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Depression and Public Health
1
Subject: HAS911: Contemporary Issues in Public Health
Assessment 4: Report
Assessment Title: Puberty Blues: Interventions for addressing adolescent depression
Report Due Date: 4th of June 2017
Tutor: Catherine MacPhail
Tutorial group: Wednesday, 1:30pm
Student Number:
Word Count: 2,253
Depression and Public Health
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Executive Summary:
Depression is undoubtedly a public health issue and, globally, its effects are
devastating. Adolescents are particularly burdened by depression, as this mental
disorder is associated with significant functional impairment, a myriad of long-term
problems and suicide. Thus, it is vital to public health that effective prevention
interventions are available to address adolescent depression. The purpose of this
report is to provide an examination of the impact of depression on adolescents.
Furthermore, this report examines the interventions that have sought to produce
change.
This report reveals three prevention interventions that have demonstrated efficacy.
These are family-based interventions, internet-based interventions and lifestyle
interventions. Whilst these interventions present equally unique approaches to
adolescent depression prevention, it was the family-based prevention intervention that
emerged as the most successful. This was due to the intervention’s focus on the
family system, adolescent specific risk factors and a longitudinal study design.
This report concludes that the prevention of adolescent depression is possible.
Prevention interventions that are well designed, and ensure the incorporation of
specific risk and protective factors can produce immense change. However, as
depression continues to persist amongst many adolescents globally, it is
recommended that further research is needed. Once suitable and efficacious
preventions
interventions
dissemination can occur.
are
identified,
widespread
implementation
and
Depression and Public Health
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Table of Contents:
Executive Summary………………………………………………………………p.2
Table of Contents…………………………………………………………………p.3
1. Introduction…………………………………………………………………….p.4
1.2 What is depression, and why is it a public health issue?………………….p.5
1.3 Depression and adolescents…………………………………………..p.6
2. Interventions that have been implemented to produce change for adolescent
depression……………………………………………………………………..p.7
2.1 Introduction………………………………………………………..p.7
2.2 Intervention one……………………………………………………….p.8
2.3 Intervention two……………………………………………………….p.9
2.4 Intervention three………………………………………………………p.10
2.5 Comparison and contrast of interventions…………………………….p.11
3. Conclusion………………………………………………………………………p.13
4. References……………………………………………………………………….p.14
5. Appendices………………………………………………………………………p.18
5.1 Appendix A……………………………………………………………p.19
5.2 Appendix B……………………………………………………………p.20
Depression and Public Health
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Puberty Blues: Interventions for addressing adolescent depression
1. Introduction:
A significant contributor to the global burden of disease is the mental disorder
depression (World Health Organisation 2012). Depression transcends geography,
ethnicity, age and sex (Schuch et al. 2016, p.48). It is estimated that depression affects
over three hundred and fifty million people worldwide (World Health Organisation
2012; Vilhelmsson 2014). It is the predominant cause of disability, and is associated
with various unfavourable health, social and personal outcomes (World Health
Organisation 2012; World Health Organisation 2017). Due to its high prevalence, cost
to society and relationship with suicide, depression has become a significant public
health issue (Merry et al. 2011). Depression is also a common problem for
adolescents (Gladstone, Beardslee & O’Connor 2011; Merry et al. 2011, p.1414).
Fifty percent of mental disorders emerge during adolescence, and by the age of
eighteen, one in five adolescents will have experienced a diagnosable depressive
episode (Cairns et al. 2014; Black Dog Institute 2016; Das et al. 2016). Adolescent
depression is associated with the disruption of healthy development, long-term
adverse outcomes and an increased risk for suicide (Gladstone, Beardslee &
O’Connor 2011; Merry et al. 2011; Hetrick, Cox & Merry 2015). Given the prevailing
impact and burden of depression on adolescents, it is imperative that effective
interventions are identified and implemented (Das et al. 2016, p.50). This report will
explore depression as a significant public health issue and its impact on adolescents.
This report will also examine three prevention interventions that have produced
change. The effectiveness and ethical practice of these interventions will be discussed.
