'Children+Waiting+For+The+Day+They+Feel+Good'+-+The+Salience+of+Depression+in+Adolescence+and+Young+Adulthood

**Student Number:** n6256058 **Tutor:** Judith Meiklejohn **Topic:** "Green, Gold and Blue: How Well Does Australia Deal With Mental Health in 2011?"
 * Name:** Madeleine Purdon

**Cultural** **Artefact**

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“Mad World”, originally composed in 1982 by the band ‘Tears for Fears’, has been subject to numerous interpretations, over the decades. This particular version was composed by the Brisbane-based orchestral rock band ‘the Red Paintings’, and was released on their 2005 Extended Play, ‘Walls’. The Red Painting’s “Mad World” is an exceptionally dark adaptation of an already morose piece, effectively encapsulating the nature of depression.

**Public Health Issue**

Depression has been defined as the presentation of depressed mood, low self-worth and the loss of interest and pleasure where it was previously found (World Health Organisation, 2011). Additional symptoms include restlessness, unsociability, and increased mental and physical fatigue (Beyond Blue, 2006), and thus, the impairment of physical, cognitive and social processes (Berndt, Koran, Finkelstein, Glenberg, Kornstein, Miller, Thase, Trapp & Keller, 2000). As of 2007, approximately 45% of Australians aged 16 – 85 (7.5 million people) were reported to suffer from a life-time mental disorder – 20% of whom had experienced symptoms of their illness in the previous year (Australian Bureau of Statistics [ABS], 2009). Of these recent cases, 6.2% had suffered an affective disorder, including dysthymia (depressed mood of a lower severity, but for a longer duration) and depression (ABS, 2009). Depression has been associated with increased mortality rates in physical disease (Jiang, Alexander, Christopher, Kuchibhatla, Gaulden, Cuffe, Blazing, Davenport, Califf, Krishnan & O’Connor, 2001), as well as self-injury and suicide (Skegg, 2005), the severity of these consequences highlighting the salience of mental health.

**Literature Review**

At the turn of the millennium, depression was ranked as the fourth highest contributor to the total global burden of disease, with a jump to second place anticipated by the year 2020 (World Health Organisation, 2011). By 2030, depression is predicted to surpass all other ailments as the leading cause of disability, internationally (Black Dog Institute, 2011), emphasising the urgency of this issue.

In 1996, mental illness accounted for approximately 30% of Australia’s non-fatal burden of disease, with the highest rate of Years of Life Lost to Disability (YLD) of any condition (Mathers, Vos, Stevenson & Begg, 2001). Depression, specifically, was found to be highly disabling, constituting 6.2% of total YLD in men and 9.8% in women – this was almost double the contribution of male heart disease, and triple that of stroke in women (Mathers, et al., 2001). Over a decade later, in 2010, the contribution of depression to Australia’s overall disease burden had decreased to 13%, suggesting an improvement in our mental health status (Australian Institute of Health and Welfare [AIHW], 2010). This could be attributed to several factors, including the documented improvements made by health professionals in the treatment and prevention of chronic disease, including depression (AIHW, 2010); however, as is highlighted by the aforementioned 7.5 million Australian sufferers, as well as the World Health Organisation and the Black Dog Institute’s projections, there is still much room for improvement in Australia’s mental health management.

Australia’s youth, in particular, is a demographic in need of attention. Adolescents and young adults aged 16 – 24 compromised 26% of those whom had experienced an episode of mental disorder in the past year, as previously mentioned - this is the highest rate of any age group. This bracket was also found to have the greatest prevalence of substance use disorders, with 13% presenting problematic drug and alcohol habits (ABS, 2009). Given the finding that mental illness can predict increased use of addictive substances (Saffer & Dave, 2005), it could be suggested that a correlation exists between the presentation rates of mental disorders and substance abuse. Depressed adolescents have also been found to present as “troubled youths” more frequently than those without depression (Keyes, 2006), which may be associated with the wide acceptance amongst the general population of a connection between drug use and delinquency, despite the causal fallacy (National Institute on Drug Abuse, 2011).

