how do adolescents define depression? - cIRcle - University of ...

Immense disparities exist between the modest use of support services and the
Chapter I: Introduction
epidemiological findings of adolescent depression and other mental disorders in the community.
Studies in the US and Australia indicate that about two out of three adolescents with mental
disorders do not receive services from a health practitioner (Cauce et al., 2002; Patton, Hetrick,
& McGorry, 2007). Canadian data on access to support services show similar figures to those
found in Australian and US studies. Specifically, about 60 percent of people with mental health
problems do not receive services from a health practitioner (Stephens & Joubert, 2001).
Treatment services to identify those most in need of intervention are fragmented, limited in their
capacity, and in general do not facilitate access to care. Takanishi (2000) indicates that
contemporary social interventions rarely aim to prepare adolescents for the rapid and often
unpredicted social change they encounter in modern society.
The accepted approach to assessing who merits mental health care in the community has
been to provide prevalence estimates based on accepted categorical or threshold diagnostic
criteria for mental disorders as identified via the DSM-IV-TR (APA, 2000). Threshold is
representative of a division between "cases" and "non-cases," which presently clinicians are
obliged to use, as they must decide who merits treatment (Goldberg, 2000). Subthreshold
depression exists between threshold depression and an asymptomatic state (Fergusson, Horwood,
Ridder, & Beautrais, 2005), and is representative of dimensions of depressive symptoms below
number and/or duration criteria for depression according to the DSM-IV-TR (APA, 2000; Judd
& Akiskal, 2000). Making decisions about who "needs" mental health care based solely on the
DSM-IV-TR (APA, 2000) diagnoses does not seem to be optimal (Sareen, Stein, Campbell,
Hassard, & Menec, 2005a) because research indicates that depression may best be
conceptualized on a continuum consisting of several dimensions (Akiskal, Judd, Gillin, &
Lemmi, 1997; Goldberg, 2000; Judd & Akiskal, 2000; Lewinsohn, Solomon, Seeley, & Zeiss,
2000b; Slade & Andrews, 2005).
The costs of depression to the individual and to society are high, not only in terms of the
impact on affected individuals and their families, but also in terms of disability, diagnostic costs,
treatment, and the resultant loss of productivity. In a Canadian report, Stephens and Joubert
(2001) specified that the direct and indirect financial costs related to mental health problems in
1998 was $14.4 billion annually, almost double the amount since 1993, and the figures are
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