Indian Pediatr 2015;52: 202-203
Stress: A Modifiable Factor in the Etiology
of Adolescent Depression
Department of Psychiatry, University College of
Medical Sciences and GTB Hospital, Delhi, India.
n India, 50% of the population belongs to the age
group of 0-25 years . The prevalence rate of depression in youth is
roughly 15% to 20% . World Health Organization (WHO) projects
depression to be the second leading cause of disability by the year 2020
. Stress plays a significant role in the etiology of depression along
with the genetic factors .
Neuroimaging studies have helped us to understand
neurobiology of stress and depression in the living brain in a
noninvasive manner. Early life stressors are found to be associated with
reduced fractional anisotropy values in the genu of the corpus callosum
despite the absence of clinically significant psychiatric symptoms .
Fractional anisotropy, a useful measure on the Diffusion tensor Imaging
(DTI) of the structural integrity of white fiber tracts, helps us to
study human brain in vivo. White matter micro-structural
abnormalities are reported in fronto-limbic neural pathways in
adolescents with Major Depressive Disorders .
The huge population of children and adolescents in a
developing country like India are subjected to stressors. Several risk
factors identified in Indian adolescents are female gender, academic
difficulties, parental fights, strained familial relationships, school
absenteeism, school dropout, and other school related factors that
contribute to psychiatric morbidity . With the limited resources, the
focus should be to identify the children and adolescents who are at risk
from depression and provide primary, secondary and tertiary level
In this current issue of Indian Pediatrics,
Jayanthi, et al.  reported a positive correlation between the
academic stress score and depression scores. Stress is an environmental
risk factor for depression which can be modified . It has been
observed that cases of depression in school and college students
increase when examinations are approaching. Notably, the stress-related
mental disorders like acute stress reaction, post-traumatic stress
symptoms, adjustment disorders, panic attacks, acute transient psychotic
disorders, dissociative disorders, suicide and deliberate self harm, and
substance use disorders have been observed in clinical experience in
Indian student population.
Interventions to reduce stress need to be carried out
at several levels. At the level of government, currently board
examination of the tenth standard school has been replaced by a grading
system which is based on the performance throughout the year in the form
of formative and summative assessments carried out at school level.
Another unique initiative is carrying out stress management workshops
for students/parents/teachers at regular intervals.
Measures like setting realistic goals and priorities,
time management, adequate relaxation techniques including yoga, walking,
jogging, and recreation breaks while preparing for examinations, can
help students cope with the mounting academic pressures .
It is equally important that parents help children
and adolescents through motivation, confidence building, ensuring
adequate sleep, fresh short meals, and avoiding caffeinated drinks or
substance use. Parents should not compare their children with other high
achievers, and should have realistic expectations. It is important to
keep home environment conducive for studies. Any form of emotional abuse
of child or adolescent in the form of insults, derogatory comments or
physical abuse in the form of slapping, etc. should not be done by the
parents/caregivers. Individuals with social supports cope up better than
the children in the isolated families.
There is a pivotal role to be played by teachers as
well. Teachers need to ensure timely completion of the syllabus so that
there is ample time for revision, clarifying individual doubts, and mock
evaluations. Teachers need to emphasize on ‘must read’ topics, regular
assignments and evaluations. There is a need to develop a good rapport
between teachers and students so that they feel comfortable and share
their thoughts. Training of teachers for picking up early symptoms of
stress and depression in the form of crying, sitting alone, irritable,
eating excessively, self harm, substance ingestion, falling grades,
inattentiveness, and behavioral oddities can prevent disastrous
consequences. Counselors in the school can assist in early
identification of at risk students.
Regular counseling sessions for depressed and
stressed out students are provided in government run psychiatric set-ups
apart from several other non-governmental organizations and private
clinics. Pharmacological interventions are effective for managing
depression, anxiety and other stress-related psychiatric disorders.
Psychiatric emergencies in the form of suicidal ideation or acts of self
harm, and substance ingestion or intoxication should be brought for
immediate care at inpatient psychiatric setting.
Funding: None; Competing interests: None
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