Abnormal Psychology: Teenage Depression and Risk of Suicide

Introduction

Depression as we know it falls under mood disorders and in order for one to understand depression he must understand mood disorders. Mood disorders are described as a group of disorders that involve emotionality disturbances that are enduring and are severe, they range from elation to severe depression. Mood disorders can often cause suffering and distress thus eroding ones quality of life and at other times have detrimental consequences and suicide is the most severe of these. And to truly attack these we need to understand what causes theses mood disorders. This assignment will discuss the importance of being able to identify and and manage depression specific reference will be made to the south African context using the case study of a south African teenager Thabo. The essay will also talk about issues affecting teenagers in south Africa thus leading them to fall into depression with possible suicide risk. The essay will study depression in teenagers the signs to look out for the biological the social and the psychological causes of depression and the biological social and psychological ways in which one can treat depression. a clinical description will be included and the essay will look at the diagnostic criteria in the assessment of Thabo.

Etiology

Cinical description

no single cause has been found for mood disorders but there are multiple factors but there are multiple factors that influence mood disorders such as a biochemical imbalance in the brain, some psychological factors and socio-economic factors tend to play a role in the development of mood disorders. The multidimensional integrative approach to studying psychopathology holds that psychological disorders as always being the product of many causal factors that interact. Main factors that influence psychopathology include biological influences, psychological influences as well as social and cultural influences.

It is a well-known fact that depression runs in the family, this phenomenon implicates both environmental and genetic processes. Several genetic polymorphisms have been linked to the risk of depression as a response to depression. Primary amongst these genes is the (5HT) serotonin system. The neurotransmitter serotonin applies effects on a broad range of physiological functions that include, sleep, emotions, appetite, thermoregulation, sexual behavior, aggression, sensorimotor reactivity and pain sensitivity. Impairments in the central 5-HT system, such as tryptophan depletion, altered 5-HT receptor binding ,impaired uptake function of the 5-HT transporter and reduced 5-HTconcentrations have been linked to a number of psychological problem including depression.

Depression is also read as a reaction to negative environmental circumstances. Etiological model are largely diathesis-stress model stating that people inherit tendencies to express certain traits and behaviors, which may then be activated under conditions of stress. Each tendency that is being inherited is a diathesis, which literally means condition that makes a person susceptible to developing a disorder when a stressful life event arises and the disorder develops. In Thabo’s case we can say that the pressure in his final year worked him up so much that that he developed the depression making his final school year the stressful life event. And the fact that he didn’t have social support increased his vulnerability to the development of the disorder.

Aaron T Beck hypothesized that the tendency to interpret every day events in a negative way may result in depression. Beck states that depressed individuals always make the worst of every situation and that the smallest setbacks are catastrophes. Beck classified types of cognitive errors that characterizes his hypotheses and two examples are arbitrary inference and overgeneralization. Arbitrary inference is seen when a person with depression places emphasis negative rather than the positive aspects of a situation. They make cognitive errors in thinking negatively about themselves, their future and their immediate world three area that together are called the depressive cognitive triad.

Diagnostic criterion

According to the DSM5 diagnostic criteria for major depressive episode on appendix A we that Thabo experiences symptoms that are related to the DSM5 criteria for major depression. Firstly, it is evident that Thabo was depressed most of his days, nearly every day as indicated by himself to the care doctor. Then we also observed that he was sleeping badly indication hypersomnia. Thabo started feeling very fatigued throughout and started struggling to concentrate on his school work meaning living quality was affected. One can also say that he had feelings of worthlessness hence why he ended his life lastly, we see that Thabo had recurrent thoughts of death and eventually attempted suicide and succeeded. Secondly, we can see that the symptoms caused distress and impairment in his social areas of functioning and lastly Thabo’s none of symptoms are due to any physiological effects of substance or a direct medical condition.

Management and treatment for depression

According to the Cleveland clinic treatment of mood disorders depends on the type and its severity, but for every mood disorder the integrative (bio psycho social model comes to play) meaning that for every disorder there is a biological treatment (which includes medication), and a psychological treatment (which includes counselling and therapy), and finally there is a social treatment (this will include ways in which social interactions and social support can help lessen the severity of disorders). Below there is the treatments available for depressive disorder.

Biological

Antidepressants

The Cleveland Clinic speaks of two types of biological treatments for mood disorders the first treatment option is antidepressants. There are many available medications to treat mood disorders specifically depression and bipolar episodes, some of the selective serotonin reuptake inhibitors (SSRIs) that are widely used. Such as paroxetine (Paxil), sertraline (Zoloft), and citalopram (Celexa). Then there are Serotonin and norepinephrine reuptake inhibitors (SNRIs) such as venlafaxine (Effexor) and duloxetine (Cymbalta). There are also mood stabilizers these reduce abnormal brain activity and help regulate mood swings in patients diagnosed with bipolar and other related mood disorders some of these drugs include lithium and anticonvulsant drugs including valproic acid (Valproic) and oxcarbazepine (Trileptal). these are just a few of the medications that can be prescribed to patients with mood disorders.

