2012. Vol.3, Special Issue, 75 6-757
Published Online September 2012 in SciRes (
Copyright © 2012 SciRes.
The Importance of Recognising Depression in Adolescents
Affected by Parental Illness*
David Morley#, Crispin Jenkinson
Department of Public Health, Ol d Road Campus, University of Oxford, Headington, UK
Email: *
Received July 17th, 2012; revised August 16th, 2012; accepted S e p tember 12th, 2012
Research focusing on the impact of parental illness has increased rapidly in recent years, with studies on a
range of both chronic and acute illnesses having now been reported. A key and consistent finding is the
elevated risk of depression that young people face when adjusting to and living with a parent experiencing
such a condition. Examples from the literature include studies focusing on parental multiple sclerosis,
Parkinson’s disease, stroke, cancer, affective disorder and traumatic brain injury. Such a body of literature
emphasises the need to recognise and manage the increased risk of depression that young people face
when confronted with such parental conditions and that a more family centred approach to parental illness
is required. Additionally, it is important that the potential threat parental illness poses to young people’s
mental well-being is reflected in relevant clinical guidelines.
Keywords: Adolescent; Depression; Parental Illness
Depression in adolescence is largely characterised by fea-
tures similar to those in adults. Low mood, lack of interest in
activities, low self-esteem, inability to concentrate, suicidal
thoughts, disturbed sleep, changes in appetite and feelings of
guilt are just some such characteristics. In addition, adolescents
can often appear agitated, may refuse to go to school and dem-
onstrate behavioural problems (Thapar, Collishaw, Potter, &
Thapar, 2010).
Alongside early adulthood, adolescence is the most prevalent
period for depression (Hammen, 1997). Importantly, unrecog-
nised depression during this period of development can lead to
poor educational attainment and psychosocial outcomes, as well
as continued depressive disorder in adulthood (Birmaher, Ryan,
Williamson, Brent, & Kaufman, 1996). This highlights the need
for its detection and treatment, and data indicates that at least
12% of adolescents report a minimum of low level depression
(Sihvola et al., 2007). However, depression in childhood and
adolescence frequently goes undiagnosed (Kramer & Garralda,
2000), and this is compounded by the fact that adolescents are
unlikely to consult general practitioners about mental health
problems (Potts, Gillies & Wood, 2001).
Research focusing on the impact of parental illness has in-
creased rapidly in recent years. Data from a number of studies
suggests young people experience a range of issues such as
changing roles, heightened responsibility and reduced inde-
pendence (Morley, Selai, Schrag, Jahanshahi, & Thompson,
2011). However, a key and consistent finding is the elevated
risk of depression that young people face when adjusting to and
living with a parent experiencing serious illness. Studies across
a range of parental conditions, both chronic and acute, appear to
confirm this.
As a relatively well investigated parental condition, multiple
sclerosis (MS) provides a sound example. Adolescent offspring
of people with MS report significantly higher levels of depres-
sion than children of healthy parents (Yahav, Vosburgh, &
Miller, 2007). Other studies confirm these elevated levels
through comparisons with the normal population (Morley et al.,
2011). Evidence suggests that the risk of such mental health
problems is, in part, associated with the mental health of both
the affected and non-affected parent, and that where both par-
ents report depressive symptoms the prevalence of internalising
disorders in their offspring is two to three times higher than that
found in the normal population (Steck et al., 2006).
MS is just one example of a parental condition that may have
an effect on young people’s mental well-being. Evidence from
the literature suggests a wide range of conditions can have such
an effect. For example, studies focusing on Parkinson’s disease
(Schrag, Morley, Quinn & Jahanshahi, 2004; Morley et al., 2011),
stroke (Visser-Meily et al., 2005a; Visser-Meily et al., 2005b),
cancer (Visser et al., 2005), affective disorder (Beardslee Glad-
stone & O’Connor, 2011) and traumatic brain injury (Kieffer-
Kristensen, Teasdale, & Bilenberg, 2011) all report data where
adolescent depression is a prominent feature. Such findings
have important implications. The key to the effective manage-
ment of depression in young people is its recognition and treat-
ment (Rowe, Tonge, & Melvin, 2004). In the United Kingdom,
National Institute for Health & Clinical Excellence (NICE)
guidelines reiterate this in recommending that “healthcare pro-
fessionals in primary care, schools and other relevant commu-
nity settings should be trained to detect symptoms of depression,
and to assess children who may be at risk of depression” (NICE,
2005: p. 149). Given the findings from a number of studies,
young people confronted with parental illness certainly appear
at increased risk of mental health problems, and should be rec-
ognised as such. As a starting point, the treatment of a serious
medical condition requires far greater emphasis on not just the
ill parent but on the wider family unit. A family centred ap-
proach at diagnosis should lead to a family centred approach to
care. It is a priority that the potential impact of parental illness
*Conflict of interests: None
#Correspo n ding author.
on young people’s mental health is recognised in relevant
clinical guidelines, something that is currently lacking in, for
example, UK guidelines for Parkinson’s and stroke.
Adolescence can be a particularly turbulent period of devel-
opment for some without the presence of serious parental ill-
ness. This only reiterates the importance of ensuring that young
people confronted with parental illness receive the support that
many are likely t o requir e.
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