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

Childhood Mental Health Affects Adult Income

A recent study in Social Science and Medicine demonstrates for the first time that childhood psychological problems have long-lasting effects on adult income. Because the study compares siblings with and without psychological conditions, the authors were able to control for the effects of childhood family background and neighborhood on adult income. They also controlled for the effects of physical illness on mental health problems.

Researchers from the Rand Corporation analyzed data from the U.S. Panel Study of Income Dynamics which has followed 5000 families, and 35,000 individuals within those families, for over 40 years. It is considered the premier panel survey measuring key dimensions of adult socioeconomic status outcomes. The authors used various criteria to select 2,457 individuals between the ages of 25 and 53 to include in their study (see the original article for details). Participants were asked whether they experienced depression, substance or alcohol abuse, or other psychological conditions before age 17. Overall, 6% reported having one or more psychological problems as children: depression (4%), substance or alcohol abuse (2%), or other psychological conditions (2%). The prevalences found for these conditions are similar to those found in other retrospective studies.

Key Findings

Compared to their siblings, adults with childhood psychological problems on average:

• Had a 20% lower family income equaling $10,400 per year and $300,000 projected over their lifetimes.
• Worked seven weeks less per year. Most of the difference was due to a greater number not working at all. When comparing only siblings who worked one or more weeks, the difference was reduced to two weeks per year.
• Achieved six months less education (most common for those with substance or alcohol abuse).
• Were less likely to be married (by 11%). Of those that were, their spouses tended to have lower incomes.
• Were seven times more likely to have an adult psychological condition (35.8% vs. 5.4%). Those that reported childhood depression were the ones most likely to report psychological problems as adults.

Limitations

• The determination of childhood psychological conditions was based on retrospective reports by adults. This method is considered to be fairly reliable, but does not meet the same level of certainty as diagnostic interviews with children.
• The authors weren't able to test the effects of gender. Although there appeared to a trend for a greater impact on men's income, dividing the sample into half did not leave enough people in each group to determine statistical significance.
• They also couldn't test the effects of specific psychological disorders that were grouped together in the category of "Other Psychological Conditions" for the same reason.
• The participants weren't asked about receiving childhood treatment. Nonetheless, given the low rates of treatment for childhood mental illness, it is safe to assume that most of the participants did not receive help as children.

Implications

The lead author, economist James P. Smith, emphasizes the cost-effectiveness of early treatment. In an interview, he stated:

This study shows childhood psychological disorders can cause significant long-lasting harm and can have far-reaching impact on individuals over their lifetimes. Our findings illustrate what the enormous potential might be of identifying and treating these problems early in life.

Not all of the people who have psychological problems during childhood will carry these problems into adulthood. But they are 10 to 20 times more likely than others to have these shortfalls during adulthood. There clearly are large economic costs during adulthood caused by childhood psychological conditions.

I believe this study provides yet another reason to increase access to mental health services for children. We can now add lower income to the problems experienced by those struggling with mental illness. Not only does less income affect living circumstances, it also affects adults' ability to afford treatment for mental illness. It is much more effective and humane to treat mental illness early to prevent negative lifelong consequences.


Smith, J., & Smith, G. (2010). Long-term economic costs of psychological problems during childhood Social Science & Medicine, 71 (1), 110-115 DOI: 10.1016/j.socscimed.2010.02.046

How Many Children Need Mental Health Treatment and Get It?

Photo by D Sharon Pruitt

There's more evidence that many children have a mental health disorder and not enough get help. The first representative survey of children in the United States found that 13% of children ages 8 to 15 had at least one psychiatric disorders during one year. The data comes from the National Health and Nutrition Examination Survey (NHANES), a collaboration between the National Institute of Mental Health (NIMH) and the National Center for Health Statistics of the Centers for Disease Control and Prevention. Over 3,000 children were evaluated in person, and their primary caretakers were interviewed by telephone shortly afterward. Along with diagnostic questions, the degree of impairment in daily life was assessed in such areas as family and peer relationships and in school performance. The children and their caretakers were also asked whether help was sought in the past year at a hospital, clinic, or professional's office for the child's symptoms.

The percentage of children who met diagnostic criteria for the following disorders is listed from most to least common.