Electroconvulsive therapy

The second treatment option is Electroconvulsive therapy (ECT) has been used to treat patients with severe depression where medicine and psycho therapy is unsuccessful. A patient is given a muscle relaxant and then placed under anesthesia there after electrodes are placed on certain areas of the forehead or the sculp then an electric current is passed through the brain to induce a seizure and the patient awakens in five to ten minutes. usually two to three sessions are required a week and in total 12 sessions are required.

Psychological

Numerous types psychotherapy may also benefit Patients with mood disorders. there are numerous types but the two most used therapies are Cognitive-Behavioral psychotherapy and interpersonal psychotherapy.

Cognitive behavioral therapy

CBT therapy isn’t one form of treatment but Based on combination of basic behavioral and cognitive research and principles. The treatment commonly begins with psycho education where the nature of depression and the factors that maintain it are outlined. Symptom relief, emphasis on behavior change is the focus on the first phase of treatment this phase also aims at engaging patients in their daily activities and restoring their psycho social functioning. In the second phase. In the second phase cognitive structuring is where the focus shifts to, this typically involves identifying, disputing and modifying the maladaptive cognitions and the distortion of cognitions of the patient. And lastly the final stage involves maintenance of the effects of treatment on the patient and on the prevention on relapse.

Interpersonal psychotherapy.

Targeted at particular psychiatric diagnosis, it is relatively a young type of therapy. It is a time limited therapy with three phases: the beginning (1-3 sessions), the middle, and the end (3 sessions). In the first stage of the therapy the therapist Identifies the target diagnosis and the interpersonal context that it presents. The therapist links the target diagnosis to the interpersonal focus. The middle phase of treatment is when the therapist uses specific strategies to deal with the problems diagnosed. The therapy is likely going to assert the ability of the client to assert their needs and wishes in interpersonal encounters to validate their anger as a normal interpersonal expressions and to encourage its efficient expression the therapist helps the patient to feel more in control and independent once the patient succeeds at a interpersonal encounter the therapist becomes more of a cheerleader, thus enforcing healthy interpersonal skills.

Causes of Suicide in teenagers

Identifying the causes of teenage suicide can be difficult because during this period of their life they go through the most vulnerable stage of their lives as they tend to get overwhelmed by situations no matter how small or big they are and to them they are always in an unbearable situation. In most situations the most noticeable changes are in observable withdrawal from family and friends or in some aggressive and violent behavior, but these vary from teenage to teenage. Jerry Shaw identified four most common factors that contribute vulnerability of a teenager committing suicide. 

Major disappointments such as rejection, break up with a lover and failing at school may trigger a suicidal tendency in teenagers who might find it hard to deal with these types of situations. A great sociologist Emile Durkheim further identified a number of suicide types based on the conditions in which they occurred either social or cultural one of the types that she identified was anomic suicide which is a type of suicide that occur as a result of marked disruptions for example Thabo failing his exams in his last year in high school. 

Stress is another factor that Shaw identifies. The American academy of child and adolescent psychiatry (2008), states that common problems that can trigger suicide in teenagers include confusion, pressure, worries about self-worth and chronic stress. Children may be exposed to having to go through their parents divorcing some are also victimized of physical and sexual abuse and these disturbing matters can cause an intense increase in the vulnerability of a teenager living with distress agitation or even anxiety. The loss of social support is matter that can impact ones’ vulnerability to suicide, Durkheim calls this egoistic suicide, a type of suicide that is provoked by loss of social support. Thabo’s case a possible explanation for his death could be that he lost the support of his parents.

Shaw states that if a teenager who is haunted by other issues such as stress or major disappointments or even mental disorders or family difficulties the abuse of drugs and alcohol leads more than often to impulsive behavior. Teenagers may believe that that abusing alcohol will relieve their distress but in actual fact it only worsens the distress and in most suicide cases substance abuse and mental disorders play a prominent role.

And finally Shaw speaks about the effects biology has on suicide. There are genetic components that are proven to be related to the brain chemistry that may be involved in teenage suicides. A possible cause of suicide is Low levels of the brain chemical serotonin as it controls impulsive actions, mood and the way we react in situations thus low levels of serotonin may lead to impulsive behavior, mood instability and a tendency to overreact in situations, this including as suicide. Other evidence shows that functional polymorphism regulating monoaminergic, in particular serotenergic, neurotransmission and genetic and epigenetic mechanisms affecting regulation as well as gene-variants play a role in suicide.

