ADOLESCENTS are those aged 13 to 17 years old, and there are 5.5 million adolescents in Malaysia. More than half of them are in schools.
Adolescents are valuable assets to the country as they will become the future leaders who will continue to drive and sustain the development of the nation.
They are perceived as the healthiest population group. However they do have their own set of unique problems and healthcare needs.
According to the Malaysian Health and Morbidity Survey 2017, one in five teenagers in Malaysia are depressed, two in five suffer from anxiety and one in 10 are stressed.
The 2017 National Mental Health Survey previously proved that at least one in 10 young people or 10 per cent of the 5.5 million youths in the country have ever thought of committing suicide.
The teenage years can be challenging. Between physical changes in the body, intense peer pressure, and an increased sense of social anxiety, teenagers often have difficulties finding their place, particularly in society.
Many want to fit in while others want to stand out and that can cause them to rebel.
Teenage depression is also becoming an alarmingly frequent trait of those transition years. Recent research has found that the rate of depression is increasing and that there are distinct gender differences in teenage depression.
The teenage years are a natural transition from being a child to growing into an adult. While women of all ages tend to be more aware of their appearance than men, particularly in terms of how others see them, most young people start to develop a heightened sense of socialisation as they enter their teenage years.
As children, their clothing choices and hairstyles were not as important to them. As teenagers, their entire social life may depend on those factors, at least in their own eyes.
The mental and emotional disorder known as teenage depression is no different medically from adult depression. However, the brains of adolescents are structurally different than the brains of adults.
Teenagers with depression can also have hormone differences and different levels of neurotransmitters. Neurotransmitters are key chemicals in the brain that affect how brain cells communicate with one another. They play an important role in regulating moods and behaviour.
The neurotransmitters that are important to our understanding of depression are serotonin, dopamine and norepinephrine. Low levels of these neurotransmitters may contribute to depression.
Depression can be associated with high levels of stress, anxiety, and — in the most serious scenarios — suicide. However, symptoms in teenagers may manifest themselves in different ways than in adults. This may be because teenagers face different social and developmental challenges, such as peer pressure, changing hormone levels and developing bodies.
As teenagers, depression can also affect the aspects of their personal life (which refers to how an individual feels, thinks, or behaves when they're alone and away from others), school, work, social and family life and can lead to social isolation and other problems.
Is teenage depression different among men and women? Yes, teenage depression is gender relative. Females are around three times as likely as males to report a depressive episode. The difference in depression rates could be attributed to the differences in the rate of physical changes between boys and girls. Puberty typically starts earlier and hormonal changes tend to be more evident in young girls.
Teenage girls are also inclined to be more concerned with how others perceive them. While these differences in gender explain the overall differences in depression rates, other factors may be involved in the recent increase for female teenagers.
Because women of all ages tend to be more aware of their appearance than men, particularly in terms of how others see them, most young people start to develop a heightened sense of socialisation as they enter their teenage years.
The rise in depression rates among teenagers also coincides with the rise in popularity of the smartphone. Today's teenagers have not known a world of social interaction that doesn't include social media. Both young men and women spend a significant amount of time on their smartphones now.
According to the National Health and Morbidity Survey 2017, six in seven secondary school adolescents were active Internet users in Malaysia and out of those, two in seven were addicted, with Form 5 students showing the highest rate of Internet addiction at 38 per cent compared with Form 1 students at 18 per cent.
Another study done by the United Nations Children's Fund (Unicef) reported that Malaysia ranked second in Asia in 2020 for cyberbullying among youths, proving that cyberbullying is becoming an increasingly prominent problem in the country.
The use of smartphones and social media appears to correlate with the increase in depression rates among teenagers. However, it seems to have impacted teenage girls more than boys. One reason for this may be that girls spend more time socialising on their smartphones, including texting and interacting on social media.
Boys also text and use social media somewhat, but tend to use their smartphones more for playing games. Since teenage girls are more focused on what others think of them than boys, the increased use of social media can increase that level of anxiety and, subsequently, the rates of depression.
An association has been found between moderate or heavy digital media use and the increased rate of mental health issues and worsened psychological wellbeing for teenage girls. One study found that the rate of depression also aligns with the amount of time spent on social media.
In that study, girls who spent six hours or more on social media were significantly unhappy than those who spent only 30 minutes a day on social media. The differences for boys were less noticeable.
The symptoms of depression can often be difficult for parents to spot. Depression is sometimes confused with the typical feelings of puberty and teenage adjustment.
Teenage depression signs and symptoms include a change from the teenager's previous attitude and behaviour that can cause significant distress and problems at school or home, in social activities, or in other areas of life. Depression symptoms can vary in severity, but changes in your teenager's emotions and behaviour may include these examples:
Feelings of sadness, which can include crying spells for no apparent reason, frustration or feelings of anger, even over small matters, feeling hopeless or empty, irritable or annoyed mood, loss of interest or pleasure in usual activities, loss of interest in, or conflict with, family and friends, low self-esteem; among others.
