Anxiety and Depression in Adolescents
with Gail Phillips
@ MHERC 18/04/19
What is mental health? It includes our social emotional and psychological well-being. It affects how we think, feel and act. It also determines how we handle stress, relate to others and make choices. It is important in all stages of life.
What is mental illness? When someone lacks the ability to manage day to day events and/or control their behaviour to that basic physical and emotional needs are threatened or unmet.
It is a result of a number of things:
Biological; poor physical health. low IQ, drug effects ...
Social; family disadvantage, trauma ...
Psychological; poor-social skills, poor copying skills ...
many of these things are interlinked.
Sometimes there can be a specific trigger
When does a mental illness become a disorder - when it impacts on daily life.
Is it depression, stress, distress or anxiety?
If the main problem is feeling down and miserable or that there is no interest or pleasure in things it may be depression.
If the main problem is having times of panic, or always being on edge and worrying it may be anxiety.
Depression
Common stressors - break up with boy/girlfriend, cyber-bullying, death of relative, divorce/separation of parents. family moves, peer pressure, poor performance at school, transition to high school
How common is it? 18-24 year olds have the highest prevalence of mental health disorders than any other age group. Youth suicide is the leading cause of death in 15-24 year olds.
It is circular - the person feels sad, which makes them focus on the negative, which makes them feel sad, which makes them focus on the negative ...
It is also a downward spiral:
How do you differentiate between teenage gloom and doom and clinical depression?
It is more likely to be depression if;
it lasts more than 6 weeks
there is a family history of depression
there are strong negative self-esteem factors
the behaviours being carried out (eg drinking, self harm) are causing danger
their personal history has trauma, lots of changes etc
personality type (not communicative on emotional matters, perfectionist
Signs and symptoms of depression -
What can you do? LISTEN
- when you notice a change check to see if they're ok
- sit quietly and listen, don't offer advice
- if they don't want to talk about it, respect that
- let them know you are worried and want to listen to them when they want to talk or suggest someone else they could go to
- listen and respond in a non-judgmental and reassuring way
- if you are very concerned contact higher powers and parents
Focus on thoughts, feelings and actions;
- provide practical support, like help with homework or large projects
- listen and offer support when needed
- believe their experiences, don't downplay them
- help to identify stressful situations at school or home
- help to find other ways to solve practical and emotional problems
- keep a close eye out for changes in how the young person feels, thinks and acts
- encourage self-determination
- HOLD HOPE
Suicide/Self Harm
You must ask - "Are you thinking about hurting yourself or others?" If the answer is "yes" then ask questions - how, when, where etc People thinking about suicide want you to ask this.
Ask "Have you looked up suicide or self-harm on the internet?"
A good resource to direct young people to is:
What next?
Assess the urgency of the risk
Remember lack of a plan doesn't mean the person isn't serious
Take ALL talk of suicide seriously
Crisis first aid for suicidal behaviour;
- own safety first
- someone must stay with them
- seek immediate help
- minimise further substance use (if any)
- remove the means?
- listen
- just listen
self harm/self injury is;
- related to psychological pain and distress, difficulty in expressing emotions and harbouring negative feelings towards oneself such as; guilt, rejection, sadness, self-hatred, worthlessness, loneliness, panic, anger or sexual confusion
- self-injury brings the person momentary feelings of peace and calm and a release of tension
- the immediate feelings of relief are usually followed by guilt, shame and more painful emotions. Self-injury is a short-term solution that can lead to a long-term problem.
- self-harm might be tied to a psychological illness such as depression, anxiety obsessive-compulsive disorder, eating disorders post-traumatic stress disorder and border personality disorder
- self-injury often starts in the teenage years, when emotions are more volatile and can be tied to other impulse control issues, such as alcohol or drug abuse
Responding to Self-Harming
Is it an emergency? Get help immediately if the person:
- has deliberately injured themselves
- is acting in a highly aggressive or abusive manner
- is expressing thoughts of suicide or killing someone
- is disorientated (does not know who they are where they are or what time it is)
- has delusions or hallucinations
- is confused or not making sense
- is badly affected by drugs and/or alcohol and acting in an abnormal manner
If the person has any of these symptoms dial 111 or visit the emergency department at the hospital
(DO you know what is in the person's crisis plan?)
Treatments -
- psychotherapy - cognitive behaviour - focuses on negative thoughts and changing them
interpersonal psychotherapy - interpersonal relationships
- counselling
- peer supports
- family/whanau therapy
- medications
- professional psychiatric interventions
Anxiety
Definition and Facts - a feeling of apprehension and worry and it a normal reaction to stressful situations. If the feelings become excessive, irrational and everyday functioning is affected then it is of concern. Anxiety disorders are characterised by excessive feelings of panic, fear or irrational discomfort in everyday situations. It is a common disorder for young people. About 13 of every 100 aged 9-17 experience some kin of anxiety disorder. Girls are more affected than boys. About 50% of children with anxiety issues have a 2nd anxiety disorder or mental health condition. Anxiety disorders may coexist with physical health conditions as well.
Some common symptoms:
Signs and symptoms of Anxiety in Youth:
- recurrent fears and worries
- difficulty falling asleep or nightmares
- hard to relax
- difficulty separating from parents
- scared about going to school
- irritability, tearfulness, avoidance
- uncomfortable in social situations at school, restaurants, parties
Production of Fear and Anxiety
- Amygdala: emotional memories are stored here and alerts the brain when a threat is present
- Hippocampus: encodes specific threatening events into memory
Types of Anxiety Disorders;
- Generalised Anxiety Disorder (GAD) - 6 + months of persistent, irrational and extreme worry causing insomnia, headaches and irritability
- Post Traumatic Stress Disorder (PTSD)
- Panic Disorders - unpredictable panic attacks
- Specific Phobias - intense fear reaction
- Social Phobia
- Separation Anxiety
- Obsessive Compulsive Disorder (OCD)
Comorbid (meaning)diagnoses of depressive disorders, ADHD and other enxiety disorders are common in anxiety patients. Symptoms that might appear to be ADHD - restlessness, feeling keyed up or on edge, difficulty concentrating, mind going blank, irritability and clinically significant distress.
What to do when a young person is experiencing excessive fear or worry:
Responding to someone who is panicking
- speak slowly and calmly
- encourage deep regular breathing
- use short sentences
- assure that they are safe and you are there to help
- explain all actions
- remove from noise and confusion
Effective Ways to Treat Anxiety -
Cognitive behavioural therapy, relaxation techniques, biofeedback (to control stress and muscle tension), family therapy medication and mindfulness
General accomodations : -
Additional suggestions:
- preferential seating, near door
- assign another person for support
- permit beverages
- video lessons
- early availability of teaching notes
- task considerations/safety
- text, assignments in alternate formats
- personal and private feedback
- strategies re managing days off
Share goal and strategies with home so there is consistency.
For URGENT HELP
Mental Health Crisis Line 0800 920 092 (24/7)
CAF Emergency - 0800 218 219 press option 2
or 111 or take to emergency room
Resources for students and families -
Videos -