Mental Health

Detangling Teen Depression in the Digital Age

Delaney Ruston, MD
February 10, 2020
Depression graph

Current data finds that about 19% of girls 12 to 17 will meet 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).

I want to make a few comments about this data. This is a higher percentage of youth than have actual clinical depression because the screening questions are designed to err on the side of not falsely missing people who are suffering (i.e., there are some “false positives” in this 59%. There are also some “false negatives” but less of those).

Also, researchers wonder if boys are truly this much less depressed or could it be that they are less in touch with feelings, less likely to admit to them, and some of their symptoms are being missed on the questionnaires.

So today I want to look at how we get to these numbers and what is clinical depression. One of the central goals I have in my work is to help parents find ways to better give health knowledge and science literacy skills to their kids and teens. I want to help you by sharing what medical providers use to help identify symptoms of depression.

There are so many headlines about teen depression and yet so few opportunities for teens to better understand what the health care profession means when we talk about depression.

It has always shocked me the degree to which mental health education is lacking in schools. This reality was painful for me when I was growing up. None of my teachers taught us anything about mental illness, not in my junior high and not in my highschool. Because of this, I never felt I could ask questions or ask for help around things that were happening in my family.

Currently, only three states in the country require their schools to teach about mental health. New York and Virginia were the first two states to pass laws, and that was just in 2018. Teachers and students are trying to change this by doing things like starting mental health clubs, which we see two fearless teens do in Screenagers NEXT CHAPTER.

To screen for depression, all of us in the health profession use a screening tool called the PHQ-9. Today I’m writing about this PHQ-9 questionnaire because talking about it to your kids can help them better understand the symptoms of depression, whether they are experiencing them now or in the future or if a friend exhibits these symptoms.

The PHQ-9 essentially asks the following: (I have shortened some things)

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?

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.
  • 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? (These questions get 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, but for now, I won’t include all the details. You can click here to print and fill in the full PHQ-9. It is a good way to drive home these important symptoms.

With the 59% increase in teens reporting symptoms, we need to keep in mind false positives. For example, we know that now compared to the past there are many more teens who are sleep deprived and that their answers on this questionnaire can mimic that of depression.

Besides false positives, there can be false negatives as well. In that case, the summation of the answers makes it seem as if the person does not have depression when they actually do. This can happen, for example, if a person does not feel comfortable answering truthfully on the questionnaire. Also, for boys, we know that often their depression can manifest as significant irritability, and the questionnaire, unfortunately, does not ask about that.

The fact that about fifty nine percent more teens meet criteria for a depression episode now  than  nine years ago, is very concerning. I want to point out that during this time period, there has been an increase in adults reporting depression symptoms as well.

We know access to social media and the internet has dramatically increased over the same time. How does this relate to more teens reporting depression symptoms? That is what we all want to understand on a population level and, of course, we want to know it on the individual level as well. To try to understand the later question, mainly researchers take surveys that ask people about time on social media, as well as depression symptoms. From there they look to see if more time on screens is associated with (i.e., correlates with) more of a chance of reporting depression symptoms. This is complicated and in an upcoming TTT I will dive into that.

For now, we all know that for any teens things can happen online that can lead to some level of depression symptoms, such as a person experiencing intense cyber cruelty.  And, we also know that when youth spend large amounts of time on screens, it can be a red flag that they may be experiencing depression. Stay tuned for a deeper exploration into all of this in a couple of weeks.  

For today’s Tech Talk Tuesday, here are a few questions to get a conversation started with your youth and teens:

  1. Have you discussed depression in any class or assembly at school?
  2. Does knowing about the PHQ-9 help you understand depression better?
  3. How often do you see people post online about their sadness or depression?
  4. Do you know anyone you think might be depressed? If so, have you reached out to them?

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