Depression in Adolescence

Anne C. Petersen, Bruce E. Compas, Jeanne Brooks-Gunn,

Mark Stemmler, Sydney Ey, and Kathryn E. Grant

  The image of adolescence as a time of storm and stress, intense moodiness, and preoccupation with the self has permeated both professional and lay perspectives on this developmental period. The belief that significant difficulties, including depression, during adolescence represent normal development has had two major effects on research and practice: (a) Difficulties during adolescence were not considered as an important developmental variation, and (b) adolescent problems were often not treated because of the belief that the adolescent would grow out of them.

Although this view of adolescence is the one commonly reflected in the media and many professional descriptions of adolescence, it is not supported by research on this period. In the late 1960s, there were reports showing that many adolescents traverse this period of life without significant psychological difficulties. It is now known that the majority of adolescents of both genders successfully negotiate this developmental period without any major psychological or emotional disorder, develop a positive sense of personal identity, and manage to forge adaptive peer relationships at the same time they maintain close relationships with their families. Conversely, research in the 1970s focusing on those youth with problems demonstrated that psychological difficulties in adolescence frequently developed into serious psychiatric disorder in adulthood. These studies demonstrated the inappropriateness of the belief that difficulties such as depression were normal manifestations of adolescence and pointed toward the need for assessment, diagnosis, prevention, and treatment at this age. These studies also highlighted the need for more research on the development of depression in adolescence.

Three approaches to the assessment and classification of adolescent psychopathology have been reflected in the literature on adolescent depression: (a) depressed mood, (b) depressive syndromes, and (c) clinical depression. Each approach reflects different assumptions about the nature of psychopathology, serves different purposes, and reflects a different level of depressive phenomena. For example, the study of depressed mood during adolescence has emerged from developmental research in which depressive emotions are studied along with other features of adolescent development. The depressive syndrome approach assumes that depression and other syndromes reflect the co-occurrence of behaviors and emotions as quantitative deviations from the norm. The clinical approach is based on assumptions of a disease or disorder model of psychopathology.

There are two major diagnostic models typically used to diagnose clinical depression: the categorization of mental disorders developed by the American Psychiatric Association and the method developed by the World Health Organization. The American Psychiatric Association is the one most widely used in the United States and abroad. It bases the diagnosis of disorders on a review of the presence, duration, and severity of sets of symptoms.

Considering all published studies of clinical depression in adolescence, the percentage of adolescents receiving a diagnosis of depression varied from near zero in a large nonclinical sample of children aged from 10 to 11 years to 57% in a clinical sample of children 8 to 13 years old. Studies based on clinical samples naturally tended to yield higher depression rates (averaging 42%, median 48%, across six studies). Fourteen studies of nonclinical samples reported an average of 7% clinically depressed. These studies generally reported minimal information on the characteristics of the samples. Two studies of community samples provided examples of base rates of depressive disorders in the population, with one reporting 8% of the population with Major Depressive Disorder (MDD) and another reporting approximately 3% of adolescents with MDD.

Although there do not appear to be age variations in community samples within the adolescent decade, depressive diagnoses as well as depressed mood appear to increase dramatically in adolescence compared with childhood. Preadolescent or adolescent onset of clinical depression is considered to be a serious risk factor for adult depression and perhaps other major mental disorders as well. In summary, although much more work is needed on the epidemiology of depression in adolescence, existing evidence suggests increased risk of depression in recent decades.