For Teen Girls, Depression Manifests Uniquely

MIAMI BEACH ? Studies increasingly suggest that adolescent girls are particularly vulnerable to many of the risk factors for major depression, and that depression in this population manifests in several unique ways.

For example, depressed girls are more likely than are depressed boys to have poor body image, to feel disappointed in themselves, to feel like a failure, and to have difficulty concentrating, Dr. Nada Stotland said at the annual meeting of the American Society for Adolescent Psychiatry.

Girls tend to have more inwardly directed symptoms, she explained at the meeting, which was cosponsored by the University of Texas at Dallas.

And they experience unique consequences of depression. A recent study suggests that depressed girls are at double the risk of nondepressed girls of becoming involved in abusive relationships, said Dr. Stotland of Rush Medical College, Chicago.

Another study showed that 3 years after being diagnosed with depression, girls had decreased self worth, poorer body image, and increased feelings of vulnerability, compared with prior to their depression. Depressive symptoms, along with dietary restrictions, weight control behaviors, and feeling that one's parents are overweight, also appear to be a risk factor for obesity.

Race also appears to play an important role in depression in girls; white girls with depression in adolescence were shown in one study to be more likely than African American girls to improve in early adulthood. And in a study of Hawaiian youth, 38% of girls in the study had a psychiatric disorder. Most of those had anxiety disorders, but crossover between depression and anxiety is significant, Dr. Stotland said.

Chinese girls in one study commonly reported anxiety; 48% said they had anxiety that interfered with enjoyment, 40% saying their anxiety interfered with relaxation, and 27% saying it interfered with sleep. About one-third of girls reported depressive symptoms, with 16% saying they sometimes feel that life is not worth living, and 9% reporting a suicide attempt.

Ethnic differences also are apparent in the effects of body image on depression, with white girls being the most likely to feel pressure to be model thin.

As for gender differences in depression, a study from Spain suggests cognitive styles may be to blame. Girls were shown to be less likely than boys to think positively, and when faced with a problem, they were less likely to consider the problem to be solvable.

Other factors shown recently to be associated with depression in girls include:

Maternal depression. A recent large study confirms much of what was already suspected: that maternal depression has a significant impact on adolescent depression risk. Other studies have suggested girls are particularly vulnerable to these effects. Adult psychiatrists should take more care in addressing this risk in the children of the depressed mothers they treat, she said.

Sexual orientation. Parental discrimination was shown to be ?an enormous risk factor? for depression in homosexual teens.

High-risk behaviors. There has been some controversy regarding whether high-risk behaviors such as drug use and promiscuity come before or after depression, but findings from a very large study suggest that such behaviors are predictive of depression, particularly in girls.

Parental marital problems. Divorce and marital distress in parents was linked in a longitudinal study in Norway to increased risk of depression in adolescents, and the effects were more lasting in girls than in boys.

Stress. While stress can be difficult to define, at least one study shows that girls experience more stress than do boys, and that they experience more depression as a result of stress.

Hormones. Depressive symptoms may change cyclically with the menstrual cycle. Premenstrual symptoms and oral contraceptive use should be considered when evaluating girls with depression.