Neither Music nor Facebook Cause Depression in Teens

Although a recent study published in the Archives of Pediatrics and Adolescent Medicine did not find that listening to music causes depression in teenagers, news headlines and tweets on Twitter may have left the impression it does. Despite caveats provided by the authors, most readers are likely to believe it  because they don't understand the difference between correlation (the degree to which things tend to occur together) and causation.

Researchers at the University of Pittsburgh School of Medicine contacted 106 adolescents up to 60 times via cellphone over 5 weeks to ask about their media use at the time of the call. Forty-six teens had already been diagnosed with Major Depressive Disorder. Of the five media activities (television or movies, music, video games, Internet, and print media, such as magazines, newspapers, and books), only listening to music and reading were correlated with depression. In other words, the depressed teens were significantly more likely to be listening to music and less likely to be reading print media than the non-depressed teens. The researchers properly conclude that the association does not prove causality:

Major depressive disorder is positively associated with popular music exposure and negatively associated with reading print media such as books. Further research elucidating the directionality and strength of these relationships may help advance understanding of the relationships between media use and MDD.

These results are not surprising. One of the symptoms of depression is withdrawal. In previous generations, depressed teens would shut themselves in their room and listen to music on their stereos. Now, Ipods and MP3 players make it possible for them to isolate themselves while in the presence of others. The finding that depressed teens spend less time reading is likely due to poor concentration--another symptom of depression.

Sometimes researchers demonstrate their own problems in interpreting correlational results. The supposed discovery of "Facebook depression" is one such example. A clinical report published in Pediatrics linked teen depression and time spent on Facebook. In it, the authors created the term "Facebook depression" which they defined as "depression that develops when preteens and teens spend a great deal of time on social media sites, such as Facebook, and then begin to exhibit classic symptoms of depression." They go on to state that "adolescents who suffer from Facebook depression are at risk for social isolation and sometimes turn to risky Internet sites and blogs for 'help' that may promote substance abuse, unsafe sexual practices, or aggressive or self-destructive behaviors."

Dr. Grohol points out in his critical analysis (Pediatrics Gets It Wrong About 'Facebook Depression') that the authors incorrectly relied on correlational results and second-hand media reports to come up with the term. He concludes:

If this is the level of “research” done to come to these conclusions about “Facebook depression,” the entire report is suspect and should be questioned. This is not an objective clinical report; this is a piece of propaganda spouting a particular agenda and bias. The problem now is that news outlets everywhere are picking up on “Facebook depression” and suggesting not only that it exists, but that researchers have found the online world somehow “triggers” depression in teens.

Overdrawn conclusions from single studies misdirects public attention away from known risk factors of depression such as child abuse, bullying, family history and learning disabilities.It leads parents to believe that limiting their teenager's time listening to music or using Facebook will prevent emotional problems including depression. If only it were that simple.

Primack, B., Silk, J., DeLozier, C., Shadel, W., Dillman Carpentier, F., Dahl, R., & Switzer, G. (2011). Using Ecological Momentary Assessment to Determine Media Use by Individuals With and Without Major Depressive Disorder Archives of Pediatrics and Adolescent Medicine, 165 (4), 360-365 DOI: 10.1001/archpediatrics.2011.27

O'Keeffe, G., Clarke-Pearson, K., & , . (2011). The Impact of Social Media on Children, Adolescents, and Families PEDIATRICS, 127 (4), 800-804 DOI: 10.1542/peds.2011-0054

Facebook Privacy Tips for Parents and Teens

All the fuss raised the past month over changes in Facebook's privacy policy is a reminder for parents to discuss online privacy with their teenagers. Although most teens have the computer skills to manage their Facebook accounts, they still need guidance from parents. Teenagers aren't capable of thinking through the consequences of personal disclosures on their own. Psychological research has shown that the portion of their brains that includes judgement and foresight doesn't fully mature until they are in their early to mid-twenties.

Let's briefly review the Facebook kerfuffle. Facebook introduced the new privacy policy as an improvement to users' experience, but it appears that the main purpose was to profit from making personal information more readily available to advertisers. As a result, most of what users had assumed was private information was suddenly made public without seeking their permission. As the New York Times described it in Price of Facebook Privacy? Start Clicking.

