Revista Adolescência e Saúde

INTRODUCTION

Adolescence is the period of transition between childhood and adulthood that is characterized by the need for social integration, the search for self-affirmation and individual independence, as well as the consolidation of sexual identity and emotions in conflict¹.

It can be considered as a period of great learning of norms, social and moral concepts, although sometimes they are violated by the limits of experimentation². If the conflicts of this phase are wrong, it can contribute to the emergence of mood disorder and in particular depression³. Depression is a mental disorder that is commonly found in the general population, with future prospects of being the leading cause of mental disability in the world in 2030⁴.

It is expected that by 2020 depression scope the second place in the ranking of the main diseases, affecting about 121 million people in the world, without distinction of race or sex. In the worst case, depression can lead to suicide⁴. The phenomenon in question can affect people at any stage of life, however, there is a significant increase in this disorder in adolescence and an indicative is in early adulthood, more common in women⁵.

Depressive disorder in adolescence tends to have long duration and recurrence, producing longer social and occupational dysfunction and may involve a high degree of morbidity and mortality ⁶. Depression in adolescents has a significant impact on school performance, which may impair concentration and cognitive performanc⁷. Depression in this age group is also associated with suicide attempts and the use of alcohol and other drugs².

Depression in adolescence has characteristics such as emotional instability, irritability, tantrums, outbursts and other behavioral changes⁸. In recent years, researches have appointed the significant presence of more and more adolescents with an average age of 16 years with depressive symptoms, currently considered the most common disease in adolescence, has been reported⁷.

Research on depressive symptomatology in adolescents is relevant insofar as they can propose alternatives for prevention, early detection, evaluation and intervention, effective for the management of such clinical symptoms in an age group that is, evidently, vulnerable to it. This article aims to verify the symptoms of depression among adolescent students of public schools.


METHODOLOGY

This study is part of the Project Use of Drugs in Adolescents of the public education network of the city of Montes Claros-MG: a population-based study. This is a cross-sectional study, of the epidemiological type, carried out with high school students from the urban area of the Municipality of Montes Claros (MG). The city of Montes Claros has 38 units of public schools in the state education system, stratified according to the list provided by the Ministry of Education in September 2016 and has 13.104 students enrolled in 2017.

The sample was defined by sample calculation finite population, considering the prevalence of the event of interest at 50% confidence level 95% margin of error of 5% confidence level 95%, Deff = 2 and an increase of 10% to compensate for possible losses. The selection of the sample was of the probabilistic type by conglomerates in two stages, being the first constituted by the schools and the second by the classes of the selected schools. In the first stage, the schools were selected by probabilistic sampling proportional to the size (PPT). In the second stage, a sample of the fraction of classes in each school was selected drawn by simple random sampling, stratified and in turn (morning, afternoon and night) and year of schooling (1^st, 2^nd and 3^rd years). The sample fraction was defined after the drawing of schools.

Considering these parameters to guarantee the representativeness of the sample, the need for to include students distributed in 21 schools was verified, with the final sample of 2050 students. Data collection occurred as of May 2017 to March 2018, having scheduled specific days for research in each participating school.

All the students selected by lottery were invited to participate in the research. Students of both sexes aged between 14 and 19 years were included, who were with their registration registers regularized in the State Middle School Network of the City of Montes Claros in 2017/2018. Students who were not in the room were excluded at the time of the application of the questionnaire, those who were not in agreement with the objective of the investigation, those who had the TALE (Free and Cleared Assent Term) not signed by the parents, or with the TCLE (Free Consent Term and Clarified) not signed by the student. A self-administered questionnaire was used to collect data.

After clearing everything about the investigation and submitted the authorization duly signed by parents and/or guardians, students were directed to a room where questionnaires were applied. Questionnaire self applied It was re filled by each teenager individually. During the re filling out the questionnaire, members of the project team were available to assist and answer questions, if necessary. By completing the final questionnaire, students deposit on the questionnaire in the urn.

In the demographic questionnaire, information was obtained regarding sex, age, skin color, marital status, level of education of the father and mother, family structure and family income. It was Adopt a Brazilian version of Inventory Filtration Drug Use (DUSIR), adapted and validated torque Brazil⁹, tackle psychiatric problems such as disorders: Are you restless and can´t sit still? ; You can easily thwarted; Do you have control problems?; Do you feel sad many times? Do you have problems during sleep (nightmares, sleepwalking, etc.)? Are you nervous?; Do you feel easily scared ?; Do you worry too much? Do you feel afraid of being among people? Do you often feel like crying?

The data were analyzed through descriptive statistics (absolute frequency, percentages, and averages). Bivariate analyzes were performed to verify the association between depression symptomatology between sexes by means of the statistical test Chi-square, using the program Statistical Package for Social Science (SPSS), version 17.0. The project of this research was submitted to the appreciation of the Research Ethics Committee of the State University of Montes Claros - Unimontes and it was approve through the resolution No. 2,073,215. All the ethical precepts of resolution 466 of 2012 have been duly respected.


RESULTS

Of the adolescents investigated, 45.8% (n = 937) were male and 54.2% (n = 1109) were female; There was a higher frequency of students in the first year, 40.7% (n = 835), with more students in the morning shift, 90.7% (n = 1859), with brown skin color 58.3% (n=1190) and singles (as) 97.0% (n=1983).

