Gender and Contextual Factors in Diagnosis of Depression in Adolescents

Question: Discuss problems related to identifying/diagnosing and the assessment of depression in adolescents taking into account gender and contextual factors.

Contents
1.
Introduction…………………………………………………………………………………………………………………………….1
1.1 Definitions……………………………………………………………………………………………………………………….1
1.1.1 Adolescence…………………………………………………………………………………………………….1
1.1.2 Mood Disorders……………………………………………………………………………………………….1
1.1.3 Depression………………………………………………………………………………………………………1
1.1.4 Adolescent Depression…………………………………………………………………………………….1
2.

Identifying and diagnosing ……………………………………………………………………………………………………2
2.1 DSM-IV-TR……………………………………………………………………………………………………………………….2
2.1.1 Critique DSM-IV-TR………………………………………………………………………………………….3
2.1.2 Normal Adolescent Developmental Behavior…………………………………………………..4

3.

Assessment ………………………………………………………………………………………………………………………….5
3.1 Ecological Model…………………………………………………………………………………………………………….5
3.1.1 Individual………………………………………………………………………………………………………...5
3.1.2 Genetics…………………………………………………………………………………………………………..5
3.1.2.1 Gender…………………………………………………………………………………………….5
3.1.2.2 Diathesis Stress Model…………………………………………………………………….6
3.1.2.3 Self-Esteem and Self-Worth……………………………………………………………6
3.1.2.4 Commorbity and other disorders…………………………………………………..6
3.2 The Family……………………………………………………………………………………………………….7
3.2.1 Parenting Styles……………………………………………………………………………….7
3.2.2 Depressed Parents………………………………………………………………………….8
3.2.3 Parental Work Schedules………………………………………………………………..8
3.3 Society……………………………………………………………………………………………………………8
3.3.1 Peers……………………………………………………………………………………………….9
3.4 Culture ………………………………………………………………………………………………………….9
3.4.1 Theological Perspective……………………………………………………..10

4.

Conclusion………………………………………………………………………………………………………………………..10

REFERENCES………………………………………………………………………………………………………………………………….11

1. Introduction

It is suggested that there are lower rates of depression in children and once adolescence is reached the rates increase (Costello et al., 2006). Adolescent depression usually persists into adulthood. Depressed adolescents are at an increased risk for suicide, substance abuse, and behavior problems. Furthermore, depressed adolescents are likely to have poor psychosocial, academic, and family functioning, which highlights the importance of early identification and prompt treatment( J Am Acad Child Adolesc Psychiatry., 1998). However, the DSM-IV-TR does not have a different category for diagnosing adolescent depression
(Tutorial Letter 101/0/2013, PSY481U: UNISA)
Factors will be discussed with regards to assessing and identifying depression in adolescents in relation to gender and contextual circumstances by doing this we will give consideration to the ecological model and diathesis stress model.

1.1 Definitions
1.1.1 Adolescence

Adolescence is a developmental period which is characterised by major developmental changes in areas of functioning this involves dramatic changes in the intellectual, social, sexual and physical parts of an individual (Mash & Wolfe, 2010).
1.1.2 Mood Disorders
“A mood disorder is a mental disorder where an individual feels depressed and/or elated, and outwardly displays signs/symptoms of depression and or mania for a significant duration of time. Importantly, the individual’s mood impairs social, occupational, or other important areas of functioning. The disorder also occurs in the absence of a clearly identifiable stressor or trigger. Mood disorders are classified with two extreme poles in mind. On the one end, occurs dysphoria (Major Depressive Episode) and on the other end occurs euphoria. In the middle of the two extremes is euthymia. All mood disorders by definition will include a depressive episode. When an individual only experiences the one pole of depression it is known as unipolar mood. When an individual has experiences of both poles, both episodes of depression and experiences of episodes of mania or hypomania, the individual’s mood is diagnosed as bipolar disorder (Burke, 2012)”. (Tutorial Letter 101/0/2013, PSY481U:
UNISA.pg. 31)
1.1.3 Depression

Intense feelings of sadness, feelings of futility, worthlessness and withdrawal from others is characterisics of depression (Sue, Sue & Sue, 2003)
1.1.4 Adolescent Depression

Symptoms of adolescent depression are persistent sadness, insomnia or hypersomnia, low self-esteem and social isolation (Mash & Wolfe, 2010). Other possible symptoms can be an increase in irritability, poor academic performance, loss of interest in things that the individual previously found pleasurable and a distorted body image (Mash & Wolfe, 2010).

