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Frida E. Trueba
Professor Olson
Psych 373-007
05 April 2023

Case Study 1 Paper

For this case study, the subject was a 15 year old Latina female named Lisa who

complained of irritability, lack of interests in activities she used to enjoy, difficulty sleeping,

body aches and pains, unintentional weight loss and feelings of hopelessness.When it comes to

who referred her to be seen, it was Lisa herself who asked her mom to see a therapist as a result

of her symptoms. Based on the information provided in her case, Lisa fits the criteria for Major

Depressive Disorder and her treatment should reflect as such.

Diagnosis

Accroding to the Diagnostic and statistical manual of mental health disorders (2013),

adolescents who have Major Depressive Disorder (MDD) meet the criteria of someone who

displays five or more of the following symptoms during the same two week period and represent

a change from previous functioning; at least one of the symptoms is either depressed mood or

loss of interest or pleasure: Depressed mood for the majority of the day everyday, diminished

interest in or pleasure in almost all activities for the majority of the day everyday, significant

unintentional weight loss, insomnia or hyper insomnia nearly everyday, feelings of worthlessness

or inappropriate guilt, suicidal ideation with or without a plan, diminished ability to concentrate,

and psychomotor agitation nearly everyday fatigue or loss of energy everyday. The symptoms

that the individual displays must also cause them significant distress in social and occupational

contexts like school and work for example (5th ed.; DSM–5; American Psychiatric Association,
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2013). When it comes to Lisa, she shows symptoms of MDD due to her suicidal thoughts and the

plan she has made but not acted upon, her reported feelings of hopelessness, unintentional

weightloss, her significant weightloss when not dieting, and disturbances in sleeping habits that

have been present for approximately four months. As previously mentioned, these symptoms can

also affect other areas of functioning and can cause impairments and Lisa’s functioning in school

was impaired as she went from being a straight A student to getting Cs and Ds. As a result of

these impairments and the symptoms that she’s expressing, Lisa would be considered a good

candidate for MDD.

A differential diagnosis that could be considered for Lisa would be Persistent Depressive

Disorder. However, based on the given information and the symptoms present, it can be said that

Lisa doesn't fit the criteria for this diagnosis. For one, according to the report, Lisa’s symptoms

have been present for four months, not for at least 1 year which is the amount of time that her

symptoms should be present in order for her to fit the basic criteria for PDD. The diagnosis of

MDD is the better fit for Lisa’s case as her symptoms and what she’s experiencing is better

explained by it. To further confirm that Lisa has MDD, she would need to be assessed in a way

that explores whether or not she has experienced a manic episode during the last four months as

part of the diagnostic criteria for MDD is that there has never been an experience of a manic or

hypomanic episode (5th ed.; DSM–5; American Psychiatric Association, 2013).

Epidemiology

Epidemiology is the study of the prevalence of a certain health related state in

psychology. In terms of what the epidemiology of MDD looks like in adolescents, MDD is

prevalent in approximately 2-8% of all youths ranging from four to eighteen years old (Mash &
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Wolfe, 2019). Now when it comes to gender differences for teens around Lisa’s age, it’s been

found that girls are at a higher rate of being clinically depressed than boys as girls report feelings

of worthlessness and weight loss/gain more than boys (Lewinsohn et al., 2003). In fact, when

comparing data from 2009 and 2019 about depression among boys and girls, a study found that

depression levels among female participants increased from 11.4% to 23.4% respectively (Daly,

2022). What this shows is that the rate of depression has continuously increased throughout the

years among adolescent girls regardless of race, ethnicity, and income. When looking at

epidemiology it’s also important to note the prevalence to the client’s ethnicity or race and, in a

study done by Menselson and colleagues (2008), they found that Latinos showed higher levels of

depressive symptoms compared to non-Latino whites. What this information conveys in this case

is that someone like Lisa, whose ethnic identity is Latina, is more at a risk of developing

depression than the rest of her peers.

