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Book Title: Treating and Preventing Adolescent Mental Health Disorders
> pp. [xl]-[4]
UNDEFINED: AUTHORS
Treating and Preventing Adolescent Mental Health Disorders
Print ISBN 9780195173642, 2005
pp. [xl]-[4]
delivery systems, and barriers to care. In this chapter, a review of the key recommendations made by the seven commissions culminates in a call to the nation to make a sustained effort to enhance adolescent mental health through science and policy changes. Adolescent mental health in the United States is, simply put, much poorer than it ought to be. We hope this book provides the reader with a new and comprehensive focus on adolescent mental health and positive youth development. To the extent that we have achieved that aim,
we believe the recommendations contained here, if acted on, have the potential to (1) promote improved adolescent mental health and related physical health; (2) prevent adolescent and adult mental illness and related physical illness; (3) promote positive youth development and help adolescents reach their potential; (4) advance the treatment and rehabilitation of mental illness and related physical illness; and (5) raise the level of adolescent mental health to a standard that this nation can look on with pride.
end p.xl
PRINTED FROM Treating and Preventing Adolescent Mental Health Disorders (www.oup.com/amhi-treatingpreventing)
© Copyright Oxford University Press, 2006. All Rights Reserved
Part I
Depression and Bipolar Disorder
COMMISSION ON ADOLESCENT DEPRESSION AND BIPOLAR DISORDER
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end p.1
PRINTED FROM Treating and Preventing Adolescent Mental Health Disorders (www.oup.com/amhi-treatingpreventing)
© Copyright Oxford University Press, 2006. All Rights Reserved
end p.2
PRINTED FROM Treating and Preventing Adolescent Mental Health Disorders (www.oup.com/amhi-treatingpreventing)
© Copyright Oxford University Press, 2006. All Rights Reserved
CHAPTER 1 Defining Depression and Bipolar Disorder
end p.3
PRINTED FROM Treating and Preventing Adolescent Mental Health Disorders (www.oup.com/amhi-treatingpreventing)
© Copyright Oxford University Press, 2006. All Rights Reserved
The development of adolescent mood disorders involves a complex, multifactorial model (e.g., Akiskal & McKinney, 1975; Cicchetti, Rogosch, & Toth, 1998; Kendler, Gardner, & Prescott, 2002). No single risk factor accounts for all or even most of the variance. The most likely causal model will include individual biological and psychological diatheses that interact with various environmental stressors. There is little question that early onset is highly related to recurrence in adulthood, whether the data derive from clinical samples (Kovacs, Akiskal, Gatsonis, & Parrone, 1994), long-term population studies (Kessler and Walters, 1998), studies of high school students (Lewinsohn, Rohde, & Seeley, 1998), or studies of depressed patients (Rao et al., 1995). Over 50% of depressed adolescents had a recurrence within 5 years (Birmaher et al., 1996; Lewinsohn, Rohde, Seeley, Klein, & Gotlib, 2000), although only a small portion continues to have significant psychopathology in any one year. The few studies of depressed adolescents followed into adulthood show strong continuity between adolescent and adult depression (Frombonne, Wostear, Cooper, Harrington, & Rutter, 2001; Harrington, Fudge, Rutter, Pickles, & Hill, 1990; Weissman, Wolk, Goldstein et al., 1999; Weissman, Wolk, Wickramaratne, et al., 1999) and an increased risk of suicide attempts as well as psychiatric and medical hospitalization. Studies of prepubertal depression also show continuity into adolescence (Kovacs & Gatsonis, 1994). The most serious outcome is suicide, which is the third leading cause of death among adolescents. Other outcomes include lack of social development and skills, withdrawal from peers, poor school performance, less than optimal career and marriage choices, and substance abuse (Frost, Reinherz, Pakiz-Camra, Fiaconia, & Lekowitz, 1999; Rao et al., 1995; Weissman, Wolk, Goldstein, et al., 1999). This chapter reviews the epidemiology and definitions of mood disorders in children and adolescence. The psychological, social, and biological factors that have been shown to increase the risk of mood disorders in children and adolescents are also discussed.
For many years, children and adolescents were thought incapable of experiencing depression, according to the psychoanalytic concept of the underdeveloped superego. Thus depression was considered “an adult disease.” However, case reports from as early as the 17th century described adolescents exhibiting symptoms resembling those observed in adults with depressive disorders. In 1975, the National Institute of Mental Health (NIMH) convened a meeting of thought leaders to discuss the incidence and diagnosis of depression among children. This meeting, followed by the publication of a book by Shulterbrant and Ruskin ( 1977), finally made clearer the diagnosis and the existence of depression acceptable in this population. The last two decades have witnessed a burgeoning database on the age of onset of mood disorders. Major depressive disorder (MDD) is no longer seen primarily as a disorder of the middle-aged and elderly. Epidemiologic and clinical research from the United States and elsewhere has clearly documented that the age of first onset of major depression is commonly in adolescence and young adulthood and that prepubertal onsets, while less common, do occur. It is now clear that adolescent depression is a chronic, recurrent, and serious illness. The offspring of depressed parents, compared with children of nondepressed parents, have an over 2-to 4-fold increased risk of depression. Depressions occurring in adolescents share similar features with those of depression at other ages. Across ages, symptom patterns are similar; rates among females are higher (2-fold risk); there is high comorbidity with anxiety disorders, substance abuse, and suicidal behaviors; and high social, occupational, and educational disability can accompany depression (Angold, Costell, & Erkanli, 1999; Costello et al., 2002). In contrast, childhood MDD tends to be male predominant, mood reactive, and commonly associated with high levels of irritability and dysphoria and tends to have very heavy comorbidity with the disruptive behavior disorders (Biederman, Faraone, Mick, & Lelon, 1995; Leibenluft, Charney, Towbin, Bhangoo, & Pine, 2003). The epidemiologic data on childhood and ad
end p.4
doi:10.1093/9780195173642.003.0002
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