Depression involves persistent feelings of sadness or irritability and lack of pleasure. It may be expressed through several different symptoms:
Although many of these symptoms may appear temporarily as normal reactions to difficult life events, the presence of five or more which persist for two or more weeks may indicate major depression.
- Persistent sad, anxious, or "empty" mood
- Feelings of pessimism or hopelessness about the future
- Feelings of guilt, worthlessness, or helplessness
- Extreme sensitivity to rejection or failure, engaging in self-criticism, or feeling criticized, misunderstood, or unloved by others
- Sulking, increased irritability, anger, hostility, or aggressive behavior
- Fatigue, lack of energy and motivation
- Loss of interest or pleasure in hobbies and activities that were once enjoyed, including spending time with friends
- Difficulty concentrating, remembering, making decisions
- Insomnia, early-morning awakening, or oversleeping
- Appetite and/or weight loss, or overeating and weight gain
- Recurrent thoughts of death or suicide; suicide attempts
- Persistent vague physical symptoms that do not respond to treatment, such as headaches, muscle aches, stomachaches, or chronic pain
- Talk of or efforts to run away from home
- Alcohol or substance abuse
- Social isolation, poor communication
- Reckless behavior
- Poor school attendance, getting into trouble at school, and/or poor academic performance
- Neglecting appearance and hygiene1,2,3
Depression can be difficult to recognize among males, and doctors are less likely to suspect it, because if often appears as irritability or anger rather than as sadness and hopelessness. Also, males are less likely to admit to depression.2
Some studies have found a relationship between depression and a pessimistic mind-set in which the youth readily takes blame for negative events, believes everything he does is wrong, feels overwhelmed by stress, and believes that a currently negative situation will endure permanently. Negative views about one’s own competence, and poor self-esteem may contribute to the hopelessness that has been repeatedly found to be associated with suicidal thoughts.1,2
It is not too hard to imagine that stress, feelings of hopelessness, and poor self-esteem may result from the stigma of having sexual feelings for younger people, from hatred by society, and from the fear that one may never be able to express one's sexual feelings in an acceptable way. The problem is compounded by treatment methods intended to change sexual feelings through punishment, shame, and forced admission that one has an aggressive and cognitively distorted nature.
Both major depression and chronic, mild depression can have far reaching effects on the functioning and adjustment of young people:
Helping those with depression
- If it is persistent or recurrent, it can lead to a circumscribed life with fewer friends and sources of support, more stress, and missed educational and job opportunities.
- It results in an increased risk for interpersonal and psychosocial difficulties that persist long after the depression is resolved.
- It often recurs and persists into adulthood, and may predict more severe illness in adult life.
- It results in an increased risk for substance abuse and suicidal behavior.1,3
Experts recommend that youth suffering from depression find a therapist to help them learn effective ways of coping with life's problems, changing negative ways of thinking and behaving often associated with depression, to gain insight into and resolve their problems, and to resolve their conflicted feelings.1,2
Unfortunately, youth attracted to younger youth or children understandably fear divulging their sexual feelings to a therapist due to stigma and the therapists' unknown reaction. No therapists publicize expertise or willingness to work with such youth, and many refer such youth to treatment programs which assume criminality and a tendency toward violence, and attempt to control thoughts and behavior through methods that further stigmatize and ostracize youth.
However, there are things that people can do without a therapist when facing depression:
Family members and friends can also help in the following ways:
- Break large tasks into small ones, set some priorities, and do what you can as you can.
- Try to be with other people and to confide in someone; it is usually better than being alone and secretive. Let your family and friends help you. (Of course, for youth who are attracted to younger people, confiding in another person can be very risky.)
- Participate in activities that may make you feel better, such as mild exercise, going to a movie, attending a ballgame, or participating in religious or social activities.
- Expect your mood to improve gradually, not immediately.
- Postpone important decisions until the depression has lifted. Before making such a decision, discuss it with others who know you well and have a more objective view of your situation.
- Some people find writing in a journal helpful.2
- Show understanding, patience, affection, and encouragement.
- Engage the depressed person in conversation and listen carefully. Do not disparage the negative feelings expressed, but offer hope.
- Invite the depressed person for walks, outings, to the movies, and other activities. Encourage participation in some activities that once gave pleasure, but do not push the person to undertake too much too soon, since too many demands can increase feelings of failure.