2. Identifying and diagnosing
2.1 DSM –IV-TR
The DSM –IV –TR ( Diagnostic and Statistical Manual of Mental Disorders) used as a tool in identifying and diagnosing depression by practioners.
The diagnostic criteria for depression are as follows:
Major Depressive Episode
“A. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure. Note:Do not include Diagnostic criteria for 296.3 Major Depressive Disorder (APA, 2000) 32 symptoms that are clearly due to a general medical condition, or mood-incongruent delusions or hallucinations.
(1) depressed mood most of the day, nearly every depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful). Note:In children and adolescents, can be irritable mood. (2) markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others)
(3) significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day.
Note:In children, consider failure to make expected weight gains.
(4) insomnia or hypersomnia nearly every day
(5) psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)
(6) fatigue or loss of energy nearly every day
(7) feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick)
(8) diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others)
(9) recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide

B. The symptoms do not meet criteria for a Mixed Episode.
C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
D. The symptoms are not due to the direct physiological effects of a substance (e.g., a drugof abuse, a medication) or a general medical condition (e.g., hypothyroidism).
E. The symptoms are not better accounted for by Bereavement, i.e., after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation,psychotic symptoms, or psychomotor retardation.
Major Depressive Disorder
Single Episode
A. Presence of a single Major Depressive Episode
B. The Major Depressive Episode is not better accounted for by Schizoaffective
Disorder andis not superimposed on Schizophrenia, Schizophreniform Disorder,
Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.

C. There has never been a Manic Episode, a Mixed Episode, or a Hypomanic Episode.
Note:This exclusion does not apply if all the manic-like, mixed-like, or hypomanic-like episodesare substance or treatment induced or are due to the direct physiological effects of ageneral medical condition.

Recurrent
A. Presence of two or more Major Depressive Episodes.
Note: To be considered separate episodes, there must be an interval of at least 2 consecutive months in which criteria are not met for a Major Depressive Episode.
B. The Major Depressive Episodes are not better accounted for by Schizoaffective
Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder,
DelusionalDisorder, or Psychotic Disorder Not Otherwise Specified.
C. There has never been a Manic Episode, a Mixed Episode, or a Hypomanic Episode.
Note:This exclusion does not apply if all the manic-like, mixed-like, or hypomanic-like episodesare substance or treatment induced or are due to the direct physiological effects or a general medical condition.” (Tutorial Letter 101/0/2013, PSY481U: UNISA.pg.
31,32 & 33)

2.1.1 Critique DSM-IV-TR
It has been suggested that the DSM-IV-TR may not be entirely suitable in diagnosing adolescent depression, and it is important for practioners to take this into account when diagnosing adolescent depression.

It is important to note that the DSM-IV-TR “does not have a separate category for diagnosing
Mood disorders in adolescents. However, the manual does note that depressed mood may be present as irritability in adolescence and that “there is an increasing risk of depression as children reach adolescence”(Tutorial letter, 101/0/2013, p. 31).
The same diagnostic criteria are applied to adults and adolescents, although the literacy suggests an inconsistency in findings as to whether the clinical manifestation is the same in both age groups.” (Crowe,Ward, Dunnachie & Roberts., 2006).
Crowe,Ward, Dunnachie & Roberts (2006) argue that it is important to have an awareness of which “symptoms are prominent in the clinical manifestation” of depression “is important for its recognition and diagnosis, given that adolescents may not present with the same symptoms as adults and there are significant psychosocial and educational consequences where such an episode remains undetected.” (Crowe,Ward, Dunnachie & Roberts., 2006).
Low self-worth is classified as a key symptom for depressive disorders in the DSM-IV however, it is unclear as it does not stipulate whether it is a risk factor or component for depression. Burwell and Shrik (2006) suggest that one must note that low-self-worth is more than likely be a predictor of depression (Burwell & Shrik, 2006).
Although the DSM-IV-TR does identify irritability as a characteristic of adolescent depression it is however, not considered as a criterion.Crowe, Ward, Dunnachie & Roberts. (2006) suggest that that the DSM-IV-TR should review irritability as their findings suggest that irritability is characteristic of adolescent depression and suggest that this must be acknowledged especially by health care workers who are not familiar with the characteristics of depression as irritability may be overlooked and considered to be due to simple the normal developmental changes in adolescents (Crowe, Ward, Dunnachie & Roberts., 2006).
This finding is supported by Mash & Wolfe (2010) that irritability is likely to be more common in adolescence and children as a feature of depression than in adults (Mash & Wolfe., 2010).

