Major depressive disorder (MDD), or clinical depression, is a major problem for 300 million people worldwide, according to the World Health Organization (WHO), and young adults may be among those most affected.
An estimated 3 million 12- to 17-year-olds in the U.S. report they have suffered at least one major depressive episode in the past year. Suicide is the second leading cause of death among people aged 10 to 24, contributing to the nearly 800,000 deaths occurring around the globe each year. These statistics indicate just how widespread and devastating depression can be, and how much better we should be at identifying and treating people, particularly the young.
Diagnostic Approaches: Distinguishing Between Mild Depression and Major Depression
Effective methods for distinguishing between episodes of ordinary sadness that we all sometimes experience and the kind of depression that can lead to dysfunction and despair are still evolving and a topic of much debate in the mental health community.
Many mental health experts argue that episodes of even mild depression warrant treatment, but the current methods used to diagnose depression seem to be needlessly complex, classifying people with milder depressive disorders into various subcategories that can obscure the fact that they need help. Some experts contend that people with subthreshold depression can experience symptoms ranging from mild to severe, many of which are “clinically relevant” and a cause for concern, yet people classified into this subgroup may not receive the support they need to manage their symptoms, leaving them vulnerable to developing more severe symptoms.
Depression May Occur on a Spectrum
Subthreshold depression, or subclinical depression, is so-named because its symptoms fall below the threshold of symptoms required for a diagnosis of full-blown clinical depression or MDD. As described in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, or DSM-5, a person with subthreshold depression suffers from two or more depressive symptoms simultaneously — sadness, loss of enjoyment or pleasure (anhedonia), diminished energy, lowered appetite and/or disrupted sleep — over a period of about two weeks. Yet symptoms of subthreshold depression, though not as severe as MDD, may linger longer than two weeks and can negatively impact a person’s social and occupational functioning and quality of life. Further, the condition is a risk factor for developing MDD and suicidal behavior.
Some researchers propose that depression as a disorder is best explained as occurring on a spectrum rather than as a collection of discrete categories, and even people with minor or subthreshold depression experience significant difficulties in daily functioning. They recommend we reexamine the thresholds for depressive disorders to more accurately distinguish cases of even mild depression that might improve with treatment.
Taking a Closer Look at Young Adults and Depression
Many teens and young adults exhibit symptoms that range from mild to major depression. Are they more vulnerable to depression than other age groups and, if so, why? A recent study of young adults explored this question, and the findings indicate that moods can be contagious among members of the same social milieu, with teenagers being particularly susceptible to “catching” their friends’ emotional states.
In an investigation into what determines depressive symptoms among teenagers, researchers from the University of Warwick in the United Kingdom looked at whether certain components of mood, such as changes in energy level, appetite and sleep, might spread among social circles. According to lead researcher Robert Eyre, “Evidence suggests mood may spread from person to person via a process known as social contagion.”
Previous studies on “social contagion theory” support the idea that our social environments impact both our behaviors and our emotional states. However, a potential problem with social contagion studies is an inherent difficulty in determining whether people become friends because of shared interests, behaviors and mood states, or if they start to share behaviors and moods after becoming friends.
Eyre’s research team took these “which-came-first” factors into account and through the use of a new research model was able to determine that among adolescents, both happy and sad mood states can be catching. That is, young adults who socialize with more sad friends tend to feel sadder, and those who socialize with more happy friends tend to feel happier.
Eyre says the study findings also indicate that happiness is more catching than sadness — a friend’s positive mood is contagious enough to push individuals over the threshold from depressed to not depressed, while a friend’s negative mood can make another individual sad without pushing them into true depression.
Why, then, are rates of depression in younger age groups so high? With adolescents, perhaps social contagion theory extends beyond whom they hang out with to the television shows and social media they are exposed to.
Theories of Social Contagion and Suicide Contagion in Adolescents
An offshoot of social contagion is the theory of suicide contagion, a phenomenon most pervasive among teens. Suicide contagion drew attention in 2017 with the airing of a Netflix television drama called “13 Reasons Why” that became enormously popular among teens. Devoting 13 hours to the story of a teen girl who commits suicide, the show ignited a firestorm of social media discussions among young people about suicide, causing concern that teens might be inspired to copy the suicidal behavior depicted in the program.
This, in turn, prompted thousands of news reports of teen susceptibility to exposure and suggestion, and motivated at least one research study to investigate how suicide contagion among teens might be impacted by media programs and the Internet.
The researchers found that for three months after the Netflix program debuted, Google searches for queries such as “how to commit suicide” and “commit suicide” spiked by 26% and 18%, respectively. While this is concerning, the researchers found that searches for suicide prevention strategies also spiked, with queries for “suicide hotline” and “suicide prevention” increasing by 12% and 23%, respectively. The research team was unable to determine if the increased interest in suicide led to a spike in suicide deaths, but the study’s lead investigator nonetheless expressed concerns about the show’s impact on public health.
“While it’s heartening that the series’ release concurred with increased awareness of suicide and suicide prevention […] our results back up the worst fears of the show’s critics: the show may have inspired many to act on their suicidal thoughts by seeking out information on how to commit suicide,” said John W. Ayers, PhD, in a news article.
Being down or feeling blue is a mood state that most of us are familiar with, regardless of our age. Whether sad feelings stem from genetics, an underlying disorder, a tragic television show, spending time with a sad friend or experiencing trauma or difficulties in our lives, the important thing is to recognize when such feelings persist and begin to affect your ability to enjoy life. Seek help if negative mood changes last longer than two weeks, particularly if you experience two or more symptoms such as:
- Sad or depressed mood
- Reduced interest or pleasure in activities previously enjoyed, loss of sexual desire
- Diminished appetite or weight loss (without dieting)
- Sleep changes such as insomnia or excessive sleeping
- Fatigue or diminished energy
- Feelings of hopelessness, worthlessness or guilt
- Difficulty concentrating or making decisions
- Restlessness or slowed movements and speech
- Recurring thoughts of death or suicide
Regardless of where on the spectrum you fall — from subthreshold or subclinical to clinical — depression is treatable. A mental health professional can help you talk through feelings and problems in psychotherapy, provide support by helping you identify and manage contributing stressors, and recommend an antidepressant medication, if appropriate. Getting the help you need can lift you up and put you on the path to rediscovering joy and meaning in your life.
“Subthreshold Depression As A Risk Indicator for Major Depressive Disorder: A Systematic Review of Prospective Studies.” – PubMed.gov (NCBI)
“Understanding Subthreshold Depression” – PubMed.gov (NCBI)
“Subthreshold” Depression: Is The Distinction Between Depressive Disorder Not Otherwise Specified and Adjustment Disorder Valid?” – PubMed.gov (NCBI)
“Definitions and Factors Associated With Subthreshold Depressive Conditions: A Systematic Review.” – BMC Psychiatry
“Subthreshold Depression in Adolescence and Mental Health Outcomes in Adulthood.” – JAMA Psychiatry