ADOLESCENTS are those aged 13-17 years old, and there are 5.5 million adolescents in Malaysia. More than half of them are in schools. Adolescents are valuable assets to the country as they will become future leaders, who will continue to drive and sustain the development of the nation. They are perceived as the healthiest population group, however, they do have their own set of unique problems and healthcare needs.
According to the Malaysian Health and Morbidity Survey 2017, one in five teenagers in Malaysia are depressed, two out of five suffer from anxiety and one in 10 are stressed.
The National Mental Health Survey 2017 has found that at least one in 10 young people, or 10% of 5.5 million youth in the country, have thought of committing suicide.
Transition years
Teenage years can be challenging. Between physical changes in the body, intense peer pressure, and an increased sense of social anxiety, teenagers often have difficulties finding their place, particularly in society. Many want to fit in while others want to stand out, which can cause them to rebel.
Teen depression is also becoming an alarmingly frequent trait in those transition years. Recent research has found that the rate of depression is increasing, and there are distinct gender differences in teen depression.
The teen years are a natural transition from being a child to growing into an adult. While women of all ages tend to be more aware of their appearance than men, particularly in terms of how others see them, most young people start to develop a heightened sense of socialisation as they enter their teenage years.
As children, their clothing choices and hairstyles were not as important to them. As teenagers, their entire social life may depend on those factors, at least in their own eyes.
What is teen depression?
The mental and emotional disorder known as teen depression is no different medically from adult depression. However, brains of adolescents are structurally different than the brains of adults.
Teens with depression can also have hormone differences and different levels of neurotransmitter, which are key chemicals in the brain that affect how brain cells communicate with one another. They play an important role in regulating moods and behavior.
The neurotransmitters that are important to our understanding of depression are serotonin, dopamine and norepinephrine. Low levels of these neurotransmitters may contribute to depression.
Depression can be associated with high levels of stress, anxiety, and – in the most serious scenarios – suicide. However, symptoms in teens may manifest themselves in different ways than in adults. This may be because teens face different social and developmental challenges.
As teenagers, depression can also affect the aspects of their personal life, school, work, social, family life, and can lead to social isolation and other problems.
Is it different among male and female?
Teen depression is gender relative. Females are around three times as likely as males to report a depressive episode. The difference in depression rates can be attributed to the differences in the rate of physical changes between boys and girls.
Puberty typically starts earlier, and hormonal changes tend to be more evident in young girls. Teenage girls are also inclined to be more concerned with how others perceive them.
Teenagers and social media repercussions
The rise in depression rates among teenagers also coincides with the rise in popularity of the smartphone. Today’s teenagers have not known a world of social interaction that does not include social media. Both young men and women spend a significant amount of time on their smartphones now.
According to the National Health and Morbidity Survey 2017, six in seven secondary school adolescents in Malaysia are active internet users and from those, two are addicted, with Form Five students showing the highest rate of internet addiction, at 38%, compared with Form One students at 18%.
Another study done by the United Nations International Children’s Emergency Fund, it was reported that Malaysia ranked second in Asia in 2020 for cyberbullying among youths, proving that cyberbullying is becoming a prominent problem in the country.
The use of smartphones and social media appears to correlate with the increase in depression rates among teenagers. However, it seems to have impacted teenage girls more than boys. One reason for this may be that girls spend more time socialising on their smartphones, including texting and interacting on social media. Boys also text and use social media, but tend to use their smartphones more for playing games.
An association has been found between moderate and heavy digital media use and the increased rate of mental health issues and worsened psychological well-being for teenage girls.
One study found that the rate of depression also aligns with the amount of time spent on social media. In that study, girls who spent six hours or more on social media were significantly unhappy than those who spent only 30 minutes a day on social media. The differences for boys were less noticeable.
How to spot depression
The symptoms of depression can often be difficult for parents to spot. Depression is sometimes confused with the typical feelings of puberty and teenage adjustment.
Teen depression signs include a change from the teenager’s previous attitude and behavior that can cause significant distress and problems at school or home, in social activities, or in other areas of life.
