Early Treatment for Childhood and Teen Depression Can Improve Outcomes

A Quick History Lesson

Before the 20^th century, most adults believed that children didn’t have mental health disorders. Or if they did, they were impossible to diagnose or various reasons, mainly because of the nature of child development. A child’s behavior can change from day to day and month to month. Behaviors common to one phase of development can completely disappear during the next phase of development. Behaviors and attitudes that didn’t fit the norm weren’t associated with mental health issues, but rather, as quirks of the developmental process. What that meant – way back then – was that kids with mental health issues didn’t get the treatment they needed. The kids with severe impairment were consigned to sanitoriums and often left, untreated, for life.

That all began to change around the beginning of the 20^th century, when a group of concerned women in Chicago sought to understand juvenile delinquency and explore its causes and pursue potential avenues of prevention and treatment. This movement, based in communities rather than the medical establishment, caught the attention of President Truman in 1946: he signed the National Mental Health Act, which led to the creation of the National Institute of Mental Health (NIMH). Then, in 1948, Dr. Frederick Allen proposed the idea of a child and adolescent subspecialty in the field of psychiatry. Finally, in 1953, a group of psychiatrists formed the American Academy of Child Psychiatry (AACP), which is now known at the American Academy of Child and Adolescent Psychiatry (AACAP).

Why the History Lesson?

We share this information because of a study we just read. The study – Associations of Childhood and Adolescent Depression with Adult Psychiatric and Functional Outcomes – discusses the effect of childhood and teen depression on social functioning and wellbeing in adulthood. We’ll talk about that in the main body of this article. However, while researching statistics on teen depression, we noticed something:

Despite the fact that adolescent psychiatry has been an accepted, recognized, and respected field of healthcare for seventy years, less than half of teens (12-17) diagnosed with depression in 2020 got professional support for depression.

We can do better.

We need to do better. When we consider the effect of the pandemic on teen mental health and the upward trend in the prevalence of teen depression identified before the pandemic – rates of depression among teens increased from 8.1% in 2009 to 15.8% in 2019 – we have to do better.

The current and future wellbeing and mental health of our teens depends on it.

With all that said, we’ll get to the topic at hand: adolescent/childhood depression and adult health and functioning.

Depression in Children and Teens: Definition and Statistics

The Diagnostic and Statistical Manual of Mental Disorders (DSM-V) defines depression – officially known as major depressive disorder (MDD) – as follows:

“…an overwhelming feeling of sadness, isolation, and despair that lasts two weeks or longer at a time.”

To learn more about diagnosis, warning signs, and types of depression, please read the following articles on our Parenting Tips and Advice page:

When Is It Time for Parents to Consider Inpatient Teen Depression Treatment?

Inpatient Treatment Options for Teenage Depression

Rehab for Teenage Depression: How It Works and Why It Helps

We also encourage you to read our Parent Guide on Depression in Teens.

Those articles, along with the parent guide, will complement the information in this article. We’ll start – excluding the history lesson above, of course – with an update on the latest statistics on teen depression in the United States. The following figures appear in the 2020 National Survey on Drug Use and Health (NSDUH), a yearly survey published by the National Institutes of Health (NIH).

Prevalence of Teen Depression and Treatment: United States (2020)

• 4.2 million adolescents diagnosed with major depressive disorder (MDE)
  • Male: 1.1 million
  • Female: 2.9 million
• 1.7 million adolescents received treatment for MDE
  • Male: 448,000
  • Female: 1.2 million
• 2.9 million adolescents diagnosed with MDE with severe impairment
  • Male: 732,000
  • Female: 2.2 million
• 1.4 million adolescents received treatment for a MDE with severe impairment
  • Male: 300,000
  • Female: 1.1 million

Prevalence of Teen Depression and Treatment: United States (2020) By Age

• Diagnosed with MDE
  • 12-13: 902,000
    • Received treatment: (data not available)
  • 14-15: 1.5 million
    • Received treatment: 629,000
  • 16-17: 1.7 million
    • Received treatment: 675,000
  • Diagnosed with MDE with Severe Impairment
    • 12-13: 641,000
      • Received treatment: (data not available)
    • 14-15: 1.0 million
      • Received treatment: 521,000
    • 16-17: 1.2 million
      • Received treatment: 527,000

[Note: those statistics put numbers to the observation we make in the introduction of this article. In 2020, only 40% of teens with MDD received treatment, while only 44% of teens with MDD with severe impairment received treatment. This is known as the treatment gap, which is something we work every day to eliminate.]

Now that we know the size and scope of adolescent depression in the U.S., it’s time to look at the study on adult outcomes among children and teens diagnosed with depression.

Childhood/Adolescent Depression and Adult Wellbeing

The study we discuss in this article is important, and stands out from many studies and depression among teens, because of three factors:

1. The size of the study group: Researchers examined records of close 10,000 clinical observations of over 3,000 participants.
2. The length of the study itself: Researchers examined records from 1993-2015, which included initial interviews with participants at ages 9-16, and follow-up interviews at ages 19, 21, 25, and 30.
3. What they measured: Researchers looked at social functioning, physical health, mental health, and criminal activity.