Facebook has revised its privacy policy to require users to opt out if they wish to keep information private, making most of that information public by default. Some personal data is now being shared with third-party Web sites. . .Facebook users who hope to make their personal information private should be prepared to spend a lot of time pressing a lot of buttons. To opt out of full disclosure of most information, it is necessary to click through more than 50 privacy buttons, which then require choosing among a total of more than 170 options.

In response to widespread criticism over the lack of transparency and difficulty of changing privacy settings, Facebook has simplified the process. Although improved, it still requires the user to reset numerous default settings from public to private.

It appears to many observers that Facebook's long-term goal is for users to openly share more and more of their personal information with the world. Even though Facebook currently protects the privacy of minors to a greater extent than for adults, it's a good idea to periodically review the privacy settings your teenager has selected for friends, friends-of-friends and everyone else on Facebook. And while you're at it, you'll want to update your own Facebook settings. Here are some resources from the tech world to guide you through the process:

How to Handle Facebook Privacy Settings for Your Kids | GeekDad | Wired.com

UPDATED: How To Put Facebook On A Privacy Lockdown

CAREFUL: Facebook's New Settings Publish Your Interests, Even If They're Private

How to Return Facebook's Privacy Settings to What You Signed Up For

When a Parent Goes to War

The nature of the conflicts in Iraq and Afghanistan, along with an all-volunteer military, has led to multiple and extended deployments for active-duty, reserve, and National Guard troops. One of the invisible effects of war is the impact of prolonged deployments on the well-being of children in military families. Until now, there has not been a comprehensive study of sufficient size to fully examine the effects of parental deployment on older children.

The first results from a large, longitudinal study finds that children from military families experience significant emotional and behavioral problems when a parent is deployed overseas. (The full text of the Pediatrics article is available here for free.) The Rand Corporation study includes families from all branches of the military. Fifteen-hundred children ages 11 to 17 and their non-deployed parents are to be surveyed three times over the course of one year. Nearly all the children (95%) had experienced at least one parental deployment over the past three years and nearly 40% percent had a parent deployed at the time of the interview.

All the families were recruited from those who applied for the National Military Family Association's Operation Purple camp--a free program held for children of military service members at 63 sites across the country. The mission of the Operation Purple Camp is to help children cope with the stress of war and a parent's deployment.

Some findings from the study:

• Compared to children in the civilian population, the military children reported higher rates of emotional and behavioral problems.
• Older teens, and girls of all ages, reported significantly more problems at home, school, and with peers.
• The longer a parent was deployed, the greater the problems experienced by a child.
• The children of non-deployed caretakers with mental health problems had greater difficulties.
• Children who did not live on a military base while their parent was gone also experienced more problems.
• No significant differences were found between the service branches or between active-duty (63%)and Reserve/Guard families (37%).

Some limitations of the study:

• The study may not be representative of all military families because it included only those who applied to the Operation Purple Camp program.
• Marine families were under-represented.
• There were few families that had deployed mothers and caretaker fathers.
• There were fewer families from the lower enlisted ranks.

It's not hard to imagine that children of deployed parents have problems adjusting to their parents' absence. Anxiety over the deployed parent's safety, more responsibilities at home, increased stress on the non-deployed parent, and the loss of daily support by the absent parent can all affect a child's adjustment.

New stressors may emerge when the deployed parent returns home. Family role changes during the parent's absence need to be renegotiated. Families are affected when a service member suffers from head trauma, post-traumatic stress disorder (PTSD), or depression as a result of their combat experiences. Marital problems, domestic violence, and child abuse becomes more common. The return may be temporary with little time as a family before the parent starts preparing for re-deployment.

