Social Psychological Contributions to the Mitigation of Adolescent Depression
Depression is increasingly common among adolescents, and suicide stemming from depression is the third leading cause of death among 15 to 19 year olds in the United States (Hallfors et al. 2004) and the second leading cause of death worldwide for 15 to 29 year olds (World Health Organization [WHO] 2018) Adolescents with depression are at greater risk for serious episodes of depression in adulthood and are more likely to become involved in the criminal justice system (National Institute of Mental Health [NIMH] 2011) The thesis of this chapter is that a social psychological analysis of parent child relations, coupled with study of factors that tend to exacerbate precarious mental states (e.g. drug use and attendant conflict, school failure, parental conflict, etc. may provide information useful in ameliorating this problem, a major threat to the health of society (Crano Donaldson, 2018) We review the epidemiological evidence, along with the parental monitoring literature in the chapter, with specific reference to drug misuse in youth. In addition, we review new findings linking parental monitoring and warmth with adolescent drug use and depression. Although parental influences on adolescent depressive symptoms and marijuana use have been examined independently, their interrelation remains seriously understudied. We contend and test the possibility that depressive symptoms have significant indirect effects on parental warmth, monitoring, and marijuana use. Our research suggests that parental influence may play an unintended facilitative role in marijuana use among adolescents, and marijuana use, in turn, appears linked to exacerbated depressive symptoms among youth. MITIGATION OF ADOLESCENT DEPRESSION 3 Social Psychological Contributions to the Mitigation of Adolescent Depression Social psychological research has contributed to the betterment of society in many ways, but its present contributions to the prevention of adolescent depression, a leading cause of adolescent and young adult suicide, have not yet made the desired impact. Clinical scientists and practitioners have been most involved in research and treatment of depression in adolescents and young adults, but this observation does not negate the possible contributions of social psychology in preventing the harm involved with this crucial issue, which falls, at least to some degree, in the realm of social psychology. In this chapter, we will review the ways in which social psychologists can, and to some degree have contributed to the amelioration of depression and subsequent suicide of youth. In addition, we will consider research on the of role psychotropic substances in the deadly dance and attempt to integrate findings on the evidence arising from the application of well established theories of persuasion to drug prevention, which might moderate the terrible losses incurred when individuals take their own lives. Significance There is little need to establish the significance of adolescent depression related suicide in contemporary society. Even trivial rates of depression linked suicide are unacceptable, and today's research indicates the frequency of adolescent self destruction is far from trivial. Establishing significance in this instance, and the potential role of social psychology, rather is concerned more with a cost/benefit analysis than in establishing the profundity of the problem. For social psychology, the issue becomes whether or not the field's potential contribution to moderating the solution of teen suicide justifies the direct or indirect (i.e. opportunity) costs involved in the attempt. Is not clinical psychology and psychiatry better equipped to deal with extraordinary interventions designed to treat acute manifestations of extreme depression? Would MITIGATION OF ADOLESCENT DEPRESSION 4 not resources be applied more wisely to the treatment of depressive teens, rather than some farfetched social psychological attempt at prevention? In our view, the answer to the first of these questions must be stated in the affirmative. When the house is burning, the need for a good dousing is clearly preferable to recondite speculation on the concept of fire. However, the answer to the second question is moot. Social psychological contributions to the solution of severe teen depression, apart from clinical interventions, may prove a wise line of attack on this perplexing and complex problem. We discuss some possible social psychological contributions to the problem of adolescent depression and invite the open minded reader to consider them carefully in assessing or suggesting alternatives that might add to their potential utility. However, before we begin, it is reasonable to gauge the severity of the problem. Afterwards, we will consider social psychology's role in its solution, with special emphasis on the application of persuasive prevention, and that of parents and drug use by both children