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

Burden of Depression in Adolescents
Chapter II: Literature Review
Depression that begins in adolescence often recurs in adulthood (Birmaher et al., 1996b;
Costello, Foley, & Angold, 2006; Federal/Provincial/Territorial Advisory Committee on
Population Health [ACPH], 2000; Feehan, McGee, & Williams, 1993; Fombonne, Wostear,
Cooper, Harrington, & Rutter, 2001; Kessler, Avenevoli, & Merikangas, 2001; Kim-Cohen et al.,
2003; Lewinsohn, Allen, Gotlib, & Seeley, 1999; Lewinsohn et al., 2000a; Lewinsohn et al.,
2000b; Millstein, Petersen, & Nightingale, 1993; Parker & Roy, 2001; Rutter, Kim-Cohen, &
Maughan, 2006). As the new millennium unfolds, we are confronted with the dramatic forecasts
of the global increase in depression in the next 15 years. It is predicted to be the leading cause of
disability in both men and women, next to heart disease (Michaud et al., 2001; NIMH (U.S.),
2002; WHO, 2001). The conference of the Canadian Economic Roundtable on Depression
(2001) identified depression as a major cause of worker disability and corresponding
productivity loss (Ministry of Health Services, 2002). Depression and stress disorders at work
account for 30 percent of all disabilities recorded at major corporations (Ministry of Health
Services, 2002). Based on the National Comorbidity. Survey, Kessler et al. (2003) report that
depression is a growing public health problem: 50 percent of the respondents born between 1965
and 1974 had their first Major Depressive Episode (MDE) by the age 18 in contrast to 20 percent
of participants born before 1965. In 1993, the economic costs of mental disorders in Canada was
estimated at just over $7 billion (Health Canada, 2002; Stephens & Joubert, 2001), and it has
about doubled in 1998 (Stephens & Joubert, 2001). The figures may be even higher if one is
considering the cost of production loss. The fact that the rate of increase is expected to continue
suggests that depression in adolescence is part of a heavy burden extending beyond the affected
individuals and their families, to a diminished quality of life.
Defining Adolescent Depression
During the last four decades, the defining characteristics of adolescent depression have
not originated in research studies of adolescents; instead, the criteria for diagnosis have been
developed and validated in adults, with age-specific modifications (APA, 2000; Birmaher et al.,
1996b; Gotlib & Sommerfeld, 1999). Further, research has shown that adolescents exhibit
diagnosable depression, but many manifest more irritability than sadness (APA, 2000; Birmaher
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