Introduction
Depression is a mental health issue characterized by a bad mood, lack of motivation, and the feeling of being personally worthless. According to the data provided by the World Health Organization (2021), about 280 million people in the world suffer from depression. The present essay focuses on depression among adolescents. In the essay, the author describes the methods to evaluate the symptoms of a patient who has been referred for counseling with depression and discusses how to promote therapeutic change in a client with depression.
Evaluation of Symptoms
Method 1: Interview
One of the methods to evaluate the symptoms of a client who has been referred for counseling with depression is to conduct an interview. In other words, a specialist should talk to a patient about their feelings and worries to see whether they are depressed. More precisely, it is necessary to ask whether a patient regularly feels sad, worthless, and guilty for no objective reason. In addition to that, a counselor should ask if a client experienced a dramatic weight loss or gain within one month, and suffers from a constant feeling of fatigue and inability to concentrate attention on one task or activity. The most important question is whether a patient has suicidal thoughts or has ever attempted to commit suicide.
The interview could be based on the Evaluation of Mental Disorders Procedure Health Questionnaire (PRIME-MD PHQ). These questionnaires differ in the number of questions; however, it is possible to distinguish the two most important ones. The first question is whether a client often feels depressed, sad, and worthless and the second question is whether a client receives pleasure from living and has a genuine interest in doing something (Chigerwe et al., 2018). Positive answers for both questions signify that a person is highly likely to have depression.
Method 2: Hospital Anxiety and Depression Scale
Another way to estimate a client’s symptoms is to ask him or her to perform self-rated screenings. One example of such a test is the Hospital Anxiety and Depression Scale (HADS), which was developed by A. S. Zigmond and R. P. Snaith at the end of the past century. This test is applicable to young adults and adolescents. This questionnaire enables us to estimate the severity of patients depression and anxiety because half of the question in HADS is dedicated to the symptoms of anxiety and another one – of depression. Each item in the questionaries could receive from 0 to 3 points. If the total score is lower than 7 points, a person has no mental health issues. A score between 8 and 10 points means that a person is a borderline case, and more than 11 points means that a client has serious symptoms of anxiety and depression and requires the help of a counselor.
Methods 3: Beck Depression Inventory
Another option is to conduct the Beck Depression Inventory (BDI) that Aaron T. Beck developed in the early 1960-s. This test consists of 21 multiple-choice questions that could be used to evaluate patients older than 13 years. These questions measure the extent of sadness, hopelessness, and disinterest of a client. A total score of fewer than 9 points means a patient experiences very slight depression, and a total score of more than 30 points signifies severe depression.
Strengths and Limitations of Each Method
The strength of an interview is that it enables a therapist to understand the client’s worldview, worries, life difficulties, and thoughts. Therefore, a counselor could give this person a practical tip on overcoming challenges and getting rid of depression symptoms. Furthermore, a dialogue between a client and a counselor is a way to establish trust which is an indispensable component of the treatment’s success. The major limitation of an interview is that a client might be shy to share real emotions and feelings and might make up a story that everything is fine even though it is not. This way, a counselor should search for an individual approach to every person.
Overall, the BDI and the HADS resemble interviews; the difference is that during a test, patients give a numerical evaluation of their feelings and emotions. This way, it is possible to give an objective estimation of the depression of a patient. For example, if a client gets 57 points for the BDI, an expert could say that a person has severe depression, whereas, after an interview, it is much harder to estimate whether depression is moderate or severe.
Despite the advantages, the BDI and the HADS both face criticism in the academic literature. For instance, Annunziata et al. (2020) argue that the accuracy of the HADS is highly doubtful. This view is shared by Saez-Flores et al. (2018), who note that the critical disadvantage of HADS is that it fails to discriminate between the symptoms of depression and anxiety. Instead, the HADS measures “a global construct of emotional distress when all items are combined” (Saez-Flores et al., 2018, p. 633). As for the BDI, the study of von Glischinski et al. (2019) reveals that the cut points that distinguish the levels of depression are not settled appropriately. According to these scholars, to screen primary care populations, depression should start with 13 points, and in psychiatric settings, it should start with 19 points. From this, it could be inferred that every method has its weak and strong sides, and it is up to a therapist to decide which one to use and which measures to combine.
Interventions
Intervention 1: Meditation
Meditation is the practice of focusing on one thought, object, or breath. The ultimate goal is to learn to get rid of all thoughts and worries and stay focused on something particular for 5, 10, or more minutes. Curiously, meditation brings measurable changes to the brain’s grey matter. The study on the brain of adolescents conducted by Yuan et al. (2020) shows that this practice “affects regions associated with physical and emotional awareness” (p. 1). From this, it could be inferred that meditation makes a person more self-aware. Additionally, meditation helps to relieve the stress and anxiety that commonly accompany depression (Behan, 2020). This way, meditation is an effective component of coping with depression strategy. This claim is also supported by Shanok et al.’s (2019) study. It might seem complicated initially, but it is necessary to keep on practicing to feel the effect of meditation and improve mental health.
Intervention 2: Gratitude Journal
People with depression, regardless of their age, usually see no positive aspects in their life. Nonetheless, it does not mean that positive events do not happen. For this reason, it is highly recommended to suggest a client write a gratitude journal. The essence of this practice lies in writing down each evening five things they are grateful for. For example, patients could note that they are thankful to their parents for their kindness and attention or write down “thank you” to a stranger who smiled at them on the street. It is also necessary to write down gratitude for yourself. The study conducted by Liang et al. (2020) reveals that appreciation, peace of mind, and depression are interrelated. Even though a gratitude journal is not a remedy that could cure depression once and for all, it is a powerful tool that could make the mindset of patients more positive. Gratitude journals also assist them in focusing their attention on good things that happen to them.