Etiology

Etiology are the possible causes or risk factors that could contribute to someone

developing a certain disorder. There are different possible biological, environmental, and

psychological risk factors that could’ve made Lisa more vulnerable to developing MDD. When it

comes to the possible biological risk factors of MDD, there can be interactions between genetic

and environmental factors that can increase an individual's risk for MDD as MDD can be

heritable and interactions with hostile environments can make it more prominent in the

individual's life (Mash & Wolfe, 2019). Those who are children of parents with depression have

three times the risk of developing depression compared to those who don’t have a parent with

psychiatric disorders (Mash & Wolfe, 2019). However, due to not knowing her parents history of
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possible psychiatric disorders, it’s not clear if Lisa was at a greater biological risk of developing

a depressive disorder. Another biological risk factor that could contribute to someone developing

MDD are the possible structural and functional brain abnormalities as those with MDD tend to

have smaller brain volume in the prefrontal cortex and amygdala and abnormally high activation

in amygdala and other regions involved in emotion processing and regulation respectively (Mash

& Wolfe, 2019). Environmental risk factors are those that increase the risk of developing a

psychiatric disorder and a common environmental risk factor can be family dynamics. Although

her family’s history with mental health is unclear, based on the reports it’s clear that Lisa grew

up in a dysfunctional household where her mom was abused when she was about four years old,

which can be an environmental risk factor even at such a young age. Psychological risk factors

are those that impact cognitive, emotional, and behavior aspects of the individual. A cognitive

risk is having negative thoughts about oneself, the world, and the future. This applies to Lisa’s

case as she had negative perceptions of herself as she reported feelings of hopelessness and has

thought about suicide several times.

Social risk factors for MDD can be peer relationship difficulties and the state of

parent-child relationships. In terms of peer relationship difficulties, the most difficult peer

relationship that Lisa has recently dealt with was her break up with her boyfriend as that is when

her symptoms became worse. When it comes to parent-child relationships, as previously

mentioned, children with depressed parents are at a higher risk for different psychiatric problems.

In a study done by Chen and colleagues (2023), they found that family violence increased the

incidence of depressive symptoms in adolescents. Although her mother’s history of mental

health is unknown, there is a possibility that her mother may have also suffered from some form
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of depression as a result of the abuse that she went through. All of these risk factors relate to Lisa

as she spent four years of her life witnessing the abuse her mother went through, she reported

that after her recent breakup that her symptoms got worse, and it was also reported that her father

has been absent for most of her life. His absence connects to attachment theory and depression as

an article by Spruit et al. (2020) noted that “repeated experiences of unavailability of the

caregiver could lead to dysfunctional cognitions about the self” and that insecure attachment can

be an increased risk factor of depression. Also, in a study about father absence and its impacts on

their children’s mental health done by Culpin and colleagues (2022), they found that girls whose

fathers were absent in early childhood had higher depressive symptoms trajectories throughout

adolescence which supports the idea of how the absence of Lisa’s father has had an influence on

her mental health and her attachment style as an adolescent.

Something that may need to be further assessed in Lisa’s case is her dislike for her sister

and that her mother was abused by her father. For the dislike for her sister, Lisa should be

consulted more on why she dislikes her as it doesn’t seem to be something that has been looked

into more in depth. Discussing this with Lisa will allow for a better understanding of her

diagnosis which can assist in the treatment process. In terms of the abuse that her mother

endured, Lisa’s mother should be consulted separately in order to discuss what she went through

with her husband to gain a better understanding of the extent of the possible genetic and

environmental risk factors that Lisa may have been exposed to.

Treatment

In terms of what Lisa should do for treatment, it’s best if she gets cognitive behavioral

therapy and is put on antidepressant medication. Cognitive behavioral therapy teaches

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adolescents how their thinking can contribute to their psychiatric disorder and how they can

modify their thoughts in a way that decreases their symptoms (Mash & Wolfe, 2019). In a study

done by Whelen and Strunk (2021), they found that CBT for depression can contribute to

changes in negative affect that an individual is facing. Negative affect is the experience of

negative emotions and is related to a hindrance on neural responses to rewards while positive

affect has to do with positive emotions and can actually increase resilience to depressive

symptoms (Whelen & Strunk, 2021). What this means is that those with depression present with

low positive affect and high negative affect and that CBT allows for the decrease in negative

affect to occur which can lead the individual to develop a better sense of self. In regards to

antidepressant medication, they allow for those with depression to experience shorter depressive

episodes and the use of selective serotonin reuptake inhibitors (SSRIs), a type of antidepressant,

that increases serotonin in the brain and block the reuptake of serotonin in the neurons thus

helping increase feelings of happiness and satisfaction in the individual as well (Whelen &

Strunk, 2021).

