Identifying pathways and patterns of adolescent depression
Strategies for identifying and preventing adolescent depression: Summarizing 15 years of research
With depression predicted to contribute to an increased disease burden in coming decades, prevention efforts have become increasingly important. Prevention needs to commence early in the lifecycle, possibly even with children as young as four years of age. To identify children and adolescents who are most at risk, our research looked to understand sub-groups of children with similarities in the development of depressive symptoms over time. We reviewed twenty English language longitudinal studies published between 2002 and 2015 originating in USA (8), Canada (5), Netherlands (2), Germany, Finland, Chile, Holland, and the UK/Wales/Scotland. We found five subgroups of children and adolescents through a unique statistical analysis known as trajectory modeling. While the majority (56%) of children followed a ‘No or low’ depressive symptom trajectory over time, 26% followed a ‘Moderate’ depressive symptom trajectory and 12% followed ‘High’, ‘Increasing’, or ‘Decreasing’ depressive symptom trajectories (total of 94% is due to rounding across studies).
Some key findings:
- the majority of children move through the teenage years and early adulthood unscathed by depressive symptoms
- this group were characterised by strong protective factors of positive parental relationships and social/peer support.
- children and adolescents in the moderate depressive symptom subgroup, including children as young as four years of age, were consistently associated with higher risk factors and poorer adjustment and outcomes relative to those in low symptom subgroup.
- risk factors included female gender, low socio economic status, stressful life events, conduct issues, and substance use.
- poor adjustment or outcomes included prolonged depressive symptom trajectories, poorer academic achievement, poorer health outcomes and lifelong tobacco/other substance use.
So what helps prevent or moderate depression in children and adolescents? We were able to confirm findings from previous resilience research that supportive parents and peers are strong protective factors against the development of depressive symptoms in middle to late childhood. Providing parental psycho-education on the importance of scaffolding children to develop positive coping skills, self-regulation, a sense of agency and self-efficacy, problem-solving, empathy and social skills may increase the protective factors available to an adolescent. Similarly promoting family cohesion, strong familial support and supportive peer relationships may also prevent the development of depressive symptoms.
The resilience literature identifies that interventions may be structured or everyday strategies, to be implemented in early childhood (0-12 years) and aimed at reducing risk factors. Resilience in children, it is argued, is built through focused effort in the following areas:
- Educating people right across society about resilience
- Building, strengthening and promoting supportive relationships
- Focusing on autonomy and responsibility
- Focusing on managing emotions
- Creating opportunities for personal challenge
Future longitudinal trajectory research into child and adolescent depressive symptoms may do well to build on the resilience research to discern which of these areas are most important in supporting the development of resilience in children to the development of depressive symptoms over time.
Lori Shore B.A, Grad Dip. Couns. Psych., M. Comm, M. Psych (Clin), PhD is a Clinical, Counselling and Organisational Psychologist affiliated with Deakin University, Geelong, Victoria, Australia. Her research has focused on depression in children and adolescents.
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