Anxiety and Depression in Adolescence: A Social Problem

1. Introduction

Anxiety and depression in adolescence has become an increasing issue in society as time has progressed. Rates of high school students who qualify for the criteria that meet a mental disorder are 6-8 times higher than the same age group in the 1960’s. A test given to high school students over the years called the Minnesota Multiphasic Personality Index (MMPI) gives us data from 1938 (“Marsh”). The test is a personal survey asking students to answer questions about themselves on a scale from strongly agree to strongly disagree (ex.

I am happy today). Mental disorder rates are higher today than during the great depression, WWII, and the cold war. So why is this happening? A factor many experts agree on is a switch from an internal locus of control to an external. A majority of teens today don’t feel as though they are in control of their own fate and that can cause a lot of stress. This is partial credit is due to the way our society is shaped today; we have made a major shift from an emphasis on play to an emphasis on work.

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Kids are asked to grow up much earlier. Children and teens are becoming anxious at a much larger rate than in past years. The culture we now live in puts much more pressure on young people at a younger age, forcing them to grow up. The anxiety is crippling if left untreated, and with the amount of people experiencing it, it’s a social problem worth looking into.

2. Where does anxiety and depression come from?

The etiology of anxiety and depression can be traced back to an individual’s first stage of life. Psychiatric specialist John Marsh writes in his book that a child’s temperament in their first year of life can show behavioral signs that may lead to becoming an anxious child and teen. A parent can identify these early signs that include: excessive bouts of crying, sleeping difficulties and gas (“Marsh”). These traits or actions may seem normal for an infant thus it’s hard to expect a parent to pick up on any of these early signs, so they shouldn’t fret too much this early on. Where anxiety really starts is with an irrational fear of something that an individual perceives as a threat or dangerous.

This fear causes a change in behavior, like an avoidance of a situation where many people are or may be present in the case of social anxiety (“Alfano”). The part of the brain responsible for this fear is the amygdala, the emotional capital of our mind. The amygdala’s structure is altered when we become fearful of something, making it hard for the fear to be conquered or shaken. When this fear manifests, it can turn into different forms of anxiety and thus become part of a person’s emotional capability (“Marsh”). In essence, anxiety alters the stimulation of a certain fear into something people cannot handle and become overwhelmed.

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The main area that psychologists and other scientists have focused in on the last 10-15 years in child psychology is behavioral inhibition of the unfamiliar, or BI (“Marsh”). BI represents the tendency to exhibit fearfulness, restraint, secretiveness, and withdrawal in the face of novel events or situations. The more inhibitions a child shows, the more likely they are to develop anxiety or have anxious tendencies. BI is moderately heritable yet the largest factor in BI is the environment and experiences one has. In a study shown in Marsh’s book, nonshared environmental influences contribute more to BI than do factors shared by siblings, such as genetics and shared experiences.

BI is lessened by socialization, if a child becomes engaged in play and conversation with others from an early age; they are less likely to be inhibited. Parental encouragement in this aspect is key such as parents making play dates for their children and things of that nature. Let me be clear, BI is not the same as anxiety, it is a studied precursor to anxiety that has a lot of valuable research to back up the link between BI and anxiety. It is a good thing for parents and clinicians to pick up on at an early age in the child’s life to make the proper adjustments to ensure no mental breakdowns occur.

Outside of BI as a child, there are other things that can play into an adolescent onset of anxiety or depression. One of these things is the parental influence, whether it be the parent’s own mental illness, style of parenting, or the sociability of the parent, they all can affect the child. Biological predisposition is a factor a child can’t control and is unfortunate. 20-50% of teens that suffer from depression, anxiety or another disorder have a family member with some form of mental illness (“Borchard”). It has long been documented that children of parent’s with any mental disorders are at a much higher risk of also developing a disorder. As for parenting style, anxiety in teens and children has been associated with parenting styles characterized by limited expression of care and warmth and more inclination toward showing control and overprotection. A study done in 1991 by Krohne and Hock, observed pairs of mother and daughter solving puzzles, high-anxious girls and low-anxious girls divided the study into two groups. The psychologists found the mothers of high-anxious girls to be much more controlling than those of low-anxious girls (“Marsh”).

