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Sarah Hockridge
Candice Calles
Comp 1302.420
21 April 2011
Lost Relationships: Adolescent Depression
School systems around the United States are over-crowded and the ratio of students to
teachers continues to grow. Today, school districts are reducing their number of teachers on the
payroll due to budget cuts. As the student-teacher ratio increases, adolescents will receive less
one on one time with teachers, requiring a dependable relationship with their parents. However,
the era of having a stay-at-home parent is fading. More parents are being forced to work irregular
or unconventional schedules outside of the home as the cost of living increases. This allows for
less time to spend with their school aged children, and in effect, leaving them home alone after
school the majority of the time. This erratic and inconsistent relationship with parents is a route
cause for depression in adolescents. In order to reduce the number of depressed adolescents,
school teachers and counselors should be solely responsible for identifying these depressed
students and referring them for treatment.
Depression is not prejudiced: it can be found in any ethnicity, religion, social status and
even age. But that was not always believed to be the case. In the article “More Than Moody:
Recognizing and Treating Adolescent Depression”, featured in the Brown University Child and
Adolescent Behavior Letter, Dr. Harold Koplewicz states “Until recently, it was widely believed
that young people had neither sufficiently formed egos, nor the brain development to cause the
kind of chemical imbalance that is at the root of clinical depression” (Koplewicz). I think that as
our society continues to advance, children are growing up faster than they were even twenty
years ago. As this premature growth continues, it is also adding unnecessary stress on an
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underdeveloped mind. Today, depression affects over 40 million people and approximately 3.5
million are children and teenagers (Koplewicz).
Reducing the number of undiagnosed and untreated adolescents is as simple as watching
for the symptoms, which are easily recognized if someone is paying attention. When a child
exhibits gradually poor performance in school, withdraws from family and friends, lacks energy
or motivation, changes eating habits, changes sleeping patterns, or is easily agitated, they may be
showing signs of depression (Carwile). The key to recognizing if a child is experiencing
depression is by the length of time the child shows symptoms. Occasional changes will occur,
but if they persist for two weeks or longer, depression may be the diagnosis (Carwile).
Many children will exhibit some or all of these symptoms at one point or another, as
intellectual, social, and emotional changes occur (Carwile). It is important to monitor a child’s
behavior for any changes so if they are showing signs of depression, they can start treatment
before the symptoms progress. In older children, early to mid-teens, they may also experience
substance abuse and suicidal thoughts or actions (Carwile). Subconsciously, when a person
thinks about depression, you think of sad, withdrawn, and just unhappy people in general. Well
these same things can happen to a child. Depressed adolescents may feel like an outsider or
alone. They will participate in risky activities like heavy drug use, heavy drinking, or sexual
promiscuity, to try to make them feel better (Carwile).
For my critical review I will cite Han Wen-Jui and Daniel P. Miller, from the Columbia
School of Social Work, on the affects that parents’ work schedules have on the development of
depression in adolescents,
“…parental shift work exacerbates parents’ own difficulties in making them less
available, disrupts their relationships with their children or otherwise jeopardizes
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the provision of an ecological environment to meet a child’s needs, such work
may pose a risk for the development of depression” (Wen-Jui).
For their study, the authors chose four main categories of work shift types: evening work falls
between the hours of two p.m. and midnight; night work falls between the hours of nine p.m. and
eight a.m.; rotating is alternating shift times with a set schedule; irregular is alternating shift time
without a set schedule (Wen-Jui). The effects of one parents’ schedule will depend greatly on
whether the other parents schedule allows them to be home and able to care for the child while
the other is away from the home. The parents’ shift work also plays a role in reducing the
amount of time spent with the child necessary for producing desirable outcomes (Wen-Jui).
Parents that offer a protective atmosphere by harboring a constructive relationship with
their children is an important part of adolescent development and fights against undesirable
outcomes (Wen-Jui). The shift work can become physically and emotionally draining on the
parent, so when they are available, they cannot adequately care for the child. Previous studies
have shown that parents who hold a close relationship with their children have less incidence of
depression and that the effects of life events that lead to the development of depression was
mediated by this close bond (Wen-Jui). Parental monitoring and the frequency of parental
contact with the child have also shown to act as a mediator against negative psychological
outcomes.