and their parents, which have been shown to have a powerful bearing on likelihood of adolescent drug initiation and its attendant outcomes, which may include teen suicide. Effects of both parents and drugs have been implicated in research on adolescent suicide, and in this context social psychology may play its strongest hand. Adolescent Depression and Suicide Depression is a mental health condition resulting in persistent sadness and loss of usual interests. It can influence how an individual thinks, feels, and behaves, resulting in serious emotional, physical, and functional problems. Depression is widespread in the United States and beyond. Worldwide, depression is the second most common illness following anxiety disorders. Among adolescents, depression is increasingly widespread. The National Institute of Mental Health (NIMH, 2011) found that teens with depression are at substantially greater risk than those MITIGATION OF ADOLESCENT DEPRESSION 5 without this condition to experience serious episodes of depression in adulthood, and are more likely to become involved in the criminal justice system as adults. Mental Health America (2010) estimated that 12.5% of teenagers experienced clinical depression, and 67% reported major depressive episodes that had caused issues with school, work, friends, or family. Changes in attitudes or behaviors about school and social activities, as well as problems at home, may be indicators of depression in youth. Compared to adults, adolescents' depression may manifest in remarkably different ways. Youth in this age group tend to have issues not faced by adults, such as powerful and highly relevant peer pressures, academic expectations, and hormonal and bodily changes. Although depressive symptoms may vary widely among individuals, emotional and behavioral changes in teenagers can be warning signs of depression or impending depression. According to findings reported by the Mayo Clinic (Hall Flavin McKean, 2018) some emotional changes include, among others, feelings of sadness, hopelessness, worthlessness, guilt, and pessimism. Teenagers experiencing depression also may have crying spells, frustration or anger disproportionate to the situation, irritability, loss of interest or pleasure in usual activities, conflict with friends or family, low self esteem, rumination or fixation on failures and self blame, trouble concentrating, poor decision making or trouble making decisions, and frequent thoughts of death or dying. Behavioral changes may include tiredness, changes in sleep patterns, changes in appetite with accompanying weight change, restlessness, choosing social isolation, poor school performance or truancy, less attention to self appearance, disruptive behavior, use of alcohol or drugs, self harm, and suicidal behaviors (Hall Flavin McKean 2018) Suicide rates are increasing. It is important to treat depression at any age to ameliorate and prevent progressive worsening of ongoing problems. Fortunately, most teenagers who MITIGATION OF ADOLESCENT DEPRESSION 6 receive treatment overcome depression. However, left untreated, adolescents are at substantially greater risk for suicide than older adults. In the United States, suicide is the second leading cause of death among individuals aged 10 to 34 (NIMH, 2018) In adolescents and young adults, suicide is more common than cancer, heart disease, birth defects, pneumonia, and influenza combined (Kann et al. 2018) Suicide obviously is not confined to adolescents; it occurs across the lifespan. Globally, suicide is the second leading cause of death among those aged 15 to 29. In this age group, it is the second leading cause of death for males, lagging behind only road accidents. For females, suicide is second only to childbirth related deaths (WHO, 2016) Across all age groups in the United States, the total suicide rate increased 31% from 2001 to 2017, with males experiencing a suicide rate four times that of females (NIMH, 2018) Suicide increased in almost every state during this time period. Worldwide, an estimated 793,000 known suicides occur annually in people of all ages. By this measure, a suicide occurs across the globe every 40 seconds (WHO, 2016) Cross sectional data from one of the longest ongoing investigations on suicide rates in U.S. adolescents are available in the archives of the national Youth Risk Behavior Survey (YRBS: Kann et al. 2018) which since 1991 has monitored health behaviors of American youngsters using nationally representative samples of adolescents in grades 9 12 in public and private schools (Kann et al. 2018) Data have been available from this source every other year since its inception. Let us consider recent data from the 2017 survey, which found that in the previous year, roughly one third of all high school students in this nationally representative sample felt sad or helpless almost every day for at least one two week period, so much so that they stopped their usual activities. This figure accounts for just over 20% of