Imagine, just for a moment and if you can, a family trapped by a natural disaster – a violent earthquake perhaps, with their lives hanging by a thread – gripped by fear, desperate for rescue, and their hopes of seeing another day together slowly fading… Would they all be affected in exactly the same way, with the same, undeniably negative impact upon their mental health, now and in the future, or would their experience and its memories be totally and utterly different?It’s a question at the very heart of understanding, diagnosing and successfully treating the various mental health disorders, such as depression, anxiety and those that are trauma-related, that can affect us all as we journey through life – from our childhood years, into our teens and adolescence, and on into our adulthood.No-one – whatever their age, social background, ethnicity, gender, and so on – is immune. Just like the current coronavirus pandemic, it’s simply another thing that makes us all so decidedly human.According to a recent data study published in the medical journal, “The Lancet,” entitled “Global Mental Health & COVID-19,” the majority of parents believe, quite wrongly, that psychological illness – a mental health disorder – is reserved solely for adults – for them, in other words. However, mental illness, eg. disorders like bipolar and schizophrenia, occur in children and teens as well.In fact, exhaustive medical research shows that the majority of psychological illnesses progress along “a developmental course beginning early in life.” This is the case not just with conditions normally associated with children, like autism and ADHD, but also obsessive compulsive disorder (OCD), depression, and many others. This research also shows clearly that the majority of those who have a mental health disorder will show diagnosable signs and symptoms of its existence before 24 years of age.With this in mind, it is important to understand that there are clear and vital differences between adult mental health and teenage mental health. Therefore, the teenage boy, along with his family, who would soon be rescued from the earthquake’s devastation in the example above will have a vastly differing experience, set of memories and mental health response when compared to his mother or father.
Mental Health in Washington State
The state of Washington continues to be challenged by ever-increasing numbers of people affected by mental health disorders, making it one of the more affected states in the U.S. With the predicted long-lasting specter of the coronavirus, people whatever their age are presented with previously unencountered difficulties in simple everyday living – social distancing, lockdowns, job losses, reduced services, and enforced isolations.Never has the teenage demographic faced, and then endured, such reduced face-to-face contact with their peers – a problem that one group of British neuroscientists believe will have serious long-term effects on their mental health. At a highly sensitive time in their life, schools and colleges remain shut, and the social effects of all this isolation could lead to seriously negative outcomes on teenagers’ brain development, behavior, and mental health.For adults, they are faced with continuing financial difficulties, job losses and employee furloughs, stress, and social isolation too – all of which will negatively impact their mental health. In fact, it’s already happening. Recently, the Benson County Coroner in Washington state sadly reported an unprecedented rise in middle-aged men taking their own lives.Mental health issues and medical disorders continue to rise in Washington state, with numerous cases of suicide, depression, anxiety, PTSD, bipolar disorder, self-harm, and substance addiction. Predominantly falling under the clinical grouping of “mood disorders,” defined as “any of several psychological disorders characterized by abnormalities of emotional state (including especially major depressive disorder, dysthymia, and bipolar disorder) – also called affective disorder,” the socio-economic effects of this major mental health problem will undoubtedly lead to further issues in the years ahead.
The Most Common Mental Health Disorders in Washington State… Now
Washington state consistently places higher in national statistics for diagnosed mental health disorders, and it is one of the lowest in terms of successful treatment, with less than half of those requiring treatment actually receiving it in the first place.Medical conditions, such as depression, anxiety, PTSD, bipolar disorder, self-harm, and substance addiction, are a serious socio-economic problem, and the possible consequence of an untreated disorder – namely, suicide – has been consistently above the national average for a number of decades.
