Skills For Depression

Teenager using laptop

To help youth who are struggling with depression symptoms, we have written this resource page that includes the statistics, diagnosis, effective interventions and links to mental health organizations.

Statistics about Teen Depression

Since 2011 the percentage of tween/teens reporting depression symptoms has been going up. Depression symptoms were going down for teen boys and girls throughout the ‘90s, and then leveled off, but then in 2011 started going up.

Current data finds that about 19% of girls 12 to 17 will meet the criteria for a depression episode in a given year and about 6% of boys. Since 2011, for youth ages 12 to 17, there has been about a 59% increase in teens reporting enough symptoms that they meet criteria for a depression episode (which includes mild, moderate, or severe). To learn more about these numbers, read Dr Ruston’s article, Detangling Teen Depression in the Digital Age.

The fact that many more teens meet criteria for a depression episode now than nine years ago is very concerning. Of note, there has been an increase in adults reporting depression symptoms as well.

Why are more teens reporting depression symptoms since 2011? There are many factors that appear behind this rise — both non-screen time-related reasons and screen time related ones.

For an analysis of these factors read Dr Ruston’s article, Reasons teens now report higher depression rates.

Diagnosing Depression

“When a teen says ‘depressed’ it can mean anything from mild sadness to profound clinical depression. Sorting this out is done in many ways. Having the teen talk with a trained person in this area is key. The professional will usually have the teen fill out a PHQ-9 questionnaire as part of the evaluation. As a physician I use the PHQ-9 often in my practice because I see many  teens and adults who may have depression and I don’t want to ever miss it.” — Delaney Ruston, MD

Here is a summary of what the PHQ-9 asks.

1. The first two questions of the questionnaire asks?

For at least several days a week for two consecutive weeks:

  • Do you have little interest or pleasure in doing things?
  • And/Or Are you feeling down, depressed, or hopeless?

2. The person needs to answer yes to at least one of those two questions. If they do, they then would answer the following questions, which are on a scale from “not at all” to “nearly every day.”

  • Do you have trouble falling or staying asleep, or sleeping too much?
  • Do you feel tired or have little energy?
  • Do you have a poor appetite, or conversely, do you overeat?
  • Do you feel bad about yourself, or feel like a failure, or do you feel like you’ve let yourself or your family down?
  • Do you have trouble concentrating on things?
  • Do you move slowly? Do you speak very slowly? Or the opposite, do you feel overly fidgety or restless?
  • There is also a question about suicidal thoughts.

3. Then there is this final question about the level of impact the symptoms are having:

  • If you’ve checked off any of these problems, how difficult have these problems made it for you to do your work? How hard is it to take care of things at home? Get along with other people?” (this question gets rated on a scale from “very much” to “not at all.”

Answers then get scored to get a sense of the magnitude of the situation. You can click here to print and have your kids fill in the PHQ-9 so that they can become more aware of some of the main symptoms that can be seen in depression. An important fact is that particularly for boys (but not solely) we know that often their depression can manifest as significant irritability, and the questionnaire, unfortunately, does not ask about that.

Interventions to Help Teens with Depression

Behavioral Activation is an evidence-based approach used to treat depression people of all ages and is often used when treating youth. It is the method of helping people become more active and involved in life by helping them schedule and do activities that have the potential to improve their mood.

One of the major hallmarks of depression is when teens lose the pleasure of things that used to be enjoyable. With depression, there are intense feelings and thoughts that can make engaging in things that should seem simple and fun to feel impossible. Teens often say things like,  “I can’t do soccer, nothing sounds fun about it anymore,” or “I just can’t, I have no energy,” or “I don’t deserve to go out with them to the movies, I am worthless,” or  “Who even wants to be with me, I will just be a burden and ruin everyone else’s fun.”

Researchers have discovered through brain scans that people with depression have, on average, less activation in the reward area of the brain when given positive stimuli as compared to those without depression.