The data in Table 2 point to the prevalence of psychiatric disorders among adolescents: 33.6% reported that they feel agitated and can´t sit still, 39.5% declared that has been easily frustrated, 22.1% have control problems, 46.8% reported being sad many times, 51.4% feel nervous, 17.3% feel easily scared, 68.5% % reported worrying a lot and 24.7% have problems during sleep.




Table 3 compares the depressive symptomatology between the male and female sexes. The bivariate analysis used to compare the depressive symptomatology of adolescents, stratified by gender, presented in Table 3, indicated that depressive symptomatology is greater in females, with a statistically significant difference.




DISCUSSION

Psychiatric disorders are similar at different ages. However, its main characteristic, sadness, can be replaced in adolescents by irritable mood, being common manifestations of instability, anger and explosion¹⁰. This has been evidenced by the results of this investigation, which showed a higher frequency of symptoms such as nervousness, problems of self-control and agitation, which implies that adolescents are more prone to depressive symptoms, as a result of incomplete development¹¹, what constituted a vulnerable period because it represents a phase of emotional reorganization. This vulnerability can hinder the correct diagnosis of depressive disorder, given that adolescence is marked by associated physical, cognitive and psychosocial changes with an emotional instability moment provided time by the Crisis¹².

The results obtained in the present investigation indicated that the depressive symptomatology is greater in the female sex, with a statistically significant difference in all the variables investigated (48.45% reported feeling easily frustrated, 58.73% said they felt sad many times, 61,25 % reported feeling nervous, 79.65% said they worry too much and 69.94% have difficulties to stop thinking about certain things). The study of Coutinho et al.¹³, who evaluated the relationship between depression and the quality of life of adolescents in schools, also pointed out the existence of different symptoms among women and adolescent males, which indicates that girls tend to present more subjective symptoms (depression, anger, loneliness, anguish), more concern with popularity, less satisfaction with the body and low self-esteem. Depressive disorder most often affects female subjects¹⁴ , while children have more behavior problems, substance abuse and feelings of disgust¹³.

Our results have been corroborated by Germain and Mascotte¹⁵ , who found depressive symptoms and anxiety in high school students, also in a higher prevalence in the female sample.

This gender difference manifests first between 11 and 14 years and remains in the course of adult life, which may suggest a determinant role of sex hormones, this being also the explanation for the higher prevalence of insomnia in the female sex. This difference may be associated with a higher intensity of interpersonal relationship it´s female; therefore they feel more interpersonal stress intensity as a threat to their own welfare. Therefore, in situations of conflict, girls experience higher levels of interpersonal stress, are more vulnerable and react more often with stress responses¹⁶.

This interpretation should be cautious; it can translate the increased resistance of children to the expression of symptoms and, in general, the expression of psychological distress, although it proved also higher prevalence of depressive symptoms in the female childs¹⁷.

Our results showed no relationship to a study carried out also in the city of Montes Claros, where 17.1% of respondents reported having episodes of deep sadness and about 10% of thought or plan suicide¹⁸. In the present study, 46.8% reported being sad many times.

In the study of Barros et al.¹⁹ about the social representations of depression in adolescents in the context of secondary education in public and private schools of the city of João Pessoa-PB, in relation to the symptoms of depression, the investigation revealed the social representation of the depression anchored, about everything, in the factors related to sadness and loneliness among adolescents. It was also verified in the students' discourse, commonly followed by crying, an apparent loss of the meaning of life as a sign of a deep sadness, which indicates that depression is the same as a sadness caused by deep existential pains. It is inferred that depression - sadness - loneliness are often presented as symptoms among the knowledge constructed/developed by groups of adolescents¹⁹.

In another survey conducted by Araújo et al.²⁰ held in a public school in the city of João Pessoa (PB) with a sample of adolescents between 14 and 19 years old, adolescents have described depression with the following words and proportions: sadness (20%), loneliness (20%) , discouragement (19%), crying (12%), illness (12%), death (8%), lack of appetite ( 5%) and anguish (4%), which demonstrates the importance of the rapidity of the diagnosis and the beginning of the treatment. In our results was found that 39.5% of adolescents reported "feeling easily frustrated", and 17.3% said they "feel scared easily." Adolescents face several new situations and social pressures that can favor their own conditions to present mood fluctuations and expressive changes in behavior. Some more sensitive and sentimental is s n may have different situations depressive symptoms, which can generates difficulties in social relationships.

There was a lack of attention to child and adolescent mental health. Therefore, the identification of the most prevalent disorders and associated factors can contribute to improving care and increasing the supply of specific services for children and adolescents¹⁹. It should be emphasized the importance of intervention to promote awareness of teachers, parents and students, conducting practice healthy lifestyles and fundamentally a critical look to the behaviors and attitudes of adolescents.


CONCLUSION

The present article evidenced the presence of depressive symptomatology in many adolescents, being higher in the female sex. Thus, future research with the adolescent population should be carried out, in addition to using other instruments that also evaluate these constructs for comparison of results. It is also important to highlight the need for new research on the understanding of depressive symptoms in adolescents, in order to enable ways of prevention and intervention in them.


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