This study was completed using the National Longitudinal Survey of Youth (NLSY-CS)
children that were followed for thirteen to fourteen years and have no missing information (WenJui). The NLSY began surveying 12,686 men and women between the ages of fourteen and
twenty-one in 1979. In 1986, a separate survey, the Child Supplement (NLSY-CS) was
administered to collect data from children of the women involved in the NLSY. The children
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were asked to fill out questionnaires about their feelings, time spent with their parents, maternal
closeness, paternal closeness, whether mother knows whom the child is with, home environment,
and hours of watching television (Wen-Jui). The study was concluded with the following
outcomes:
1. Ongoing night shift work by the mother and evening shift work by the father resulting
in a lower quality of home life and lower parental closeness leading to a higher rate of
adolescent depression (Wen-Jui).
2. Irregular shift work by the mother and father increased the quality of home life and
allowed for a better parent-child relationship leading to a lower rate of adolescent
depression (Wen-Jui).
I agree with first outcome that parents who work night and evening shifts are more likely to have
a depressed child. These two shifts do not allow the parents any time at home when the child is
home. On the other hand, I was surprised to see that the second outcome showed a lower rate of
depression for irregular shifts. It makes sense because if a parent is constantly changing working
hours, maybe they are checking in more with their child and are trying to have more quality time
together when the work schedule permits.
Overall, the results from this study were supportive of closer parent-child relationships
and a good home environment to lower the onset of depression and lead to better adolescent
well-being (Wen-Jui). Though not all parents are able to choose the work they do and the
specific shifts that they work, particularly for lower paid and lower skilled professions. The lack
of availability of a parent to their child is clearly detrimental to that child’s mental health and
well-being (Wen-Jui).
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In 2000, the Council of Economic Advisors put out a report suggesting that “teenagers
who often ate dinner with their parents were significantly less likely to have suicidal ideations or
to attempt suicide” (Wen-Jui). As depressed teens start pulling away from their friends and
socializing less, they may begin to think or feel that suicide is their only way out. Growing up in
a family that ate dinner together almost every night, I can appreciate the need for spending this
time together. We would turn off the television and we all sat at the kitchen or dining room table
and just talked about our day or what was going on at school and in our lives in general. It was
very important to my parents to convey the need for family time to us as children. It not only
allowed us to talk to each other about our lives, but it also let my sister and I see how our parents
handled life: how they worked through disagreements with each other and with us, how they
handled stress, how they would talk to each other or to us when something was bothering them.
This gave my sister and me an understanding that it was alright to talk about your feelings and
problems, and usually, someone would be able to come up with a solution.
At this point, I would like to introduce a resolution to adolescent depression as described
by Julia R. Evans, Patricia Van Velsor, and Joseph E. Schumacher from their article "Addressing
Adolescent Depression: A Role for School Counselors." They argue that “Since most teenagers
spend a majority of their day in schools, it is not unreasonable to assume that school counselors
may need to play a role in addressing adolescent depression” (Evans). It is important for
counselors to be aware of the symptoms and coexisting conditions associated with depression to
provide referral to appropriate mental health professionals.
The most frequently seen coexisting conditions include anxiety, substance abuse, eating
disorders in females, and disruptive behavioral problems in males (Evans).
Clinical
investigations have shown that 40% to 70% of depressed adolescents have at least one coexisting
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condition. These conditions can increase the likelihood of recurrent depression, affect the
duration of the depressive episode, and can persist even after the depression has been overcome
(Evans).
Other areas of concern are the “cognitions of depressed adolescents” (Evans). Depressed
adolescents are more likely to view negative events as exclusively their fault. However, they
view positive events as having no influence from themselves and completely controlled by an
outside force. They are also dominated by feelings of worthlessness, bleakness and hopelessness
(Evans). These views cause them to distort experiences and are unable to process information
correctly. As depressed adolescents fail to see that they can impact the world in a positive way,
the result is a helpless attitude. “Signs of persistent thought patterns of this nature in an
adolescent suggest to the school counselor that there is a need for assessment” (Evans).