2.1.2 Normal Adolescent Development Behavior
It is important to not mistaken symptoms of depression in adolescents are normal adolescent behavior. It is suggested that there are lower rates of depression in children and once adolescence is reached the rates increase (Costello et al., 2006).Symptoms of adolescent depression are persistent sadness, insomnia or hypersomnia, low self-esteem and social isolation (Mash &
Wolfe, 2010). Other possible symptoms can be an increase in irritability, poor academic performance, loss of interest in things that the individual previously found pleasurable and a distorted body image (Mash & Wolfe, 2010).
Mash & Wolfe (2010) suggest that the above symptoms may occur in the developmental stages of a normal adolescent therefore, it is important to be able to identify depression in adolescence by not mistakenly seeing these symptoms as normal developmental changes but to identify whether loss of interest, irritability and feelings of sadness are present and if so do they show a change in the individual’s behaviour, persist over time and cause significant impairment in functioning ( Mash & Wolfe, 2010).

Acting out behaviours refers to behaviours that arise in relation to emotional discomfort this may predominate depressive symptoms which mask depression (Van- Wicklin, 1990).Van Wicklin (1990) suggests that it is important to note that adolescents do not have enough selfawareness to recognise their discomfort as depression therefore, they may mask their depression by acting out behaviours such as taking risks, promiscuity, eating disorders, substance abuse, running away and suicide (Van-Wicklin, 1990) it is therefore important to be able to diagnose an adolescent suffering from depression as they be unable to recognise that they are suffering from depression and practioners must not misinterpret their masked behaviours as normal adolescent behaviour before it leads to suicide (Van- Wicklin, 1990).

3. Assessment
The above critique of the DSM-IV-TR suggests that diagnostic problems can result from only commitiing to the DSM-IV-TR criteria when looking at adolescent depression. Due to adolescent depression not being straight forward one could suggest looking towards the
Ecological model when assessing adolescent depression.

3.1 Ecological Model
Bronfenbrenner’s (1997) Ecological model, (as cited by Mash & Wolfe, 2010) approach points out that when a therapist deals with a client they need to into account there are interconnected structures that effect the individual such as family, society and culture (Mash
& Wolfe., 2010).
3.1.1

Individual

When assessing an adolescent depression the practioner should take into account individual characteristic of an individual, although there are numerous individual characteristics, only genetics and self-esteem and self-worth shall be discussed.

3.1.2

Gentics

3.1.2.1 Gender

It is important that the practioner acknowledges that there are differences in gender when accessing and diagnosing depression.
In preadolescence there is no notable difference in the ratio of boys and girls reporting depression however, from ages 13 to 15 years old more females than males are diagnosed with depression and increases from 15 to 18 years old. (Mash & Wolfe, 2010). The ratio after puberty of males to females is 2:1 to 3:1 (Mash & Wolfe, 2010).

