Many adolescents experience worry from time to time, shifts in their moods, or times of dysphoria, including sadness or anger. Mood and anxiety disorders differ from normative concerns in that they can cause marked impairment, can produce changes in global functioning, and are pervasive. This chapter will provide an understanding of the epidemiology, clinical manifestations, diagnosis, treatment, and prevention of depression, anxiety, and other mental health disorders of children and adolescents.
The importance of recognizing and addressing mental health concerns not only is important for the individual patient, but also has a profound impact on public health. Suicide was the third leading cause of death for 10- to 24-year-olds in 2014. It followed only unintentional injury and homicide, and accounted for 5504 deaths in the United States. Significant risk factors for suicide include major depressive episodes and manic episodes.
Multiple factors play a role in mental health problems in youth. Risk factors for developing mental health problems, such as anxiety and depression, include family conflict, poverty, and school violence. Youth of color are more likely to experience greater barriers to care and higher prevalence of mental health concerns than their white peers. Heredity can be a risk factor for mood and anxiety disorders. In the case of major depression, youth with first-degree family members who are also depressed are 2 to 4 times more likely to have major depression.
Adolescence is a complicated period when individuals reach maturity in physical and sexual development, with a lag of maturity in other areas such as cognitive and emotional development. Biological changes, such as hormonal changes, may play a role in adolescents’ vulnerability toward emotional and behavioral issues. Regions of the adolescent brain, such as the prefrontal cortex, which controls executive function, are still in the process of developing until the mid-20s. There is discussion that the changes that occur during adolescence are possibly linked to the vulnerability during adolescence of mood disorders, schizophrenia, and other conditions.
Initial screening for mood, anxiety, and other disorders may be done through the clinical screening during a medical visit (eg, HEADSS exam) and screening questionnaires. However, an extensive diagnostic interview to include self-report, caregiver report, history of symptoms, and other formal assessments are the ideal standard for the diagnosis of a mental health disorder.
MAJOR DEPRESSIVE DISORDER AND PERSISTENT DEPRESSIVE DISORDER
Major depression and other depressive disorders are further discussed in Chapter 94. This discussion focuses on these disorders in the adolescent patient.
The clinical presentation of depression varies with age. Unlike school-aged children, adolescents are less likely to present with primarily somatic complaints, and unlike adults, adolescents are less likely to appear melancholic or sullen. More often, adolescents present with symptoms of irritable mood; anhedonia; boredom; hopelessness; sleep changes such as insomnia, hypersomnia, or ...