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Mid-Adolescent Hispanic Females and Depression

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According to Kessler, Foster, Webster, & House (1992), the risk for major depressive disorder are far more obvious during adolescence, particularly for females. Adolescent depression rates have increased substantially over the last several years. In a study by Mojtabai, Olfson, & Han (2016), research showed that the 12-month prevalence of major depressive episodes increased from 8.7% in 2005 to 11.3% in 2014 based upon the 172,495 adolescent study participants.

Adolescent depression can manifest in a vast array of emotional and behavioral changes that can vary in severity. Just a few of the emotional changes one should be aware of are; crying for what appears to be no reason, increased sadness, feelings of hopelessness or worthlessness, irritability, increased frustration and anger, loss of interest in activities and people that were once important, no hope in the future, self-criticism, low self-esteem and frequent thoughts of suicide and death. Behavioral issues may also manifest in different ways such as; lack of energy, sleeplessness or sleeping too much, restlessness, agitation, loss of appetite or eating too much, unkempt or neglecting appearance, isolating self, use of drugs and/or alcohol, poor performance in school and self-harm behaviors (DSM-5, 2013).

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In a study conducted by Zayas, Kaplan, Turner, Romano, & Gonzalez-Ramos (2000), it was stated that female Hispanic adolescents are twice as likely than their African American and non-Hispanic White counterparts to have made a suicide attempt that necessitated medical care. This study also showed that over 50% of 13-19-year-old Hispanic females have reported sporadic suicidal thoughts. Additional factors that may induce a depressive disorder amongst this age group are often relating to acculturation, familial expectation, and cultural traditions. They start feeling the pressures of living up to their cultural expectations while simultaneously fitting in with their non-Hispanic peers.

Historically mid-adolescent Hispanic females are assigned very specific gender roles as the female family member is expected to be the caretakers of both the home and the family beginning at a very young age. The belief is that overall family needs come before that of the individual family member. Most Hispanic households are multi-generational and have more members of family residing under one roof. Religion commonly plays a large part in the Hispanic household, particularly if the home is multi-generational. Hispanic females are often assigned to womanhood at the age of 15-years-old without regard to biological or cognitive developmental functioning. Cultural values dictate expectation that one will grow up to be productive and independent members of society. Pressure is placed on performing at high standards to receive an education to meet these goals.

Families are generally on the larger side, and the family unit is usually strong, however, joblessness, low-income, alcoholism and domestic violence are prevalent amongst Hispanic cultures. In today’s society, fear and the media play a significant role in maladaptive behaviors by Hispanic females. A study performed by Lorenzo-Blanco (2012), suggests that there is an increased risk of depression when a Hispanic youth acculturates to U.S. society. For Hispanic girls this association is tougher than it is for their male counterparts’. This study also suggests that family struggles and unity are linked with depressive symptoms.

In today’s ongoing battle the fear of deportation of self or family members is a constant source of contention. An increasing number of children face the painful truths that are associated with the possibility of parental deportation such as forced family separations, material deprivation, anxiety, and depression. The accumulation of these stressors placed on mid-adolescent female members of this culture can lead to the onset of any number of the depressive symptoms mentioned previously.

Intervention

It is important to recognize the manifestation of depressive symptoms in an adolescent and to be aware of when it is time to seek help. Many temperately sized, individual treatment studies have shown that adolescent depression can be enriched through a combination of individual psychotherapies, such as cognitive-behavioral therapy (CBT) interpersonal psychotherapy, and antidepressants. Weighing both risk factors along with potential benefits the impression is that a combination of anti-depressants and cognitive behavioral therapy is the best short-term treatment for adolescent clinical depression.

The evidence-based practice of cognitive-behavioral therapy (CBT) is based on the idea that our thoughts cause our feelings and behaviors and that an individual can change the way they think, feel and act even if the situation stays the same. CBT is considered to be one of the fastest ways to obtain results. The average number of sessions clients participate in is 16. What allows CBT to be the quicker model is that it encourages homework assignments for the client and the method is also highly instructive in nature. CBT is considered a time-limited therapy in that it helps a client understand from the beginning that there is a specified time limit to the treatment. The decision as to when to end therapy is made by both the client and the therapist. CBT counselors will focus on teaching the client comprehensive self-analysis skills while gaining knowledge of what it is that the client’s goals are. They can then support their clients in achieving said goals. During a CBT session it is the counselor’s role is to observe the client by listening and to educate and encourage the client. The role of the client is to express their concerns, acquire information, and implement that information for the purpose of learning. CBT counselor’s set an agenda with a certain set of concepts and techniques tailored specifically to each client’s needs. The ultimate goal of CBT therapy is to assist a client to unlearn undesirable responses and to learn how to respond differently than they had prior to treatment.

Engagement

Implementation of previously addressed treatment modality, cognitive behavioral therapy will include engaging the client in their own treatment and potential outcomes. Allowing the client to set their own goals based upon their desired outcome. Engagement for this specific age range will vary according to the client’s preference and regional location. In some states, such a Washington, a child aged 13-years and older may legally make decisions for reproductive and mental health care without the consent of the parent or legal guardian. According to Washington State Administrative Code RCW 71.34.530, minors are able to receive outpatient mental health treatment without the knowledge or consent of the child unless a release of information has been signed for by the client. In the case of inpatient mental health services being obtained by a minor, per RCW 71.34.500, they may do so without parental consent, but a parent or legal guardian will be notified without consent of the client.

In the case that a client makes the decision to include family members, a parent or legal guardian would take part in the assessment of depressive disorders. Therapy may include familial goal setting and counseling services. Some CBT counselors may also make recommendations from individual treatment of family members based upon information gathered during treatment. In the Hispanic household language and cultural barriers may pose potential issues when attempting to establish services. Fear of the system may also inhibit some participation from families. In these cases, it is important for the practitioner to be mindful of the cultural norms and expectations. If language barriers exist perhaps a bilingual practitioner is required.

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