Depression and Public Health
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1.2. What is depression, and why is it a public health issue?
Remarkable advances have been made in the management and awareness of
mental disorders over the last decade, but the prevalence of depression continues to be
a challenge worldwide. It has been predicted that by 2030, depression will be
associated with the highest level of disability attributed to any physical or mental
disorder worldwide (Australian Psychological Society 2012). Depression, or major
depressive disorder is commonly referred to as clinical depression (Purcell et al.
2013). Depression is characterised by sadness, low self-worth, lethargy, poor
concentration, disturbed sleep, agitation, a loss of interest in daily activities and
feelings of guilt (World Health Organisation 2012; World Health Organisation 2017).
The aetiology of depression is complex, and occurs due to a combination of
psychological, social and biological factors (Merry et al. 2011, p.1414; Beyond Blue
2016). There are different types of depressive disorders, with symptoms that range
from relatively minor to severe (Purcell et al. 2013). Depression may also be chronic
or recurrent. Nevertheless, individuals with depression can become severely impaired
and may not be able to function effectively in their everyday lives (World Health
Organisation 2012; Purcell et al. 2013).
Depression has shown to reduce the health of an individual more than diseases
such as arthritis, asthma, angina and diabetes (Jacob 2012; Kvam et al. 2016). There
are significant personal and social costs that must also be considered, such as family
stress and the comorbidity of other mental disorders. Depression is often highly
correlated with anxiety, substance abuse and eating disorders. Perhaps most alarming,
depression leads to a substantial risk for suicide (Australian Psychological Society
2012). It is estimated that worldwide, one million lives are lost each year due to
pervasiveness of depression (World Health Organisation 2012).
Depression and Public Health
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1.3. Depression and adolescents:
It is clear that that depression has a detrimental effect on all individuals
worldwide (Kvam et al. 2016). However, it has been consistently identified in the
literature that young people are increasingly burdened by depression (Purcell et al.
2013; Hetrick, Cox & Merry 2015). Adolescence is not only a period characterised by
physical, emotional, social and educational development, it is a period that is marked
by the emergence of mental disorders such as depression (Cairns et al. 2014).
Depression can disrupt the healthy development of an adolescent, and result in
adverse long-term outcomes such as impairment in school, difficulties in the
workplace, dysfunctional interpersonal relationships, substance abuse and a risk for
suicide (Gladstone, Beardslee & O’Connor 2011; Merry et al. 2011; Cairns et al.
2014; Hetrick, Cox & Merry 2015). Suicide is now the third leading cause of death
for adolescents worldwide (Gladstone, Beardslee & O’Connor 2011). For Australia’s
youth, suicide is now the leading cause of death (Australian Bureau of Statistics
2014). As such, intervening in adolescence presents an optimal opportunity for
preventing depression (Hetrick, Cox & Merry 2015).
Depression and Public Health
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2. Interventions that have been implemented to produce change for adolescent
depression:
2.1. Introduction:
Adolescence is arguably the most promising period to intervene for
depression, due to its peak in incidence, high prevalence and long-term negative
outcomes (Gladstone, Beardslee & O’Connor 2011; Cairns et al. 2014). Adolescent
depression is generally treated using medication and evidence based treatments such
as cognitive behavioural therapy. Whilst these treatments can be beneficial, many
adolescents who receive treatment continue to receive residual symptoms, experience
relapse or do not respond at all. For these reasons, efforts for preventative
interventions are warranted (Gladstone, Beardslee & O’Connor 2011, p. 2).
It is imperative that prevention efforts for depressed adolescents involve a
comprehensive understanding of specific risk factors and protective factors. Specific
risk factors are those that are associated with increased risk for adolescent depression.
These include a lack of social support, negative cognitive styles, low self-esteem and
inadequate coping skills. Perhaps the strongest risk factor for adolescents is having a
parent with a history of depression. Indeed, the offspring of depressed parents have a
two-to-four fold increased risk in developing depressive disorders. Protective factors
for adolescent depression are those that include having support from parents, strong
family relationships, relationships with peers, and sufficient coping skills (Gladstone,
Beardslee & O’Connor 2011, p. 3). Targeting risk and protective factors within
prevention interventions may be the most efficient method of reducing the collective
impact of adolescent issues (Cairns et al. 2014, p. 73).
