When Your Head Spins
An on-line resource for youth at risk

  Examples of the Signs of Depression
  What Is Depression
  Other types of mood disorder
  Incidence of Depression
  Depression in Young People
Information provided by the Mental Health Foundation of New Zealand


Checklist for signs of depression 
(Rey (1995) outlines the following checklist to help parents of adolescents become aware of possible signs of depression in  adolescent children)

Your adolescent child probably suffers from Depression if he or she:

Has shown a marked change in character, a decline in school work and a changed relationship to family and friends and appears unhappy, tearful, down in the dumps or complains of sadness or emptiness or has lost interest or enjoyment in most activities and pastimes previously enjoyed and at the same time has shown four or more of the following symptoms:

1. Appetite or weight has changed considerably (has lost or gained a substantial amount of weight)

2. a change in sleeping pattern: can't sleep at night or sleeps too much

3. is restless, agitated (pacing, wringing hands) or has slowed down (e.g., spends hours staring in front, finds it hard to move)

4. has lost a lot of energy, complains of feeling tired all the time

5. feels worthless or complains of feeling inappropriately guilty ('everything is my fault', 'I am bad')

6. believes that life is not worth living, there is no future and will be better off dead

 Examples of the Signs of Depression

People working closely with adolescents are finding Rey's checklist a useful guide if they are concerned that a young person's behaviour has changed significantly. The following signs of depression in young people have been observed by workers in the community: they may make depression difficult to identify, but they are very important as they provide early warning signs, and opportunity for early intervention:

Changes in character

  Irritable; e.g., snapping at people for no apparent reason
  Physically aggressive or verbally aggressive
  Abandoning favourite hobbies or sports
  Passive TV watching
  Risk-taking; e.g., dangerous driving
  Misuse of drugs and alcohol.
  Changes in school behaviours (including training courses and work settings)
  Frequent absences from school through 'wagging' & Gets poorer grades for assignments than formerly
  Complains of being bored. Becomes disruptive in class
  Loses interest in activities which once were fun
  Finds it harder to stay on task. Loses concentration
  Mentally confused. Finds decisions difficult to make
  Cannot remember commitments: doesn't turn up to appointments
  Has difficulty staying still or conversely, is lethargic
  Projects personal difficulties on to others; e.g., bullying
  Sets self up for rejection by peers and/or teachers. Takes on the victim role
  Changes in relationship to family and friends
  Stops going out with friends; shows no interest in group outings
  Increase or decrease in sexual activity
  May start associating with a different peer group
  Expresses negativity about family
  More than normal conflicts with parents and siblings
  Changes eating and sleeping habits
  Changes in feeling, thinking and perceiving
  Expresses inappropriate guilt
  Feelings of not being good enough, worthlessness, failure
  Expressions of hopelessness: nothing to look forward to
  Speaks in a monotonous or monosyllabic manner
  Preoccupied with self; withdrawn, shows inner distraction
  Cries easily, looks sad, feels alone or isolated
  Fears about having to be perfect. Fearful of doing something bad
  Incidents of self-injury. Ideas of killing self


 What Is Depression

Life is full of 'ups and downs', and most people have periods of experiencing the 'blues' or feeling 'down'. Depression is not just 'feeling blue' or 'down in the dumps', and it is more than experiencing normal grief and sadness after a loss.

Like many illnesses, it affects the whole person - his or her physical, mental, emotional and spiritual well-being.
Depression is also an experience which allows one to assess the difficulties in one's life and to change and grow.
Depression is a lasting state of distress, which persists over a period of time - two weeks or more.
As with other illnesses, biological changes may take place.
Because a wide range of symptoms can occur, depression is often a confusing illness to diagnose.

There are generally considered to be three categories of depression which may be described on a continuum from MILD to MODERATE to SEVERE. Rating Scales have been developed which can help mental health workers differentiate with some precision among them. The following definitions indicate in no more than a general sense the degree of severity of depression.

Severe Depression -is present when a person has nearly all of the signs of depression, and the depression almost always interferes with his or her ability to initiate, enjoy, and perform a range of activities. Severe depression is very debilitating, interfering with daily life and work.

Moderate Depression - is present when a person has some signs of depression which often interfere with the person's life.

Mild Depression -is present when a person has a few signs of depression, requiring a greater effort to function normally.

Co-morbidity. With adolescents depression often occurs in combination with other disorders. This is known as 'co-morbidity'.

