Negative Behavior Can Be a Depression Smokescreen

By Kristine Carrillo, LISW, Program Manager with the New Mexico School Mental Health Initiative, and member of the Technical Assistance and Training Center Advisory Panel

Something happened recently that profoundly shook me.  A young friend of mine tried to kill herself.  How did we miss that she was depressed?  I’ll tell you how: her negative behaviors obscured her emotional pain. We thought she was bad, not sad. Instead of getting weepy, she got angry.  She raged at her parents, ditched school, blew off her friends and engaged in risky activities.  And then, after a particularly nasty fight in which she hurt a loved one, she took 30 sleeping pills and lay down to die.  When she didn’t die, she got up and took 20 more.

It is a story that has become all too familiar. An adolescent girl overdoses on sleeping pills.  A high school sophomore shoots himself with his grandfather’s gun.  A top athlete hangs himself.  Nationally, suicide is the third leading cause of death for ages 10-19.  It is too painful a concept for many adults to consider when faced with a troubled adolescent that teenagers can be so unbearably unhappy they would choose to end their life. Although, it is difficult to understand the depth of adolescent pain, or comprehend all of the various triggers that would prompt a teen to self-injury, more than 90 percent of suicides are associated with mood disorders, the most common of these being depression (Shaffer, Gould, et al. 1996, from Emotional & Behavioral Disorders in Youth, vol.1, no. 2, Spring 2001).

Depression is a killer.  It strikes people of all ages, nationalities, backgrounds and lifestyles.  It is characterized by feelings of gloom, sadness, and despair.  More than just a low mood state, depression is a “whole being” illness that involves one’s body, perceptions, moods, thoughts and behaviors. Adolescents are particularly hard hit.  Estimates vary, but somewhere between five and eight percent of the general adolescent population experience major depression. 

 Adolescent depression is often invisible. It can be difficult to distinguish between depression and the normal mood swings of adolescence. How many of us know teens that are moody, stormy, unmotivated, and willful?  Particularly difficult for many depressed adolescents is that their behavioral symptoms can alienate them from the very people who are their lifeline: parents, teachers, and friends.  We might respond with concern to the emotional symptoms of depression (persistent sadness, crying, hopelessness, loss of pleasure), or to the physical symptoms (major changes in sleeping or eating patterns, dramatic changes in weight, excessive fatigue, chronic somatic complaints); however, we react less kindly to the behavioral symptoms, such as rage, aggression, negative attitude, risky behaviors, sulkiness, substance abuse, sexual acting out, or antisocial behavior.  In addition, thought process symptoms, such as difficulty concentrating, inability to make decisions, polarized or distorted thinking, combined with school performance signs, like excessive school absences, lack of motivation and effort, failing grades, can result in a teen having to face harsh consequences at home or school.  Adolescents who act out their depression in angry, negative behavior get suspended from school.  They get grounded. They can be removed from the very things that sustain them, such as friends, sports, or music. They get kicked out of their homes.  They do drugs. Their behavior can get them into trouble with the law. They are told to “shape up” or “get it together” or to “try harder,” especially in school.

 Most depressed teens can’t articulate why they act the way they do.   They see themselves and the world through a distorted lens.  They act in ways that reinforce their negative self-perceptions. As adults, we have to develop ways to see through their behaviors to get them the help they need.  We must seek to understand and support these struggling adolescents, based upon a realistic and objective understanding of the illness of depression and not based upon our emotional reactions to their confusing behavior.  We get angry when our attempts to intervene with a troubled teen are met with indifference, apathy, hostility or noncompliance. Ever had a discussion with a teen that quickly became a monologue?  How many of us have compounded the problems of a depressed adolescent by blaming them for acting they way they do? 

 There is a certain irony in the fact that depression, while being a lethal mental illness, is also one of the most treatable.  Antidepressant medications, combined with individual or family therapy, can help teens get on a track toward recovery.  If a toddler is cranky and sleepless, or behaves in ways that are contrary to what we have come to expect, we are quick to think that there might be something wrong, and we find the right help.  Not unlike a toddler, a teen might not be able to articulate how we can help them. 

 Youth of all ages do best when the adults in their lives communicate with each other.  Talk to a teacher if you’re worried about a change in your child’s school performance.  Teachers, talk to a parent about a troubled or apathetic student. School nurses, counselors, and primary care physicians can uncover a myriad of symptoms, and ways they can help, if they just ask. Coaches, got a kid with attitude?  Ask him how his life is going. Are you a probation officer facing a youth with persistent, negative behavior?  Drugs?  Don’t take it at face value. We have to ask the questions.  We have to ask the right questions, and we have to keep asking them.  How do we know if our teens are depressed?  We have to ask. They are dying to tell us.

 For more information, join us at the National School-Based Health Center Convention on June 26-28, 2003 in Reston, Virginia. At the convention, featured workshops will include topics such as depression, collaboration with family, school, and community, practice management, funding updates, evaluation and research, clinical skills building to address important health concerns and advocacy and policy to support SBHCs.

Go to http://www.nasbhc.org/ampreliminary.pdf to get more information about specific workshops offered.

Depression Web-Based Resources   

This website is maintained by the Center for Mental Health in Schools and contains a wide variety of resources including tools, publications and links.  http://smhp.psych.ucla.edu

This website offers general information about depression awareness www.nami.org/youth/depression.html

This website offers general depression information www.nimh.nih.gov/publist.sp_023561.cfm

This website offers information about current research projects on mood and anxiety disorders funded by the National Institutes of Mental health and information about symptoms, diagnosis, and treatment of mental illness. www.intramural.nimh.nih.gov/mood/

This fact sheet presents parents with an overview of childhood and adolescent depression, including a discussion of the incidence and prevalence, signs and symptoms, diagnosis, and appropriate treatment. www.aacap.org/publications/factsfam/depressed.htm