Fact – both teenagers and adults take their own lives. Regardless of age, when a teenager or an adult feels that nothing can resolve their own angst, whatever that may be, the only recourse is a suicide attempt, and some succeed.Additionally, according to the Centers for Disease Control and Prevention (CDC), the rise in teenage suicides specifically has far outpaced that of the increase in suicides in general – it continues to do so – to the extent that suicide is now the second-leading cause of death for U.S. teenagers, just behind accidental deaths.According to data from WA’s Department of Health, around 10% of WA 10th-graders have attempted suicide in 2018, and between 2008-18, the number of 10th-graders experiencing suicidal thoughts increased dramatically – by 35%. Lastly, while teenage girls in WA attempted suicide more often, boys in the state were 4 times more likely to succeed in their attempt.
One of the most common mental health disorders affecting both teens and adults in Washington state (and, indeed, nationally) is depression and is clinically defined as major depressive disorder. This mood disorder is not just a case of “the blues” that passes in time – it’s a persistent, debilitating disorder that can result in substance abuse, self-harm, and suicide.A recent study showed teenagers tended to have symptoms that were typical of adult depression, including depressed mood, sleep disturbance, cognitive difficulties, weight problems, low self-esteem, guilt, loss of energy, and suicidal thoughts. 12.54% of Washington state’s teenagers and young adults suffer from major depression disorder – that’s a deeply disturbing ratio of 1 in 8. Of these, 62.5% – a staggering 6 out of 10 WA teenagers – with this disorder do not receive any mental health services whatsoever.
Stress is the single most predominant factor in causing anxiety, and untreated anxiety can lead to a number of mental health disorders, including generalized anxiety disorder – the most common disorder affecting the mental health of U.S. citizens, be they a teenager or an adult.According to a recent American Psychological Association (APA) survey, teenagers are exceeding the stress level experienced by adults. For example, the younger demographic reported that, as a result of stress, 36% felt tired and lethargic, 31% felt overwhelmed and 30% felt depressed or sad.Furthermore, other medical research suggests that women are nearly twice as likely than men to be diagnosed with an anxiety disorder in their lifetime, with a coalition of women’s health groups recommending that both adult and teenage women should be screened for anxiety to improve detection and treatment. Anxiety disorders include:
- Generalized Anxiety Disorder (GAD)
- Obsessive-Compulsive Disorder (OCD)
- Panic Disorder
- Post-Traumatic Stress Disorder (PTSD)
#4. Post-Traumatic Stress Disorder (PTSD)
Post-traumatic stress disorder (PTSD) is a mental health disorder, usually severe in nature, that occurs as a result of a major traumatic event in a person’s life. During the time of the trauma, the sufferer feels utterly powerless, and this feeling of powerlessness often stays with them. Common causes of PTSD include:
- Sexual abuse/assault
- Childhood abuse
- Natural disasters
- Military combat
Neuroscientists recognize that children and teens, because of their underdeveloped brains, tend to be more vulnerable to the effects of trauma than adults. The underdeveloped brain is scientifically not mature enough to process the traumatic experience in a way that helps recover fully from it.According to the U.S. National Institute of Mental Health (NIMH), an estimated 3.6% of adults had PTSDin the past year, with prevalence higher for females (5.2%) than for males (1.8%). Furthermore, studies show that an estimated 5% of teenagers experienced PTSD, including an estimated 1.5% with severe impairment. As with adults, the prevalence of PTSD was higher for females (8.0%) than for males (2.3%).
#5. Bipolar Disorder
Again according to the NIMH, bipolar disorder affects approximately 5.7 million U.S. adults – about 2.6% of the population aged 18 and over. Children and teenagers can also suffer from bipolar (around 1-5%), and when it occurs, it is known as an early-onset form of the disorder. Experts believe that the difference in the experience of bipolar mood swings between teens and adults is due to the differences in brain development, as a teenager’s prefrontal cortex (the part of the brain that governs reason and logic) is underdeveloped, making them more impulsive and emotional.For both teens and adults, severe depression can lead to suicide, and extreme mania can lead to substance abuse – approximately 40% of bipolar teens also have a substance abuse disorder.
