Fact Sheet #99-70
Patrick Day, M.A.
Southern Area Specialist
Depression is regarded as the major psychiatric disorder of the
20th century, affecting approximately sixteen million people in
North America [1,2]. It also seems to affect at least 6% of youth
per year, [2] although young women will experience depressive
episodes more frequently than young men. Nationally, of every
100,000 adolescents, almost three thousand will experience depressive symptoms, with eight to ten
suicides out of this group [3]. Depression also affects the youth of Southern Nevada, especially those
experiencing major transitions in their lives. For example, the Nevada Division of Child and Family
Services recorded 448 episodes of treatment for depression among 2,089 youth in managed care in
Clark County between July, 1997 and June of 1999 [4].
Signs of depression may be caused by something as minor as receiving a poor grade, something
more stressful such as placement in or preparing to leave foster care, or as tragic as the death of a
loved one. Typically most people are able to come to terms with the event that caused the depressed
feeling and are able to get on with their lives.
Occasionally, the process spirals downward to the point that they are overwhelmed and no longer
able to cope without professional help. If left untreated, depression in adolescents may interfere with
natural growth and development. In severe cases it can lead to thoughts or acts of personal harm or
suicide.
It is not uncommon for young people to be preoccupied with issues of mortality and to contemplate
the effect their death would have on those around them. Thankfully, these ideas usually are often not
acted out. However, any statements involving suicidal thought must be taken seriously and acted
upon immediately. (See Resources
Youth in out-of-home Placement
Youth in out-of-home settings are dealing with many events that may cause them to feel sad, lonely,
hopeless and unable to control any aspect of their life. They are coping with removal from their
normal environment, adapting to strangers deciding what is in their best interest, possibly being
denied visitation opportunities with their family of origin and expected to conform to rules and
boundaries that may be completely outside of their realm of experience.
Depression in such situations can occur and may cover a wide range of symptoms (see Table 1).
Feeling depressed, in varying levels of intensity, has been experienced by most of us. It is an integral
part of the human condition and has been referred to as the "common cold of mental health" [5].
Table 1 Levels of Depression with selected symptoms
Bad Mood
Mild Depression
Situational Depression
Major Depression
This describes
temporary
frustrations, a
normal
reaction
May feel sad but
can still find
enjoyment in
surroundings and
activities
Response to normal,
healthy sadness about
some loss or major life
changes. Can, without
treatment; support; or
intervention, lead to
major depression
Sadness that won’t go away;
noticeable loss of energy; tiredness;
difficulty concentrating or making
decisions; difficulty sleeping or
waking up; feeling irritable; feelings
of guilt and worthlessness; unable
to enjoy former interests; having
consistent thoughts of death and
suicide
Characteristics of Depression by Age Group [6]
Ages 6-12
As children reach school age, symptoms of depression will begin to be more identifiable than those of
younger children. The child may attempt to verbalize their feelings of sadness and feeling helpless.
Usually children in this age group do not have the vocabulary to clearly express how they are feeling.
See Table 2
LEGEND for recognition signs that are observed in different age groups
• L - Low Frequency
• M - Moderate Frequency
• H - High Frequency
• VH - Very high Frequency
It must be pointed out that there may be other explanations for these behaviors. No single symptom is
significant by itself. Observing multiple symptoms, as outlined above, may be evidence of something
going on with the young person. The concerns should be discussed with the young person and with
their case manager, counselor or therapist. This is especially true if five or more symptoms are
observed in a two-week period[8]. The subject of suicide, especially with adolescents, must be taken
very seriously. Immediate steps must be taken to assure the young person is not in imminent danger
and an assessment made by a competent mental health professional. See "resources" for a list (by
county) of suicide prevention resources in Southern Nevada.