Behavioral activation induces positive feelings by helping a person engage in activities they used to find pleasurable. Helping the person gain a deeper understanding that emotions are influenced by what one does, they don’t just arise out of nowhere. Positive emotions can be elicited by positive experiences and so even if their brain is saying, you don’t want to do such and such, it is to ignore those thoughts but do the behaviors the person has identified as potentially enjoyable.

It is not like a person with depression will go to the movies with a friend and suddenly feel happy. Usually, this much of an outing would be really hard for them because the negative self-talk would be very active and they would have low energy. With the help of an emotional coach, i.e., a therapist, a school counselor, or even a parent, the person would be told to try to focus on any positive moments of the evening. To help you would ask, “Was there one fun moment at all with your friends?” or “Did one of them put their arm around you give you a smile or shared their popcorn?” or  “Did you laugh for even a few minutes?”

Overtime by having more and more positive experiences,  this behavioral activation helps to lift the depression.

Building a team to help with Behavioral Activation:

“As a parent, seeing my daughter not doing things that I know she enjoyed in the past was so painful to see. I  would find myself suggesting, nudging her to do things — as a doctor I know about behavioral activation, so how to get her to activate? But it rarely worked.

I had to learn how invalidating my suggestions could feel to Tessa. If it were so easy for teens to just start doing the things they have not been doing, they would! I also realized it was extra hard for her to want to listen to my input since she was right at the stage of life when gaining more independence from her parents was so critical. I needed help.

I mustered up the courage to talk with my friend and neighbor, who Tessa loved baby sitting for her kids. In the past Tessa would reach out to her to let her know her availability. Now Tessa was not doing that but being with kids would have a high chance of lifting her mood. I reached out to the mom and let her know Tessa was going through a hard time and that might she reach out to Tessa rather than waiting for her to reach out. Our friend was so happy I talked with her and she started to have her come over to sit more often and it greatly helped Tessa.” — Delaney Ruston, MD

Other examples of team building

Ismael (in Screenagers NEXT CHAPTER), a teen who started having depression in 6th grade, was helped when a family friend kept encouraging him to audition for being in a musical. He was hesitant at first but with her help he finally did and participating in the play greatly helped his emotional well-being.

Working to get people close to the teen to try and initiate in-person time is also a wonderful move. For example, a peer might be encouraged to say to the teen, “I know you texted you, and you said you are fine, but I really want to stop by for a sec.”

Finding ways to get the teen doing activities that help others is a can work well as a behavioral activation intervention. Perhaps a friend of yours works in park restorations — could they come to your home and talk about how interesting it is and how next Saturday he would really love your teen’s help.

Therapy

Finding adults that can help the teen in overcoming depression is key. They will work with them in helping them recognize thoughts that are unhelpful and work to replace them with helpful ones. This has a fancy term called cognitive restructuring.

They will also help them in making small changes in what they are doing each day in their life to improve wellbeing.

So much of if the interactions with such adults is helpful is how is the connection between the teen and the adult. These adults can include a therapist, a social worker at school, or school counselor.

There are different forms of therapy and often a therapist uses techniques from more than one type. Some examples are:

  • Psychotherapy which is talk therapy. Unlike the old image of a person sitting on a chair and therapist just nodding and listening, it is now common, and more effective, for it to be a more interactive process.
  • Cognitive behavioral therapy, (CBT)
  • Dialectical Behavioral Therapy (DBT)
  • Interpersonal therapy
  • And, many others

It can be very hard to find counselors for many reasons (costs, availability, lack of connection). One way to find people is through the school district. Another is to talk with other parents, and see the organizations we list below

Other people that can be helpful allies and active listeners for teens are caring teachers, coaches, family members, and their bosses or co-worker if they have a job.

Parents Need Help

“The emotional pain I felt as a parent of a daughter dealing with depression, was at times indescribable. The thing that was instrumental in helping me in those days was having a handful of other moms going through similar situations. It took work to find these other mothers. I can not say enough about how important it was to have their support and how good it felt also for me to be able to support them too.” — Delaney Ruston, MD

Finding other parents who are or have gone through similar situations is key. They can help find resources and all sorts of other support.

