The Importance of Recognising Depression in Adolescents Affected by Parental Illness

doi:10.4236/psych.2012.329114

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Psychology

2012. Vol.3, Special Issue, 75 6-757

Published Online September 2012 in SciRes (http://www.SciRP.org/journal/psych) http://dx.doi.org/10.4236/psych.2012.329114

756

The Importance of Recognising Depression in Adolescents

Affected by Parental Illness*

David Morley#, Crispin Jenkinson

Department of Public Health, Ol d Road Campus, University of Oxford, Headington, UK

Email: *[email protected]

Received July 17th, 2012; revised August 16th, 2012; accepted S e p tember 12th, 2012

Research focusing on the impact of parental illness has increased rapidly in recent years, with studies on a

range of both chronic and acute illnesses having now been reported. A key and consistent finding is the

elevated risk of depression that young people face when adjusting to and living with a parent experiencing

such a condition. Examples from the literature include studies focusing on parental multiple sclerosis,

Parkinson’s disease, stroke, cancer, affective disorder and traumatic brain injury. Such a body of literature

emphasises the need to recognise and manage the increased risk of depression that young people face

when confronted with such parental conditions and that a more family centred approach to parental illness

is required. Additionally, it is important that the potential threat parental illness poses to young people’s

mental well-being is reflected in relevant clinical guidelines.

Keywords: Adolescent; Depression; Parental Illness

Depression in adolescence is largely characterised by fea-

tures similar to those in adults. Low mood, lack of interest in

activities, low self-esteem, inability to concentrate, suicidal

thoughts, disturbed sleep, changes in appetite and feelings of

guilt are just some such characteristics. In addition, adolescents

can often appear agitated, may refuse to go to school and dem-

onstrate behavioural problems (Thapar, Collishaw, Potter, &

Thapar, 2010).

Alongside early adulthood, adolescence is the most prevalent

period for depression (Hammen, 1997). Importantly, unrecog-

nised depression during this period of development can lead to

poor educational attainment and psychosocial outcomes, as well

as continued depressive disorder in adulthood (Birmaher, Ryan,

Williamson, Brent, & Kaufman, 1996). This highlights the need

for its detection and treatment, and data indicates that at least

12% of adolescents report a minimum of low level depression

(Sihvola et al., 2007). However, depression in childhood and

adolescence frequently goes undiagnosed (Kramer & Garralda,

2000), and this is compounded by the fact that adolescents are

unlikely to consult general practitioners about mental health

problems (Potts, Gillies & Wood, 2001).

Research focusing on the impact of parental illness has in-

creased rapidly in recent years. Data from a number of studies

suggests young people experience a range of issues such as

changing roles, heightened responsibility and reduced inde-

pendence (Morley, Selai, Schrag, Jahanshahi, & Thompson,

2011). However, a key and consistent finding is the elevated

risk of depression that young people face when adjusting to and

living with a parent experiencing serious illness. Studies across

a range of parental conditions, both chronic and acute, appear to

confirm this.

As a relatively well investigated parental condition, multiple

sclerosis (MS) provides a sound example. Adolescent offspring

of people with MS report significantly higher levels of depres-

sion than children of healthy parents (Yahav, Vosburgh, &

Miller, 2007). Other studies confirm these elevated levels

through comparisons with the normal population (Morley et al.,

2011). Evidence suggests that the risk of such mental health

problems is, in part, associated with the mental health of both

the affected and non-affected parent, and that where both par-

ents report depressive symptoms the prevalence of internalising

disorders in their offspring is two to three times higher than that

found in the normal population (Steck et al., 2006).

MS is just one example of a parental condition that may have

an effect on young people’s mental well-being. Evidence from

the literature suggests a wide range of conditions can have such

an effect. For example, studies focusing on Parkinson’s disease

(Schrag, Morley, Quinn & Jahanshahi, 2004; Morley et al., 2011),

stroke (Visser-Meily et al., 2005a; Visser-Meily et al., 2005b),

cancer (Visser et al., 2005), affective disorder (Beardslee Glad-

stone & O’Connor, 2011) and traumatic brain injury (Kieffer-

Kristensen, Teasdale, & Bilenberg, 2011) all report data where

adolescent depression is a prominent feature. Such findings

have important implications. The key to the effective manage-

ment of depression in young people is its recognition and treat-

ment (Rowe, Tonge, & Melvin, 2004). In the United Kingdom,

National Institute for Health & Clinical Excellence (NICE)

guidelines reiterate this in recommending that “healthcare pro-

fessionals in primary care, schools and other relevant commu-

nity settings should be trained to detect symptoms of depression,

and to assess children who may be at risk of depression” (NICE,

2005: p. 149). Given the findings from a number of studies,

young people confronted with parental illness certainly appear

at increased risk of mental health problems, and should be rec-

ognised as such. As a starting point, the treatment of a serious

medical condition requires far greater emphasis on not just the

ill parent but on the wider family unit. A family centred ap-

proach at diagnosis should lead to a family centred approach to

care. It is a priority that the potential impact of parental illness

*Conflict of interests: None

#Correspo n ding author.

