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
- Emotional changes:
- Feelings of unhappiness, 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 you once
- Tiredness, lack of energy and motivation
- Feeling worried or tense
- Cognitive changes:
- 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
- Behavioral changes:
- Poor attention to personal hygiene and appearance
- Decreased participation with peers and normally enjoyed
- Self harm or deteriorated self-care or promiscuity
- Avoidance of family interactions and activities
- More withdrawn behaviour including clearly more time spent
- Physical changes:
- Loss of appetite and weight (but sometimes people 'comfort eat'
and put on weight)
- Either trouble sleeping, or over-sleeping and staying in bed
most of the day
- Lowered libido
- Restlessness and agitation
- Unexplained aches and pains
Onset of depression in young people
Depressive disorders tend to first appear in adolescence or
early adulthood (1,2). One in
every five adolescents are likely to experience a diagnosable
depressive episode by the age of 18 (3,4). In Australia, it's estimated that 6 to 7 percent
of young people aged 16 to 24 will experience depression in any
year. The rates tend to be higher among young females (8.4%)
compared to young males (4.3%)(5).
A number of factors are known to increase the likelihood that a
person will experience a depressive disorder. They include:
- Genetic vulnerability (for example, depressive disorders in
other family members)(6), especially in females
- Stressful life events, especially family adversity (8) and interpersonal difficulties. These stressors
seem to be more important in the development of the first episode
of depression than in subsequent episodes (9),
and in people with a genetic vulnerability (7, 10-11).
- Low self-esteem, a sense of low self-efficacy, and a sense of
helplessness and hopelessness (12).
- Fluctuating mood, or 'ups and downs', in the past (13).
Protective factors that can reduce the risk that a young person
will develop depression include the presence of a supportive adult,
good interpersonal relationships, a strong sense of self (14), family cohesion and social support (15).
Depression and other mental health problems
Depression is often associated with other mental illnesses, such
as anxiety disorders, disruptive behaviour disorders and substance
use disorders (3, 16-17).
Depressive disorders are the most common identifiable risk
factor for suicide (18-22).
1.Kessler, RC, Berglund, P, et al. Lifetime prevalence and age-of-onset distributions
of dsm-iv disorders in the national comorbidity survey
replication. Arch Gen Psychiatry. 2005 Jun;62(6):593-602.
2.Rutter, M. Relationships between mental disorders in
childhood and adulthood. Acta Psychiatr Scand. 1995
3.Birmaher B, Ryan ND, Williamson DE, Brent DA,
Kaufman J, Dahl RE, Perel J, Nelson B. Childhood and adolescent depression: a review of
the past 10 years.Part I. J Am Acad Child Adolesc Psychiatry.
4.Lewinsohn PM, Hops H, Roberts RE, Seeley JR,
Andrews JA. Adolescentpsychopathology: I. Prevalence and incidence of depression and other
DSM-III-R disorders in high school students. J Abnorm Psychol.
5.Australian bureau of statistics. 2007 national survey of mental health and
wellbeing: Summary of results. (document 4326.0). 2008
6. Sullivan PF, Neale MC, Kendler KS. Genetic epidemiology of major depression: review
and meta-analysis. Am J Psychiatry. 2000
7. Goldberg D. The aetiology of depression. Psychol Med. 2006
8. Fergusson DM, Lynskey MT. Adolescent resiliency to family adversity. J
Child Psychol Psychiatry. 1996 Mar;37(3):281-92
9. Lewinsohn PM, Allen NB, Seeley JR, Gotlib IH.
First onset versus recurrence of depression:
differential processes of psychosocial risk. J Abnorm Psychol.
10. Kendler KS. Twin studies of psychiatric
illness. Current status and future directions. Arch Gen
Psychiatry. 1993 Nov;50(11):905-15.
11. Kendler KS, Kessler RC, Walters EE, MacLean C,
Neale MC, Heath AC, Eaves LJ. Stressful life events, genetic liability, and onset
of an episode of major depression in women. Am J Psychiatry.
12. Asarnow JR, Carlson GA, Guthrie D. Coping strategies, self-perceptions, hopelessness,
and perceived family environments in depressed and suicidal
children. J Consult Clin Psychol. 1987 Jun;55(3):361-6.
13. Angst J, Gamma A, Endrass J. Risk factors for the bipolar and depression
spectra. Acta Psychiatr Scand Suppl. 2003;(418):15-9.
14. Beardslee WR, Podorefsky D. Resilient adolescents whose parents have serious
affective and other psychiatric disorders: importance of
self-understanding and relationships. Am J Psychiatry. 1988
15. Carbonell, D. M., Reinherz, H. Z., &
Giaconia, R. M. (1998). Risk and resilience in late adolescence.
Child and Adolescent Social Work Journal, 15, 251-272.
16. Kovacs M. Presentation and course of major depressive
disorder during childhood and later years of the life span. J
Am Acad Child Adolesc Psychiatry.1996 Jun;35(6):705-15.
17. Kovacs M, Gatsonis C, Paulauskas SL, Richards
C. Depressive disorders in childhood. IV. A
longitudinal study of comorbidity with and risk for anxiety
disorders. Arch Gen Psychiatry. 1989 Sep;46(9):776-82.
18. Lewinsohn, PM, Gotlib, IH, et al. Gender differences in anxiety disorders and anxiety
symptoms in adolescents. J Abnorm Psychol. 1998
19. Spirito A, Esposito-Smythers C. Attempted and completed suicide in adolescence.
Annu Rev Clin Psychol. 2006;2:237-66.
20. Sanchez LE, Le LT. Suicide in mood disorders. Depress
21. Esposito, CL, Clum, GA. Psychiatric symptoms and their relationship to
suicidal ideation in a high-risk adolescent community sample. J
Am Acad Child Adolesc Psychiatry. 2002 Jan;41(1):44-51.
22. Brent DA, Kalas R, Edelbrock C, Costello AJ,
Dulcan MK, Conover N. Psychopathology and its relationship to suicidal
ideation in childhood and adolescence. J Am Acad Child