Intervention 3: Lifestyle and Diet
The food we eat and the daily activity rates affect our brain, hormone system, and mood. Fat is essential for the smooth functioning of the human central nervous system. Numerous research papers, including the one by Liao et al. (2019), prove that the intake of omega-3 fatty acid accelerates the recovery of people with depression. At this point, it is necessary to explain to a patient that this does not mean that he or she should eat more greasy food. Instead, it is worth including fish, nuts, eggs, or supplements in the diet. A low activity rate is detrimental not only to mental but also to physical well-being. Askari et al. (2020) discovered that aerobic exercises are beneficial for people with depression. Doing sport is a way to clear ahead and gain a feeling of accomplishment.
Strengths and Limitations
The problem with meditation is that adolescents do not know much about it and might think it is somehow related to religion. Furthermore, they might give up because it is almost impossible to succeed in meditation when one tries it for the first time. Nonetheless, as it has already been mentioned above, meditation is immensely beneficial for curing depression, and a counsellor should persuade a patient to give this practice a chance.
The major limitation of practicing a gratitude journal is that it might be hard for a person to determine positive things in a day he or she is grateful for. Nevertheless, this problem has a solution – one should start with one gratitude per day. If patients see absolutely nothing positive in their lives, this gratitude could be addressed to themselves for surviving the day and hoping for the better.
The problem with the intervention on lifestyle is that a person might be too depressed to exercise or cook healthy food because he or she sees no sense in it. The critical task of a therapist is to explain to such people the significance of lifestyle for healing depression and tell them that no one but themselves is capable of coping with their depression. What is more, if a person hates jogging, no one asks him or her to do this kind of sport. In the same way, if a person hates the taste of fish, no one requires him or her to eat it. Instead, it is necessary to find what works for a specific person.
Conclusion
Adolescents are likely to face depression during the growing up period. To estimate a patient’s symptoms, a counselor could conduct an interview or several self-report tests such as the HADS or the BDI. There are several ways to cure depression, including meditation, gratitude and changes in lifestyle and diet. It might be hard to keep on performing the prescribed interventions in the first stages. Still, as a proverb says, a journey of a thousand miles begins with a single step. Hence, it is necessary to support a patient until interventions bring tangible results.
References
Annunziata, M. A., Muzzatti, B., Bidoli, E., Flaiban, C., Bomben, F., Piccinin, M., & Mella, S. (2020). Hospital Anxiety and Depression Scale (HADS) accuracy in cancer patients. Supportive Care in Cancer, 28(8), 3921-3926. Web.
Askari, J., Saberi-Kakhki, A., Taheri, H., Yassini, S. M., & Hassanbeigi, A. (2020). The effect of aerobic exercise on various symptoms of depression: The mediating role of quality of life. Sport Sciences for Health, 16(2), 273-280. Web.
Behan, C. (2020). The benefits of meditation and mindfulness practices during times of crisis such as COVID-19. Irish Journal of Psychological Medicine, 37(4), 256-258. Web.
Chigerwe, M., Boudreaux, K. A., & Ilkiw, J. E. (2018). Assessment of depression and health-related quality of life in veterinary medical students: Use of the 2-item primary care evaluation of mental disorders questionnaire (PRIME-MD PHQ) and the 8-item short form-8 survey (SF-8). Journal of veterinary medical education, 45(3), 358-366. Web.
Liang, H., Chen, C., Li, F., Wu, S., Wang, L., Zheng, X., & Zeng, B. (2020). Mediating effects of peace of mind and rumination on the relationship between gratitude and depression among Chinese university students. Current Psychology, 39(4), 1430-1437. Web.
Liao, Y., Xie, B., Zhang, H., He, Q., Guo, L., Subramaniapillai, M., & Mclntyer, R. S. (2019). Efficacy of omega-3 PUFAs in depression: A meta-analysis. Translational Psychiatry, 9(1), 1-9. Web.
Saez-Flores, E., Tonarely, N. A., Barker, D. H., & Quittner, A. L. (2018). Examining the stability of the hospital anxiety and depression scale factor structure in adolescents and young adults with cystic fibrosis: A confirmatory factor analysis. Journal of Pediatric Psychology, 43(6), 625-635. Web.
Shanok, N. A., Reive, C., Mize, K. D., & Jones, N. A. (2019). Mindfulness meditation intervention alters neurophysiological symptoms of anxiety and depression in preadolescents. Journal of Psychophysiology, 34(3), 159-170. Web.
von Glischinski, M., von Brachel, R., & Hirschfeld, G. (2019). How depressed is “depressed”? A systematic review and diagnostic meta-analysis of optimal cut points for the Beck Depression Inventory revised (BDI-II). Quality of Life Research, 28(5), 1111-1118. Web.
World Health Organization (2021). Depression. Web.
Yuan, J. P., Connolly, C. G., Henje, E., Sugrue, L. P., Yang, T. T., Xu, D., & Tymofiyeva, O. (2020). Gray matter changes in adolescents participating in meditation training. Frontiers in Human Neuroscience, 14, 1-9. Web.