To aid in the assessment, Evans, Velsor and Schumacher provide specific prevention
tactics for schools to initiate for all students. “School based prevention activities” can be used by
the counselors to address substance use and abuse, development, and relationships (Evans).
These activities are broken down into three categories: Primary Prevention, Secondary
Prevention and Tertiary Prevention (Evans).
Primary prevention is intended to be used for the entire student body. Counselors will
provide information to all students on coping with the stress of puberty, school transitions and
normal development (Evans). The topics covered would include typical challenges facing the
adolescents such as peer pressure, relationships and depressive feelings. The importance here is
to raise awareness about depression in the students (Evans). Adolescent years are scary enough
with puberty, your body changing at different rates than your friends, and then add on peer
pressure from the older students. Both my sister and I were close with our counselors in high
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school. We did not have anything as serious as depression to talk to them about, but knowing
that we had them there to just let us talk through whatever was on our minds, meant the world to
us as teenagers. They were the ones that guided us through our awkward adolescent years. The
more information counselors can provide for students, the better they will be able to understand
and cope with their feelings and development.
Secondary prevention is used to focus on specific individuals that are exhibiting some
problems. This program is also being used for students with a higher risk of developing
depression due to a depressed parent (Evans). The counselor will conduct a session with a small
group and focus on the specific problem. The groups can be broken down by low self-esteem,
social isolation or the specific risk factors like children of alcoholics, stress management
difficulty or exposure to acts of crime and violence (Evans). In addition, counselors may need to
focus on learning-disabled students as they also have a higher risk of depression. The counselors
should provide remediation with the participation of teachers and parents (Evans).
Tertiary prevention is designed for those students with symptoms of depression and
includes assessment and referral. This activity conducts individual interviewing and requires
input from the student’s teachers and sometimes the student’s parents (Evans). Once completed,
it is the counselors’ responsibility to either refer the student for diagnosis and medical treatment
or the counselor may decide that the student requires ongoing monitoring without further
evaluation. Ongoing monitoring by the counselor may include continued one-on-one sessions as
well as involving the student in a small group session as described in secondary prevention
(Evans). If the student is referred for further evaluation and completes an inpatient treatment, the
counselor can still provide monitoring to assist in the prevention of reoccurrence. Again, this
would involve either continued one-on-one sessions, involving the student in a small group
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session with other high risk students or a combination of both. This would help the student adjust
to returning to school as well as day-to-day issues they may face (Evans).
In addition to the tertiary prevention, the counselor may also need to develop a “suicide
prevention and intervention program” in the event that a crisis intervention is necessary (Evans).
This program would utilize the school and any available community resources (Evans).
Another critical tool in all levels of prevention is collaboration with teachers, parents and
mental health care providers. The need for collaboration is verified with the following statement:
“Collaboration with teachers can strengthen the school counselor’s ability to
identify students in need. Teachers may refer students experiencing problems to
school counselors and, conversely, the counselor may provide the teachers with
information to enhance their abilities to make referrals. School counselors can
increase teachers’ understanding of depression by providing them with
information about risk factors, developmental tasks and challenges, normative and
non-normative life occurrences, and internal and external resources involved in
the development of depression” (Evans).
Furthermore, collaboration with the student’s parents can help to achieve a positive outcome
both in prevention and while working with a student already exhibiting symptoms. However,
some parents do not agree that their child is depressed and may actually reinforce their child’s
negative attitude with verbal abuse (Evans). The responsibility will fall on the school counselor
to educate the parents on depression or, if the parent completely refuses to see the true issue, the
counselor may have to continue treatment for the student without reinforcement from the parents.