Depression and Public Health
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2.2. Intervention one:
The prevention of depression in the offspring of parents who have a history of
depression is a public health priority (Compas et al. 2015, p.542). As such, the
incorporation of the family system into prevention interventions for depressed
adolescents is becoming increasingly well established (Gladstone, Beardslee &
O’Connor 2011; Poole et al; 2017). Family-based interventions have the ability to
enhance youth engagement, target interactions between family members, increase
family cohesion, reduce family stressors and ensure adolescents have protective
family environments (Lewis at al. 2013, p. 4). Building upon their previous study,
Compas et al. (2015) sought to examine the efficacy and moderators of the family
cognitive behavioural prevention intervention for adolescents who have parents with a
history of depression. The design of the family cognitive behavioural prevention
intervention provides education to families about depressive disorders, increases
family awareness of depression and promotes adaptive coping strategies. It is a 12week program for families, which requires the inclusion of both parents and their
adolescent children (Compas et al. 2009; Compas at al. 2011; Compas et al. 2015).
The participants were assessed at 2, 6, 12, 18 and 24-months.
Compas at al. (2015) revealed that at the two-year follow-up, participation in
the intervention had successfully reduced depressive symptoms, depressive episodes,
internalising symptoms and externalising symptoms for the adolescents and their
parents. The results of the intervention provide support for the efficacy of the family
cognitive behavioural prevention intervention. It is clear that is possible to prevent the
onset of major depressive disorder. Whilst these achievements must be recognised,
there were a few limitations of the study. These limitations included not utilising a
diverse sample, not assessing the success of their blinding method and the inclusion
Depression and Public Health
9
of more mothers than fathers.
2.3 Intervention two:
A burgeoning approach to adolescent depression prevention is interventions
that are internet-based (Brunwasser & Garber 2016, p.779). Interventions delivered
through the Internet are cost-effective, and can increase participation, flexibility and
sustainability (O’Kearney et al. 2009; Gladstone et al. 2015; Brunwasser & Garber
2016). Kruger et al. (2017) evaluated the protective and risk factors for depression in
adolescents after they had undertaken the Internet intervention CATCH-IT
(Competent Adulthood Transition with Cognitive-Behavioral, Humanistic, and
Interpersonal Training). CATCH-IT is an internet-based depression prevention
program that targets at risk adolescents in a primary care setting. It is based on the
principles of cognitive behavioural therapy and provides resiliency skills to
adolescents through internet-based modules (Gladstone et al. 2015, p.2). Kruger et al.
(2017) examined factors that are known to protect against or increase the
development of depression. These included automatic negative thoughts, educational
impairment, social support from the family and social support from friends. The
adolescents were assessed at baseline, 6 weeks, and at 2.5 years.
Kruger et al. (2017) revealed that there was an enormous decrease in
automatic negative thoughts and educational impairment for the duration of CATCHIT. The CATCH-IT Internet intervention could be useful for not only interrupting the
vicious cycle of depression, but its prevention in adolescents. Nevertheless the
researchers highlighted a number of limitations. Limitations included the failure to
report any differences in perceived social support, not including a control group and a
non-representative sample. In addition, adherence to the Internet intervention proved
Depression and Public Health
10
difficult. At the final two and half year follow up, only half of the participants
remained in the study.
2.4. Intervention three:
The importance of lifestyle for adolescent mental health outcomes has also
been highlighted in the literature (Cairns et al. 2014, p.73). There are modifiable,
lifestyle related practices that can be promoted to young people. It appears that
exercise may be a lifestyle practice that is associated with lowered levels of
depression (Cairns et al. 2014, p.73). Indeed, there are an increasing number of
reviews that demonstrate an association between reduced depressive symptoms and
adolescent participation in exercise (Dopp et al. 2012, p. 2; Carter et al. 2016). Dopp
et al. (2012) conducted a twelve-week intervention that was designed to examine the
impact of aerobic exercises on depressive symptoms in adolescents. The exercises
were a combination of independent and supervised exercise sessions, whilst
performed on aerobic exercise equipment.