When military parents are involved in a war or conflict long-term, so too are their families. The accumulated stress of multiple deployments takes its' toll on children's resiliency. Fortunately, the growing recognition of the effects of war on military children has led to more resources to address their needs. Here are a few:

Deployment - from the National Military Family Association

Helping Kids Deal with Deployment - from afterdeployment

Operation Healthy Reunions - from Mental Health America

Returning from the War Zone: A Guide for Families of Military Personnel - from the National Center for Posttraumatic Stress Disorder


Chandra, A., Lara-Cinisomo, S., Jaycox, L., Tanielian, T., Burns, R., Ruder, T., & Han, B. (2009). Children on the Homefront: The Experience of Children From Military Families PEDIATRICS, 125 (1), 16-25 DOI: 10.1542/peds.2009-1180

Grand Rounds Blog Carnival Vol. 6, No. 8

I'd like to thank Colorado Health Insurance Insider, the host of this week's edition of Grand Rounds, for including my post What Mental Health Parity Means for You. Of interest to readers of this blog is a post by Dr. Nancy Brown at Teen Health 411 - The Ideal Relationship With A Parent. In it a group of teens completed the following sentences. My favorite answer is listed after each.

1. The perfect parent would ...
   

Understand when I need someone to talk to who is more understanding than judgmental.

2. The perfect parent would not ...
   

Treat me like a friend, confidant, or source of support.

3. In the perfect world my parent and I would ...
   

Be able to enjoy each others company, but parent would know when to leave me alone.

Read the complete list and tell me which you aspire to as a parent. Better yet, ask your teenager for his or her answer and share it here.


Grand Rounds is "a weekly summary of the best health blog posts on the internet. Each week a different blogger takes turns hosting Grand Rounds, and summarizing the best submissions for the week...It's the oldest and most popular medical blog carnival on the internet."

Teens Don't Twitter, Facebook Still Rules

Mashable reports that only 16% of those under 25 use Twitter. (This rather high age-range for teenagers is one many parents of young adults can easily agree with!) Their report comes via a Nielsen survey which notes that the Twitter trend remains largely an adult phenomenon. This is good news for parents still trying to catch-up on their teen's texting, MySpace, and Facebook communication. As Nielsen reports elsewhere, 83% of teen cell-phones users are texting, and nearly half of ages 12-17 visited MySpace and Facebook in one month (May 2009).

So why aren't teens joining their elders on Twitter? According to one 17-year-old's comment:

I think it's just because we're more into things like MySpace and FaceBook. They have more to do, so most teens probably get bored by twitter because they'll see it simply as updating their status, which they can do on other social networking sites, as well as loads of other things - such as photo albums and quizzes/games and commenting on each others walls.

Sixteen-year-old TechCrunch blogger, Daniel Brusilovsky, explains Why Teens Aren’t Using Twitter: It Doesn’t Feel Safe. He also provides a more targeted Twitter statistic for users ages 12-17 (11.3%).

In the meantime, parents still worry about how to protect their teen's safety and privacy on social networking sites. One way is for parents to sign-up for Facebook and "friend" their teen to gain access to his or her profile page. For this and other Facebook tips, see Lisa Belkin's Facebook for Parents - Motherlode Blog - NYTimes.com.

On the other hand, Teen Checkup's Sarah Newton discusses the cons of spying on your child online - Teens and Tracking Their Online Activity. She makes some good points about parental anxiety and trusting your child. Nonetheless, some basic safety steps seem warranted to me.

Here's a great place to start - NetSmartz411: Internet Safety Helpdesk

Keep Kids Safe This Summer

The National Center for Missing and Exploited Children has released Ten Safety Tips to Help Parents Keep Children Safe This Summer:

1. MAKE SURE children know their full names, address, telephone numbers and how to use the telephone.
2. BE SURE children know what to do in case of an emergency and how to reach you using cell phone or pager number. Children should have a neighbor or trusted adult they may call if they're scared or there's an emergency.
3. REVIEW the rules with your children about whose homes they may visit and discuss the boundaries of where they may and may not go in the neighborhood.
4. MAKE SURE children know to stay away from pools, creeks, or any body of water without adult supervision
5. CAUTION children to keep the door locked and not to open the door or talk to anyone who comes to the door when they are home alone.
6. DON'T drop your children off at malls, movies, video arcades or parks. These are not safe places for children to be alone. Make certain a responsible adult supervises your younger children at all times when they are outside and away from home.
7. TEACH your children in whose vehicle they may ride. Children should be cautioned to never approach any vehicle, occupied or not, unless accompanied by a parent or other trusted adult.
8. BE SURE your children know their curfew and check in with you if they are going to be late. If children are playing outside after dark, make sure they wear reflective clothing and stay close to home.
9. CHOOSE babysitters with care. Obtain references from family, friends, and neighbors. Many states now have registries for public access to check criminal history or sex-offender status. Observe the babysitter's interaction with your children, and ask your children how they feel about the babysitter.
10. CHECK out camp and other summer programs before enrolling your children. See if a background screening check is completed on the individuals working with the children. Make sure there will be adult supervision of your children at all times, and make sure you are made aware of all activities and field trips offered by the camp or program.

