Depression in young people.

Depression rates in young people have risen sharply in the past decade, especially in females, which is of concern because adolescence is a period of rapid social, emotional, and cognitive development and key life transitions. Adverse outcomes associated with depression in young people include depression recurrence; the onset of other psychiatric disorders; and wider, protracted impairments in interpersonal, social, educational, and occupational functioning. Thus, prevention and early intervention for depression in young people are priorities. Preventive and early intervention strategies typically target predisposing factors, antecedents, and symptoms of depression. Young people who have a family history of depression, exposure to social stressors (eg, bullying, discordant relationships, or stressful life events), and belong to certain subgroups (eg, having a chronic physical health problem or being a sexual minority) are at especially high risk of depression. Clinical antecedents include depressive symptoms, anxiety, and irritability. Evidence favours indicated prevention and targeted prevention to universal prevention. Emerging school-based and community-based social interventions show some promise. Depression is highly heterogeneous; therefore, a stepwise treatment approach is recommended, starting with brief psychosocial interventions, then a specific psychological therapy, and then an antidepressant medication.

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Declaration of interests AT receives a salary from Cardiff University; honoraria that go to Cardiff University from speaker contributions to international scientific meetings, from Wellcome Trust for serving on an interview panel, and from Wiley for textbook royalties; research grant funding to her university from Wolfson Foundation, Wellcome Trust, and Medical Research Council (MRC); and serves on the board of the UK charity ADHD Foundation (unpaid). VP reports personal fees from Johnson and Johnson and Librum; current grants from the National Institute of Mental Health (NIMH), Grand Challenges Canada, MRC, and Wellcome Trust; and serves as an adviser to Modern Health. DB reports grants from NIMH, American Foundation for Suicide Prevention (ASFP), Once Upon a Time Foundation, and Beckwith Foundation; royalties from eResearch Technology, UptoDate, Guilford Press, and Healthwise; honorarium for membership on the Scientific Advisory Board of the Klingenstein Third Generation Foundation and AFSP, outside the submitted work; and intellectual property, currently with no financial interest, supported by funding from NIMH for the development of BRITE (a safety planning web-based mobile application), the As Safe As Possible intervention (a brief intervention for suicidal youth), the Computerized Adaptive Screen for Suicidal Youth measure (ie, a screen designed to estimate the risk for a suicide attempt in the subsequent 3 months), a suicide risk machine learning algorithm (for which DB has also received funding from the Beckwith Institute), and the Screening Wizard screening tool (ie, a support tool for primary care physicians to aid in assessment and referral of patients who screen positive for depression and suicidal risk). OE receives a salary from Cardiff University, funded by Wolfson Foundation.