• Attention-deficit Hyperactivity Disorder (ADHD)  8.6%
• Depression (Major Depression or Dysthymia)  3.7%
• Conduct Disorder   2.1%
• Anxiety (Generalized Anxiety Disorder or Panic Disorder)  0.7%
• Eating Disorder (Anorexia or Bulemia)   0.1%

Similar to the results of other studies, boys were twice as likely as girls to have ADHD. Girls were twice as likely as boys to have one of the two types of depression. There was no difference between boys and girls in the other disorders. The rates of depression and conduct disorder were higher in young adolescents ages 12-15. All but the anxiety disorders were reported more often in poor children. Higher rates of the two types of anxiety disorders were found in children from higher income families.

Only half of the children with diagnosed disorders sought help for their symptoms in the past year. Children with disruptive behavior (ADHD and Conduct Disorder) were most likely to seek treatment. Only a third of children with an anxiety disorder received services. The children with more severe symptoms were only slightly more likely to get help. There was no information reported about type (medication, therapy, or both), length (one or more visits), or response to treatment. As a result, we don't know how many children were receiving adequate treatment.

How do the current study's estimates differ from older findings? As I noted in Children's Access to Mental Health Care, the Surgeon General's 1999 Report on Mental Health found that 1 in 5 children and adolescents had a diagnosable mental illness. This was a higher rate (20%) than is found in the NHANES study (13%). The difference is likely due to the broader range of disorders included in the Surgeon General's report.

The major strength of the NHANES study is that it provides the first estimates of the overall prevalence of specific mental disorders in children in the United States. Because the researchers used a standardized method of diagnosing the children, the results can be directly compared with local and international studies that use the same criteria. As the lead author Kathleen Merikangas, Ph.D. concludes, "Until now, there has been a dearth of reliable data on the magnitude, course and treatment patterns of mental disorders among U.S. youth. When combined with data from other nationally representative surveys, the data will provide a valuable basis for making decisions about health care for American youth."

Merikangas, K., He, J., Brody, D., Fisher, P., Bourdon, K., & Koretz, D. (2009). Prevalence and Treatment of Mental Disorders Among US Children in the 2001-2004 NHANES PEDIATRICS, 125 (1), 75-81 DOI: 10.1542/peds.2008-2598

Mental Health Roundup: Seasonal Affective Disorder

In the first of an occasional series, I'm providing a roundup of blog posts on a specific mental health topic. I'm starting off with Seasonal Affective Disorder (SAD) since this is the time of year that most people who suffer from SAD start to experience symptoms. As you'll read below, some people experience reverse SAD in the spring and summer.

Dr. Deb covers the basics in her post Seasonal Affective Disorder including symptoms and treatments.
The psychiatrist and researcher who first described SAD, Norman Rosenthal, includes a self-assessment checklist in How Seasonal Are You? | Psychology Today.

Phillip Dawdy at Furious Seasons discusses whether SAD is a separate disorder rather than a variant of Major Depressive Disorder in Should Seasonal Affective Disorder Be A Separate Disorder?. He quotes an editorial by Norman Rosenthal in the American Journal of Psychiatry from which the following table is taken.


Douglas Cootey at A Splintered Mind: Overcoming AD/HD & Depression With Lots Of Humor And Attitude writes about his inexpensive solution to SAD--full-spectrum CFL's in Putting a Spotlight on Seasonal Affective Disorder - Haunting My Family With My Spectral Personality.

John Briffa reviews two research studies in ‘Blue’ light found to be most effective in combating seasonal affective disorder | Dr Briffa's Blog and mentions his own experience using a blue-light box.

For those of you interested in neuroscience, read Seasonal Affective Disorder - The Basics | A Blog Around The Clock written by chronobiologist Bora Zivkovic at Science Blogs. He discusses the relationship between circadian rhythms, melatonin, and SAD.

That's it for this Mental Health Roundup. Tell me what you think. Do you have other resources or experiences to share, especially, on SAD in children or adolescents? If not, what about your own success in coping with SAD?

Please note that I allow anonymous comments. I also moderate comments to exclude commercial or otherwise inappropriate comments.

E-mail me with your suggestions for future roundups with links to your own or other people's non-commercial posts for consideration.

Depression in Pre-Schoolers?

When researchers at the Washington University School of Medicine published the first longitudinal study of Major Depressive Disorder (MDD) in preschool children, it came as a surprise to many that young children even get depressed. Most people were unaware that MDD had already been found to be as common among preschoolers as among school-age children (approx. 2%).

