A single risk factor rarely results in depressive outcomes. Instead, biological, psychological, and social systems are considered within a larger framework for explaining the etiology of depression. A developmental perspective suggests: 1) the manifestation of depression varies with age; 2) how individuals experience depression internally varies greatly from one individual to the next; and 3) the context of ongoing development changes should be taken into account when assessing for depression in adolescents.  With this in mind, aspects unique to adolescents should also be considered within a developmental perspective in order to understand depression in this client category.

Special Issues for Adolescents with HIV:Depression

Diagnostic CriteriaA major depressive disorder is diagnosed when there is a history of one or more major depressive episodes without a history of manic, mixed (manic – depressed), or hypomanic episodes. There must also be at least two weeks of pervasive change in mood, manifested by either depressed or irritable mood and/or a loss of interest and pleasure. Additionally, several signs and symptoms must be present before a diagnosis of major depression is indicated.

Clinical Resource Guide

Etiology Risk Factors Signs Symptoms Treatment

• Family counseling and individual psychotherapy

• Medications

• Diet, exercise and sleep modifications with family involve- ment to increase compliance

• Targeted interventions for problem resolution involving the home or school environment

• Combination of psychotherapy and medications

Condition

• Family history of depression or previous episode(s) of depression*

• Dropping out of school or unattainment of a significant goal*

• Diagnosis of an illness, disease progression or hospitalization

• Disclosure of a diagnosed illness to family and friends

•Low satisfaction with assistance received from support network*

• Low adaptive/coping ability*

• Family financial difficulties, neglect/abuse, parental alcohol or substance abuse*

• Stress or trauma (including natural disasters)

• Attentional, conduct, anxiety or learning disorders*

• Questioning sexual orientation*

• Previous suicide attempt

• Loss of a parent or loved one, divorce of parents or other losses*

• Only child or living with adoptive parents*

• Persistent sad or irritable mood*

• Loss of interest in activities he/she once enjoyed, becomes apathetic*

• Difficulty sleeping or excessive sleeping patterns

• Low self-esteem, feelings of hopelessness or inappropriate guilt*

• Difficulty concentrating

• Recurrent thoughts of death or suicide

• Increased irritability, anger, or hostility*

• Frequent somatic complaints (e.g., reoccurring stomachaches, headaches and muscle aches)* • Unstable moods and potential for violence*

• Extreme sensitivity to rejection, criticism, or failure*

• Withdrawn or social isolation, poor communication*

• Frequent absences from school or poor performance in school* • Talks about or tries to run away from home*

• Outbursts of shouting, complaining or unexplained crying

• Alcohol or substance abuse

• Reckless behavior

• Obsessed with poetry or music with morbid themes*

• Significant changes in eating and sleeping patterns*

• Significant weight gain or loss*

• Frequent displays of misconduct

• Self-destructiveness (e.g., high risk sexual behavior*

• Talks of self injury or prior episode(s)

• Prior attempts or expres- sions of suicide

AdolescentDepression

Signs = “objective”indication(s) of a medical fact or quality that can be detected by a clinician

Symptoms = “subjective” experiences that a patient might report to a clinician

* = directly associated with adolescents

Depression may be the result of many factors, either individually or acting in concert.

These may include environmental factors, which may be reactions to events, such as a loss. A depressed mood may also be related to or triggered by psycho-logical factors including a lack of self-esteem or a pessimistic view of life.

Other factors that are physiological in nature, such as serotonin deficiencies, could also lead to depression.

References

1. Depression in Children and Adolescents. (1996). Retrieved June 26, 2006, from www.athealth.com/consumer/disorders/ChildDepression.html.

2. Huebner A., Morgan E. (2001). Adolescent Depression. Retrieved June 27, 2006, from http://www.ext.vt.edu/pubs/family/350-851/350-851.html.

3. Depression: REACH Study Addresses Adolescents with HIV. (2001). Available from http://www.newsrx.com.

4. Gaynes, B., Lohr, K., Mills Burchell, C., Mulrow, C., Orleans, C., Pignone, M., & Rushton, J. (2002). Screening for Depression: Recommendations and Rationale. Annals of Internal Medicine, 136, 760-764.

5. Teen Depression: Warning Signs, Information, Getting Help. (2000). Retrieved June 26, 2006, from www.focusas.com/Depression.html.

6. Frisch, L., & Frisch, N. (2002). (2nd Ed.,), Psychiatric Mental Health Nursing. The Adolescent (p. 533). Albany, N.Y: Delmar.

7. Medical Sign. (2006). Retrieved June 27, 2006, from http://en.wikipedia.org/wiki/medical_sign.

8. Brown, A. (2002): Patient Care for the Nurse Practitioner. Available from http://find.galegroup.com.

Credits

This tool was developed by the Mental Health subset (Chair: Linda Frank, PhD, MSN, ACRN, PA/MA AETC) of the AIDS Education and Training Centers (AETC) National Resource Center, Adolescent HIV/AIDS Workgroup (Chair: Marion Donohoe, RN, MSN, CPNP, St. Jude Children’s Research Hospital, ANAC and Ronald Wilcox, MD, FAAP, Delta Region AETC). Collaborating members include Elizabeth Cabrera, MEd (TX/OK AETC), Verita Ingram, MBA (TX/OK AETC), Elise Johnson, MSW (Bickerstaff Pediatric Family Center), Jennifer Scanlon, FNP (The Children's Hospital, Denver), and Ronald Wilcox. The workgroup efforts were coordinated by the AETC National Resource Center (Managing Editor: Megan Vanneman, MPH).