Ages 12-18
Adolescents who are not depressed go through periods of unhappiness, loneliness, and
dissatisfaction with adults or themselves, experimentation with drugs and alcohol, and emotional
turmoil [7]. This is an intensely stressful time in their development. As with younger children,
adolescents may exhibit outward signs due to a lack of verbal ability. See Table 2
Table 2 Recognition Signs
612
1218
A dramatic decline in performance when recent performance has been satisfactory. This
applies to school work; chores or sports
M
M
The avoidance of activities that have been enjoyable in the past.
M
M
Sudden changes in eating patterns. Either not eating or over-eating (especially true for
adolescents).
M
H
Fatigue with no apparent cause, wants to sleep at unusual hours. Difficulty sleeping
during normal sleep pattern
M
H
Complaining of boredom over a prolonged period of time when activities are available
that have been enjoyed in the past
M
M
Low self-esteem. May refer to themselves as dumb or stupid.
M
M
Apathy or not seeming to care about anything.
M
M
Volatile mood, easily angered over trivial (to the observer) incidents. May go into rages
that quickly subside or that may turn violent.
L
H
Social withdrawal; moodiness; irritability; alienation from peers. This may not be as
noticeable at first, but as the depression continues or deepens, peers may withdraw
because of behaviors exhibited by the youth.
L
H
Intense self-consciousness. This would be more pronounced than the normal selfconsciousness exhibited by most adolescents.
L
H
Substance abuse – either drugs or alcohol or both. This may be an attempt at selfmedication to ease the pain of what they are experiencing. This would be more severe
than casual experimentation.
L
H
Sexual acting-out beyond the normal experimentation of adolescents. May include
extreme promiscuous behavior, unsafe practices or self-degrading behavior.
L
H
Thoughts or threats of suicide. This must be taken seriously. Since a significant risk of
suicide exists in the adolescent group, any evidence of suicidal thought must be taken
seriously and acted upon immediately!
H
VH
This is not intended, nor should it be used, as an assessment instrument or treatment planner. The
purpose of this document is to provide basic information regarding depression in school-age children
and adolescents.
Many different approaches to treatment of depression are available. Because it is sometimes difficult
to identify, as well as treat, the assistance of a trained professional is very important in this process.
This publication does not address the variety of treatment protocols for depression, for they are best
addressed in a separate forum. A separate fact sheet reviewing some of the common approaches to
treatment of depression in children and adolescents is in process.
Resources
Clark County
Suicide Prevention Center of Clark County = (702) 731-2990
Lincoln County
Family Crisis Center (Volunteer staffing) = (775) 962-5888 (days) (775) 962-5262 (evenings)
Nye County
Mental Health Crisis Line = (800) 992-5757
References
1. National Institute of Mental Health. (1994). Helpful Facts About Depressive Illness. (NIH
Publication No. 94-3875). Bethesda, MD: U.S. Government Printing Office.
2. National Institute of Mental Health. National Data for Depressive Episodes in Youth. (1999).
[Electronic Data Base]. Cave, L. (Producer) Bethesda, MD
3. Brown, A. (September 14, 1999). Mood Disorders in Children and Adolescents. National
Alliance for Research on Schizophrenia and Depression. Internet. www.narsad.org
4. Nevada Division of Child and Family Services. (1999). Statistical Data on Selected DSM-IV
Cases. [Electronic Data Base]. Thomas, J. (Producer). Las Vegas, NV
5. Seligman, M.E.P. (1975). Helplessness: On depression, development and death. San
Francisco: Freeman
6. Kronenberger, W.G., Meyer, R.G. (1996) The Child Clinician's Handbook. (pp. 155-210).
Needham Heights, Mass.: Allyn & Bacon
7. Sallee, E., (1996). Diagnosis and Treatment of Emotionally Disturbed Pre-Adolescents and
Adolescents. Unpublished manuscript. National University, Sacramento, CA
8. American Psychiatric Association: (1994). Diagnostic and statistical manual of mental
disorders (4th ed.). Washington D.C.: American Psychiatric Association
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