My position on the importance of more involvement from school counselors, is further
proved in the article "Adolescent depression treatment: Findings from the NSDUH" from The
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Brown University Child & Adolescent Behavior Letter. This article argues that health insurance,
or lack of, has played a major role in determining treatment for adolescent depression. It states
that “Adolescents without health insurance are less than half as likely to get treatment for
depression as those with State Children’s Health Insurance Program (SCHIP) or private health
insurance” ("Brown University Child & Adolescent Behavior Letter" 4-5). With the high cost of
insurance these days, there are many families that go without insurance. In 2009, the census
report (2009, published September 2010) showed the percentage of people without health
insurance increased to 16.7% in 2009 from 15.4% in 2008 ("National Conference of State
Legislatures"). Also, not all jobs offer medical insurance to their employees, specifically for part
time workers. As a full time student and part time employee, I pay about $200 per month for my
private insurance with only myself on the policy. It is easy for me to understand how these
families can go without medical insurance. On the other hand, without the insurance, more
adolescents will go untreated.
In a 2007 survey completed by National Survey on Drug Use and Health (NSDUH), it
was reported that approximately 8.2% of adolescents between the ages of twelve and seventeen,
experienced a major depressive episode in the previous year ("Brown University Child &
Adolescent Behavior Letter" 4-5). They also found that less than half (38.9%) of those
adolescents received treatment. In regards to the adolescents that received treatment, more than
half (58.8%) “saw or spoke with a counselor” ("Brown University Child & Adolescent Behavior
Letter" 4-5). The role of a counselor is proving to be one the most influential in an adolescent’s
life. Many adolescents are not comfortable talking to their parents about issues they may have.
They think that their parents won’t understand or maybe don’t care.
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Some of you may be wondering why all of the pressure of identifying depressed
adolescents should fall on the school counselor’s shoulders. I thought the same thing until I
really stopped and realized that our children spend 40 hours per week at school. That is a fulltime job. Also, the school day ends usually before a parent’s work day ends. So you can probably
figure your teenager spends eight hours per day at school, then at home alone for maybe two to
three hours until a parent gets home from work. Ideally, this parent will spend maybe four hours
with their teenager per day. You also have to think about what a normal teenager would be doing
during these hours: playing video games, playing on the computer, talking on the phone, playing
“Words with Friends” on their iPhone, none of which includes hanging out with their parents or
getting the quality time needed to prevent or detect depression.
At the same time, parents may not always be available when their children are home. As
previously noted from the article "Parental work schedules and adolescent depression", not all
parents have the luxury of choosing their job and therefor choosing their working schedule.
Lower income families are more likely to have one or both parents out of the home the majority
of the time. At no fault of their own, they have to leave their adolescents home alone. This is
exactly why counselors need to take this responsibility into their own hands and help these kids
be identified and get treatment.
Other people may wonder why we can’t just medicate teenagers or send them to a
psychiatrist. It is not always as easy as that. As Amir Raz, from Columbia University’s
Department of Psychiatry, points out in his article "Perspectives on the Efficacy of
Antidepressants for Child and Adolescent Depression" (Raz). He states that we should use
therapeutic type treatments that have no side effects over medications that have the potential to
cause long term damage to adolescents (Raz). At the same time, therapy does not always produce
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a positive outcome on its own. Amanda Brody from the University of Arizona Psychology
Department, points out in her article “Motivational Interviewing with a Depressed Adolescent”,
that there are many factors that go into the effectiveness of therapy. She states that the limitations
for this type of therapy to work includes the patients’ want to make a change and the “therapeutic
relationship” between the patient and the therapist (Brody). As a parent, I would prefer to subject
my child to group therapy or one-on-one therapy sessions than risk the side effects that
accompany medications. I would only consider introducing a mild medication if the therapy was
not completely successful. The easiest way for any child to receive therapeutic treatment is at
school.
While I do agree that this should be a team effort involving counselors, teachers, parents
and even classmates, it is becoming apparent that this collaboration is not always feasible. When
I was in high school, there was a girl on the drill team with me that always seemed a little
strange. In the end, there were too many factors that led to this poor girl’s fate: her parents were
never home; teachers didn’t pay attention; counselors didn’t pay attention; other students, like
me, did realize that something was different with her, but no one ever told us that something like
this could happen to a teenager. If the students had been informed, we could have spoken with
the counselor, who would have then spoken with her parents, and just a little collaboration could
have saved this girl’s life.