'One of the most consistent findings has been that most children with depressive disorder have associated co-morbidity, the most likely being conduct disorder, anxiety states and school refusal, hyperactivity, drug use or anorexia nervosa.'(Watkins, 1995)

Other types of mood disorder include:

Chronic Low Grade Depression. (known as Dysthymia or Dysthymic Disorder).
Dysthymia greatly affects the quality of life of the person experiencing it. There is a sense of gloom, a lack of pleasure in life, low self-esteem and little confidence. For a young person to be diagnosed as having chronic low grade depression (Dysthymia), the symptoms of altered mood must be present for at least one year. If dysthymia presents during the teenage years, it may be expressed as irritability.
Chronic Low Grade Depression is equally common in boys and in girls and increases with age, affecting one in ten people in the 45-64 age group (Oakley-Browne et al. 1989.) This condition is likely to lead to social avoidance and low self confidence which will affect the social, vocational and personal development of a young person. Moreover there is an increased risk of a Major Depressive Episode and possibly a suicide attempt.

Manic Depression or Bipolar Disorder.
This illness is marked by extreme swings of mood. These changes are more intense than the changes of mood which are part of normal life. Usually there is a 'high' (manic) phase alternating with a 'low' (depressed) phase, with a period of normal mood level in between. There are wide variations, however. This illness affects about 30,000 New Zealanders and their families.

Postnatal Depression
Depression occurring after the birth of a baby, an illness experienced by 10%-15% of women. Risk factors, (Hunt et al. 1995) such as poor social support, relationship difficulties, and stressful life events indicate that the adolescent mother may be vulnerable to postnatal depression.

Seasonal Affective Disorder - SAD
Depression coinciding with the onset of seasonal changes.

Substance Induced Mood Disorder
Alcohol and other drug misuse can change the body's chemistry, causing depressive symptoms.

Incidence of Depression

 Precise data relating to the prevalence of depression in the community are unavailable because it often goes unreported. However, even the conservative figures we do know indicate that depression is a major health problem in New Zealand. 'There are about as many people with depression as there are people with asthma.' (What is Depression? National Health Committee, 1996).

The following information is generally accepted in the literature:
Depression can affect people of any age, culture, and occupation.

About ONE in every SEVEN people.... in New Zealand will develop a Depressive Disorder during their lifetime. (Wells et al. 1989)

In any two week period, ONE in TWELVE people will have a Depressive Disorder: 6.4% will have Dysthymic Disorder, and 3.7% will have a Major Depressive Episode. (Oakley-Browne et al. 1989)

Depression is one of the three most common mental health problems in young people. (Along with alcohol and drug missuse and addiction and anxiety disorders).

The first onset of a major depression often occurs in mid to late adolescence. Adolescents who experience depression are at risk of having a recurring episode of depression.

Chronic Low Grade Depression (Dysthymia) often precedes a Major Depressive Disorder.

Depression is a significant problem for young people who are in custody or who are shelterless (homeless). Clinical Practice Guidelines:Depression in Young People, Draft Document, September, 1996. NHMRC, Canberra.

Comparative data from Canada, Germany, United States, and New Zealand indicate that major depression rates have been increasing. Since 1945 the onset of depression has been occurring at an increasingly earlier age, a trend that has been more marked in recent years, especially among young men born since the 1960s. (Weissman et al. 1977)

Studies in New Zealand have found that the prevalence of depression increases with age in adolescence, with a three-fold increase post puberty, and 'about equal prevalence among boys and girls until 15-years, after which there appears to be a greater prevalence in females. '(McGee et al. 1992). Although the incidence of young women being diagnosed with depression is higher than for young men, it is not known whether this indicates a greater willingness to seek help on the part of the women.

Depression in Young People
Adolescence is a period of transition between childhood and adulthood. For the purposes of this resource the term adolescence applies to young people in the approximate age range of 12 to 20 years. Adolescence is a time of adaptation and integration into broader society, including establishing one's own identity. It is a time of major physical, emotional, intellectual and social changes for the young person.

Adolescence is a vulnerable time for depression as it is a period characterised for many young people by:

Natural mood swings
Concerns over body image
Precarious self-esteem, dependent on outside circumstances
Relationship problems and break-ups
A future that is beginning to exert fears and pressures
A lot of natural idealism which the day-to-day realities of life constantly threaten
Attempts to establish sexual identity and security
Concerns about sexuality and sexual behaviour
Exposure to peer group pressure
Exposure to alcohol and drugs
Frequent value conflicts with parents
Acute academic pressures
Transition from school to the public arena

(Adapted from Mourant, 1989)

Depression in young people is similar to that in adults in many respects. For example, a young person may have clinical depression if they have had a number of the signs of depression for two weeks or more, as in adults. The key differences are in the manner of presentation. That is: In a young person the signs of depression may be expressed differently than in an adult. This can result in depression in young people going undetected.

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