A young person, with the exception of school, has most their social interactions due to their parent’s connections. They have Thanksgiving with their cousins, aunts, and uncles and have barbecues with their parent’s work colleagues and their families. If a child’s parents are less socially involved, it hinders the child’s ability to grow and advance these skills, causing an emergence of anxiety in these situations (“Marsh”). Besides parental contact, the most beneficial relationships for young people to have are positive relationships with their peers. Peer victimization is a common experience that negatively affects young people psychologically. Recent research findings are a bit appalling, indicating that one in five youths are chronically exposed to ongoing abuse, whether it was physical, verbal, or any other form (“Muris”). These occurrences of bullying were most strongly linked to depression, low-self esteem, and social anxiety. An interesting study was done in 2005 by Strawser, Storch, and Roberti. They gave undergraduates a Teasing Questionnaire (TQ), which measures the degree to which people could recall being teased during childhood.

Results demonstrated that TQ scores were linked to social anxiety, trait anxiety, worry, and anxiety sensitivity (“Muris”). This study shows that peer victimization can play a key role in the development of mental disorders and the long lasting effects it can have. A place of interest I had while researching was if there were any differences in financial and ethic status in the community and if that had any significant effect on anxiety and other mental disorders. In general, the socioeconomic status of a youth was not a deciding factor in occurrence of mental disorders but one thing that does hinder those of less fortunate situations is they are much less likely to seek or receive treatment due to the costs. Most studies carried out in the US have found that children from ethic minorities (i.e. African American, Hispanic American) display higher levels of fear and anxiety than Caucasian counterparts. This also may be due to the fact that more minorities live in urban settings versus suburban settings, which can cause a sometimes more stressful living environment. Stressful or traumatic life events are definitely a factor in a child or teen developing any number of disorders.

Post Traumatic Stress Disorder (PTSD) is a disorder that is directly connected to a significant single event or string of events happening. In a journal I found, the goal of the study conducted was to look at the difference between dependent and independent events and the effect they had on pre-adolescent children. Dependent events are events that the individual actually chooses to do or directly involves the individual, such as choosing to partake in drugs. Independent events are things the individual has no control over such as the death of someone close to them. The findings of the study were that anxiety and depression are very likely to occur after dependent stressful events and independent life events were less likely to have effects lasting longer than six months (“Eldemira”). The results of this study suggest that life choices have more influence in mental disorders than things out of one’s control.

These are just general reasons children and young adults can develop mental disorders. Today’s society produces a variety of other factors that are specific to our time, showing the difference that has progressed over the decades. Students suffer today the immense pressure to get good grades in order to get into one of the elite colleges of the nation. From 9th grade in high school, kids are under the impression that unless they get straights A’s, their college options are going to be very limited. This is a level of stress that in past generations was not present at such a young age. Another thing unique to our decade is the phenomenon that is social media. The popularity of sites like Facebook and Twitter and the smartphone era in general has caused raised levels of anxious teenagers. This anxiety doesn’t come directly from social media, but from being away from it. A study done by Wilhelm Hoffman of the University of Chicago compared social media addictiveness to other things with addictive qualities. The results came back with the fact that social media was harder to resist than alcohol, caffeine, or cigarettes (“Fitzgerald”). Overall, the most significant factor in recent years is the change from intrinsic to extrinsic goals.

3. Different Types of Disorders

There are a large number of anxiety and depression disorders, with many twists and turns that make diagnoses very specific. In order to keep from being too repetitive this section will focus on some of the most largely diagnosed disorders including general anxiety disorder, social anxiety, and general depression. Discussing the symptoms and what these disorders entail is the goal of this section in order to provide a solid base of knowledge of just what young people are suffering with today.

