People with depressive disorders have persistently depressed
mood or loss of interest or pleasure in usual activities, often
accompanied by changes in thinking, behaviour and/or physical
health. Having depression is also a significant risk factor for
suicidal thoughts or actions.
The typical symptoms of major depression in a young person
- Feelings of unhappiness, or moodiness and irritability, and
sometimes emptiness or numbness
- Tearfulness or frequent crying
- Feelings of worthlessness and guilt, sadness and/or
- Losing interest and pleasure in activities that was once
- Tiredness, lack of energy and motivation
- Feeling worried or tense
- Difficulty concentrating and making decisions
- Being self-critical and self-blaming
- Negative body image and low self esteem
- Having dark and gloomy thoughts, including thoughts of death or
- Poor attention to personal hygiene and appearance
- Decreased participation with peers and normally enjoyed
- Self harm or deteriorated self-care
- Avoidance of family interactions and activities
- More withdrawn behaviour, including clearly more time spent
- Loss of appetite and weight (but sometimes people 'comfort eat'
and put on weight)
- Either difficulty sleeping, or over-sleeping and staying in bed
most of the day
- Lowered libido
- Restlessness and agitation, or being slowed down
- Unexplained aches and pains
Onset, prevalence, and burden of depression in young
Depressive disorders tend to first appear in adolescence or
early adulthood. Overall, about 25% of people who develop a
depressive disorder will do so before the age of 20 years, and 50%
before the age of 30 years (1).
Depression is the most frequently managed mental health problem
for young people aged 12-24 years, with 13.5% of GP encounters for
mental health reasons in Australia related to this disorder (3).
The lifetime prevalence of depression is 16.6% and the rates
tend to be higher among young females compared to young males. In a
single year, 3 in 100 Australian males aged 18-24 years, and 1 in
10 females of the same age will have a depressive disorder (1,2).
Depression is the leading contributor to the burden of disease
and injury in females aged 10-24 years, and the second leading
contributor (after road traffic accidents) for males of the same
A number of factors are known to increase the likelihood that a
person will experience a depressive disorder (5-7). They include:
- Genetic vulnerability (heritability of depression during
adolescence is estimated at 30-50%, and having a parent with
depression increases a person's risk of also developing depression
by 3-4 times (6))
- Stressful life events (more associated with females and those
with an underlying genetic vulnerability)
- Chronic relationship stressors or interpersonal
- Family adversity (e.g. negative family relationships)
- Peer victimization and bullying
- Unhelpful thinking styles that contribute to low self-esteem
and high self-criticism, a sense of low self-efficacy, and a sense
of helplessness and hopelessness
Having a genetic vulnerability or being exposed to adversity
does not mean a young person will develop a depressive disorder.
Research on resilience has found a number of protective factors
that can reduce a young person's risk of developing depression. The
most consistent finding is related to having good quality
interpersonal relationships (e.g. the presence of a supportive
adult). Other protective factors include having adaptive coping
mechanisms and thinking styles, and parental relationships that are
characterized by warmth and acceptance, and low hostility and
parental control (5,8).
Depression and other mental health problems
Depression is often associated with other mental illnesses, and
it is estimated that two-thirds of young people with depression
have at least one comorbid mental disorder (5).
Compared to young people who are not depressed, young people with
depression are 6-12 times more likely to have anxiety, 4-11 times
more likely to have a disruptive behavior disorder (e.g. conduct
disorder, ADHD), and 3-6 times more likely to have substance misuse
problems (9). Depressive disorders in young
people are also a major risk factor for suicide (5, 10).
- Kessler, R. C., Berglund, P., Demler,
O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions
of DSM-IV disorders in the National Comorbidity Survey
Replication. Archives of General Psychiatry,
- Australian Institute of Health and
Welfare 2011. Young Australians: their health and wellbeing
2011. Cat. no. PHE 140 Canberra: AIHW
- Australian Institute of Health and
Welfare 2007. Young Australians: their health and wellbeing
2007. Cat. no. PHE 87 Canberra: AIHW.
- Gore, F. M., Bloem, P. J., Patton, G.
C., Ferguson, J., Joseph, V., Coffey, C., ... & Mathers, C. D.
(2011). Global burden of disease in young people aged 10-24
years: a systematic analysis. The Lancet, 377(9783),
- Thapar, A., Collishaw, S., Pine, D.
S., & Thapar, A. K. (2012). Depression in adolescence. The Lancet,
- Rice, F., Harold, G., & Thapar, A.
(2002). The genetic aetiology of childhood depression: a
review. Journal of Child Psychology and Psychiatry,
- Birmaher, B., Ryan, N. D., Williamson,
D. E., Brent, D. A., Kaufman, J., Dahl, R. E., ... & Nelson, B.
(1996). Childhood and adolescent depression: a review of
the past 10 years. Part I. Journal of the American Academy
of Child & Adolescent Psychiatry, 35(11),
- Reivich, K., Gillham, J. E., Chaplin,
T. M., & Seligman, M. E. (2013). From helplessness to optimism: The role of
resilience in treating and preventing depression in youth. In
Handbook of Resilience in Children (pp. 201-214). Springer
- Costello, E. J., Foley, D. L., &
Angold, A. (2006). 10-year research update review: the epidemiology of
child and adolescent psychiatric disorders: II. Developmental
epidemiology. Journal of the American Academy of Child
& Adolescent Psychiatry, 45(1), 8-25.
- Cash, S. J., & Bridge, J. A.
(2009). Epidemiology of youth suicide and suicidal
behavior. Current Opinion in Pediatrics,