Adolescence is a developmental inflection point replete with vast changes across biological, social and psychological domains. Not surprisingly, it is arguably one of the most misunderstood periods of human development. Of the many misconceptions regarding adolescence, few are more ubiquitous than the notion that it is a time of inevitable depression and prolonged psychological turmoil. While epidemiologically, the teenage years represent an increased risk for depression, the vast majority of adolescents report few to no depression symptoms. It is all too common for parents and caregivers to mislabel clinically significant signs of depression as mere “hormones” or “normal teenage stuff.” Although depression is certainly not inevitable during adolescence, recent research has identified symptom profile patterns unique to teenagers.
When we consider depression as a clinical construct, we think of a constellation of various symptoms from depressed mood, inability to experience pleasure, to sleep difficulties and changes in appetite. Given the many signs and symptoms of depression, there exists a high degree of variability among diagnostic profiles. Among adolescents, individual differences greatly impact the cognitive, emotional and behavioral manifestation of depression. To improve clinical assessment of depression, researchers have taken a keen interest in better understanding common symptom patterns in adolescent depression. In a 2019 study in the Journal of Clinical Child Psychology, researchers from The University of Texas at Austin examined adolescent depression using a large sample of roughly 1,500 adolescents ages 13-19. The researchers were interested in which particular symptoms were most important with regard to overall distress and associated functional impairment. In other words, what is the true “core” of adolescent depression. Results indicated that self-hatred and loneliness were the most central symptoms in adolescent depression, followed by sadness and pessimism. The results of study illuminate a key difference in depression symptom manifestation between adolescents and adults, with depressed mood and anhedonia being more central to adult depression.
From a developmental perspective, these findings make sense given that identity formation is a key task during adolescence. Many adolescents struggle during these years to better understand themselves, clarify their values, and develop a more robust sense of self. A predisposition toward depression in conjunction with this challenging developmental task can often lead to feelings of self-hatred. Loneliness is also logical from a developmental perspective given the importance of social engagement during adolescence. As children enter the teenage years, the drive for social affiliation and building new peer relationships increases exponentially. Adolescents are therefore more likely to experience more intense feelings of loneliness when encountering struggles with social engagement.
Pediatric providers are in a unique position to recognize early warning signs of adolescent depression. Most providers rely on a summative score on a self-report measure to evaluate adolescent depression. While these measures have great economic utility, relying on a sum total score fails to take into account that some symptoms are simply more important than others. In line with this, it may be prudent for pediatric providers to assess for signs of self-hatred, perceived social support, and social connectedness. Assessing these important areas can help providers zero in on the possible core of adolescent depression.
Sam Marzouk, Ph.D., L.P. is a pediatric psychologist and specialist in adolescent mental health. Dr. Marzouk completed his postdoctoral training at Children’s Minnesota and is currently the owner of Promethean Psychology in Edina, Minnesota. A strong advocate for evidence-based psychology, Dr. Marzouk is passionate about translating research into clinical practice to empower children, adolescents and families.