Mash & Wolfe (2010) suggest that it is important to identify that the symptoms of depression for both sexes are generally similar (Mash & Wolfe, 2010). However, there is a difference in females reporting more symptoms that are related to their weight and appetite disruptions and feelings of guilt and feeling worthless but the statistics of the ratio of girls to boys reporting these symptoms are not significantly high (Mash & Wolfe, 2010). Feelings of low self –esteem reported by girls is supported by Brage & Meredith (1994) (Brage & Meredith,
1994).Whereas, boys are more likely to be more vulnerable to depression when exposed to school related stress (Mash & Wolfe, 2010).
Ward, Dunnachie & Roberts (2006) suggest that boys are more likely to express depression through externalizing behavior (Ward, Dunnachie & Roberts., 2006) such as aggressive and delinquent acts (Mash & Wolfe, 2010) while girls are more likely to express their depression through internalized behaviour (Ward, Dunnachie & Roberts., 2006) such as somatic complaints and withdrawal (Mash & Wolfe, 2010).
Kahlil at al (2010) suggest that it is important to note that somatic symptoms are highly the most common symptom for female adolescents suffering from depression such as fatigue, low energy, changes in the psychomotor functioning, difficulties in concentrating and changes in weight may be the presenting complaints instead of the classic sad mood (Khalil et al, 2010).
It is suggested by Namedi et al (2007) that females may be more vulnerable to depression due to their ovaries which produce estrogen. A low level of estrogen can lead to neurotransmitters being norepinephrine and serotonin disrupted this drop of estrogen can happen during the premenstrual phase of females (Namedi et al., 2007)
Another reason why girls may suffer more than boys from depression is due to low birth weight as this may lead to a weak uterine condition which can result in disturbances in fetal development which is linked to girls and not boys being vulnerable to depression especially when exsposed to stress in adolescence (Mash & Wolfe, 2010).
3.1.2.2 Diathesis -Stress Model

By looking at the diathesis –stress model the practioner is aware that we have predisposed characteristics within us. The individual has pre-existing vulnerability known as diathesis, therefore can have a genetic vulnerability to form depression it can be activated by being exposed to a stressor.looking at it from this perspective the stress is not the cause of depression but just a stressor (Mash & Wolfe, 2010).
Burwell and Shrik (2006) note that “among the most well-established cognitive vulnerabilities for depression is low self-worth”(Burwell & Shrik, 2006. p., 479). “Despite these consistent findings, some have argued that low self-worth and depression are so highly associated that they represent different facets of the construct” (Burwell & Shrik, 2006. p. 479). In fact, DSMIV criteria for depressive disorders incorporate low self-worth as a key symptom”’ (Burwell &
Shrik, 2006, p. 479). “Therefore, it is unclear whether self-worth represents a component of or a risk factor for, depression” (Burwell & Shrik, 2006, p. 480).

3.1.2.3

Self Esteem and Self -Worth

Low self –worth is considered an extensively agreed on cognitive vulnerability. However, the
DSM-IV criteria consider low self-worth as a symptom and not as criteria for depression
(Burwell & Shrik, 2006).
It has been argued by investigators that low self-worth is a risk factor rather than a symptom of depression. This is consistent with information processing -model of depression For individuals who have self-worth contingencies that are high are more likely to have a highself-worth when receiving a external positive feedback, whereas when confronted with negative external feedback they are more likely to have a negative self-worth (Burwell &
Shrik, 2006).
Adolescences who are high in self-worth contingencies are more than likely to be vulnerable to depression when entering high school as there self-worth contingencies are at risk when exposed to the changes that high school exposes the adolescence to such as academic and social aspects. It is therefore, argued that individuals with high self-worth contingencies should be identified as self-worth contingencies are risk factors before it develops into depression (Burwell & Shrik, 2006)

3.1.2.4

Comorbity of other disorders

Due to it estimated that 40% to 90% of depressed adolescents have at least one comorbid disorder, anxiety, oppositional defiant disorder, and conduct disorder being the most common (Possel et al.,2008). There is importance in the practioner identifying whether commordity is present in the adolescent to avoid misdiagnosis of depression or primarily seeing depression or another disorder in isolation and only present in the individual.
Despite the high rates of commorbity present, according to Caron & Rutter (1991) there has not been extensive research in literature and classification issues of the co-occurance of disorders has generally been ignored. Furthermore, it has been argued that the DSM –III-R avoids the identification of commorbity as it would involve difficulty in classification (Caron and Rutter, 1991).

3.2

The Family

There are several factors to take into account when looking into how the family can be linked to adolescent depressed, however, parenting styles, parents work schedules as well as whether a parent with depressed is present in the family shall only be discussed.

3.2.1 Parenting Styles

There have been numerous studies on the relationship between parenting styles and the link to their childs’ adjustment, however, fewer studies have been done on their link to adolescence (Milevsky et al., 2007).

