Combatting the Impact of the COVID-19 Pandemic on Adolescent Mood Symptoms
Erin Dillon-Naftolin, MD
PAL Consultant
A study published in the Journal of Adolescent Health this January looked at a cohort of 3000 adolescents to help guide us in identifying protective factors that could help minimize the impact of the pandemic on adolescent mental health. Specifically, for depression, they noted that quality of relationships with friends and relationships with family members were the most protective for decreasing depressive symptoms. Participating in family activities and regular meal times were also strong supports. Risk factors included preexisting internalizing problems, being separated from friends, isolating from people, female gender and witnessing racism related to coronavirus. These results support other studies showing social connectedness as a protective factor against depression during the pandemic. Further the authors argue that modifiable lifestyle factors such as increased physical activity, maintaining routines and supporting social and family relationships could all be targets for prevention of depression in adolescents.i
This data fits with a growing body of work looking at Behavioral Activation as an intervention for adolescent depression. Behavioral Activation (BA) is a type of structured brief intervention therapy focused on increasing adaptive activities. Typically, BA focuses on increasing engagement in activities that give pleasure or mastery and decreasing activities that maintain depression. Particularly important for teens, BA focuses beyond simply scheduling activities and focuses on individual interests, social relationships, and overcoming avoidance. Authors argue that BA may be particularly helpful for teens who are still developing their neural reward system and are more likely to struggle with anhedonia, response to reward and avoidance. Avoidance behaviors (such as sleeping all day) often offer short-term escape from symptoms, but contribute to maintaining depression and functional impairment. There is good data for BA in treating adult depression and this meta-analysis by Ekers et al. showed it was comparable to CBT in managing adult depressionii. Several recent studies have found support for BA to target adolescent depressioniii,iv,v.
In primary care, helping educate families about the protective role of positive activities, physical activity and engaging in relationships with family and friends can help build up a teen’s natural protective factors. For more serious signs of depression, providing psychoeducation about Behavioral Activation (BA) through a diagram such as this could be helpful to introduce teens to the possibility of boosting their mood through behavioral change.
You can start his work together by picking a specific activity they want to target, setting a goal and monitoring and mood between visits. BA can be a more attractive modality for teens who are resistant to therapy, those less interested/able to engage in the cognitive components of CBT or those with more extensive trauma history.iii
i Kiss O, Alzueta E, Yuksel D, et al. The Pandemic's Toll on Young Adolescents: Prevention and Intervention Targets to Preserve Their Mental Health [published online ahead of print, 2022 Jan 25]. J Adolesc Health. 2022;S1054-139X(21)00636-4. doi:10.1016/j.jadohealth.2021.11.023
ii Ekers, D. , Richards, D. , & Gilbody, S. (2008). A meta‐analysis of randomized trials of behavioural treatment of depression. Psychological Medicine, 38, 611–623. doi:10.1017/S0033291707001614
iii McCauley E, Gudmundsen G, Schloredt K, et al. The Adolescent Behavioral Activation Program: Adapting Behavioral Activation as a Treatment for Depression in Adolescence. J Clin Child Adolesc Psychol. 2016;45(3):291-304. doi:10.1080/15374416.2014.979933
iv Tindall L, Mikocka-Walus A, McMillan D, Wright B, Hewitt C, Gascoyne S. Is behavioural activation effective in the treatment of depression in young people? A systematic review and meta-analysis [published correction appears in Psychol Psychother. 2021 Dec;94(4):1083]. Psychol Psychother. 2017;90(4):770-796. doi:10.1111/papt.12121
v Malik K, Ibrahim M, Bernstein A, Venkatesh RK, Rai T, Chorpita B, Patel V. Behavioral Activation as an 'active ingredient' of interventions addressing depression and anxiety among young people: a systematic review and evidence synthesis. BMC Psychol. 2021 Oct 7;9(1):150. doi: 10.1186/s40359-021-00655-x. PMID: 34615559; PMCID: PMC8494510.
|
|
|
News & Notes
Join us for our Webinar this Saturday 2/26!
Featured topics & Speakers:
- Antidepressants | Dr. James Peacey
- Teen Substance Use Disorders | Dr. Nicholas Weiss
- Perinatal Psychiatry | Dr. Carmen Croicu & Dr. Ramanpreet Toor
Register now!
|
|
|
 PAL Spotlight
Dr. Erin Dillon-Naftolin joined the PAL team in September 2015. Born and raised in the Seattle area, she attended medical school at the University of Washington School of Medicine and completed her General Adult Psychiatry training there as well. She completed her fellowship at University of Washington/Seattle Children’s Hospital in 2014 and joined the faculty upon graduation. In addition to working for PAL, she does consultation in integrated care at the Roosevelt clinic and she is an attending psychiatrist in the outpatient psychiatric clinic at Odessa Brown and at Family Solutions Community Mental Health Center in Vancouver, WA. Her primary clinical interests are anxiety disorders, telemedicine, community mental health and consultation to primary care. Dr. Dillon-Naftolin lives in Seattle with her husband, daughters and labradoodle. Like a true northwestern native, she enjoys running, hiking, snowshoeing and camping, rain or shine.
|
|
|
Upcoming CME Conferences
Webinar
February 26, 2022
Register now!
Webinar (Formerly listed as "Vancouver, WA")
April 30, 2022
Webinar (Formerly listed as "Spokane, WA")
June 11, 2022
Conferences run 8:00 AM - 12:30 PM and are FREE to attend.
Registration opens two months in advance.
CME credits are available.
Visit our website for the most updated information on upcoming conferences and to view slides from our previous conferences.
|
|
|
|
|
|
