The incidence of depression among children and adolescents is of great concern because of the acute and lasting consequences associated with depressive disorders. Approximately 60 percent of adolescents with depression have recurrences throughout adulthood.2 Furthermore, adults with a history of adolescent depression have a higher rate of suicide than those without such a history.2 Adolescent-onset depression has been associated with abuse and neglect3; poor academic performance; substance use; early pregnancy; and disruptions in social, employment, and family settings into adulthood.4–6 Although the prevalence of adolescent depression is high, it is significantly underdiagnosed and undertreated.7 Because of the lack of mental health care professionals, family physicians are often responsible for detecting and treating childhood and adolescent depression.
We need to screen for depression in children 12-18 years in the primary care setting and often time teachers help refer a minor health care. During this stressful time for kids and adults at home it is important to screen yourself and or family members for depression.
Depression Q & A
WHAT ARE THE SIGNS AND SYMPTOMS OF DEPRESSION?
Sadness is only one small part of depression and some people with depression may not feel sadness at all. Different people have different symptoms. Some symptoms of depression include:
Persistent sad, anxious, or “empty” mood
Feelings of hopelessness or pessimism
Feelings of guilt, worthlessness, or helplessness
Loss of interest or pleasure in hobbies or activities
Decreased energy, fatigue, or being “slowed down”
Difficulty concentrating, remembering, or making decisions
Difficulty sleeping, early-morning awakening, or oversleeping
Appetite and/or weight changes
Thoughts of death or suicide or suicide attempts
Restlessness or irritability
Aches or pains, headaches, cramps, or digestive problems without a clear physical cause and/or that do not ease even with treatment
HOW CAN I HELP MYSELF IF I AM DEPRESSED?
As you continue treatment, you may start to feel better gradually. Remember that if you are taking an antidepressant, it may take 2 to 4 weeks to start working. Try to do things that you used to enjoy. Go easy on yourself. Other things that may help include:
Trying to be active and exercise
Breaking up large tasks into small ones, set priorities, and do what you can as you can
Spending time with other people and confide in a trusted friend or relative
Postponing important life decisions until you feel better. Discuss decisions with others who know you well
Avoiding self-medication with alcohol or with drugs not prescribed for you
Treatment Options with Professionals
Medications called antidepressants can work well to treat depression. They can take 2 to 4 weeks to work. Antidepressants can have side effects, but many side effects may lessen over time. Talk to your health care provider about any side effects that you have. Do not stop taking your antidepressant without first talking to your health care provider.
Psychotherapy helps by teaching new ways of thinking and behaving and changing habits that may be contributing to depression. Therapy can help you understand and work through difficult relationships or situations that may be causing your depression or making it worse.
If you or someone you know is in crisis, get help quickly
This depression inventory can be self-scored. The scoring scale is at the end of the questionnaire.
0 I do not feel sad.
1 I feel sad
2 I am sad all the time and I can’t snap out of it.
3 I am so sad and unhappy that I can’t stand it.
0 I am not particularly discouraged about the future.
1 I feel discouraged about the future.
2 I feel I have nothing to look forward to.
3 I feel the future is hopeless and that things cannot improve.
0 I do not feel like a failure.
1 I feel I have failed more than the average person.
2 As I look back on my life, all I can see is a lot of failures.
3 I feel I am a complete failure as a person.
0 I get as much satisfaction out of things as I used to.
1 I don’t enjoy things the way I used to.
2 I don’t get real satisfaction out of anything anymore.
3 I am dissatisfied or bored with everything.
0 I don’t feel particularly guilty
1 I feel guilty a good part of the time.
2 I feel quite guilty most of the time.
3 I feel guilty all of the time.
0 I don’t feel I am being punished.
1 I feel I may be punished.
2 I expect to be punished.
3 I feel I am being punished.
0 I don’t feel disappointed in myself.
1 I am disappointed in myself.
2 I am disgusted with myself.
3 I hate myself.
0 I don’t feel I am any worse than anybody else.
1 I am critical of myself for my weaknesses or mistakes.
2 I blame myself all the time for my faults.
3 I blame myself for everything bad that happens.
0 I don’t have any thoughts of killing myself.
1 I have thoughts of killing myself, but I would not carry them out.
2 I would like to kill myself.
3 I would kill myself if I had the chance.
0 I don’t cry any more than usual.
1 I cry more now than I used to.
2 I cry all the time now.
3 I used to be able to cry, but now I can’t cry even though I want to.
0 I am no more irritated by things than I ever was.
1 I am slightly more irritated now than usual.
2 I am quite annoyed or irritated a good deal of the time.
3 I feel irritated all the time.
0 I have not lost interest in other people.
1 I am less interested in other people than I used to be.
2 I have lost most of my interest in other people.
3 I have lost all of my interest in other people.
0 I make decisions about as well as I ever could.
1 I put off making decisions more than I used to.
2 I have greater difficulty in making decisions more than I used to.
3 I can’t make decisions at all anymore.
0 I don’t feel that I look any worse than I used to.
1 I am worried that I am looking old or unattractive.
2 I feel there are permanent changes in my appearance that make me look unattractive
3 I believe that I look ugly.
0 I can work about as well as before.
1 It takes an extra effort to get started at doing something.
2 I have to push myself very hard to do anything.
3 I can’t do any work at all.
0 I can sleep as well as usual.
1 I don’t sleep as well as I used to.
2 I wake up 1-2 hours earlier than usual and find it hard to get back to sleep.
3 I wake up several hours earlier than I used to and cannot get back to sleep.
0 I don’t get more tired than usual.
1 I get tired more easily than I used to.
2 I get tired from doing almost anything.
3 I am too tired to do anything.
0 My appetite is no worse than usual.
1 My appetite is not as good as it used to be.
2 My appetite is much worse now.
3 I have no appetite at all anymore.
0 I haven’t lost much weight, if any, lately.
1 I have lost more than five pounds.
2 I have lost more than ten pounds.
3 I have lost more than fifteen pounds.
0 I am no more worried about my health than usual.
1 I am worried about physical problems like aches, pains, upset stomach, or constipation.
2 I am very worried about physical problems and it’s hard to think of much else.
3 I am so worried about my physical problems that I cannot think of anything else.
0 I have not noticed any recent change in my interest in sex.
1 I am less interested in sex than I used to be.
2 I have almost no interest in sex.
3 I have lost interest in sex completely.
INTERPRETING THE BECK DEPRESSION INVENTORY
Now that you have completed the questionnaire, add up the score for each of the twenty-one questions by counting the number to the right of each question you marked. The highest possible total for the whole test would be sixty-three. This would mean you circled number three on all twenty-one questions. Since the lowest possible score for each question is zero, the lowest possible score for the test would be zero. This would mean you circles zero on each question. You can evaluate your depression according to the Table below.
LEVELS OF DEPRESSION
These ups and downs are considered normal
Mild mood disturbance
Borderline clinical depression