Skills For Depression

Teenager using laptop

We have written this resource page for youth struggling with depression symptoms. It includes the statistics on depression, effective interventions and links to mental health organizations.

TEEN DEPRESSION STATS

Since 2011, the percentage of tweens/teens who report depression symptoms has been increasing. Depression symptoms were going down for teen boys and girls throughout the ‘90s, and then leveled off. But then in 2011, they started going up again.

According to the CDC, in 2009, 26.1% of American high school students reported persistent feelings of sadness or hopelessness. In 2019, that number had increased to 36.7%. In 2021, the number of teens reporting persistent sadness or hopeless was up to 44.2%, with girls reporting higher rates than boys.

The fact that so many more teens meet the criteria for depression now than 12 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 behind this rise — both non screen time-related reasons and screen time-related.

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.

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

  1. Do you have little interest or pleasure in doing things?
  2. And / or are you feeling down, depressed, or hopeless?

If the person answers "yes" to at least one of these two questions, they are asked the following questions, which are on a scale from “not at all” to “nearly every day.”

  1. Do you have trouble falling or staying asleep, or sleeping too much?
  2. Do you feel tired or have little energy?
  3. Do you have a poor appetite, or conversely, do you overeat?
  4. Do you feel bad about yourself, or feel like a failure, or do you feel like you’ve let yourself or your family down?
  5. Do you have trouble concentrating on things?
  6. 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.

Then there is this final question about the level of impact the symptoms are having. The person answers on a scale from "very much" to "not at all." 

  1. 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?

Answers are scored and provide a sense of the magnitude of the situation. You can click here to print the questionnaire and have your kids fill it out so that they can become more aware of some of the main symptoms associated with depression. An important fact to remind them of is that particularly for boys (but not solely), we know that often depression can manifest as significant irritability. Unfortunately, the questionnaire does not ask about that.

HELPFUL INTERVENTIONS

Behavioral Activation

An evidence-based approach used to treat depression in people of all ages. It's most 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 no longer feeling pleasure while engaging in activities that used to be enjoyable. With depression, dark feelings and thoughts can make engaging in things that should seem simple and fun 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 they'll say something like, “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.”

Through brain scans, researchers have discovered that people with depression have, on average, less activation in the reward area of their 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. This intervention can help a person gain a deeper understanding of the fact that emotions can be influenced by what one does; they don’t just arise out of nowhere. Positive emotions can be elicited from positive experiences and so, even if a person's brain is saying, "You don’t want to do such and such," ignoring those thoughts and engaging in enjoyable activities can improve their mood.

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 could be really hard for a clinically depressed person because active negative self-talk depletes energy. However, a young person can learn to train their brain with the help of an emotional coach, i.e., a therapist, a school counselor or even a parent. Learning to focus on the positive moments of the evening can help a lot.

To help your adolescent, you could ask them, “Was there one fun moment with your friends?” or “Did one of them put their arm around you, give you a smile or share their popcorn?” or  “Did you laugh for even a few minutes?”

By having more and more positive experiences over time, behavioral activation helps to lift or lessen the effects of 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, 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. Tessa loved babysitting 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. She started to have Tessa 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 sixth grade, got help after a family friend kept encouraging him to audition for the school musical. He was hesitant at first but with her help, he finally did. Participating in the play greatly helped his emotional wellbeing.

Encouraging your child's friends or mentors to initiate in-person time with them can be a wonderful move. For example, you might encourage a peer to say to your 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 to engage in activities that help others can also work well as a behavioral activation intervention. Perhaps a friend of yours works in park restoration. You might ask that friend if your kid could help out.

Therapy

Finding adults that can help the teen overcome depression is key. It's all about learning to recognize thoughts that are unhelpful, working instead to replace them with helpful ones. This has a fancy term called cognitive restructuring.

Cognitive restructuring can also help a teen make small changes in what they do each day to improve their wellbeing.

Building connections with trusted adults can help a teen a lot too. These adults can include a therapist, a social worker at school, a family friend or a school counselor.

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

  • Psychotherapy — 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 therapy to be a more interactive process.
  • Cognitive Behavioral Therapy, (CBT) — Focuses on reframing negative thoughts , learning and changing unhelpful patterns of behavior and learning coping mechanisms. Emphasis on teaching a patient how to identify and cope with their own struggles.
  • Dialectical Behavioral Therapy (DBT) — Emphasis on developing mindfulness skills, distress tolerance, emotional regulation and exercises in becoming more assertive.
  • Interpersonal Therapy (IPT) — Works to improve the client's interpersonal relationships and social functioning.

Finding a helpful therapist can be hard for a lot of reasons (cost, availability, lack of connection, etc). A school district can be helpful in finding your child a therapist. Talking with other parents can also be helpful in finding your child help. We've also provided a list of resources below.

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

Parents need help too

“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 cannot 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 you resources and all sorts of other support.

Getting counseling and finding support groups are other important means of support. Remember, your mental health matters too and managing your own will allow you to be a better support for your struggling child.

MENTAL HEALTH ORGANIZATIONS FOR TEENS AND PARENTS

NAMI

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

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.

Psychology Today

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.

Better Help

This is a service that matches you with affordable online counselors quickly.

PHONE AND TEXT LINES

Crisis Text Line

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.

The Trevor Project

Offers LGBTQ+ youth resources, tools and phones lines to chat with counselors 24/7, confidentially and for free. You can also text their help line "START" at 678-678 to get support.

National Suicide Prevention Lifeline

Call 988 to get 24/7 free and confidential help.

7 Cups

Connects you to caring listeners for free emotional support

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

A free and confidential national hotline that connects callers with resources and support in their area.