Depression is a principal cause of significant health complications and disabilities around the world. It is a form of mental disorder associated with a cluster of specific symptoms that are broadly similar to adults and adolescents. Despite its prevalence, studies often miss depression in adolescents than in adults. The current body of literature attributes this to the prominence of elements such as mood reactivity, fluctuating symptoms, and irritability in adolescents. The population makes up a significant portion of the United States population. Therefore, it is essential to determine young people's current mental health status, risks in developing the disorder, and possible solutions. Adolescent depression is a severe public health care problem that requires improved solutions considering current measures' ineffectiveness to address its devastating prevalence.
The United States is currently showing worrying trends of major depressive disorder among adolescents. An estimated 3.2 million Americans aged between 12- and 17-years report at least one major depressive episode with severe impairment translating to 13.3 percent of adolescents in the country ("NIMH » Major Depression," 2020). The most affected ages are 17 years (at 18.5 percent), 15 (at 17.2 percent) and 16 years (16.9 percent) ("NIMH » Major Depression," 2020). Depression is significantly higher in adolescent females (20 percent) than in males (6.8 percent) ("NIMH » Major Depression," 2020). Even more frightening, despite the prevalence, only a handful of teenagers suffering from the disorder receive quality treatment. Only 19.6 percent received help from healthcare professionals with more than 60.1 percent not receiving any form of therapy ("NIMH » Major Depression," 2020). Because of the extent of its prevalence, the government has branded the problem a public health issue.
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The justification for addressing adolescent depression is because adolescence is a critical transitional period and financial burdens involved. According to a Healthy People 2020 publication on the importance of health in teenagers and young adults, adolescence is one of the most important transitional periods ("Adolescent Health | Healthy People 2020", 2020). People undergo significant physical, social, and psychological developments at this stage, which include normative learning and learning to be independent. People at this stage experience a wide array of challenges emanating from social and economic dynamics and, at the same time, receive insignificant organizational support even when they are expected to take on adult obligations and responsibilities. Adolescent depression also imposes a burdensome financial cost on the country's health care system. The financial implications of health problems that can be prevented at adolescence are huge, with some of them exceeding the national budget.
The causes and risk factors of depression in adolescents are diverse and plenty. Bernaras, Jaureguizar, and Garaigordobil (2019) align the causes of depression to genetic, psychosocial, and neuroendocrine mechanisms as risk factors. According to the authors, the offspring of parents who have faced depression are four times likely to develop the condition. As such, genes and familial factors play a critical role in contributing to the risk of depression. Psychosocial risk factors can involve the exposure of extraordinarily stressful events like accidents, physical illness, peer bullying, and family discord, among others (Bernaras, Jaureguizar, & Garaigordobil, 2019). Interestingly, both inherited and psychosocial stressors can come into play to cause distal risk factors in the form of neuroendocrine mechanisms that cause depression—for instance, changes in activities in underlying neural circuits and endocrine systems.
Preventive measures for depression in adolescents involve an approach aimed to minimize the associated risk factors. According to Stockings and his collaborators (2016), these approaches should mostly be applied at school- and family-based settings where teenagers spend the majority of the time. The first preventive measure includes providing continual warmth, caring, and support. Stockings and his colleagues (2016) argue that adolescents with a high parental support level report significantly lower rates of depression symptoms than their counterparts in less supportive homes. Establishing a positive relationship between parents and their teenage children creates an environment where teen risk-taking levels that build up to depression minimize. The second prevents measure involves changing the school environment. Schools should be sensitized to incorporate educational elements that encourage learners to develop positive peer relations, seek purpose in life, develop and maintain strong social and emotional skills.
Diagnosis of the disorder involves a multiple of approaches with treatment options also varying. A physician may determine a teenager's diagnosis based on lab tests, physical examinations, and psychiatric evaluation. During the physical examination, a doctor will inquire about physical health by asking a set of questions because they believe depression is sometimes connected with underlying issues ( Diego, Field, & Sanders, 20103) . Psychiatric evaluation is common, and it usually involves a doctor inquiring about a patient's thoughts, feelings, symptoms, and behaviors. Doctors can also subject patients to blood tests known as complete blood count or thyroid to make sure everything is functioning well. Clinical treatments for depression include medications and psychotherapy. Examples of medications include antidepressants, monoamine oxidase inhibitors (MAOIs), and selective serotine reuptake inhibitors (SSRIs) ( Diego, Field, & Sanders, 2013) . It is advisable to evaluate a patient's condition before subjecting them to a treatment plan.
Both the federal and state governments have actively been involved in addressing adolescent depression through policies and regulations. There have been recent developments in the United States' mental health care. Examples include the Mental Health Parity Addiction Act of 2008, the Affordable Care Act of 2010, and also Medicaid expansion across multiple states. These regulations have been instrumental in improving access to mental health services to all Americans, including adolescents ("Recent Advances in Mental Health Care", 2020). For instance, the Affordable Care Act (ACA) expands on the parity legislation in that it requires that individual and small-employer insurance plans cover extend to mental health disorder services. Because of the legislation's improvements, more than 174 million Americans can benefit from various insurance plans ("Recent Advances in Mental Health Care," 2020). Additionally, Medicaid's expansion has seen all states offer mental health disorder services to all people aged 18 and under. These regulatory advancements have helped steer the country in the right direction regarding mental health.