Research done by Milevsky,et al, (2007) between the associations on parenting -styles to the relationship on the adolescence self-esteem, life-satisfaction and the link to depression suggested that adolescence who had authoritative parents were more likely to be linked to having higher self-esteem, life satisfaction and less likely to experience depression compared to those adolescents who had more authoritarian and permissive parents
(Milevsky et al., 2007).
It is further suggested that if there is a low level of parental attachment they adolescent may be unable cope with developmental changes that develop during adolescence this can be related to low self-esteem and feelings of helplessness (Allen-Meares, 1987; Sander &
McCarty, 2005). However, it has been suggested that there has not been as much research of the paternal effects on adolescence depression and research has focused more on maternal and maternal and paternal combined on the effects on adolescent depression
(Milevsky, 2007).
Adolescents may feel helpless if they feel that they are unable to live up to their parents’ high expectations of achievement as they may feel that if they do not meet their parents’ expectations they would loss their parents affection (Lefkowitz & Jesiny, 1984).

3.2.2 Depressed Parents

It has been suggested by Stark (1990) that mothers with depression tend to lack communication skills and are more than likely rejecting, hostile, tense and cold towards their children. This leaves little opportunity for adolescence to learn coping skills (Stark et al.,
1990).
Furthermore, it is suggested that for children who have a depressed parent are more vulnerable to depression as their depressed parent is unable to communicate effectively with their child and therefore the child models out their parents depressed behaviour (Garber at al, 1997). Mash & Wolfe (2010) suggest that children who have mothers who are depressed are more likely to be vulnerable to depression (Mash & Wolfe, 2010).
3.2.3 Parental Work Schedules

Han & Miller suggested that there is a relationship between the adolescent depression and their parents’ work schedules (Han & Miller, 2009). Han & Miller research on the above suggested that mothers who work at night were linked to having “a lower quality of home environment (e.g. lower emotional support, having less frequent meals together)” (Hahn &
Miller, 2009, p. 46) and their adolescent children were therefore more likely to be linked to a higher risk of depression (Han & Miller, 2009). Furthermore, “lower paternal closeness” was linked to fathers who worked at night which was linked to a higher risk of adolescent depression. (Han & Miller, 2009, p. 39).
Han & Miller (2009) suggested that parents who worked night shifts were less likely to monitor the presence of their children which was linked to higher level of depression compared to parents who did not work night shifts (Han & Miller, 2009).

3.3

Society

The practioner should also take into account the society which the individual is within. It has been argued that the socioeconomic status of the society which the individual belongs can be linked to depression. There is a strong likelihood of depression for those in lower –socio economic groups (Akhtar-Danesh and Landeen, 2007)
From a South African context adolescent – headed – households are becoming commonly known in lower socio-economic groups. The rise in adolescent-headed – households in the
South African society today is due to a rise in single parents, young mothers and HIV/AIDS.
Poverty is common in these societies and.adolescents not being able to cope with stress may turn to substance abuse or remodel the destructive behaviour of their parents which may in turn make them even more vulnerable to depression (Krug et al., 2002; Herek, 1999;
Matisonn, 2004; Ratela, 2007).
Furthermore, Han & Miller argue that parents who have a higher SES status are more likely to be able to monitor there children’s’ behaviour as they are at the advantage of having more flexible working hours compared to parents with a lower SES status (Han & Miller, 2009).
3.3.1 Peers

Depressed adolescence show social skill impairment and do not have a lot of friends they therefore feel lonely and isolated (Mash & Wolfe, 2010). Social withdrawal is therefore common (Mash & Wolfe, 2010).
Depressed adolescence lack the ability to be able to initiate conversation and therefore it is difficult to make friends. Furthermore, they may have irritable and aggressive behaviour towards others which reflects their inability to maintain social interaction (Mash & Wolfe,
2010). Passive, avoidant and ruminative behaviour reflects the adolescence ineffective coping styles in social settings (Mash & Wolfe, 2010).
Wordarski & Harris (1987) suggest that that adolescence who are unable to get along with their peers are more likely to have a low self-worth (Wordarski & Harris.,1987).
For adolescence who report poor friendships when referred to a practioner have a lower recovery rate than for those who have stronger friendships (Mash & Wolfe, 2010).However, on another note when adolescents do have a good relationship with their peers Wordarski &
Harris (1987) suggest that when adolescence are involved in a clinical programme the practioner should consider involving their friends in the programme as often adolescents may feel more comfortable talking to their friends compared to nurses, teachers and relatives (Wordarski & Harris, 1987)

3.4 Culture

From a diagnostic position we must understand that firstly, culture and ethnicity can influence personality variables and social conditions, secondly, misunderstanding and misinterpreting behaviors from cultures may lead to practitioners biased diagnosis.Therefore, depression can be expressed differently across cultures (Ward, Dunnachie & Roberts.,
2006).