Here’s what they found.

Compared to children or adolescence without a diagnosis of depression, any diagnosis of depression during childhood or adolescence was associated with:

• Higher levels of anxiety
• Higher levels of illicit drug disorders
• Lower levels of overall health
• Higher levels of criminal activity
• Lower levels of social functioning

In addition, age at diagnosis was a significant factor:

• A diagnosis of depression during childhood (before age 12) was associated with fewer adverse outcomes during adulthood
• A diagnosis of depression during adolescence (age 12-17) was associated with increased frequency of adverse outcomes during adulthood.

Researchers observed another important trend in the data:

• Adverse outcomes during adulthood following a diagnosis of depression during childhood or adolescence may be reduced or attenuated by early diagnosis and evidence-based treatment during childhood or adolescence

That brings us directly to the history lesson above and the statistics on rates of depression and treatment for depression among teens. We offered that history and those statistics to make it clear that (1) psychiatric treatment for child and adolescent mental health disorders – including depression – is a well-established specialty in modern healthcare, and that (2) despite the availability of evidence-based, time-tested treatment for child and adolescent depression, a large treatment gap still exists:

Close to 60% of teens diagnosed with clinical depression (MDD)

do not get the treatment they need.

We’ll now talk about the most effective known treatments for child and adolescent depression.

Evidence-Based Treatment for Teen Depression

If you’re the parent of a teen with diagnosed with depression, it’s crucial to get them into treatment as soon as possible. The data above show the potential negative outcomes if your teen does not receive treatment.

If your teen shows the symptoms of depression described in the articles we link to above, then it’s crucial to arrange for a full psychiatric assessment administered by a mental health professional. A professional can confirm or rule out the presence of MDD. When they diagnose MDD in a teen, they will most likely recommend an outpatient treatment program, an intensive outpatient program (IOP), a partial hospitalization program (PHP), or a residential treatment program (RTC). The level of are depends on the severity of the disorder.

In all cases, and for all levels of severity, it’s important for parents to understand that in most cases, evidence-based treatment for depression works. The most effective approach to treatment follows the integrated, holistic model, which includes individual therapy, group therapy, family therapy, complementary therapies (experiential and expressive), community support, and, in some cases, medication.

Here are the most common – and effective – treatments for depression.

Modes of Treatment for Teen Depression

• Individual Support:
  • Dialectical behavior therapy (DBT)
  • Cognitive behavioral therapy (CBT)
  • Mindfulness based cognitive behavioral therapy (MBCBT)
  • Applied Behavioral Analysis (ABA)
  • Behavioral Activation (BA)
  • Motivational Interviewing (MI)
  • Interpersonal Psychotherapy (IPT)
• Group Support:
  • Peer Group CBT
  • Peer Group DBT
• Family Support:
  • Families participate in therapy with their teen and a therapist/counselor
  • Multi-family groups: several families and their teens participate in therapy sessions
  • Parenting groups: parents of teens participate in group workshops without their teens present
• Mindfulness-based stress reduction (MBSR):
  • Meditation
  • Yoga
  • Mindful walking
• Experiential therapies:
  • General exercise
  • General outdoor activities
  • Activities specific to treatment location, which often include:
    • Boxing
    • Surfing
    • Equine therapy (horses)
    • Hiking
  • Expressive therapies:
    • Visual art
    • Writing: journaling or creative
    • Music
    • Dance
    • Drama
  • Medication (if necessary)

When a teen participates in treatment at any level, what they learn comes down to one thing: empowerment. They learn about the science behind their diagnosis and the evidence that supports the treatment they receive. They learn practical coping strategies and skills to manage the symptoms of depression. In workshops with family, treatment peers, and counselors, they learn how to advocate for themselves, how to communicate their needs effectively, and how to talk about their diagnosis and symptoms in ways that are positive and life-affirming.

The Power of Timely Treatment

In summary, what teens learn during treatment for depression is how to live a life of their choosing, rather than a life dominated by the symptoms of a depressive disorder.

When we look at the data from the study we discuss above, what we learn is that treatment can prevent and/or reduce the likelihood of adverse outcomes during adulthood, including anxiety, drug use, and criminal activity.

That means treatment leads to outcomes both adults and teens want. Teens want to live an independent life, make their own decisions, and feel a sense of agency and ownership with regards to the small choices and large decisions that characterize adolescence. Parents want their teens to be happy. In other words, parents want their teens to experience an adolescence without significant adversity, and grow into an adulthood that’s not defined by the negative consequences of and untreated mental health disorder.

That’s why we live by this adage: the right treatment at the right time makes all the difference in the world.

Finding Help: Resources

If you’re seeking treatment for your teen, please navigate to our page How to Find the Best Treatment Programs for Teens and download our helpful handbook, A Parent’s Guide to Mental Health Treatment for Teens.

In addition, the American Academy of Child and Adolescent Psychiatry (AACAP) is an excellent resource for locating licensed and qualified psychiatrists, therapists, and counselors in your area. Both the National Institute of Mental Health (NIMH) and the National Alliance on Mental Illness also provide and high-quality online resources, ready and waiting for you right now.