Case conceptualization of anxiety and depression in adolescence
Diagnostic formulation: depression is a mood state described by a depressed mood or loss
of interest or pleasure for at least two weeks (Shebib, 2020). Anxiety is excessive fear or worry
about an anticipated threat and can impact adolescents in various domains, including school,
home, and social settings (Shebib, 2020).
Predisposition (Clinical formulation): Biological factors can be hereditary, gender, and
body mass index (BMI); obese adolescents are more likely to have negative emotions, and
depressed adolescents are more likely to become obese (Josey, 2016). Attention deficit
hyperactivity disorder (ADHD) is a common psychological factor which affects mental health in
adolescence because the inability to maintain focus and concentration, agitation, and sometimes
irritability cause issues in academic settings (Malhotra & Sahoo, 2018). Social factors can be
adverse childhood experiences (ACEs), such as physical, emotional, and sexual abuse or neglect
(Josey, 2016). Social media is another mode through which adolescents compare themselves to
each other and can lead to increased depressive symptoms in adolescents when the comparison
and feedback-seeking are excessive (Josey, 2016).
Cultural formulation: In multi-race adolescents, identity formation, which is already
challenging, can be even more challenging when deciding which race to identify with. There can
be experiences of discrimination based on how one looks, whether one is “black enough,” “white
enough,” or “whichever race enough” to fit in with peers that identify with that race (Josey,
2016). Social justice in rural areas can overwhelm children with a climate of poverty, refusing
them access to equal opportunity to develop the talent, skills and abilities society values and
rewards, and LGBTQ youth faces discrimination, leading to depression and anxiety (Wagaman,
2016).