The Escalating Global Challenge of Adolescent Depression

The Global Consortium for Depression advocates for a systemic approach to preventing depression and suicidal behavior in teens and adolescents.

Last fall, Brown University’s Hassenfeld Child Health Innovation Institute hosted the 8th Conference of the Global Consortium for Depression Prevention. The event, “Depression Prevention in the Context of Diversity, Development, and the Digital Age,” gathered over 40 authorities from around the world to tackle the escalating crisis of youth mental health. They examined evidence for school-based prevention programs, the impact of digital technology and widening socio-economic disparities, as well as the use of pioneering methodologies to advance the science of depression prevention.

The urgency of this issue is illustrated by a startling increase in depression and suicidal behaviors among teens in the US - which doubled between 2011 and 2019 - and has been exacerbated by the COVID-19 pandemic, inequality, political conflicts and the overarching threats of climate change. 

Treatment alone offers only a partial solution and is unable to meet current demand. “Even if optimal evidence-based treatments were available, equitable and completed by everyone with depression,” Consortium members write, “they would only reduce the burden of depression by 28%.”

Given these limitations, the Consortium is focused on prevention as a more viable and cost-effective approach, potentially lowering depression rates by 19% or more, particularly among high-risk groups. This is especially important in countries with fewer resources, where prevention might be the only available option.

Some depression prevention approaches, particularly universal programs delivered in schools, just haven’t worked when taken to scale.

Tracy Gladstone, Ph.D. Associate Professor of Psychiatry and Human Behavior, Associate Professor of Behavioral and Social Sciences
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Currently, the path to effective prevention strategies is fraught with obstacles, with studies of large-scale school interventions showing mixed results at best. Consortium members highlighted challenges such as underdeveloped methodologies, and difficulties in quantifying outcomes and clarifying the specific features of prevention strategies. 

“Some depression prevention approaches, particularly universal programs delivered in schools, just haven’t worked when taken to scale,” said Tracy Gladstone, associate professor of psychiatry and human behavior and of behavioral and social sciences. Gladstone cites the work of Pim Cuijpers, a Consortium founder and professor emeritus of clinical psychology at the Amsterdam Public Health Research Institute, which shows that targeted programs aimed at high-risk groups tend to be more effective than those applied universally to all students. 

Consortium members also noted the challenges of conducting long-term prevention studies, which are necessary but costly, and complicated by the immediate needs of those currently suffering from depression.

“It’s difficult to focus attention on prevention when the problem of current depressive disorder is so visible and concerning,” Gladstone said. “When there are so many suicidal adolescents in emergency rooms waiting for treatment, it’s hard to allocate resources to preventing the problem in kids who are not currently suffering.”

To clear these hurdles, Consortium members stress addressing foundational issues like racism and lack of access to housing and health care, in addition to focusing on more downstream, individual-level interventions. They argue for tailoring interventions to the distinct cultural and personal identities of its end users. And they suggest that interventions may be better received and less stigmatized if they promote lifestyle changes such as improving sleep and nutrition and increasing exercise. 

They also emphasize the need to include adolescents and young adults in the intervention design process; at the Consortium’s satellite meeting, a panel of young people shared their experiences with depression and offered ideas for prevention approaches that would appeal to their peers. 

Consortium members are currently collaborating to compile these and other ideas from the conference for publication.