Differentiating ‘depression’ from understandable reactions to adversity was difficult for patients. Almost like a vicious cycle, these YP were aware of the distress that they might cause their parents and wanted to protect them from it, by not speaking about what was going on for them. Special thanks also to Dr. Silvia Krumm and Prof. Silke Wiegand-Grefe for their supervisional advice, and to Helmut Hofmann for his valuable support in recruiting the young people! INTRODUCTION. How was it given? In all the interviews, the YP also spoke about irritability and aggression. 1 Some see depression as independent of time, place, and culture; common in primary care; 2 and effectively managed there. School problems were also very prevalent in previous studies (Dundon, 2006; Farmer, 2002), and the authors of these studies frequently commented on the severity of the symptoms described by YP. Adding to the burden of psychological symptoms, several of the participants also talked about physiological symptoms, in particular insomnia: I could not sleep at all, just zero. There is a lack of research in health psychology on the subjective experience of adolescents with mental health disorders. One third reported their initial diagnosis came as a result of an emergency department visit. None reported having, before diagnosis, acquaintance with views of depression as a frequently heritable condition involving neurotransmitters in the brain, regardless of their educational attainment. Because this is not really my fault. We expected comorbidities as is often the case in routine care in Germany. Although this study did not specifically address stigma associated with depression, several of our participants raised this issue. A dominant experience of the YP was the “overwhelming” nature of their reported symptoms and distress. The following statement by Katrin illustrates how this low self-esteem and lack of caring for herself was compounded with resignation and passivity: Actually, I am, I let far too much just happen to me. Nick Midgley, PhD, is a child and adolescent psychotherapist based at the Anna Freud Centre and a lecturer in the Research Department of Clinical, Educational and Health Psychology, University College London (UCL), UK. In this theme, the YP spoke about the experience of being overwhelmed by the symptoms as well as the consequences. The following four key themes were identified: “Suffering is experienced as overwhelming,” “An experience of loneliness and isolation,” “Struggling to understand the suffering,” and “Therapy as a last resort.” Reasons for a delay in accessing treatment were not knowing what is “normal,” the feeling that they have to deal with it by themselves, and/or the lack of a caring adult who supports the YP in getting help. We used a qualitative descriptive approach24 based on our interview template. . The YP were recruited from routine outpatient health care in Germany and had the opportunity to identify their own priorities and speak about what they considered to be most significant, which adds to the external validity of the study and warrants to consider what might be learned from these YP. Sharing links are not available for this article. We sought to gain a better understanding of barriers to diagnosis of and entering treatment for depression in primary care. (E.g., someone from your doctor’s office called you or they scheduled a follow-up appointment a week or two after you decided to start treatment.). . We chose to retain and analyze interviews with participants reporting a diagnosis of bipolar disorder, because their reported experiences with depression diagnosis and treatment were quite similar to those of our participants not reporting a bipolar diagnosis, and depression is a common presentation of bipolar disorder. A number of subjects reported having received written information, but this information was frequently recalled as not very helpful. . Because, to some extent I was able to hide it well from him. It involved sampling the fifteen teenagers and the interview was audio taped for further reference. Although different countries have made an effort to tackle this, such as the United Kingdom’s Improving Access to Psychological Therapies program (IAPT), the service gap has remained largely unchanged in many countries (Wittchen et al., 2011). If not, what else would you have liked to know? The tipping points were, for instance, additional traumatic experiences or an increasingly unbearable level of symptom severity. Quantitative approach on the experience of depression applied more easily than qualitative research. The recurrent nature of this finding emphasizes how much YP feel unable to cope when experiencing clinical levels of depression and the importance of reaching this vulnerable group and offering targeted care. Inclusion criteria were youth (aged 14–19 years) entering psychotherapy after undergoing a maximum of two sessions with a therapist, currently suffering from a depressive disorder, and having sufficient command of the German language. The study was embedded in the multi-centre, primary care-based, cohort study AgeMooDe, which was designed to describe and compare the use of health services by primary care patients with and without symptoms of depression over the period of one year. The aim of this study was to build on previous studies, by examining the lived experience of YP diagnosed with depression living in Germany, and additionally to look at the way these YP accessed therapy in the context of the German mental health system, including reported reasons for any treatment delay. Enter multiple addresses on separate lines or separate them with commas. Farmer (2002) interviewed five YP with depression (13–17 years) in the United States and identified that anger, fatigue, and interpersonal difficulties were focused on by the YP. One of the interviews and the superordinate themes of all cases were translated into English in full, to enable close supervision by N.M. A second theme that is strongly related to the overwhelming nature of the feelings is the experience of loneliness and isolation, which was described by all the participants in the study. 5 Others suggest that … However, the YP felt unable to confide in these friends and share their distress with anyone, for fear of being stigmatized or judged. Lara, however, seemed to have a better understanding of her depression, as she felt that something within her had been destroyed by the traumatic experiences she had experienced. View or download all the content the society has access to. Similarly, we have retained the participants in our sample who reported histories of substance use as the issues raised by these participants were very much the same as those raised by other participants, with the addition of active substance use being a barrier to willingness to undertake treatment for depression. 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