But what about teenagers?

I always recommend that parents pay close attention to the whereabouts of younger teenagers. Middle-schoolers in particular are more likely than younger children to be home alone during the summer. Ages of 12 to 15 are riskier due to lack of experience, immature decision-making, and an overwhelming desire to spend time with peers. They are more likely to have friends over while parents are at work, go somewhere without permission, and be enticed into forbidden activities by older teens they meet at the mall or other teen hang-outs. Because younger teens can't anticipate negative consequences that may arise in social situations, they are more likely than older teenagers to end up in unsafe circumstances beyond their control.

Some common-sense tips:

Contact friends' parents to confirm plans and adult supervision. Don't trust the older siblings of your child's friends to be good supervisors. Chaperone or discreetly shadow your teenager at the mall, movies, and other public venues.

Don't rely only on cell phone contact from your teen. It's too easy for them to disguise their location. Call home numbers to confirm your teen's whereabouts.

Don't make it too easy for teens to predict your schedule. Come home early once in awhile, drop by unexpectedly, and call at unpredictable times. This prevents them being able to count on leaving and getting back before you come home from work.

Assume you have to double-check all plans. At the same time, avoid giving your teen the impression that you don't trust him. Let her think that you are an anxious and over-protective parent. This will decrease power struggles and help your teen save face when he has to decline an invitation that breaks your rules.

The National Center for Missing and Exploited Children also has a summer safety tip sheet for kids. Although written for children, the tips can still apply to young teens.

Please share any other parent tips you might have for child and teen safety and have a safe summer!

Many Depressed Teens Go Untreated

According to a recent report from the 2007 SAMHSA National Survey on Drug Use and Health, during the past year, 8% of teenagers ages 12-17 experienced at least one episode of major depression defined as:

...a period of 2 weeks or longer in which there is either depressed mood or loss of interest or pleasure and at least four other symptoms that reflect a change in functioning, such as problems with sleep, eating, energy, concentration, and self-image.

Even though 70% of the depressed teens reported severe impairment in daily functioning (chores at home, school or work, close relationships with family, or social life), only 39% received any mental health treatment!

Why did less than half of the depressed teens get help? The study points to at least one cause--lack of health insurance. Only 17% of uninsured, depressed teenagers obtained treatment. However, this does not explain why nearly 60% of teens covered by health insurance weren't treated.

The primary reason depressed teens don't get help is that neither they nor their parents recognize the source of their problems. It's easy to ascribe moodiness, irritability, lack of energy, and poor concentration to the stress and sleep deprivation experienced by today's over-scheduled teens.

In addition, the stigma of mental illness affects teenager's willingness to ask for help. Many suffer in silence and hide their pain from parents and friends. In an excerpt from Day for Night: Recognizing Teenage Depression, teens who have dealt with major depression describe the symptoms they had:

It's important for both teens and parents to become better informed about the symptoms and treatments for depression. The following publications from the National Institute on Mental Health are a good place to start. Because they are not currently available from NIMH, I've linked to pdf's on my website's Resources page:

Let's Talk About Depression

What to Do When A Friend is Depressed

Teens, Distracted Driving, and ADHD

Here in Maryland, there’s been much ado about texting while driving. Although it was already banned for teenagers, there’s been a surprising amount of debate among legislators on whether to include adults in the ban.

Regardless, texting is just the latest activity (soon to be replaced by Twitter?) that has been tagged as a driving distraction along with cell phones, multiple passengers, changing music, and eating.

Until now, only teen drivers with graduated licenses were required to limit distractions after a series of highly publicized fatal crashes related to cell phone use and multiple passengers. It also made sense to target teens because being distracted by friends, entertainment, and other pastimes, instead of attending to the task at hand, is their normal state of being.