Getting counseling and finding support groups are other important means of support.

Mental Health Organizations - Resources for Teens and Parents

The following are examples of mental health organizations

NAMI

The National Alliance on Mental Illness has local branches across the country and offers support groups, online resources, programs in schools, and more.

Child Mind Institute

The site has many written materials and links to awareness campaigns. My Younger Self, for example, is 30 short interviews with actors, athletes, and other celebrities who discuss their past mental health challenges.

Youth Mental Health First Aid

These are free day-long courses designed to help parents learn how to understand youth mental health issues better and as a parent, things to do. On the website, you can find if there are classes near you.

Mental Health America

This organization has affiliates across the country. The website has links to information, and they also do important work in working to increase mental health access, locally and nationally. This page on their website is helpful for the nuts and bolts of finding mental health support.

Anxiety and Depression Association of America

This organization has information on stress and depression conditions as well as links to find help for children, teens, and adults.

6 seconds

The international emotional intelligence network researches and shares tools, methods, and training to create a kinder, more positive world.

BTWF

Born This Way Foundation – Started by Lady Gaga and her mother, the organization works to build a "braver, kinder world" for youth by creating safe-spaces and promoting self-care skills.

Psychology Today (link to https://www.psychologytoday.com/)

This site is very well respected as a way to find a therapist, psychiatrist, or support group in one's area. One puts in their zip code, and any indicators, such as "adolescent" and it will list many possible providers. Then the provider can be contacted, and a short call can be set up to see if there will be a good fit.

Phone and Text Lines for Mental health

Crisis Text Line is free, 24/7 support for those in crisis. Text 741741 from anywhere in the US to text with a trained Crisis Counselor. Crisis Text Line trains volunteers to support people in crisis. This organization is a resource that many youth and adults report using and feeling helped. People who volunteer for CT receive 30 hours of training before they start, and they volunteer several hours a month.

"My good friend is a volunteer, and we spent an afternoon together, where she showed me how their training works and examples of the work she does with people. It was powerful. A person can text about anything they are struggling with, and the volunteers are there and provide supportive interactions. Even though it is called Crisis Text, the texter does not have to have an imminent crisis; they get all sorts of people seeking support for things like eating issues, problems with peers, and just people dealing with hard emotions." — Delaney Ruston, MD

National Suicide Prevention Lifeline Call 1-800-273-8255

7 Cups - Connects you to caring listeners for free emotional support

Better Help - This is a fee-based service that provides online therapy via Skype and text

Boys Town National Hotline 1-800-448-3000. 24-hour, free, confidential hotline staffed by trained counselors for boys and girls to receive help with bullying, anger, abuse, depression, school issues, and more.

211.org is a free and confidential national hotline that connects callers with resources and support in their area.

Phone and Text Lines for Mental health

Crisis Text Line is free, 24/7 support for those in crisis. Text 741741 from anywhere in the US to text with a trained Crisis Counselor. Crisis Text Line trains volunteers to support people in crisis. This organization is a resource that many youth and adults report using and feeling helped. People who volunteer for CT receive 30 hours of training before they start, and they volunteer several hours a month.

“My good friend is a volunteer, and we spent an afternoon together where she showed me how their training works and examples of the work she does with people. It was powerful. A person can text about anything they are struggling with, and the volunteers are there and provide supportive interactions. Even though it is called Crisis Text, the texter does not have to have an imminent crisis; they get all sorts of people seeking support for things like eating issues, problems with peers, and just people dealing with hard emotions.” — Delaney Ruston, MD

National Suicide Prevention Lifeline Call 1-800-273-8255

7 Cups - Connects you to caring listeners for free emotional support

Better Help - This is a service that matches you with online counselors

Boys Town National Hotline 1-800-448-3000. 24-hour, free, confidential hotline staffed by trained counselors for boys and girls to receive help with bullying, anger, abuse, depression, school issues and more.

211.org is a free and confidential national hotline that connects callers with resources and support in their area.