- Do not accuse the depressed person of faking illness or of laziness, or expect him or her "to snap out of it."
- Take remarks about suicide seriously.2,3
Studies have found that youth who suffer from depression are at much greater risk of committing suicide, and that the majority of young people who complete suicide suffer from depression.4
In the past twenty years, the suicide rate in the U.S. has increased 6% for teens 15 to 19 years old and over 100% for adolescents 10 to 14 years old. In 1998, among youth ages 10 to 19, there were 2,054 suicides. Survey data from 1999 showed that 20% of high school students had seriously considered attempting suicide.4 Suicide attempts are most common during the midadolescent years, and suicide, which increases steadily through the teens, is the third leading cause of death at that age, after accidental injury and homocide.1
Risk factors for suicide or attempted suicide include:
Suicide attempts are often precipitated by a life-event involving shame or humiliation, such as arrest, assault, school disciplinary event, family problems, conflict over sexuality, or self-labeling as a member of a sexual minority. Suicide victims have often previously exhibited poor self-concept, social isolation, and sexual conflicts.6 Youth attracted to younger people are at high risk for any of these events or characteristics.
- A previous suicide attempt, increasing the rate of suicide over 30 times
- Depression, increasing the rate of suicide by about 12 times
- Substance abuse
- Having a friend or relative who has attempted suicide
- Frequent, enduring, or intense suicidal thoughts, particularly if the youth has developed a plan for committing suicide.
- Stressful life events, such as getting into trouble at school or with a law enforcement agency
- Experiencing some kind of rejection
- Living in poor family or environmental circumstances.
- Low levels of communication with parents1,5,6
However, there is professional disagreement over the role sexuality plays in suicide. Several studies have reported that the rate of suicidal thoughts and attempts among gay and bisexual adolescents is 3 to 4 times that among straight youth.6 On the other hand, researchers disagree on the best way to measure suicide attempts and sexual orientation, so results are tentative.4 Nevertheless, there is growing concern about an association between suicide risk and sexuality for youth, particularly males.7 And they agree that efforts should focus on how to help gay, lesbian, and bisexual youth grow up to be healthy and successful despite the obstacles that they face.5
Certainly the stigma attached to sexual feelings for younger people is far more severe than that associated with homosexuality in itself, and, unlike the situation for peer-attracted gay youth, there is little information or support for those attracted to younger people. Thus, the rate of suicidal thoughts may be even higher among them than among gay youth in general.
Preventing youth suicide
Of course, it is doubtful that the mental health care community will apply these strategies to youth attracted to younger people in the near future.
- Establishing strategies to reduce the stigma associated with mental illness and seeking mental health care.
- Providing safe and effective educational programs that address adolescent distress, provide crisis intervention, and incorporate peer support.
- Promoting overall mental health by reducing early risk factors for depression, substance abuse, and aggressive behaviors.
- Building resiliency.
- Detecting youth most likely to be suicidal by confidentially screening for depression, substance abuse, and suicidal ideation, and referring them to professionals for evaluation and treatment as needed.
- Access to effective and appropriate mental health care and support for help-seeking.
- Encouragement and support from concerned family members.2,4,7
Professionals say that family and friends can help:
- If someone tells you they are thinking about suicide, take their distress seriously, listen nonjudgmentally, and help them get to a professional for evaluation and treatment.
- Help them to see alternative solutions to problems, and give them hope.
- If someone is in imminent danger of harming himself or herself, do not leave him alone. You may need to take emergency steps to get help, such as calling 911.
- Limit access to firearms or other lethal means of committing suicide.5
1"Depression and suicide in adolescents," chapter 3 from Mental Health: A Report of the Surgeon General.
2National Institute of Mental Health, "Depression," NIH Publication No. 02-3561, 2002.
3National Institute of Mental Health, "Depression in Children and Adolescents: A Fact Sheet for Physicians", 2000.
4National Youth Violence Prevention Resource Center, "Youth suicide," 2002.
5National Institute of Mental Health, "Frequently Asked Questions about Suicide", 2000.
6Caitlin Ryan & Donna Futterman, Lesbian and Gay Youth: Care & Counseling,
New York: Columbia University Press, 1998.
7U.S. Surgeon General, "Call To Action To Prevent Suicide," 1999.