Her name was Jessica but that was all we really knew. She never really socialized with us
and always seemed to be off sitting by herself. We just thought maybe she was shy. We tried
talking to her a couple times, but when she didn’t return the conversation, we gave up. After a
while, we noticed that she was starting to talk to people, and these people just happened to be the
known druggies in the school. But, it didn’t really seem that strange since they also were loners
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and outcasts. Not long after her new friendships began, she started coming to school late and
skipping classes. I don’t know that we really thought anything about it though. It was just what
those people did. It was expected. Surely some teachers or a counselor would also notice her new
acquaintances. So we just went on with our own business and pretty much ignored her. It wasn’t
until a couple years later that I finally found out what was wrong with her.
On the evening news, the reporter was talking about a girl from my high school. I rushed
to turn up the volume. It was then that they flashed her picture across the screen and said that she
had taken her own life with a drug overdose. I was in shock. We all knew she was a little
different, but suicidal? The reporter went on to say that she had been depressed all through high
school, never really had any friends, both her parents were workaholics and rarely even called to
check on her. She had experimented with drugs her freshman year, but it wasn’t until her junior
and senior years when the heavy drug use started. They reported that she had started with
marijuana, like most kids, but when that didn’t help, she moved up the line trying anything she
could get her hands on. It was heroine that eventually took her life.
Still in shock, I just stared at the screen. I couldn’t believe that this girl that was on the
drill team with me, was just, gone. Why hadn’t anyone realized what was going on with her? We
all knew her parents were never around, but we thought that it was cool. It never occurred to us
to talk to someone about her. We didn’t even know what depression was back then. Or if we did,
we thought it was only something that happened to adults. If we had known what depression was
and what it looked like, we may have saved this girl’s life.
As parents are either unavailable or unwilling to see the truth, classrooms are growing so
teachers are not able to provided one-on-one support, and students and teachers alike are not
informed on the signs of depression, counselors should be at the forefront of this fight against
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adolescent depression. School counselors have the knowledge and experience to work with
adolescents in any situation. A child’s depression can be caused by numerous factors, but if that
child had just one person looking out for them no matter what, it will change their life.
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REFRENCES
Koplewicz, Harold S. "More than moody: recognizing and treating adolescent depression.
(Cover story)." Brown University Child & Adolescent Behavior Letter 18.12 (2002): 1.
Web. 20 Feb. 2011.
Carwile, Brandie. “Adolescent Depression.” Department of Psychology, Northern Illinois
University. <http://www.cedu.niu.edu/~shumow/iit/ Depression.pdf>.
Wen-Jui, Han, and Daniel P. Miller. "Parental work schedules and adolescent depression."
Health Sociology Review 18.1 (2009): 36-49. Web. 20 Feb. 2011.
Evans, Julia R., Patricia Van Velsor, and Joseph E. Schumacher. "Addressing Adolescent
Depression: A Role for School Counselors." Professional School Counseling 5.3 (2002):
211. Web. 20 Feb. 2011.
"Adolescent depression treatment: Findings from the NSDUH." Brown University Child &
Adolescent Behavior Letter 25.7 (2009): 4-5. Web. 20 Feb. 2011.
"Health Insurance and State: NCSL Overview, 2011." National Conference of State Legislatures.
National Conference of State Legislatures, Feb 2001. Web. 13 Apr 2011.
<http://www.ncsl.org/?TabId=14509>.
Raz, Amir. "Perspectives on the Efficacy of Antidepressants for Child and Adolescent
Depression." PLoS Medicine 3.1 (2006): e9-0041. Web. 20 Feb. 2011.
Brody, Amanda E. "Motivational interviewing with a depressed adolescent." Journal of Clinical
Psychology 65.11 (2009): 1168-1179. Web. 20 Feb. 2011.