Furthermore, it has been suggested that the state of one’s mental health during adolescence and young adulthood can have significant implications for one’s future wellbeing (Fergusson, Boden & Horwood, 2007). Research has suggested that adults whom have suffered mood disorders in childhood are at greater risk of suffering anxiety, depression and suicidality (Fergusson & Woodward, 2002). An association between depression in youths and adverse environmental factors (such as harmful familial situations) has also been observed (Fergusson & Woodward, 2002). Such environments have previously been linked with unemployment and unhealthy coping strategies (such as smoking, alcoholism and self-harm) (Fergusson & Woodward, 2002), which, again, present health risks of their own.

Given the cognitive and socially limiting effects of depression, it is also no surprise that educational outcomes can be negatively affected by poor mental health during schooling years (DeRoma, Leach & Leverett, 2009; Hysenbegasi, Hass & Rowland, 2005). Particularly in women, consequential low academic achievement can minimise one’s potential for ‘human capital’ (that is, the ability to produce fiscal value) (Berndt, et al., 2000). This presents a barrier to health in itself, as low socio-economic status and financial struggle have been identified as risk factors of developing depression (Lorant, Croux, Weich, Deliège, Mackenbach & Ansseau, 2007), illustrating the potentially cyclic effect of mental illness.

This is not to say that suffering depression during adolescence and young adulthood will undoubtedly beget low achievement, however. Though a negative correlation between depression and academic achievement has been identified, according to DeRoma, Leach & Leverett (2009), the severity of depressive symptoms does not predict achievement levels. North American college students suffering severe depression were found to have similar (if not better) grade point averages than those of their peers whom presented mild to moderate symptoms (DeRoma, et al., 2009), perhaps highlighting the significance of individual traits when comparing mood and achievement. However, nonetheless, it is clear that one’s mental health during adolescence and young adulthood can have a significant impact upon one’s quality of later life.

Self-harm and suicide, in particular, are grievous and extreme potential consequences of depression (Skegg, 2005). In 2005-06, there were 8,040 hospitalisations for self-inflicted injuries reported amongst Australians aged 15 – 24 (392 females and 294 males per 100,000 people) (ABS, 2008). Of course, these figures may not be truly representative of the wider population, as not all cases of self-harm will result in hospitalisation, or necessarily be reported at all (ABS, 2008). In the same year, 266 instancesof successful suicide by Australians aged 15 – 24 were reported, accounting for 20% of all deaths in this age bracket (ABS, 2008). When contrasted against the 1% of total deaths attributed to suicide by those over the age of 25 (ABS, 2008), the magnitude of this issue is exemplified. Considering the variety of health risks depression in youths presents, it is imperative that the mental health of adolescents and young adults receives adequate attention.

**Cultural Theory**

In the last decade, improvements have been observed in the rates of youth suicide and overall mental health. Between the years of 1997 and 2006, the reported instances of suicide by Australians under the age of 25 had approximately halved, decreasing from 525 in 1997 (425 males; 100 females) (Ruzicka & Choi, 1999) to 266 successful attempts in 2006 (ABS, 2008). Though this decrease is potentially due to underreporting, this data may also be indicative of an improvement in the state of young Australians' mental health.

According to the Australian Institute of Health and Welfare (2011), between 2005-06 and 2009-10, the rate of visits to general practitioners regarding mental health issues increased from an estimated 11 million to 13 million (AIHW, 2011). Considering the reduction in suicides, it is one suggestion that increased contact with health professionals has aided in the decrease of suicide in young people, as various therapy methods, such as cognitive therapy (Wellbery, 2006), have been found to reduce suicidal behaviour. This increase in contact may be on account of the overall increase in Australia’s employment of health professionals (ABS, 2001, 2006; cited in AIHW, 2011), but may also reflect a shift in the general population’s attitude towards mental illness, which has previously been recognised as unjustifiably negative and detrimental to health (Sartorius, 2007).

In the past, several factors have been identified as barriers to youths seeking help regarding mental illness, including embarrassment, the desire to be self-sufficient, limited “mental health literacy” and the stigmatisation of the mentally ill (Gulliver, Griffiths & Christensen, 2010; Sartorius, 2007). As such, it could be suggested that technologies such as the internet contribute to the improvement of youths’ mental health, surmounting these obstacles by offering information (and thus, perceived self-sufficiency), entertainment, support networks and anonymity (Bell, 2007). Progressing technology is not without its disadvantages, however. Conversely, excessive internet use may serve to perpetuate isolation and depressed mood (Bell, 2007), which would, of course, detract from the benefits listed.