This combination of treatment will work best in getting the most effective results for Lisa

as CBT will help her to modify her negative thoughts and perceptions about herself and others

and the medication will help reduce symptoms and shorten the depressive episodes; it’s also

important to note that studies have found that combined treatment works best rather than singular

(March, 2010). Additionally, when it comes to pursuing CBT, although any therapist can be

beneficial in helping Lisa with her MDD, treatment would be more effective if her therapist was

of a similar cultural background. According to an article by Alejandro Interian and Angelica

Diaz-Martinez (2007), the best CBT that Lisa should get should be culturally competent meaning
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that it would probably be best if she meets with a therapist that comes from a similar background

or is bilingual as it can improve treatment outcomes and inhibit her from stopping treatment

The sequence of the treatment should start with CBT first before adding the medication

as it’s important to see how Lisa improves with therapy first before deciding what kind of

medication she should possibly pursue if needed. Also, although Lisa has mentioned her suicidal

ideations, she advocated for herself and told her mom that she wanted to seek treatment. Her

motivation to seek treatment is considered a protective factor in allowing her to complete her

goals for treatment. Another protective factor is the parental support that she has as her mom

agreed to assist Lisa in finding help which is beneficial when going through treatment as it can

motivate the individual to continue treatment. Some potential barriers that might hinder these

treatment goals can be her use of alcohol and marijuana as they can negatively interact with her

medication and it can possibly lead to a feeling of dependence on those substances as she

reported that she used them 1-2 times a week to help her feel better. Another potential barrier

could be cost and access to a good therapist as, although the income of Lisa’s family is unknown,

potential cost and having proper access to a therapist are common barriers to receiving effective

treatment.
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References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders

(5th ed.). https://doi.org/10.1176/appi.books.9780890425596

Chen, Q., Song, Y., Huang, Y., & Li, C. (2023). The interactive effects of family violence and

peer support on adolescent depressive symptoms: The mediating role of cognitive

vulnerabilities. Journal of Affective Disorders, 323, 524–533.

https://doi-org.proxy.lib.umich.edu/10.1016/j.jad.2022.11.080

Cobb, C. L., & Martínez, C. R., Jr. (2023). Trajectories of depression for Latino immigrant

adolescents: The influence of individual, family, and sociocultural factors. Journal of

Psychopathology and Clinical Science, 132(1), 1–12.

https://doi-org.proxy.lib.umich.edu/10.1037/abn0000798.supp (Supplemental)

​Culpin, I., Heuvelman, H., Rai, D., Pearson, R. M., Joinson, C., Heron, J., Evans, J., & Kwong,

A. S. F. (2022). Father absence and trajectories of offspring mental health across

adolescence and young adulthood: Findings from a UK-birth cohort. Journal of Affective

Disorders, 314, 150–159. https://doi-org.proxy.lib.umich.edu/10.1016/j.jad.2022.07.016

Daly, M. (2022). Prevalence of depression among adolescents in the US from 2009 to 2019:

Analysis of trends by sex, race/ethnicity, and income. Journal of Adolescent Health,

70(3), 496–499. https://doi-org.proxy.lib.umich.edu/10.1016/j.jadohealth.2021.08.026

Interian, A., & Díaz-Martínez, A. M. (2007). Considerations for culturally competent

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Lewinsohn, P. M., Pettit, J. W., Joiner Jr., T. E., & Seeley, J. R. (2003). The Symptomatic

Expression of Major Depressive Disorder in Adolescents and Young Adults. Journal of

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adolescents.” Current Opinion in Psychiatry, 23(1), 63–65.

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Mash, E.J., & Wolfe, D.A. (2019). Abnormal Child Psychology (Seventh Edition). Cengage

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Menselson, T., Rehkopf, D. H., & Kubzansky, L. D. (2008). Depression among Latinos in the

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(2020). The relation between attachment and depression in children and adolescents: A

multilevel meta-analysis. Clinical Child and Family Psychology Review, 23(1), 54–69.

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