Symptoms can vary in severity, but changes in your teen’s emotions and behavior may include the examples below:
> Feelings of sadness, which can include crying spells for no apparent reason;
> Frustration or feelings of anger, even over small matters;
> Feeling hopeless, helpless or empty;
> Irritable or annoyed, having self-injurious behaviour;
> Loss of interest or pleasure in usual activities;
> Loss of interest in, or conflict with, family and friends;
> Low self-esteem;
> Feelings of worthlessness, unrealistic guilt;
> Fixation on past failures or exaggerated self-blame or self-criticism;
> Extreme sensitivity to rejection or failure, and the need for excessive reassurance;
> Trouble thinking, concentrating, making decisions and remembering things, poor school performance;
> Ongoing sense that life and the future are grim and bleak;
> Changes in appetite and weight, less attention to personal hygiene or appearance;
> Alcohol or drug misuse;
> Major changes in sleeping habits, insomnia, frequent complaints of unexplained body aches and headaches;
> Frequent thoughts of death, dying or suicide.
The intention of these behaviours is not usually to end one’s life, but they must be taken seriously. They are typically transient and usually end as the teen develops better impulse control and other coping skills.
It is not known exactly what causes depression, but a variety of issues may be involved. These include: Brain chemistry, hormones, inherited traits, early childhood trauma, and learned patterns of negative thinking.
Factors that may increase risk of depression:
> Personal/personality issues – having a difficult time with their sexual orientation, in the case of teens who are lesbians, gay, bisexual, transgender, queer, intersex, asexual, and more;
> Having trouble adjusting socially;
> Having no social or emotional support;
> Living in a violent household – is a victim or witness of violence, such as physical or sexual abuse;
> Having issues that negatively impact self-esteem, such as obesity, peer pressure, being bullied;
> Having a chronic illness, mental health conditions – such as bipolar, anxiety and personality disorders, anorexia or bulimia;
> Having a learning disability or attention-deficit/hyperactivity disorder.
Untreated depression can result in emotional, behavioural and health problems that can affect every area of a teenager’s life. Complications related to teen depression may include: Alcohol and drug misuse; academic problems; family conflicts and relationship difficulties; suicide attempts or suicide.
How to diagnose teen depression?
For proper treatment, it is recommended that a psychologist or psychiatrist perform a psychological evaluation, asking the teen a series of questions about their moods, behaviours and thoughts.
The evaluation should also take into account the teen’s family history, school performance and comfort in peer settings. A physical examination may also be used to help rule out other causes.
Some medical conditions can also contribute to depression. Medications are used to treat teen depression. Just as depression has no single cause, there is no single treatment to help everyone who has depression. It can take time to determine which one works best.
Medication and psychotherapy
Treatment for adolescents with depression is usually a combination of medication and psychotherapy.
Teens with depression should see a qualified mental health professional before or at the same time as starting medication therapy. Psychotherapy has been found to be effective for treating depressed teens who have turned to substance abuse, and those who are engaging in self-destructive behaviour.
Cognitive behavioural therapy or interpersonal therapy (IPT) during psychotherapy sessions can help by replacing negative thoughts and emotions with good ones.
In IPT, the aim is to strengthen personal relationships by improving communication and problem-solving skills. Parents or caregivers will participate in select sessions.
It can be difficult to tell the difference between the ups and downs that are part of being a teenager. Talk with your teen. Try to determine whether he or she is capable of managing challenging feelings, or if life seems overwhelming.
If depression signs and symptoms continue, interact with your teen. If you have cause to be concerned about your teen’s safety, talk to a doctor or a mental health professional trained to work with adolescents. Your teen’s family doctor or pediatrician is a good place to start.
Depression symptoms will not likely get better on their own – and they may get worse or lead to other problems if untreated.
Depressed teenagers may be at risk of suicide, even if signs and symptoms do not appear to be severe. If you are a teen and you think you may be depressed, or have a friend who may be depressed, do not wait to get help. Talk to a healthcare provider such as a doctor or school nurse.
Share your concerns with a parent, a close friend, a spiritual leader, a teacher or someone you trust.
There is no sure way to prevent depression. However, these strategies may help:
> Take steps to control stress, increase resilience and boost self-esteem to help handle issues when they arise;
> Practise self-care, for example by creating a healthy sleep routine and using electronics responsibly and in moderation;
> Reach out for friendship and social support, especially in times of crisis;
> Get treatment at the earliest sign of a problem to help prevent depression from worsening;
> Maintain ongoing treatment, if recommended, even after symptoms let up, to help prevent a relapse of depression symptoms.
Dr Azhar Md Zain is a psychiatrist at KPJ Ampang Puteri Specialist Hospital. Comments: letters@thesundaily.com
