Depressive episodes involving depressed mood symptoms

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Exercise: Camila’s Case

Symptoms and Diagnostic Considerations

Camila is a 17-year-old who identifies as non-binary and uses she/her pronouns. Camila presents with several concerning signs and symptoms that support a possible diagnosis of Major Depressive Disorder (MDD). According to the DSM-5, a major depressive episode must involve symptoms such as depressed mood, diminished interest in tasks, notable shifts in eating or weight, sleeplessness, fatigue, low self-esteem, trouble focusing, and frequent suicidal ideas, all of which have been present almost daily for no fewer than two weeks and indicate an alteration from prior functioning (Durand et al., 2019). Camila has been crying herself to sleep, feeling unworthy, disinterested in her goals, struggling to eat, and experiencing suicidal thoughts, though with no current plan or means. These symptoms indicate a severe disturbance in mood, energy, and functioning.

Additionally, in teenagers, depression is manifested in different ways compared to adults, and the most common signs are irritability and social withdrawal (Sue et al., 2022). In the case of Camila, the lack of motivation for college and alienation from the family indicate general mood dysfunction. The argument in favor of MDD is enhanced by the fact that the symptoms have been experienced for over two months. Adolescent depression is strongly related to suicidal thoughts and may be triggered by acute interpersonal loss, like her being rejected and then betrayed by her best friend. Considering the symptoms and their effects on Camila, including motivation to perform academically, social performance, and emotional status, the diagnosis of Major Depressive Disorder, moderate severity, single episode, is indicated. The lack of mania or hypomania excludes bipolar spectrum disorders. She has passive suicidal ideation, which contributes to the exigency of intervention.

Psychosocial Factors Impacting Camila

The psychosocial environment affects Camila in the center of the occurrence and sustainability of her distress. Family invalidation is one of the most noticeable ones. Her mother and her grandmother downplay her emotional needs as drama and focus more on her academic achievements rather than her emotional well-being. This dismissive attitude leads to emotional unsupportiveness, which is an established risk factor for developing depression in adolescents (Sue et al., 2022). Camila also complains that she is ignored when she needs to feel accepted, and this is the root of self-states of worthlessness. MDD is well documented to be worthless (Durand et al., 2019). Other significant psychosocial variables include romantic disappointment and peer betrayal, as in the case of adolescent identity formation. According to the literature, social rejection and loss of close relationships with peers are strong triggers of depressive episodes and suicidal behavior in adolescents (Sue et al., 2022). Camila’s betrayal by her best friend and rejection by her prom date appear to be salient precipitating stressors.

In addition, Camila’s non-binary and multicultural cultural identity is likely to increase these psychosocial stressors. Minority-gender teenagers are likely to feel stigmatized, confused, or not accepted by peers and family members and, hence, are at increased risk for psychological health problems (Sue et al., 2022). Additionally, with her father incarcerated, Camila may be carrying the emotional burdens of family instability and unresolved trauma that could affect her internal working model of safety and belonging. Such psychosocial mechanisms, invalidation of feelings at home, social loss, potential stress associated with identity, and the breaking up of the family all enhance her emotional susceptibility and increase her vulnerability to depression and suicidal ideation.

Recommendations for Assessment: Columbia Suicide Severity Rating Scale (C-SSRS)

In order to be able to determine severity and risk based on Camila’s suicidal thoughts, the Columbia Suicide Severity Rating Scale (C-SSRS) is a valid, evidence-based assessment measure that is most appropriate to be employed here. The C-SSRS assesses suicidal ideation, level of intensity, behavior, and lethality of attempts, and is necessary information with which to make treatment decisions (Brown et al., 2020). It distinguishes between active ideation and passive suicidal ideation, for example, not wanting to live, and assesses preparatory behavior, for example, engaging in preparatory behaviors such as giving away belongings. The C-SSRS would be useful in the case of Camila to establish whether she is developing suicidal ideation or if protective factors remain. She has stated that she feels worthless, though she lacks a plan or a way at present; thus, constant monitoring is necessary to determine whether there will be any changes in the level of her thoughts. The Such denotes her willingness that a school counselor or a licensed therapist is able to apply C-SSRS in a caring and organized way. Besides the C-SSRS, a clinical interview would add more data about her mood, thinking, and safety risk, either the Structured Clinical Interview for DSM-5 (SCID) or mental status exam. The condition of Camila should also be monitored regularly, given that teenagers tend to underreport suicidal intent during the early stages.

Strengths and Protective Factors in Camila’s Life

Despite her distress, Camila possesses several internal and external strengths that may support recovery. She is academically capable, maintains a B+ average, and has professional aspirations to become a veterinarian. This goal orientation is a sign of future orientation and purpose, which are protective against suicide and chronic depression. Camila also volunteers at the Boys and Girls Club. This practice suggests her prosocialism, empathy, and altruism skills. Empathy and altruism lead to resilience and provide positive points of social interaction (Durand et al., 2019). Camila is also employed part-time in a pet shop, which provides structure, responsibility, and a chance of personal efficacy. This indicates her feeling of responsibility, time, and perseverance.

Moreover, consulting the school counselor is an expressive agency. This implies that Camila has not lost her knowledge of her condition and can even request help if necessary. Coping skills, positive identity strength, and connection to the community are some of the core strengths that can be used as a buffer against depression using the resilience model. Helping Camila acknowledge and draw on these strengths, such as her animal affection, community focus, and drive, will likely enhance hope and self-worth. These may be supplemented by cognitive behavior therapy (CBT), which has been demonstrated to affect thought patterns and the emotional brain (Durand et al., 2019). Strengths-based CBT is a particularly promising intervention that can be used to enhance Camila’s strengths.

Recommended Clinical and Supportive Interventions

Because Camila is currently receiving attention from school counseling and home, it is necessary to have a well-planned, inclusive care plan with multiple steps. First, a safety plan, ideally with a no-suicide contract, removal of suicide means, and support options readily available, must be developed immediately. If Camila begins to exhibit a suicide plan or intent, she needs to be referred for crisis intervention services. Second, Camila can also be provided with one-on-one treatment by a therapist who is trained in the mental health aspects of both adolescents and LGBTQ+ individuals. Such evidence-based treatments as CBT and Dialectical Behavior Therapy (DBT) have proven to decrease depressive symptoms and suicidal thoughts in adolescents (Sue et al., 2022). Third, Camila can be referred to the community agencies, including the LGBTQ+ youth agencies, where she can find her identity in a secure and non-judgmental environment. Multicultural support services could also assist her in coping with cultural stressors that are based on her identity, family, or origins.

Fourth, there should be family counseling. The goal is to create an environment of emotional validation and authentic communication. Family therapy can help better understand the condition and its trigger thresholds (Durand et al., 2019). Family systems therapy can help Camila’s mother and grandmother better understand the importance of their emotional support compared to academic motivation. Their inclusion in her healing would alleviate the tension in the house and improve Camila’s feeling of safety. Lastly, school-based interventions must be kept active. To minimize academic stress, a social worker or a school psychologist can coordinate accommodations at school, including a longer time frame or tutoring. Isolation may also be decreased by initiating group therapy or peer mentoring programs, which will help a person feel a part of a community.

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