3.1 Generalized Anxiety Disorder

Children with general anxiety disorder or GAD are plagued by worries most children or teens can shrug off. Often referred to as “little adults”, these children are concerned about things like health, personal value, safety, and their future. They also tend to worry a lot about other people and their issues, which have nothing to do with themselves, such as the neighbors’ fight they had last night. These worries become a central part of daily thoughts and this can disrupt development and adjustment to life (“Essau”). GAD has mostly been documented and studied in adults; this is because in the Diagnostic and Statistical Manuel of Mental Disorders (DSM) up until the 4th edition over-anxious disorder (OAD) was what this was called in children. These conditions are considered very similar and overlap many symptoms so now GAD is the universal term used regardless of age.

The main symptoms of GAD in the DSM-IV are excessive worry about multiple topics, difficulty controlling or regulating the worry, somatic symptoms that accompany the worry, and functional impairment resulting from the worries. There are a lot of overlaps in symptoms of anxiety so if these are restricted to: separation from someone, social situations, or a specific event than GAD is not the right diagnosis.

3.2 Social Anxiety Disorder

Anxiety as a whole is conceptualized as a tripartite system (“Alfano”) consisting of physical symptoms, subjective or cognitive distress, and behavioral avoidance. Social anxiety affects about 5-16% of young adults ages 15-24 depending on what study or survey you look at. Regardless, it’s too many people being affected than should be. The physical symptoms of social anxiety include: tachycardia (a heartbeat that exceeds 100 beats per minute), blushing, trembling, and sweating. These can occur not only in a social situation but in the anticipation of an upcoming event as well. An investigation performed in 1985 by Beidel, Turner & Dancu found that systolic blood pressure and heart rate significantly increase when someone who suffers from SAD was talking to someone of the opposite sex (“Alfano”).

Cognitive symptoms are very similar to that of GAD but it’s mostly the unreasonable worry that the person will do or say something that will be seen by others in a group as embarrassing or humiliating. This can take the form as specific negative thoughts, a general unease in social settings, or even specific beliefs that one will not behave how they think one should in social situations. The negative thoughts are something that is commonly seen in most patients. It’s usually one of the things that appear on self-reports and it’s hard to break. In my personal experience with a psychologist, she had told me that these are referred to as NATs or negative automatic thoughts. Just like the insect gnat, they are annoying thoughts that will not seem to leave someone caught in this struggle, which is why therapy is helpful to reshape the way someone thinks.

The behavioral aspect of SAD is avoidance of social settings. Many people who suffer from SAD become reclusive. These behaviors can be very subtle such as avoiding eye contact with teachers or asking to be behind-the-scenes when putting on a school play (“Alfano”). An interesting table I found surveyed a high school on different social events and what percentages said it caused at least a moderate level of distress and caused avoidance. The top 5 categories, oral reports, attending dances or parties, asking a teacher a question in class, starting or joining a conversation, and athletic or musical performances all had 85% or more of the students say it caused at least moderate distress and 55% or more said it caused avoidance of those situations (“Huberty”).

3.3 Depression

Depression, for the most part, is less of a chronic disorder like most anxieties are. Depression is usually a bout that people deal with from two weeks anywhere to two years. If the symptoms don’t pass after that amount of time, it becomes diagnosed as dysthymia, which is the chronic form of depression. Regardless of whether an individual is suffering for a short period of time or chronically, depression can be extremely debilitating. At any time about 10-15% of people under 21 suffer from depression. The more frightening statistic is that only 30% of these depressed people are receiving or seeking help (“Borchard”).

