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Millions of Americans face serious health problems. Everyone in the American society deserves to live a happy and long life, which is not possible without treating the existing and emerging health disorders. Mental health remains one of the most serious problems affecting the lives of Americans. Of particular concern are the mental health problems affecting adolescents. One of the main goals of Healthy People 2020 is to "reduce the proportion of adolescents aged 12 to 17 years who experience major depressive episodes (MDEs)" (Healthy People, 2012). Unfortunately, serious health disparities related to this health condition continue to persist.
Thousands of adolescents are at risk of developing major depression. According to DSM-IV-TR, major depression is diagnosed when the adolescent reports reduced mood or the loss of pleasure in most essential life activities for no less than 2 weeks, leading to considerable impairments workplace and social performance. Statistically, major depression affects 3-5 percent of adolescents (Bhatia & Bhatia, 2007). However, in 2008, 8.3 percent of adolescents were diagnosed with major depressive episodes (Healthy People, 2012). The incidence of depression usually increases, as adolescents approach puberty, and by the age of 14, major depression becomes twice as common among girls as it is among boys (Bhatia & Bhatia, 2007). The main risk factors for major depression in adolescents include: family history, gender (girls are more susceptible to the risks of MDEs than boys), stressful events, violence and abuse, as well as chronic illness (Bhatia & Bhatia, 2007; Boutelle et al., 2010; Dunn et al., 2012). Among chronic conditions, obesity is a common prerequisite for the development of major depression in female adolescents (Boutelle et al., 2010).
Healthy People (2012) reports significant racial and gender disparities in MDEs. According to Healthy People (2012), male adolescents are much less likely to report the incidence of major depression than their female peers. Only 4.4% of male adolescents reported having MDEs in 2010 compared to 11.9% of females (Healthy People, 2012). The lowest proportion of MDEs was found among Asian adolescents, while white non-Hispanic adolescents reported one of the highest levels of MDEs incidence (Healthy People, 2012). Age was also found to play a role in the existing health disparities: the rates of MDEs among 16-17 year olds were twice as high as among 12-13 year olds (Healthy People, 2012).
Still, even these disparities are not as dangerous to public health in America as the problems with diagnosing and managing major depressive symptoms in adolescents. Many researchers claim that adolescent depression is severely unrecognized and untreated (Millen, Walker & Chow, 2003; US Preventive Services Task Force, 2009). The statistical data are gruesome: Bhatia and Bhatia (2007) suggest that more than 70 percent of adolescents with the symptoms of MDEs do not receive adequate diagnosis and treatment. Merikandas et al. (2011) and the Substance Abuse and Mental Health Services Administration (2011) claim that only one-third of adolescents with mental health problems receives diagnosis and treatment. Half of adolescents diagnosed with serious mental health disorders have never received any treatment (Merikandas et al., 2011). Among those, who attended a mental health specialist in 2010, more than a half did not take any prescribed medications for major depression (SAMHSA, 2011). Possible explanations include stigmatization of mental health disorders, the lack of mental health insurance coverage, inadequate supply of child psychiatrists, as well as the absence of adequate diagnostic criteria for major depressive episodes in pediatrics (Bhatia & Bhatia, 2007; Milin et al., 2003). However, these explanations require further empirical support.
Major depressive episodes in adolescents represent an important public policy problem, mainly due to the devastating impacts of MDEs on public health. SAMHSA (2011) reports higher incidence of substance abuse in adolescents with MDEs. Major depressive episodes lead to serious disruptions in adolescents' family, social, and school life (Milin et al., 2003). Up to 93% of adolescents with major depression develop comorbid psychiatric condition, which further increase the costs of medical care at the national level (Milin et al., 2003). Finally, it is MDEs that present the strongest risk factor for suicide (Milin et al., 2003). Still, researchers are almost unanimous in that major depression in adolescents can be treated, and its national scope can be substantially reduced. With available treatment options, at least 38% of new MDE cases can be successfully prevented (Munoz, Beardslee & Leykin, 2012). The main barriers in the U.S. health system that impede disease prevention and health promotion for this health condition are stigma and the absence of adequate diagnostic criteria to be used in child and adolescent populations.
Today, it is essential that the message of major depression in adolescents is communicated to the public. It is possible to organize meetings with target groups in schools and public health facilities to educate adolescents and their parents about the symptoms and dangers of major depressive episodes. This is one of the most effective and cheapest ways to raise public awareness of the MDE problem. At the same time, increasing health insurance coverage could bring a greater number of adolescents to seek timely mental health assistance. A manager's policy to deliver mental health screening for children and adolescents in at-risk groups could help alleviate the burden of MDEs on adolescents and prevent the development of comorbid conditions later in life. In the long run, such policies will lead to tangible reductions in the incidence and prevalence of MDEs in adolescent populations.
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