Prevalence of depression among adolescents

Last Updated 13 Oct 2007, 07:11 +04:00

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OBJECTIVE : To find out the prevalence and pattern of depression among adolescents. METHODS : Adolescents of age group from 13 to 19 belonging to school/college students and school dropouts were assessed using Beck’s Depression Inventory (BDI) by a team consisting of a pediatrician, psychologist and PGDCCD (Post Graduate Diploma in Clinical Child Development) students. RESULTS : 11.2% of school dropouts had severe and extreme grades of depression as against 3% among school going and nil among college going adolescents.

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Adolescence is a stage of emotional instability, being the transition period from childhood to adulthood. Traditionally in the joint family system we imbibed a great deal of understanding and skills and moral values from our family members. Adolescents have stress, as they get confusing message, have conflicts with in family and school and have difficulties in establishing self-identify and self-esteem. It is a time of increased thinking emotionality and empathy. As a result it is also a time for mood swings ranging from depression to the height of elation. Personal adjustment problems and unhappy family environment may be factors contributing to depression.
The term depression describes a wide range of emotional lows, from mere sadness to a pathological suicidal state. Though the term “depression” can describe a normal human emotion, it also can refer to a psychiatric disorder. Depressive illness in children and adolescents include a cluster of symptoms, which have been present for at least two weeks. As suggested by Sugar, in adolescents it may be a part of the adolescent developmental process, resulting from the giving up of childlike security in the drive for separation and independence.[1] However, moderate and severe depression can affect the scholastic performance of adolescents. Hence this study was undertaken to find out prevalence and pattern of depression among school going, college going and school dropouts.

Materials and Methods
The study sample consisted of 1014 adolescents from Thiruvananthapuram District Kerala, including all 16 school dropout girls of one panchayat, 388 school going girls of class IX, XI and XII, 430 school going boys of Class XI and XII and 80 college going girls of B.Sc. Home Science. In this study prevalence of depression was assessed using Beck’s Depression Inventory (BDI), a mood-measuring device developed by Dr. Aaron T. Beck. This multiple-choice questinnaire has 21 groups of statement with the score for each statement ranging from 0 to 3 and the total score being 63. A score of 0-16 is considered as normal, 17-20-border line clinical depression, 21-30 moderate depression, 31-40 severe depression and over 40 is extreme depression. The cut off score for depression, taken in this study is 16 as has been done in many previous studies.[2],[3],[4]

Results
Prevalence of severe and extreme depression among adolescents using BDI was 9.5% and 1.7% respectively among school dropout girls, 2.6% and 0.2% respectively among school going girls, 1.4% and 0.2% respectively among school going boys and nil among college going girls.

Discussion
A number of epidemiological studies have reported that up to 2.5% of children and up to 8.3% of adolescents in the US suffer from depression.[5] An NIMH-sponsored study of 9 to 17-year-olds have estimated that the prevalence of any depression is more than 6% in a 6-month-period, with 4.9% having major depression.[6] A recently published longitudinal prospective study found that early-onset depression often persists, recurs, and continues in to adulthood, and indicates that depression in youth may also predict more severe illness in adult life. Depression in young people often co-occurs with other mental disorders, most commonly anxiety disruptive behaviour, or substance abuse disorders.[7] In addition, research indicates that depression onset is occurring earlier in life today than in past decades.[8] Hence it was appropriate to study the prevalence of depression among adolescents both school/college going and among school dropouts.
Epidemiological utility and characteristics of the Beck Depression Inventory (BDI) were examined in a sample of 304 non-clinical adolescents.[9] Psychopathological diagnosis according to ICD-10 criteria were assessed by the Schedules for Clinical Assessment in Neuropsychiatry. The depressed adolescent scores were significantly higher than for non-depressed adolescents. Different scores as discriminators of depression subtypes were reported and according to the rates of sensitivity and specificity, the best cut off scores found were 16 for major depression. Thus the BDI proved to be a reliable and valid instrument that could be used as a depression screening in non-clinical adolescents and hence it was appropriate to use in this study Beck’s inventory with a cut off score of 16.
The observation that the school dropout girls have a higher prevalence of 11.2% severe and extreme depression as against 2.8% among school going girls and nil among college going girls may suggest that out of school girls do not have opportunities for meaningful social interaction and hence need to be specially targeted for intervention. The observation that 22.4% of school going girls and 12.8% of school going boys had depression of various grades suggest that at the school level both boys and girls must have access to group counselling facilities within the school and for the needy ones, individual counselling facilities at least within the educational district.

Acknowledgement
1. Dr. Babu George, Medical Superintendent, Child Development Centre (CDC) 2. Mr. G. Suresh Kumar, Registrar, CDC. 3. Deepa Susan Chacko, Consultant Adolescent Pediatrician, CDC 4. Dr. Narayanan Potti, Consultant family physician, CDC 5. Heads of the schools who participated in the study 6. PG-DCCD students 1999-2001, CDC 7. N. Asokan, Word Processing Assistant, CDC.

References
1.Sugar M. Normal Adolescent Mourning. Am Psych 1968; 22: 258-269.
2.Carter CL, Dacey CM. Validity of the Beck Depression Inventory, MMPI and Roras chach in assessing adolescent depression. Adoles 1996; 19(3) : 223-231.
3.Bennett, D.S. Ambrosini PJ, Bianchi M, Barnett D, Metz Rabinovich H. Relationship of Beck depression inventory factors to depression among adolescents. Affective Dis Sep; 45(3) : 127-134.
4.Winter BL, Steer RA, Jones-Hicks L, Beck AT. Screening for major depression disorder in adolescent medical outpatients with the Beck Depression Inventory for Primary Care. J Adoles Health 1999; 246(6) : 389-394.
5.Birmaher B, Rayan ND, Williamson DE et al. Childhood and adolescent depression: a review of the past 10 years. Part I. J Am Academy of Child and Adolescent Psychiatry 1996; 35(11) : 1427-1439.
6.Shaffer D, Fisher P, Dulkan MK et al. The NIMH Diagnostic Interview Schedule for Children version 2.3 (DISC - 2.3): description, acceptability, prevalence rates and performance in the MECA study. J Am Academy of Child and Adolescent Psychiatry 1996; 35(7) : 865-877.
7.Weissman MM, Wolk S, Goldstein RB et al. Depressed adolescents grown up. J Am Med Association 1999; 281 : 1701-1713.
8.Klerman GL, Weissman MM. Increasing rates of depression. J Am Med Association 1989; 261 : 2229-2235.