There is a large range of symptoms and signs that someone is suffering from depression. These include: apathy, complaints of physical pain such as headaches, stomachaches, difficulty concentrating, loss of appetite or overeating, memory loss, thoughts or obsession with death and dying, sadness or feeling of hopelessness, trouble sleeping or too much sleep, drop in grades, substance abuse and many other things. Depression, rather than getting scared, seems to make someone numb to the world. Often due to some sort of disappointment such as inadequate social status, sexual frustration with orientation or inability to talk to the opposite sex, school performance or any other number of things (“Gray”).

4. Treatment

Treatment is a glimmer of hope in today’s world. Although rates of anxiety and depression have continued to climb, treatment methods are also continuing to improve as science and technology advance. The most widely accepted or praised method for treatment is cognitive-behavioral therapy. “Cognitive-behavioral is meant to represent an integration of cognitive, behavioral, affective, and social strategies for change” (“Marsh”).

A study that is pretty representative of the cognitive-behavioral process as a whole was done in 1989 by Kane and Kendall. The study took a group of adolescents suffering from anxiety and put them through therapy for 6 months. Kane and Kendall were able to divide the process of recovery into four major components: “1. Recognizing anxious feelings and physical reactions to anxiety, 2. Identifying and modifying negative self-statements, 3. Generating strategies to cope effectively in anxiety-provoking situations, and 4. Rating and rewarding attempts at coping” (“Marsh”). After the six months, self-reports, parental reports, and reports done by the clinicians had improved significantly. A follow up appointment was made three months after the study had ended and about 50% of the subjects had made considerable gains in adopting and using their newfound knowledge. The other half had regressed at least in some way back to old habits. This shows the differences between individuals and their needs, some can have an intense short treatment and be fine for the rest of their days while others need a constant support over many years.

The other portion of treatment that is of importance in our time especially is intervention by the means of pharmacotherapy. Using drugs such as anti-depressants and anxiolytics in order to stop anxiety and depression has increased as technology has improved. The three most commonly prescribed medicines for anxiety and depression are benzodiazepines, beta-blockers, and SSRIs. Benzos are prescribed for a short-term period for severe disabling anxiety. The way this drug works is it dampens the overall activity in the brain in order to calm the person. Beta-blockers are commonly prescribed to those who suffer from social anxiety because they essentially block adrenaline output, lessening the nerves one can feels from being excited or nervous. SSRIs are the latest and most effective antidepressant. They have been praised for their lack of side effect compared to older anti-depressants. Formally selective serotonin reuptake inhibitors, they keep serotonin, the neurotransmitter in charge of mood, in the brain longer causing a raise in mood.

Just from 1996 to 2005, antidepressant use in the US has gone from 5.84% of the population to 10.12% (“Grohol”). The trend is still increasing and it may just be because more people are becoming depressed but it also could be because of a shift to a “quick-fix” societal norm. We live in a world where if someone can no longer get an erection, they take a blue pill called Viagra and are ready to go. This same mentality can be applied to drugs used for mental disorders. People can go into a doctor’s office and say they need something to make them feel better and skip the most important part of the process, therapy. Without a change in behavior, the antidepressant won’t have a strong effect. It has been proven time and time again that cognitive-behavioral therapy accompanied by a drug is the most effective strategy in lowering anxiety or beating depression. “Two treatments provide a greater ‘dose’ and thus may provide a more rapid and efficient response” (“Marsh”).

5. Conclusion and Possible Improvements

We live in a rapidly changing time, and that may be one of the very reasons that so many people are anxious and depressed, the fear of the unknown and change. Regardless of whether that holds true or not, we have an obligation as a society to change the way we approach anxiety and depression in young people because they will be the leaders of tomorrow. The idea of just fixing things by throwing a pill at the problem is not the right way to handle things because it doesn’t have long-term benefits. It may initially be helpful but it doesn’t allow an individual to look at a problem and realize the error of their ways and why was something going on. The “quick-fix” we have going on is in part due to a loss of sensitivity in our world as a whole. Things like Facebook and texting makes face-to-face contact less and less necessary and we lose a sense of humanity because of it. The result that may come forth if this downward trend continues is about 1/5 of our country’s soon-to-be adult population suffering from mental disorders and not being able to contribute or enjoy life to their full potential. Adolescent-onset of mental disorders has been proven to have an even stronger overall toll than the adult-onset version; therefore, action is necessary as early as possible (“Marsh”).

