Tired all the time: Fatigue in adolescents with depression

Fatigue is an extreme state of tiredness or exhaustion and can be felt both physically and mentally. Fatigue is a relatively common experience in adolescence, which is the period between childhood and adulthood (usually 10 to 19 years old). However, when feelings of fatigue linger and continue for a long period of time, it can become highly disabling and can get in the way of living life to the fullest.

Depression frequently starts during adolescence, and fatigue is one of the nine main symptoms. Previous research has found that many adolescents with depression also report problematic fatigue. Whilst mental health professionals working with adolescents recognise the importance of fatigue on mental health, it is often not addressed or treated.

To-date, minimal research has focused on fatigue in adolescents with depression, meaning that there are lots of unanswered questions. Therefore, the main aim of this research is to further our understanding of fatigue as a common symptom of adolescent depression. To do this, we will be answering the following research questions:

1. How is fatigue experienced by adolescents with depression?

2. How do we measure fatigue in adolescents with depression?

3. Do current treatment for depression in adolescents address fatigue?

4. What interventions and techniques are helpful for addressing adolescent fatigue?

To answer these questions, I plan to do 4 studies:

Study One will address the first research question by exploring how adolescents with depression experience fatigue and what can be done to help. This will be a qualitative study, with data collected through semi-structured interviews and analysed using either Thematic Analysis or Interpretative Phenomenological Analysis. Participants will be adolescents aged 11-18 years old, who will be recruited through Child and Adolescent Mental Health Services and charities specialising in adolescent mental health.

Study Two will look at how fatigue in adolescent depression can best be measured. We will either develop a new scale for adolescents or will attempt to validate an existing scale that is currently used to measure fatigue in adults. This revised measure will then be tested with a sample of adolescents and young adults at the university. A psychometric analysis will be used to assess the reliability and validity of the measure.

Study Three will address whether current treatments used for adolescent depression also treat fatigue. This will be done in collaboration with researchers from the IMPACT study (Goodyer et al., 2017), which is a large-scale randomised controlled trial of psychosocial treatments for adolescent depression. I will conduct a secondary analysis of the data from this study, and will see if levels of fatigue change throughout treatment, and if this change is different depending on what treatment is received (including Cognitive Behavioural Therapy [CBT], psychodynamic psychotherapy, and a brief psychological intervention).

Study Four will be a systematic review, which will pool all the existing evidence about how effective interventions for adolescent fatigue are, with a focus on identifying the behaviour change techniques used. This will address the final research question.

Fatigue in adolescent depression is an under-researched area, so the work produced from this research will address an important gap in current knowledge. It is anticipated that the findings from these studies will be used to inform future research and clinical practice, and lead to better treatment for those adolescents who have depression and problematic fatigue.