Elsevier

Health Policy

Volume 79, Issues 2–3, December 2006, Pages 121-131
Health Policy

Review
Possibilities for intervention in adolescents’ and young adults’ depression from a public health perspective

https://doi.org/10.1016/j.healthpol.2005.11.012Get rights and content

Abstract

When considering measures to decrease the burden of disease that is caused by depression, depressive disorders of adolescents and young adults are of increasing interest.

The prevalence of depressive disorders in adolescents and young adults is high. The probable increases in prevalence affect predominantly young people and their prognosis is particularly bad. This review discusses the potentials to influence the burden of disease through interventions such as therapy, including measures to detect persons at risk early, selective and universal prevention, and health promotion for adolescents and young adults. It considers the available evidence for the effectiveness of these interventions on the public health level. In addition, the suitability of implementation and ethical considerations are discussed.

As a conclusion, health policy in its aim to reduce the burden of depressive disease should focus on increasing treatment rates and improving the efficiency of treatment in adolescents and young adults as well for depression as for other mental disease that has high co-morbidity with depression. In addition, the focus should be set on indicated prevention for children of depressed parents and – for health promotion reasons – on policies that impact on living-conditions of families.

Section snippets

Background

Consideration about how to deal with the significant impact that is caused by depression and its consequences [1] are increasingly focusing on depressive disorders of adolescents and young adults. There are several reasons for that:

  • 1.

    In the past 50 years, epidemiologic studies report an augmentation in lifetime prevalence of depression, caused by a cohort effect. This means, that more and more young people are found to be affected by depression at increasingly younger ages [2], [3]. However, it

Therapy

Treatment of depressive disorders is considered to be one of the most effective interventions to reduce the burden of depressive disease: model-estimations for adults suggest that if all currently available effective treatment methods for depression (pharmacotherapy, psychotherapy, proactive collaborative care) would be applied, than the burden of disease could be reduced by 10–30% [19]. In addition, models estimated for Australia show that with the present coverage and with optimal therapy,

Prevention

Preventive measures for a disease are only feasible, if its prevalence shows a particular plasticity that would suggest that it could be influenced by external factors (whether these external factors could be altered is a second question). This is the case in depressive disorders:

  • Studies that measured point prevalence at several times, find in their recent follow-ups higher prevalence rates [30], [31]. The interesting question however is, to what extent this period effect is a result of what

Indicated prevention

Youths with elevated depressive symptoms not only have a greater risk for depressive disease, but also suffer impairment of functioning that parallel the rise of depressive symptoms [13], [37]. Prospective studies revealed that mental health problems in childhood (whether self-reported or by parents or teachers) are predictive for mood disorder later on [38], [39]. Thus, detecting and offering early help to children, adolescents and young adults that suffer under mental health symptoms is

Selective prevention

Approaches for selective prevention apply to adolescents and young adults that suffer an increased risk for becoming depressed because of certain circumstances. This refers to children of depressed parents, adolescents that are exposed to adverse life events, such as the loss of a parent due to divorce or death, or violence as well as to youths that suffer under other mental disease particularly anxiety disorders. Examples for possible target groups for selective prevention measures would

Universal prevention

Because universal prevention tackles all members of a population or group, problems concerning stigma do not arise. Universal prevention aims to promote positive mental health by promoting health on a behavioural level. One major setting for universal prevention of depression in adolescents is the school and education system. Often interventions imply cognitive-behavioural oriented groups. It is not clear how effective these interventions are. Because many people with low risk participate, no

Health promotion

Health promotion refers to the promotion of resilience against ill health. The term health promotion as it is used in the context of this article, focuses on influencing living conditions and environment, as a precondition for health and disease [70]. The effects of health promotion might be small; however, they are wide spread and affect not only many individuals, but also different social and health areas. Interventions that impact families are of core significance for mental health promotion

Summary and conclusion

The frequency of depression in adolescence and young adulthood, the unfavourable prognosis of an early onset of this disease and its rising economic burden call for interventions to reduce the burden of depressive disease. Powerful potential to influence the burden of disease is located in the area of therapy. This can be learned from model-calculations for adult depression [20]. Under the assumption that these models could be transferred to adolescents and young adults, powerful effects on the

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