D. MORLEY, C. JENKINSON

on young people’s mental health is recognised in relevant

clinical guidelines, something that is currently lacking in, for

example, UK guidelines for Parkinson’s and stroke.

Adolescence can be a particularly turbulent period of devel-

opment for some without the presence of serious parental ill-

ness. This only reiterates the importance of ensuring that young

people confronted with parental illness receive the support that

many are likely t o requir e.

REFERENCES

Beardslee, W. R., Gladstone, T. R., & O’Connor, E. E. (2011). Trans-

mission and prevention of mood disorders among children of affec-

tively ill parents: A review. Journal of the American Academy of

Child and Adolescent Psychiatry, 50, 1098-1109.

doi:10.1016/j.jaac.2011.07.020

Birmaher, B., Ryan, N., Williamson, D., Brent, D. & Kauf man, J. (1996).

Childhood and adolescent depression; a review of the past 10 years.

Part II. Journal of the American Academy of Child and Adolescent

Psychiatry, 35, 1575- 1583. doi:10.1097/00004583-199612000-00008

Hammen, C. (1997). Children of depressed parents: The stress context.

In S. Wolchik, & I. Sandler (Eds.) Handbook of child ren’s coping (pp.

131-157). New York: Plenum Press.

Kieffer-Kristensen, R., Teasdale, T. W., & Bilenberg, N. (2011). Post-

traumatic stress symptoms and psychological functioning in children

of parents with acquired brain inju ry. Brain Injury, 25, 752- 760.

doi:10.3109/02699052.2011.579933

Kramer, T., & Garralda, M. (2000). Child and adolescent mental health

problems in primary care. Advances in Psychiatric Treatment, 6, 287-

294. doi:10.1192/apt.6.4.287

Morley, D., Selai, C., Schrag, A., Jahanshahi, M., & Thompson, A. (2011).

Adolescent and adult children of parents with Parkinson’s disease:

Incorporating their needs in clinical guidelines. Parkinson’s Disease,

2011, 951874. doi:10.4061/2011/951874

National Institute for Health & Clinical Excellence (2005). Depression

in children and young people: Identification in primary, community

and secondary care. London: HMSO.

Potts, Y. Gillies, M., & Wood, S. (2001). Lack of mental well-being in

15-year-olds: An undisclosed i ce b erg? Family Practice, 18, 95-100.

doi:10.1093/fampra/18.1.95

Rowe, L., Tonge, B., & Melvin, G. (2004). When should GPs prescribe

SSRIs for adolescent depression? Australian Family Physician, 33,

1005-1008.

Schrag, A., Morley, D., Quinn, N., & Jahanshahi, M. (2004). Impact of

Parkinson’s disease on patients’ adolescent and adult children. Park-

insonism & Related Disorders, 10, 391-397.

doi:10.1016/j.parkreldis.2004.03.011

Sihvola, E., Keski-Rahkonen, A., Dick, D., Pulkkinen, L., Rose, R.,

Marttunen, M., & Kaprio, J. (2007). Minor depression in adolescence:

Phenomenology and clinical correlates. Journal of Affective Disor-

ders, 97, 211-218. doi:10.1016/j.jad.2006.06.019

Steck, B., Amsler, F., Grether, A., Dillier, A., Baldus, C., Haagen, M. ,

Diareme, L., Tsiantis, J., Kappos, L., Burgin, D., & Romer, G. (2006).

Mental health problems in children of somatically ill parents, e.g.

multiple sclerosis. European Child & Adolescent Psychiatry, 16, 199-

207. doi:10.1007/s00787-006-0589-5

Thapar, A., Collishaw, S., Potter, R., & Thapar, A. K. (2010). Mangaing

and preventing depression in adolescents. British Medical Journal,

340, 254-258. doi:10.1136/bmj.c209

Visser, A., Huizinga, G. A ., Hoekstra, H. J., van der Graaf , W. T., Klip ,

E. C., Pras, E., & Hoekstra-Weebers, J. E. (2005). Emotional and be-

havioural functioning of children of a parent diagnosed with cancer:

A cross-informant perspective. Psychooncology, 1 4 , 746-758.

doi:10.1002/pon.902

Visser-Meily, A., Post, M., Meijer, A., Maas, C., Ketelaar, M., & Lin-

deman, E. (2005a). Children’s adjustment to a parent’s stroke: De-

terminants of health status and psychological problems, and the role

of support from the rehabilitation team. Journal of Rehabilitation

Medicine, 37, 236-241. doi:10.1080/16501970510025990

Visser-Meily, A., Post, M., Meijer, A., van de Port, I., Maas, C., &

Lindeman, E. (2005b). When a parent has a stroke: Clinical course

and prediction of mood, behavior problems, and health status of their

young children. Stroke, 36, 2436-2430.

doi:10.1161/01.STR.0000185681.33790.0a

Yahav, R., Vosburgh, J., & Miller, A. (2007). Separation-individuation

processes of adolescent children of parents with multiple sclerosis.

Multiple Sclerosis, 13, 87-94. doi:10.1177/1352458506071163