and economic factors. The interplay of these various contributing factors is not well understood. Of particular relevance to this paper is research which examines the relationship between adolescent depression and sociodemographic variables such as poverty and race. One such study carried out by Kaplan and his colleagues found a prevalence rate of depression of 22 percent in their group of adolescents and reported that lower socioeconomic status was positively correlated with degree of depression.10 In a particularly well-designed study using a large sample of adolescents from various social, economic, and racial groups, Kandel and Davies found that adolescents from the lowest income group were more depressed than those from any other sociodemographic group. Females had significantly higher depression scores than males, which parallels findings in research on adults, but there were no racial differences among whites, blacks, or Hispanics. The overaU prevalence of depression in the pastyear (1971-72) for all adolescents studied was 20 percent.11 One important limitation of the studies cited above is that there were no statistical or design controls for variables (e.g., parental depression, loss of a parent, significant life events) which might affect the observed relationship between poverty and depression. The importance of controlling for these relevant variables is dramatically illustrated in studies of the relationship between depression and race. Whereas most of the research both on adults and adolescents shows a positive relationship between race and depression...