Self-harm, the act of inflicting pain and injury onto yourself, has always been mistakenly looked upon as the domain of the young. However, it is far more common in adults than people realize. Adult self-injury is often the sign of a disorder such as depression, bipolar disorder, or borderline personality disorder. It’s exceptionally difficult to gauge how many adults self-harm, as it usually begins in childhood, and many do not seek treatment because of the shame and guilt associated with the behavior.Over 2 million cases, predominantly young people (teenage girls being the majority), are reported annually in the U.S. alone. According to medical community-based data:
- Around 17% of all people will self-harm at some point in their lifetime – 90% of cases begin in adolescence
- The average age for self-harm to begin is only 13, which aligns with the possible emergence of mental health disorders
- 45% cut themselves as a method of self-harm
- Self-harm is more common among teenage girls, leading to the gender-based stigma they are attention-seeking
Regardless of age, substance abuse and addiction is a continuing, unstated national epidemic. Apart from the opioid epidemic (which will take years to bring under control), a study published in JAMA Psychiatry reports that the rate of alcohol use disorder (AUD, or alcoholism) rose by a shocking 49% in the first decade of the 2000s.Worryingly, 1 in 8 U.S. adults (12.7% of the U.S. population) now meets diagnostic criteria for AUD. The CDC estimates that 88,000 people a year die of alcohol-related causes, more than twice the annual death toll of opiate overdose.Neuroscientists agree that, again, it is the underdeveloped teenage brain that makes adolescents more at risk from substance addiction, either through, for example, an attempt to self-medicate for a mental disorder or peer and academic pressures.
Mood Disorder Treatment
Medical treatment for mood disorders, such as depression, anxiety, PTSD, and bipolar disorder, and the consequences of these disorders remaining untreated, such as suicide, self-harm and possible substance addiction, is based along the clinical “Biopsychosocial & Lifestyle Model” for mood disorders, as depicted below:
Source: Australian & New Zealand Journal of Psychiatry 2015, Vol. 49(12) 1087-1206
As you can see from the model, the treatment for different mood disorders is covered by a range of biological, psychological, social and lifestyle elements – medications, therapies, social interactions, and lifestyle improvements, all depending upon the primary state of the illness, whether it’s psychotic, manic, melancholic or reactive in nature. For example, bipolar disorder will require medication (the biological element) to cover the manic and melancholic aspects of the condition.
Primary Differences Between the Teenage & Adult Approach to Mood Disorder Treatment
Because a teenager’s brain is considered medically as underdeveloped (the primary reason for a mood disorder developing as it does during childhood years), the approach between treating a teenager and treating an adult for a disorder will differ in several aspects.
1. Mitigation & Early Diagnosis
It is imperative that a mood disorder is caught early in its development, before it progresses into a more severe form that causes further consequences, such as addiction. Parents and caregivers can promote a teenager’s mental health using lifestyle improvements as directed by the model, eg. exercise and diet.
2. Family-Focused Treatment
Any treatment approach must be clearly centered upon family support, relationships, and effective communication.
Psychotherapy should include one, if not all, of the following:
- Cognitive Behavioral Therapy (CBT): The most widely researched form of therapy for mood disorders, including depression and bipolar disorder. With CBT, children, adolescents and young adults learn about the connections among their thoughts, feelings, and behaviors.
- Dialectical Behavior Therapy (DBT): Recommended for adolescents and young adults who have difficulty regulating their emotions, DBT involves learning skills to tolerate distress, manage emotions, decrease impulsive behaviors, including self-harm, and improve relationships.
- Interpersonal Psychotherapy for Adolescents (IPT-A): Originally developed to treat adult depression, IPT-A addresses common issues involving romantic relationships, parental communication, and interacting with peers.
A range of mood disorders can be effectively treated in part by medication, playing an important role in symptom relief, recovery, and prevention of future mood episodes for teenagers.