Updated 10 April 2013

More than just the blues

Mood swings are common during the teenage years, but in some teens it can be one of the first indications of a mental disorder.


"My daughter is 16 years old and is diagnosed with bipolar and borderline personality. She is also severely depressed, has no interest in school and everyone and everything is always negative against her. My daughter just came out a clinic which helped her to learn the life skills and to cope with bipolar. I' m worried that although she is very positive that she will fall back to her old depressed self. I don't know what to do for her anymore as I cannot keep on rescuing her from every situation."- Teen Forum

The World Health Organisation (WHO) estimates that worldwide up to 20% of children and adolescents have a mental health disorder that needs professional help, however fewer than one in five receive the treatment they need.

Emotional problems which affect teenagers include depression and anxiety disorders, grief, conduct disorder, attention deficit disorder hyperactivity, post-traumatic stress, psychosis, eating disorders and suicide.

"Depression is certainly on the increase, with children as young as 12 presenting with severe depression and suicidal thoughts. Teenagers (15-24) are the highest risk age-group for suicide, and it is the second leading cause of deaths amongst teens," says counselling psychologist, Diane Mallaby.

A rising epidemic
An Australian report found that one in four Australian teenagers live with mental illness. Teenagers show enough symptoms to be defined as suffering from a mental illness of some kind - most commonly anxiety disorders and depression. Smaller numbers have more serious disorders, such as schizophrenia and psychosis.

"The cause of the increase in depression and anxiety is the increased stressors that teenagers face, such as the breakdown of families, broken relationships, drug/alcohol abuse (which can trigger a mood or anxiety disorder) and bullying in schools. In the poorer areas teenagers are dealing with violence, gangs and poverty," says Mallaby.

The link between substance abuse
According to Mallaby substance abuse is a huge concern, especially tik in the Western Cape.

"In severe cases of substance abuse (where there is a predisposition to psychosis or schizophrenia), a psychotic episode can be triggered by drugs such as tik or ecstasy."

A report done in the US analyzing studies on marijuana showed increased depression in teens that smoke marijuana. The report found that teens who used marijuana to help fight their depression, however it worsened and increased the risk of existing mental problems, and also caused certain conditions. Teens who used marijuana at least once a month for a year were three times more likely to have suicidal thoughts

Another study published in the online journal Child and Adolescent Psychiatry and Mental Health found that teenagers who drink heavily were more prone to having behavioural problems or symptoms of depression and anxiety.

The study done on 9 000 Norwegian teenagers found that teens who said they had been drunk more than 10 times in their lives were more likely to have attention and conduct problems in school.

In girls who drank heavily higher rates of depression and anxiety symptoms were found.

In both these studies researchers stressed that although mental health problems and substance abuse are closely connected, they are unable to say which came first.

Is screening the key?
TeenScreen a school based mental health screening programme in the US offers voluntary mental health screening in teens.

Screening is done in two stages: teens fill out a short questionnaire and are then interviewed by a master's level social worker or clinical psychologist.

In 2005 the program screened 55, 000 teens in 42 states about one third screened positive on the questionnaire and 17% were referred for further evaluation.

"Mental illness or (psychological disorders) can be diagnosed at any time during childhood and adolescence. We treat children as young as 4/5 for anxiety such as separation anxiety, specific phobias, generalized anxiety and even depression. Children may present with attention deficit disorder which commonly presents in childhood."

"Screening, especially early diagnosis and treatment of depression can prevent suicidal ideation and behaviour," says Mallaby.

Symptoms of depression in teens to look out for:

  • Low mood/irritability
  • School refusal or avoidance
  • Withdrawal from friends and family
  • Avoidance of activities they once enjoyed
  • Sadness or anger for no apparent reasons
  • Low self-esteem
  • Self-mutilation
  • Defiant/acting out behaviour
  • Talking of 'not wanting to be here' or writing letters to saying good bye

These are serious symptoms, and if not treated depression can lead to substance abuse, suicide and other serious conditions.

Where to get help
"Have your child assessed as soon as possible and following the recommendations of the professionals involved. If they recommend therapy and/or medication, it is imperative that they follow the combined treatment and research the illness/disorder thoroughly. For teens, group therapy is often beneficial, "advises Mallaby.

(Leandra Engelbrecht, Health24, updated June 2011)

Read more:

Worried about teen suicide?

Any questions? Ask Teen Expert

- Diane Mallaby, Counselling psychologist
- South African Anxiety and Depression Group (SADAG)
- Youth and Mental Illness, Canadian Psychiatric Association
- Drug Abuse and mental illness fast facts,
- Uncovering and epidemic – screening for mental illness in teens. Richard A Friedman. The New England Journal of Medicine,
- Psychaitric problems in teens difficult to pinpoint. ScienceDaily,
- Teens' drinking linked to mental health problems. Amy Norton, Reuters UK.
- Teens 'aware of cannabis harm'. BBC News.
- New Report shows teens smoking pot worsens depression and other mental illness.
- 1 in 4 teens live with mental illness. Bronwyn Herbert for the World Today. ABC News.


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