Some of these symptoms may not always be indicators of depression. Appetite changes are often normal, namely in times of growth spurts and particularly if your teenager plays sports. Still, looking out for changing behaviours in your teenager can allow you to help them when they are in need.
Self-injurious behaviour, such as cutting or burning oneself, are also a warning sign. These behaviours may be rare in adults but are more common in teenagers.
The intention of these behaviors isn't usually to end one's life, but they must be taken very seriously. They are typically transient and usually end as the teenager develops better impulse control and other coping skills.
It's not known exactly what causes depression, but a variety of issues may be involved. These include brain chemistry, hormones, early childhood trauma, among others.
Factors that may increase a teenager's risk for depression include: having a difficult time with their sexual orientation, having no social or emotional support, living in a violent household, being bullied, having a chronic illness, teenagers who have trouble adjusting socially or who lack a support, having issues that negatively impact self-esteem, such as obesity, peer problems, long term bullying or academic problems, having been the victim or witness of violence, such as physical or sexual abuse, having other mental health conditions, such as bipolar disorder, an anxiety disorder, a personality disorder, anorexia or bulimia, having a learning disability or attention-deficit/hyperactivity disorder (ADHD), among others.
Untreated depression can result in emotional, behavioural and health problems that affect every area of your teenager's life. Complications related to teen depression may include, for example: alcohol and drug misuse, academic problems, family conflicts and relationship difficulties, suicide attempts or suicide.
For proper treatment, it's recommended that a psychologist or psychiatrist perform an evaluation, asking the teenager a series of questions about their moods, behaviours and thoughts.
The evaluation should also take into account the teenager's family history, school performance and comfort in peer settings.
A physical examination may also be used to help rule out other causes of their feelings. Some medical conditions can also contribute to depression.
Just as depression has no single cause, there's no single treatment to help everyone who has depression. It can take time to determine which one works best. Treatment for adolescents with depression is usually a combination of medication and psychotherapy. Numerous classes of medications are designed to alleviate the symptoms of depression.
Teenagers with depression should see a qualified mental health professional before or at the same time as starting medication therapy. Psychotherapy has been found to be effective for treating depressed teenagers, those who have turned to substance abuse, and those who are engaging in self-destructive behaviour.
Cognitive behavioural therapy (CBT) or interpersonal therapy (IPT) during psychotherapy sessions can help by replacing negative thoughts and emotions with good ones. In IPT, the aim is to strengthen personal relationships by improving communication and problem-solving skills. Parents or caregivers will participate in select sessions.
It can be difficult to tell the difference between ups and downs that are just part of being a teenager and teenage depression. Talk with your teenager. Try to determine whether he or she seems capable of managing challenging feelings, or if life seems overwhelming.
If depression signs and symptoms continue, begin to interfere in your teenager's life, or cause you to have concerns about suicide or your teenager's safety, talk to a doctor or a mental health professional. Your teenager's family doctor or pediatrician is a good place to start. Or your teenager's school may recommend someone.
Depression symptoms likely won't get better on their own — and they may get worse or lead to other problems if untreated. Depressed teenagers may be at risk of suicide, even if signs and symptoms don't appear to be severe.
If you're a teenager and you think you may be depressed — or you have a friend who may be depressed — don't wait to get help. Talk to a health care provider such as your doctor or school nurse. Share your concerns with a parent, a close friend, a spiritual leader, a teacher or someone you trust.
Suicide is often associated with depression. If you think you may hurt yourself or attempt suicide, call 911 or your local emergency number immediately.
There's no sure way to prevent depression. However, these strategies may help. Encourage your teenager to: take steps to control stress, increase resilience and boost self-esteem to help handle issues when they arise; practise self-care, for example by creating a healthy sleep routine and using electronics responsibly and in moderation; reach out for friendship and social support, especially in times of crisis; get treatment at the earliest sign of a problem to help prevent depression from worsening; and, maintain ongoing treatment, if recommended, even after symptoms let up, to help prevent a relapse of depression symptoms.
The writer is a psychiatrist at KPJ Ampang Puteri Specialist Hospital
If you are feeling depressed or stressed, know that help is available. All you have to do is reach out. The Befrienders is an example of a place you can call if you have suicidal thoughts or feeling overwhelmed. They provide emotional support 24/7. For more info, visit www.befrienders.org.my or contact 03-76272929.
You can also contact Talian Kasih at 15999 (24/7), BuddyBear Helpline at 1800-18-2327 (BEAR) (daily 12pm to 12am), Mental Illness Awareness & Support Association (MIASA) at 1-800-820 066 (24/7), and the Health Ministry - Mercy Malaysia Psychosocial Support Helpline at 03-2935 9935.