The future isn’t entirely gloomy though. We have the chance as a society to change how we deal with mental disorders in young people. One thing that would benefit many would be to go back to a more creative and individualized education experience. By allowing children and teens the ability to “play” and seek passions, we can create a system that may not produce as many CEOs but instead people who are simply happy in their career and life. Allowing more time for children to grow up could be very beneficial for their mental health. Another possible improvement is in the medical field. Making psycho-evaluations mandatory or as important as annual health check-ups could allow early preventative action to take place. By starting this process early in an individual’s life, it could greatly reduce the chance of an anxious or depression outburst to occur.

The number one thing that can happen in order to change the prevalence of mental disorder rests on the shoulders of parents. By being knowledgeable in the dangers of mental disorders today, like 5,000 annual suicides, a rate triple of the 1960’s, they can be the best preventative force. It’s better to be proactive and than reactive. Muhammad Ali said it well when he stated, “you can set yourself up to be sick, or you can choose to be well.” The future of this social problem is in our hands, whether we choose to continue down the track where anxiety and depression rates rise, or take a stand, is all up to us. Regaining an internal locus of control, allowing creativity and individualism to thrive, and caring about happiness more so than financial wealth are ways we can stop the progression of anxiety and depression in adolescence.

Works Cited

Alfano, Candice A., and Deborah C. Beidel. Social Anxiety in Adolescents and Young Adults: Translating Developmental Science into Practice. Washington, DC: American Psychological Association, 2011. Print.

This book is based on social anxiety in adolescents. Social anxiety symptoms are often seen in teens but only recently books like this one have come out that really dig into the adolescents. It looks at the etiology of the problem, which is what I will be mainly using this source for.

Borchard, Therese J., “Why Are So Many Teens Depressed?” Psychcentral.com 03. Apr. 2004. Web. 10 Nov. 2012. .

Borchard is an associate editor for Psychcentral.com and upon reading her article she had a few interesting facts that I thought were worth sharing because they show a general hopelessness in today’s youth that we need to fix.

De Jong, P.J., B.E. Sportel, E. De Hullu, and M. H. Nauta. "Co-occurrence of Social Anxiety and Depression Symptoms in Adolescence: Differential Links with Implicit and Explicit Self-esteem?" Psychological Medicine 42.03 (2012): 475-84.EBSCOhost. Web. 14 Oct. 2012.

This article talks about social anxiety and depression and how they very well can go hand in hand. The study looks at two different types of self-esteem, implicit and explicit. Explicit self-esteem is deliberately self-evaluating while implicit has more to do with memory. The goal of the study was to see if these explicit and implicit self-esteems did in fact result in higher levels of depression and social anxiety. I will use this study to look at the differences between a teen’s memory and actual thoughts of themselves effect on mood.

Eldemira Domenech-Llaberia, et al. “AGE, GENDER AND NEGATIVE LIFE EVENTS IN ANXIETY AND DEPRESSION SELF-REPORTS AT PREADOLESCENCE AND EARLY ADOLESCENCE. (English). “Ansiedad Y Estres 17.2/3 (2011): 113-124. Academic Search Complete Web. 17 Oct. 2012.

This is a study that took students from 4th to 6th grade from 13 randomly selected schools participated. The study looked at the difference in age, gender and life events on a student’s prevalence to get anxiety and depression. Provides me with information based on different groups of people.

Essau, Cecilia A., and Franz Petermann, eds. Anxiety Disorders in Children and Adolescents: Epidemiology, Risk Factors and Treatment. New York: Taylor & Francis, 2001. Print.