The significance of the longitudinal study conducted by Dr. Luby and her colleagues is their evidence that depression in preschoolers is similar to that of school-age children. It's already known that an episode of severe depression in childhood often leads to more episodes as children get older. The researchers examined whether the same was true for preschoolers, that is, whether children depressed at the beginning of the study would be depressed two years later.

They also examined the risk factors that predicted depression both at baseline and at follow-up. Among school-age children, the strongest predictor of depression is a family history of depression. Both genetics and a depressed mother independently contribute to childhood depression. Stressful or traumatic events also predict depression, especially, in combination with a family history.

At the beginning of this study, depressed children were more likely to have mothers with a history of depression compared to children with other psychiatric disorders or no disorder. They also had experienced more traumatic events than the other groups. The types of events included "death of a parent, experience of physical or sexual abuse, and removal from one's home."

At follow-up, the strongest predictor of chronic depression was earlier depression. Children who were diagnosed with MDD at baseline were 4 times as likely to have MDD 2 years later. The second most powerful predictor was a family history of depression. Traumatic events contributed to a lesser degree.

Unfortunately, the popular press has reacted with the usual concerns about stigma and psychiatric medication. As Jennifer Gibson states in How Young is Too Young to Diagnose Depression? | Brain Blogger :

Experts are wary of labeling preschool-aged children with depression, since the diagnostic tools for this age group are not well established. However, early identification of depression may save a child from a lifetime of social and emotional consequences. Many adolescents and adults present to health care providers for mental health treatment, indicating that their symptoms started at an early age, and most adults with depression did, in fact, meet diagnostic criteria for depression in childhood. However, if children are labeled as “depressed” so early in life, are they set up for a lifetime of medications and treatments and stigmatization?

This ignores the opportunity for prevention by treating children who have experienced stressful or traumatic events. Most child clinicians are aware that the death of close relatives, prolonged separations from caretakers, separation and divorce of parents, and chronic abuse or neglect can lead to depression in children. I believe the results of this study provide further support for the early treatment of childhood trauma.

The treatment of choice for preschoolers should be psychotherapy. Given that research has found psychotherapy and medication equally effective at treating depression in adolescents and adults, there is no reason to assume it would be different for young children. For safety reasons, I believe anti-depressant medication should be considered only for children with severe or chronic depression that has not responded to psychotherapy.

Luby, J., Si, X., Belden, A., Tandon, M., & Spitznagel, E. (2009). Preschool Depression: Homotypic Continuity and Course Over 24 Months Archives of General Psychiatry, 66 (8), 897-905 DOI: 10.1001/archgenpsychiatry.2009.97

For those without access to the full article, see Dr. Nestor-Duran's review Depression in preschool children: not a temporary phase. - Child Psychology Research Blog.
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This post was featured in Grand Rounds, Vol. 6, No. 13

You Asked: Depression - Thyroid or Hormonal Changes?

A reader wants to know if depression could be caused by undetected thyroid or hormonal changes. The short answer is yes. Hypothyroidism (an underactive thyroid gland), hyperthyroidism (an overactive thyroid gland), and adrenal insufficiency (a dysfunctional adrenal gland) are hormone disorders that can cause symptoms of depression. These illnesses can be detected by simple tests performed by your child's pediatrician.

Other medical conditions that may be associated with depressive symptoms include metabolic illness, anemia, seizure disorder, acquired immunodeficiency syndrome, Addison's disease, post-concussion, tuberculosis, diabetes, brain tumor, and chronic fatigue syndrome. Medications that can cause depression include antihypertensives, barbituates, corticosteroids, oral contraceptives, and albuterol. Green-Hernandez, C., Singleton, J. K., & Aronzon, D.Z. (2001). Primary care pediatrics. Philadephia: Lippincott, Williams & Wilkins, pg 314.

Hormonal changes at puberty have been linked to an increase in depression in adolescents as compared to children. There is little difference in the rates of depression between boys and girls prior to puberty, but among teenagers, twice as many girls as boys become depressed. It is unclear why there is such a significant gender difference. Many research studies show inconsistent results for hormone levels, early or late onset of puberty, psychosocial differences, and body image issues as possible causes. One explanation could be that hormonal changes only affect girls with a genetic predisposition for depression. Gotlib, I. H. & Hammen, C. L. (Eds.),2008. Handbook of depression (2nd ed.). New York: Guilford Press, pgs 388-389.

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