Dopp et al. (2012) revealed that not only did all participants report reductions
in their depression, these reductions were recognised in a clinician-administered
measure. The participants also reported their ongoing participation in exercise at the
three-month post intervention assessment. The results of the intervention suggest that
exercise levels are related to a moderate decrease in depressive symptoms.
Alternatively, exercise could be used as an adjunctive intervention for some
adolescents. This study highlights that ongoing research should urgently focus on the
relationship between exercise and depression (Dopp et al. 2012, p.7). However, the
study had a number of limitations that must be considered. Limitations included the
lack of blinding for the clinical staff administering the assessments, a lack of a control
Depression and Public Health
11
group and having no objective measure of exercise for the vast majority of the
independent exercise sessions. Some of the adolescents had also previously engaged
with medication and/or psychological interventions.
2.5. Comparison and contrast of interventions:
Upon comparing these prevention interventions, each displayed varying
successes and degrees of efficacy. Whilst entirely different interventions, Compas et
al. (2015) and Kruger et al. (2017) examined the specific risk and protective factors
for adolescent depression over an extended period of time. Despite a few limitations,
Compas at al. (2015, p.541) found that their study provided some of the strongest
evidence to date for at risk adolescents of parents who had a history of depression.
Kruger et al. (2017) concluded that the Internet interventions, such as CATCH-IT,
provide a new form of intervention available to adolescents. They are high quality,
cost effective, accessible and have proven some efficacy. In contrast, Dopp et al.
(2012) found that exercise levels were related to a moderate decrease in depressive
symptoms and emphasised that it could be used to influence the course of depression
in adolescence (Dopp et al. 2012, p.8). However, the researchers did not focus on
specific risk and protective factors for adolescent depression. Although exercise is
important to promote during adolescence, its ability to act as a protective factor
against depression is still largely unknown (Toseeb et al. 2014, p.1093).
The family cognitive behavioural prevention intervention, as examined by
Compas at al. (2015), proved to be perhaps the most effective intervention. The
significant reductions in depressive symptoms and sustained effects of the
intervention have important implications for depressed adolescents. As one of the
most powerful risk factor for adolescents is having a parent with a history of
depression, family-based interventions appear to be a promising and appropriate
Depression and Public Health
12
approach to preventing adolescent depression (Compas at al. (2015). Utilising
prevention interventions that focus upon the family can produce meaningful change
and positive long-term outcomes (Gladstone, Beardslee & O’Connor, 2011, p. 11).
Nevertheless, it should be noted that further, rigorous research and greater
coordination efforts for prevention will be required to adequately prevent adolescent
depression (Gladstone, Beardslee & O’Connor 2011; Brunwasser & Garber 2016)
Depression and Public Health
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3. Conclusion:
Adolescent depression is undoubtedly a significant public health issue.
Adolescent depression is devastating in nature. It erodes quality of life, impairs one’s
sense of purpose and increases the risk for suicide. However, the period of
adolescence presents a window of opportunity for prevention. Prevention
interventions for adolescent depression have shown to prevent the onset of depression
and are more beneficial than traditional forms of treatment, such as medication or
cognitive behavioural therapy. In this report, three different prevention interventions
that were shown to produce change were examined. Whilst these interventions
obtained varying successes and degrees of efficacy, the family cognitive behavioural
prevention intervention proved to be the most beneficial for adolescents with a high
risk of developing depression. This was due to the intervention’s adaption of
adolescent risk factors, longitudinal study design and focus upon the family as a
whole.
Depression and Public Health
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4. References:
Australian Bureau of Statistics 2014, Causes of Death, Australia, 2014, cat. no.
3303.0, ABS, Canberra.
Australian Psychological Society 2012, A review of depression diagnosis and
management,
Australian
Psychological
Society,
viewed
…
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