PREVENTING DEPRESSION
Dana, sixteen, had always seemed to get along. But now, suddenly, she just could not relate with other girls, and, more troubling for her, she could not find a way to hold on to boyfriends, even though she slept with them. Morose and constantly fatigued, Dana lost interest in eating, in having fun of any kind; she said she felt hopeless and helpless to do anything to escape her mood, and was thinking of suicide.
The drop into depression had been triggered by her most recent breakup. She said she didn't know how to go out with a boy without getting sexually involved right away—even if she was uncomfortable about it—and that she did not know how to end a relationship even if it was unsatisfying. She went to bed with boys, she said, when all she really wanted to do was get to know them better.
She had just moved to a new school, and felt shy and anxious about making friends with girls there. For instance, she held back from starting conversations, only talking once someone spoke to her. She felt unable to let them know what she was like, and didn't even feel she knew what to say after "Hello, how are you?"22
Dana went for therapy to an experimental program for depressed adolescents at Columbia University. Her treatment focused on helping her learn how to handle her relationships better: how to develop a friendship, how to feel more confident with other teens, how to assert limits on sexual closeness, how to be intimate, how to express her feelings. In essence, it was a remedial tutorial in some of the most basic emotional skills. And it worked; her depression lifted.
Particularly in young people, problems in relationships are a trigger for depression. The difficulty is as often in children's relationships with their parents as it is with their peers. Depressed children and teenagers are frequently unable or unwilling to talk about their sadness. They seem unable to label their feelings accurately, showing instead a sullen irritability, impatience, crankiness, and anger—especially toward their parents. This, in turn, makes it harder for their parents to offer the emotional support and guidance the depressed child actually needs, setting in motion a downward spiral that typically ends in constant arguments and alienation.
A new look at the causes of depression in the young pinpoints deficits in two areas of emotional competence: relationship skills, on the one hand, and a depression-promoting way of interpreting setbacks, on the other. While some of the tendency to depression almost certainly is due to genetic destiny, some of that tendency seems due to reversible, pessimistic habits of thought that predispose children to react to life's small defeats—a bad grade, arguments with parents, a social rejection—by becoming depressed. And there is evidence to suggest that the predisposition to depression, whatever its basis, is becoming ever more widespread among the young.
A COST OF MODERNITY: RISING RATES OF DEPRESSION
These millennial years are ushering in an Age of Melancholy, just as the twentieth century became an Age of Anxiety. International data show what seems to be a modern epidemic of depression, one that is spreading side by side with the adoption throughout the world of modern ways. Each successive generation worldwide since the opening of the century has lived with a higher risk than their parents of suffering a major depression—not just sadness, but a paralyzing listlessness, dejection, and self-pity, and an overwhelming hopelessness—over the course of life.23 And those episodes are beginning at earlier and earlier ages. Childhood depression, once virtually unknown (or, at least, unrecognized) is emerging as a fixture of the modern scene.
Although the likelihood of becoming depressed rises with age, the greatest increases are among young people. For those born after 1955 the likelihood they will suffer a major depression at some point in life is, in many countries, three times or more greater than for their grandparents. Among Americans born before 1905, the rate of those having a major depression over a lifetime was just 1 percent; for those born since 1955, by age twenty-four about 6 percent had become depressed. For those born between 1945 and 1954, the chances of having had a major depression before age thirty-four are ten times greater than for those born between 1905 and 1914.24 And for each generation the onset of a person's first episode of depression has tended to occur at an ever-earlier age.
A worldwide study of more than thirty-nine thousand people found the same trend in Puerto Rico, Canada, Italy, Germany, France, Taiwan, Lebanon, and New Zealand. In Beirut, the rise of depression tracked political events closely, the upward trends rocketing during periods of civil war. In Germany, for those born before 1914 the rate of depression by age thirty-five is 4 percent; for those born in the decade before 1944 it is 14 percent at age thirty-five. Worldwide, generations that came of age during politically troubled times had higher rates of depression, though the overall upward trend holds apart from any political events.
The lowering into childhood of the age when people first experience depression also seems to hold worldwide. When I asked experts to hazard a guess as to why, there were several theories.
Dr. Frederick Goodwin, then director of the National Institute of Mental Health, speculated, "There's been a tremendous erosion of the nuclear family—a doubling of the divorce rate, a drop in parents' time available to children, and an increase in mobility. You don't grow up knowing your extended family much anymore. The losses of these stable sources of self-identification mean a greater susceptibility to depression."
Dr. David Kupfer, chairman of psychiatry at the University of Pittsburgh medical school, pointed to another trend: "With the spread of industrialization after World War II, in a sense nobody was home anymore. In more and more families there has been growing parental indifference to children's needs as they grow up. This is not a direct cause of depression, but it sets up a vulnerability. Early emotional stressors may affect neuron development, which can lead to a depression when you are under great stress even decades later."
Martin Seligman, the University of Pennsylvania psychologist, proposed: "For the last thirty or forty years we've seen the ascendance of individualism and a waning of larger beliefs in religion, and in supports from the community and extended family. That means a loss of resources that can buffer you against setbacks and failures. To the extent you see a failure as something that is lasting and which you magnify to taint everything in your life, you are prone to let a momentary defeat become a lasting source of hopelessness. But if you have a larger perspective, like a belief in God and an afterlife, and you lose your job, it's just a temporary defeat."
Whatever the cause, depression in the young is a pressing problem. In the United States, estimates vary widely for how many children and teens are depressed in any given year, as opposed to vulnerability over their lifetime. Some epidemiological studies using strict criteria—the official diagnostic symptoms for depression—have found that for boys and girls between ten and thirteen the rate of major depression over the course of a year is as high as 8 or 9 percent, though other studies place it at about half that rate (and some as low as about 2 percent). At puberty, some data suggest, the rate nearly doubles for girls; up to 16 percent of girls between fourteen and sixteen suffer a bout of depression, while the rate is unchanged for boys.25
THE COURSE OF DEPRESSION IN THE YOUNG
That depression should not just be treated, but prevented, in children is clear from an alarming discovery: Even mild episodes of depression in a child can augur more severe episodes later in life.26 This challenges the old assumption that depression in childhood does not matter in the long run, since children supposedly "grow out of it." Of course, every child gets sad from time to time; childhood and adolescence are, like adulthood, times of occasional disappointments and losses large and small with the attendant grief. The need for prevention is not for these times, but for those children for whom sadness spirals downward into a gloom that leaves them despairing, irritable, and withdrawn—a far more severe melancholy.