Though it has been ascertained that suicide will not be the ultimate result of every instance of depression, given their association, Durkheim’s theory of suicide (Durkheim, 1897; cited in Durkheim & Simpson, 1951) could offer some insight into the aforementioned improvements in youths’ mental health. Durkheim (1897) posited that four categories of suicide exist – Egoistic, Altruistic, Anomic and Fatalistic suicides. Egoistic and Altruistic suicides relate to one’s level of social cohesion - Egoistic suicides occurring due to excessive individualism and Altruistic suicides resulting from excessive social integration. Anomic and Fatalistic suicides occur due to extreme levels of social regulation - Anomic suicide resulting from a lack of direction and Fatalistic suicide occurring as a consequence of over-regulation. Durkheimian theory might propose that increased contact with health professionals, as well as the supportive qualities of the internet, may explain a reduction in “Egoistic suicides” (that is, depression as a result of isolation). It might also be suggested that the recent increase in accessibility of information via the internet could reduce “Fatalistic suicides”, increasing the general public’s knowledge (and therefore, autonomy) regarding their mental health.

**Artefact** **Analysis**

Though there have been many interpretations made of “Mad World”, depression has been repeatedly recognised as the song’s overall theme (Blahblahsongs, 2008; LeaTelamon, 2008). Lyrics such as “their tears are filling up their glasses; no expression, no expression,” and “I find it kind of funny, I find it kind of sad; the dreams in which we’re dying are the best I’ve ever had,” effectively express many of the symptoms of depression, as previously detailed. The line “I find it hard to tell you I find it hard to take,” may also be representative of the hesitance many sufferers feel towards seeking help (Gulliver, et al., 2010; Sartorius, 2007). Even the title itself, “Mad World”, may refer to way in which the mentally ill see the world, or possibly, themselves.

Whilst the subject of depression undoubtedly makes the song relatable irrespective of the audience’s age, its original singer, Curt Smith, stated that “it's very much a voyeur's song. It's looking out at a mad world from the eyes of a teenager.” (Smith, 1999; cited in Tears For Fears Unofficial Fan Page, 2010). As such, it is evident that “Mad World” was intended to be of exceptional relevance to adolescent and young adult listeners.

Though “Mad World” has been performed and reinvented by several artists since 1982, lyrically, there has been little deviation from the original. This could simply be interpreted as an appreciation of Roland Orzabal’s (the lyricist’s) work; however, this consistency may also highlight the universality of the themes encapsulated in “Mad World”, resonating across generations.

This particular cover by the Red Paintings has been selected for a variety of reasons. Primarily, given the band’s locality and the cover’s recent release, their interpretation is, arguably, the most likely to represent Australian youths. Moreover, the composition of the Red Paintings’ version is both melancholic and engrossing, not unlike the nature of many mental illnesses (Finke & Bettle, 1996), effectively conveying the original ideas of the song.

Furthermore, in addition to being a ‘cultural artefact’ in itself, the music of The Red Paintings has gone on to inspire the creativity of many of their listeners, generating work that even further embody the culture. The band frequently involves fans in their live performances, whom ‘speed paint’ impromptu art works throughout the show. As seen below, the works produced are highly emotive, capturing the artists’ responses to the music, as well as their individual motifs. Deciphering the complexities of these pieces would require a separate analysis; however, the inspirational qualities of The Red Paintings, as these works illustrate, cement their music as a significant artefact of this culture.





**References**

American Psychological Association. (2011). //Depression//. Retrieved from []

Anonymous, Watson, M., & Red Paintings, (2005). //The red paintings cyber art gallery// [Image], retrieved October 18, 2011, from []

Australian Bureau of Statistics. (2008). //Australian social trends, 2008//. Retrieved from []

Australian Bureau of Statistics. (2009). //National survey of mental health and wellbeing: Summary of results.// Retrieved from []

Australian Institute of Health and Welfare. (2010). The twelfth biennial health report of the Australian Institute of Health and Welfare [Electronic version]. Retrieved from []

Australian Institute of Health and Welfare. (2011). //Health workforce.// Retrieved November 2, 2011 from []

Australian Institute of Health and Welfare. (2011). //Mental health services – In brief 2011.// Retrieved from []

Bell, V. (2007). Online information, extreme communities and internet therapy: Is the internet good for our mental health? //Journal of Mental Health, 16//(4), 445-457. doi: 10.1080/09638230701482378