However, they remain unexpectedly ineffective, thus requiring significant modifications. The current approaches, either at organizational, state, and national levels, are notably flawed. The Healthy People 2020 program had a goal of attaining a target of less than 7.5 percent of adolescents with a major depressive episode ("Adolescent Health | Healthy People 2020", 2020). Currently, as seen earlier in the discussion, the number stands at 13.3 percent – a difference of 5.8 percent. The number suggests that the nationwide legal mechanisms the government has adopted are hugely ineffective and require modifications. A key recommendation for the legal framework in place is that it should be expanded or new laws introduced that have a more targeted approach. There are no public policies that specifically address mental health problems in adolescent people in America. Having comprehensive and adolescent-oriented legislation on mental health would be useful in identifying and addressing such issues.
Barriers to successful prevention, elimination, or minimization of adolescent depression include stigma and discrimination, healthcare cost, and the fragmented healthcare system. The stigma around mental health illnesses is a primary concern for deterring adolescents from seeking treatments. Stigma is a broad term that encompasses prejudicial attitudes and stereotypical behaviors towards people with mental disorders ( Roberts & Duong, (2013) . This kind of discrimination makes victims of depression fear and distance themselves from the public. It deters people from seeking professional help, thus leading to more significant risks such as suicide, which are rampant among teenagers ( Roberts & Duong, (2013) . Even those seeking professional help from experienced care providers do not adequately disclose their conditions. As a result, this leads to under-treatment, which also builds up to extreme cases of mental health complications with time.
The cost of care is among the frequently mentioned barriers to accessing quality mental health services. Haugen, McCrillis, Smid, and Nijdam (2017) note that about 65 percent of Americans are concerned about the cost of care for mental illnesses. The use of mental health services is directly proportional to the cost of care. This is to say, the accessing to mental disorder services are sensitive to prices in that when the prices rise, the need for such services fall and vice versa. Although ACA and Medicaid's likes have played a significant role in ensuring mental health disorders are covered in insurance, there is still more to be done Haugen, McCrillis, Smid, and Nijdam (2017). Also, the current healthcare system is appallingly fragmented. A public health crisis, such as adolescent depression, requires a highly integrated and seamless service system that brings mental health services directly to the community. Such a system is yet to materialize in the United States.
Factors that facilitate the prevention and minimization of depression include mental health literacy, targeted mental health programs, and continuity of care. Unlike before, there is an improved understanding of mental health issues today, thanks to plenty of scientifically approved resources on the subject (Pierce & Brewer, 2014). Such a literacy level is critical in supporting help-seeking behaviors directly and reducing the level of stigma associated with depression. There are also numerous targeted mental health initiatives at national and local levels geared towards addressing mental health. Such actions promote good mental health by encouraging help-seeking behavior, reducing the time it takes for a patient to see a physician, improving access to quality care, and many others (Pierce & Brewer, 2014). For instance, some nongovernment organizations devoted to mental wellness in youth promote a healthy lifestyle, mentor, and educate teenagers on resilience. Lastly, continuity of care enabled by the recent patterns of healthcare reforms removes the need of one telling their story again and again.
The implication of the finding to advanced practice includes solutions towards healthy adolescent development and the development of youth well-being interventions. Studies into nationwide problems such as depression among adolescents provide substantial evidence that supports different theories of adolescent development. It allows practitioners in the field of medicine to evaluate adolescents on a deeper level, including social, cultural, familial, societal, and psychological contexts to understand the uniqueness of their conditions ( Roberts & Duong, (2013). Through this, they can develop more accurate and effective treatment plans that produce desirable results in the current approaches. The study informs the future actions and decisions of physicians and nurses towards addressing mental health in adolescents.
Mental health is a serious public health problem in the United States and other parts of the world. Recent decades have seen a massive shoot in the rates of depression in children aged 12 to 17 years. Often, this population is overlooked, with a majority of studies focusing on the adult population. However, as the discussion demonstrates, scholars must pay attention to the health group. This is not only because adolescents are at higher risk but also because they are at a critical transition into adulthood and thus present multiple other health implications. The adoption of the recommendations above would play a significant role in accomplishing the goal of Healthy People 2020.
References
Adolescent Health | Healthy People 2020. (2020). Retrieved 15 July 2020, from https://www.healthypeople.gov/2020/topics-objectives/topic/Adolescent-Health/objectives
Bernaras, E., Jaureguizar, J., & Garaigordobil, M. (2019). Child and adolescent depression: a review of theories, evaluation instruments, prevention programs, and treatments. Frontiers in Psychology , 10 , 543.
Diego, M. A., Field, T. M., & Sanders, C. E. (2003). Academic performance, popularity, and depression predict adolescent substance use. Adolescence , 38 (149), 35-43.
Haugen, P. T., McCrillis, A. M., Smid, G. E., & Nijdam, M. J. (2017). Mental health stigma and barriers to mental health care for first responders: A systematic review and meta-analysis. Journal of psychiatric research , 94 , 218-229.
NIMH » Major Depression. (2020). Retrieved 15 July 2020, from https://www.nimh.nih.gov/health/statistics/major-depression.shtml
Pierce, D., & Brewer, C. (2014). Factors promoting the use of mental health services in a rural area of Australia. Journal of Community Medicine and Health Education , 2 (11), 190.
Recent Advances in Mental Health Care. (2020). Retrieved 15 July 2020, from https://www.hhs.gov/ash/oah/adolescent-development/mental-health/access-adolescent-mental-health-care/recent-advances/index.html
Roberts, R. E., & Duong, H. T. (2013). Depression and insomnia among adolescents: a prospective perspective. Journal of affective disorders , 148 (1), 66-71.
Stockings, E. A., Degenhardt, L., Dobbins, T., Lee, Y. Y., Erskine, H. E., Whiteford, H. A., & Patton, G. (2016). Preventing depression and anxiety in young people: a review of the joint efficacy of universal, selective, and indicated prevention. Psychological medicine , 46 (1), 11-26.