Management and prevention of suicide

Tailored to each individual unique personal and contextual needs a holistic approach should be followed. Dr. Karren Armstrong (2018), advises that the family, and community of the patient should be involved actively in the planning and implementing interventions once the teenagers’ safety has been confirmed. She suggested steps that should be taken in managing risk of suicide and preventing it from happening. First, she states that one should identify and treat underlying psychological disorders in teenagers. Secondly, to decrease stress demands on the teenagers. Thirdly, address psychological stressors that contribute to stress through family and school interventions. And lastly, she says parents should improve the levels of support for their teenagers moving forward. In Thabo’s case had his parents firstly identified and treated Thabo’s underlying stress and secondly decreased the pressure they put on him then thirdly allowed him to address his psychological stressors appropriately and finally gave him the moral support he needed, Thabo could’ve probably avoided suicide.

SADAG: teenage suicide in south africa

9% of all teenage deaths in south Africa are due to suicide. With suicide being the second leading and fastest growing cause of death in the 15-24 year old age group, everyday an estimated 22 teenagers take they own lives and the question everyone is asking is why. One ten year old once said “I pray to God every night that I will die and not wake up” and a 15 year old says “I feel so empty” these words as disturbing as they are, are being uttered by children whose parents dismiss as being in a phase or being a victim of witch craft that should pass or needs a traditional healer to solve them. Research, however, proves that 75% of people who commit suicide or attempt to do so, gives warnings and signals before hand. Dr Colinde Linda cautions that during adolescence, the physical and social changes that occur can be overwhelming and sometimes unresolved conflict from childhood.

The south African depression and anxiety group suggests that it is very vital to build an understanding about why young people kill themselves, SADAG development manager says suicide is a permanent solution to a temporary problem. She states further that people need to understand that there are people out there that can help them. People also need to understand that suicide happens in all classes and cultures and both the youth and the adults need to learn about what leads to suicide in order for prevention efforts to be effective and when left undiagnosed or under treated.

Conclusion

Shocking statistics are released every year on the prevalence of depression In teenagers in South Africa. As many as one in five teenagers show signs of depression and sadly not all of them deal with their depression accordingly. And teenagers like Thabo end up committing suicide because they feel hopeless and alone. This assignment has discussed the signs and causes of mood disorders specifically depression. I has discussed the clinical description and has assessed Thabo’s case according to the clinical description given by the DSM5. It further identified the types of treatments for depression. The essay continues to speak about suicide identifying causes and possible cause to Thabo’s case in conclusion reference is made to the South African context and suicide and depression is put into context.

Bibliography

1. American Association of Child and Adolescent Psychology. (2008). Teen suicide. Retrieved 17th march, 2019 from: www.aacap.org/cs/root/facts_or_families_/teen_suicide
2. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington DC.
3. Armstrong, K. (2018). How to prevent teenage suicide. Retrieved 15th march, 2019 from: https://www.iol.co.za/lifestyle/health/mind/hw-to-prevent-teen-suicide-13448600
4. Barlow, D.H., Durand, V.M., du Plessis, L.M., Visser, C. (2017). Abnormal Psychology An Integrative Approach United Kingdom. Cengage learning.
5. Cleveland Clinic, (2018). Treatment of mood desorders. Retrieved 15th march from: https://my.clevelandclinic.org/health/doseases/17843-mood-disorders/management-and-treatment
6. Cuijpers, P., Geraedts, A.S., van Straten, A. (2011). Iterpersonal Psychotherapy for depression: A meta-Analysis. Retrieved 15 march 2019 from: https:// www.ncbi.nlm.nih.gov/pmc/articles/PMC3646065
7. England, M.J. (2009) Etiology of Depression – Depression in parents, parenting and children. Retrieved 15th March from : https://www.ncbi.nlm.nih.gov/books/NBK215119
8. Goldberg, J. (2017). Electroconvulsive therapy. Retrieved from: https://www.webmd.com/depresssion/guide/electroconvulsive-therapy
9. Kendler, K.S,. Garder, C.O,. and Prescott, C.A. (2006). Toward a comprehensive development model for major depressive developmental model for major depression in men. American journal of psychiatry.
10. Markowits, J.C. (2004). Interpersonal Psychotherapy: principles and applications Retrieved 17th march from: https://www.ncib.nlm.nih.gov/pmc/article/PMC1414693
11. Nuemeister, A,. young, T,. and Strastny, J. (2004). Implications of genetic research on role of serotonin in depression: Emphasis on the serotonin type 1A receptor and the serotonin transporter. Psychophamachology.
12. Picardi. A., Gaetano, P. (2014). Psychotherapy of mood disorders. Retrieved from: https://.ncbi.nlm.nih.gov/pmc/articles/PMC4258697/
13. South African Depression And Anxiety Group. (2018) Curbing Teen Suicidein South Africa. Retrieved from: www.sadag.org/index.php?option=com_content&view=article&id=816:curbing-teen-suicide-in-south-africa&catid=94&Itemid=132
14. Shaw. J. (2017). Causes of teenage suicide. retrieved from: https://www.livestrong.com/article/130491-causes-teenage-suicide/
15. The South African Collage of Applied Psychology. (2017) The symptoms of depression in teens. Retrieved 16th march 2019 from: https://www.sacap.edu.za?blog?councelling/teen-depression/