This book is another look at how to diagnose, deal with, and treat anxiety issues. The interesting thing with this book is it’s about ten years older than the other books and so the difference in findings will be gripping to look at it.

Fitzgerald, Britney. "Social Media Is Causing Anxiety, Study Finds." The Huffington Post. TheHuffingtonPost.com, 10 July 2012. Web. 15 Nov. 2012.

Fitzgerald’s article talks about the effect that social media has on anxiety and just how addictive Twitter, Facebook and other things in the same category are.

Gray, Peter. "Freedom to Learn." The Dramatic Rise of Anxiety and Depression in Children and Adolescents: Is It Connected to the Decline in Play and Rise in Schooling? Psychology Today, 26 Jan. 2010. Web. 15 Nov. 2012. .

Peter Gray talks about one of my main focuses, the switch from play to work early on in a child’s education and the effect that has.

Grohol, John M., Psy.D. "Antidepressant Use Up 75 Percent | Psych Central News."Psych Central.com. N.p., 3 Aug. 2009. Web. 15 Nov. 2012. .

This article is all about the rise in the usage of antidepressants and why this is happening.

Huberty, Thomas J. Reed. Anxiety and Depression in Children and Adolescents: Assessment, Intervention, and Prevention. New York: Springer, 2012. Print.

Thomas Reed’s book was written in as an insight or somewhat of a guide in understanding what goes on in a young person’s development that allows anxiety and other mental disorders to develop. Historically there has been five major factors in the development of mental disorders such as biological or social but this book adds a sixth: schools. Reed thinks that a child’s school is not only for educational growth but all other factors as life as
well. Looking into a school setting is critical because outside of the home it’s where children usually spend most their time.

March, John S. Anxiety Disorders in Children and Adolescents. New York: Guilford, 1995. Print.

This is the last print source that I have; it seems to be the most technical and scientific as well. John March is the chief child psychiatry specialist at Duke University and so he’s a specialist among specialists. I will look into what he says and try to elaborate my research with it.

McLaughlin, Katie A., Joshua Breslau, and Jennifer Green. "Childhood Socio-economic Status and the Onset, Persistence, and Severity of DSM-IV Mental Disorders in a US National Sample." Social Science & Medicine 73.7 (2011): 1088-096.EBSCOhost. Web. 15 Oct. 2012.

This article dives into the idea that a socio-economic status is a factor in a child or adolescence’s mental health. It has been documented many times, but this article found that childhood financial status wasn’t usually the main factor in a child’s overall mental health. I will use this article because I think that a social economic status seems like it would matter tremendously in mental health.

Muris, Peter. Normal and Abnormal Fear and Anxiety in Children and Adolescents. Amsterdam: Elsevier, 2007. Print.

Peter Muris’ book goes into the epidemiology of anxiety in children and the difference between that and normal fears. He examines how some children have a worse way of adapting to bad situations. That vulnerability is a key factor in the development of according to this book and I want to look at that portion of this book.

Nicholas Allen, et al. “Parental Behaviors During Family Interactions Predict Changes In Depression And Anxiety Symptoms During Adolescence.” Journal Of Abnormal Child Psychology 40.1 (2012): 59-71. Academic Search Complete. Web.
17 Oct. 2012.

A journal investigated the longitudinal relations between parental behaviors observed during parent-adolescent interactions, and the development of depression and anxiety. Positive and negative parental behaviors were examined. This is a great thing to look at for my paper because parents play a huge role in a child’s development.

Zavos, Helena M.S., Ph.D, Chloe C.Y. Wong, Ph.D, Nicola L. Barclay, Ph.D, and Jonathan Mill, Ph.D. "Anxiety Sensitivity In Adolescence And Young Adulthood: The Role of Stressful Life Events, 5HTTLPR And Their Interaction."Depression and Anxiety 29.5 (2012): 400-08. EBSCOhost. Web. 14 Oct. 2012.