It is suggested by Franz Fanon (1991) that when young adolescent black South Africans leave their traditional cultural rural areas and enter into in urban areas which are westernised may cause the adolescent to feel alienated and when returning home they are not entirely accepted as they may have adapted some westernized ways. Therefore, the adolescent may be vulnerable to depression as they feel no sense of belonging (Meyer, 2005: Allen
Meares,1987).
Another aspect to take into account regarding cultural influences on depression is that there may differences in the symptoms of depression between western and non-western cultures.
A study by Khalil et al (2010) found that somatic symptoms were high in Egyptian adolescents with depression this finding was in line with a study done by Torros et al (2004) where somatic symptoms were highly reported by Turkish adolescents suffering from depression mood (Khalil et al, 2010).
However; these findings differed to findings of studies done in western countries were the most common symptoms reported by adolescents suffering from depression were feelings of sadness and joylessness having a depressed mood and difficulty with sleeping patterns mood (Khalil et al, 2010).
The difference between these two cultures in the way that adolescents report their symptoms of depression may be due to non-western cultures having more of a social acceptance to physical complaints than compared to psychological problems whereas in western cultures psychological complaints are more accepted. In non-western cultures psychological problems may not be taken seriously, may be mistaken for insanity or it may a cultural belief that the psychological problem may be cured by resting and praying mood
(Khalil et al, 2010).

3.4.1

Theological Perspective

The practioner should also take into account the theological perspective which the culture in which the individual belongs as the individual will more than likely adopt this perspective.
It is suggested by Van-Wicklin (1990) that one who denies an afterlife tends to focus intensely on the present condition of life. Therefore, is the good situations in their life out way the bad then the individuals general mood will be positive. However, for an depressed indivual the bad has overwhelmed the good (Van-Wicklin 1990)
An individual who beliefs in an afterlife who believes that they not following the rules for entry into the afterlife and will not be accepted into internal bliss is more likely to be depressed
(Van-Wicklin, 1990)
Row identifies belief patterns that maintain a depressed state an individual may believe that if I am having fun I am sinning another premise of depression is the depression-inducing

belief regards forgiveness believing that one cannot forgive anyone for their wrong doings especially themselves this leads to them believing that there is no possibility of a clean slate or new opportunities in life (Van-Wicklin, 1990).
Van – Wicklin (1990) suggests that from a Christian perspective that there is many gospel themes to counter the effects of alienation, lost control, and lost hope therefore if a adolescent is depressed then they conclude that since this message is there but it doesn’t reach me I must have no faith and God doesn’t love me therefore this can further the depression (Van-Wicklin, 1990).

4

Conclusion

Therefore, one can conclude that in assessing and identifying depression in adolescence that that there are difficulties involved in diagnosing and assessing adolescent depression.
The practioner, caregivers and adolescent must be careful not to misinterpret depressive symptoms as normal developmental changes that occur in adolescence. Furthermore, when diagnosing one must not take a linear approach as adolescent depression is not straight forward thus practioners can not rely solely on the DSM TR criteria for diagnosis and assessing but instead take the ecological model’s approach taking into account that an individual is interlinked to their family, culture and society which all play a role in the vulnerability to depression. Lastly, one must also take into account the diathesis stress model where one can have predisposed dispositions making them more vulnerable to depression as well as gender differences when trying to diagnose and assess depression in adolescence. REFERENCES

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Tutorial Letter 101/0/2013, PSY481U: UNISA.
Van Wicklin, J.F. (1990), Adolescent depression: A systematic overview. Journal of
Psychology and Christianity, 9 (4),5-14
Wodarski, J.S., & Harris, P. (1987). Adolescent suicide: A review of influence and the means of prevention. Social Work, 32(6), 477-484.

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