Depression in Teens in Care: What Families Need to Know

Parenting teenagers can often trigger memories of growing up and the roller coaster ride of emotions, drama, unpredictability, and the need to fit in. You may realize that being a teenager today is more complicated than ever due to the steady stream of social media in all its various forms.

As the parent or caregiver of a teen in foster, kinship, or adoptive care, your role has become even more challenging as you need to keep in mind the extra layers of teen emotions and identity issues that come with their history and experiences. You may wonder what is considered typical teenage behavior and what requires more immediate attention. This tip sheet focuses on whether your teen may be going through a temporary phase or, instead, may be struggling with depression.

According to the American Psychological Association, approximately 20% of teens will experience at least one depressive episode before they graduate from high school. After age 16, girls are significantly more likely to be diagnosed with depression than boys. However, it is important to note that these figures may not tell the whole story. Because of societal expectations, boys often feel less comfortable reporting feelings of vulnerability. Instead, they may channel their depression into frustration, irritability, or social detachment, making it harder for parents and professionals to recognize their underlying emotional struggle.

Teen depression is widespread among all teenagers. However, youth who have experienced multiple losses, transitions, or trauma — as many teens in foster, kinship, or adoptive care have — are more vulnerable to depression. Moreover, questions about identity, belonging, and history can weigh heavily on teens in care. They might struggle with who they are and where they fit in.

How is Depression Defined?

Depression is generally categorized under three main types: dysthymic disorder (mild depression), major depressive disorder (also called clinical or unipolar depression), and bipolar disorder (which used to be called manic depression).

As a parent, recognize that depression—no matter the severity—can be emotionally disruptive to a teen and your family and that there are professionals available to help you sort out treatment options.

When to Be Concerned: Typical Teen Behavior vs. Depression

All teenagers experience difficult emotions — moodiness, irritability, pulling away from family, and intense reactions to everyday situations are a normal part of adolescent development. The key difference between typical teen angst and depression is often duration, intensity, and impact on daily life. Typical moodiness tends to be situational — it flares around specific events and eases with time. Depression is more persistent. Signs that may indicate a teen is struggling beyond normal adolescent moodiness include:

• Sadness, emptiness, or hopelessness that lasts most of the day, nearly every day, for two weeks or more
• Withdrawal from friends, family, and activities they used to enjoy
• Significant changes in sleep — sleeping too much or too little
• Changes in appetite or weight
• Difficulty concentrating, making decisions, or remembering things
• Expressions of worthlessness, guilt, or hopelessness about the future
• Talking about death or suicide, or engaging in self-harm

For teens who have experienced trauma, loss, or instability — as many youth in foster, kinship, or adoptive care have — these signs can sometimes be harder to recognize, as they may overlap with grief responses or trauma reactions. When in doubt, trust your instincts and consult a professional.

Potential Risk Factors

Teen depression does not generally develop from one single occurrence—often, there are several risk factors. They’re more evident in teens who have encountered trauma in childhood, such as physical and/or sexual abuse or having an unstable or absent caregiver. Other risk factors include:

• The break-up of a romantic relationship
• Hormonal changes
• Being bullied at school
• Substance abuse
• Having a learning disorder or a family history of depression
• Feelings of rejection and abandonment
• Difficulty with self-identity

Ways to Help Your Teen with Depression

Mental Health America reports that “6 out of 10 young people who have depression and who are most at risk of suicidal thoughts, difficulty in school, and difficulty in relationships with others do not get the treatment needed to support them.” If you have concerns, share your thoughts with your teen, identify some of the risk factors you see, and encourage them to talk about it.

General guidelines to consider:

• Offer support and reassurance: Communicate that you are here for them no matter what and that you love them unconditionally. Try not to ask too many questions, but make it clear that you want to see them get the help they need.
• Be gentle but persistent: Try not to force the issue, but don’t give up if your teens shut down when you talk with them. They may not be willing to open up about their feelings, and they may not feel comfortable admitting that they are feeling depressed. Offer support and encouragement.
• Listen without judgment: When your child starts to open up, hold back on criticism and don’t offer too much advice.
• Validate feelings: Refrain from playing “the therapist” by trying to talk about possible reasons for their depression. Instead, validate their feelings by acknowledging their sadness and pain.

As the parent or caregiver of a teen in care, you may also want to ask yourself some additional questions and consider how their history and experiences in care might also be affecting their mood.

Questions to think about and help initiate conversation:

• Family history: Do any birth or biological family members have a history of depression?
• Past health concerns: Has your teen ever experienced a long-term illness or disability, whether physical or mental?
• Previous issues: Were there previous difficulties at home, in past placements, at school, or with friends?
• History of abuse: Has my teen ever been the victim of, or a witness to, any violence or abuse?
• Unresolved questions about their history and identity:
  • Do they have unanswered questions about why they entered care, were placed for adoption, or moved between homes?
  • Do they have questions about their birth family — who they are, where they are, or why things happened the way they did?
  • Are they struggling with their identity — trying to figure out who they are and where they belong?
  • Are they struggling with loyalty — feeling torn between love for their birth family and their current family? Are they worried about siblings in different placements?
  • Do they feel secure and settled in your home, or do they fear that things could change again?

These questions will hopefully provide some awareness of and sensitivity towards the impact a teen’s history in care may be having on their emotional wellbeing, in addition to all the other factors listed above that may contribute to depression.

Next Steps

Talking to your teens is only the first step in helping them with depression. Treatment is also available. Often, therapy and medication together are the most effective treatments. The tips on page three are also practical resources.

The treatment process may sometimes feel overwhelming and frustrating, but this is normal. Recovery can be unpredictable but don’t give up. The difference between a challenge and an opportunity is often in your perspective—you might find that working together will help you get closer to each other.