Berndt, E. R., Koran, L. M., Finkelstein, S. N., Glenberg, A. J., Kornstein, S. G., Miller, I. M., Thase, M. E., Trapp, G. A., & Keller, M. B. (2000). Lost human capital from early-onset chronic depression [Electronic version]. //American Journal of Psychiatry, 157,// 940-947. Retrieved from []

Beyond Blue. (2006). //Depression: Signs and symptoms//. Retrieved from []

Black Dog Institute. (2011). Facts and figures about mental health and mood disorders [Electronic version]. Retrieved from []

Blahblahsongs. (2008, October 07). Tears For Fears: Mad World meaning [Online forum comment]. Retrieved from []

DeRoma, V. M., Leach, J. B., & Leverett, J. P. (2009). The relationship between depression and college academic performance [Electronic version]. //College Student Journal, 43//(2), 325-334. Retrieved from [|http://web.ebscohost.com.ezp01.library.qut.edu.au/ehost/detail?sid=8c08932e-bd67-4bc6-ae94-b935f23fe89f%40sessionmgr112&vid=1&hid=107&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=tfh&AN=42517481]

Durkheim, E., & Simpson, J. (1951). Suicide: A study in sociology [EBL version]. Retrieved from [|http://books.google.com.au/books?hl=en&lr=&id=v23YleX1UskC&oi=fnd&pg=PA9&dq=eg%20oistic+suicide&ots=sXUIDYkaWk&sig=-%20YrL7Ai32e_zOqlLbGOaT4HkvWg#v=snippet&q=egoistic&f=false]

Fergusson, D. M., Boden, J. M., & Horwood, J. L. (2007). Recurrence of major depression in adolescence and early adulthood, and later mental health, educational and economic outcomes. //British Journal of Psychiatry, 191,// 335-342. doi: 10.1192/bjp.bp.107.036079

Fergusson, D. M., & Woodward, L. J. (2002). Mental health, educational, and social role outcomes of adolescents with depression [Electronic version]. //Arch Gen Psychiatry, 59//(3)//,// 225-231. []

Finke, R. E., & Bettle, J. (1996). //Chaotic cognition: Principles and applications// [EBL version]. Retrieved from [|http://books.google.com.au/books?id=BumTdADeBp8C&pg=PA146&lpg=PA146&dq=mental+illness+chaotic&source=bl&ots=cFwjO5K2M3&sig=K-KCrKPNC32yqzDsxytj_mJAr8U&hl=en&ei=jvGcTsqDIYSdmQXjzfmACQ&sa=X&oi=book_result&ct=result&resnum=4&ved=0CEAQ6AEwAw#v=onepage&q=mental%20illness%20chaotic&f=false]

Gulliver, G., Griffiths, K. M., & Christensen, H. (2010). Perceived barriers and facilitators to mental health help-seeking in young people: A systematic review. //BMC Psychiatry, 10//(130). doi: 10.1186/1471-244X-10-113

Hysenbegasi, A., Hass, S. L., & Rowland, C. R. (2005). The impact of depression on the academic productivity of university students. //Journal of Mental Health Policy and Economics, 8//(3), 145-151. Abstract retrieved from []

Jiang, W., Alexander, J., Christopher, E., Kuchibhatla, M., Gaulden, L. H., Cuffe, M. S., Blazing, M. A., Davenport, C., Califf, R. M., Krishnan, R. R., & O’Connor, C. M. (2001). Relationship of depression to increased risk of mortality and rehospitalization in patients With congestive heart failure [Electronic version]. //Archive of Internal Medicine, 161,// 1849-1856. Retrieved from []

Keyes, C. L. M. (2006). Mental health in adolescence: Is America’s youth flourishing? //American Journal of Orthopsychiatry, 76//(3), 395 – 402. doi: 10.1037/0002-9432.76.3.39

LeaTelamon. (2008, April 24). Analysis of “Mad World” [Web log post]. Retrieved from []

Lorant, V., Croux, C., Weich, S., Deliège, D., Mackenbach, J., & Ansseau, M. (2007). Depression and socio-economic risk factors: 7-year longitudinal population study. //British Journal of Psychiatry, 190,// 293-298. doi: 10.1192/bjp.bp.105.020040

Mathers, C. D., Vos, E. T., Stevenson, C. E., Brigg, S. J. (2001). The burden of disease and injury in Australia [Electronic version]. //Bulletin of the World Health Organisation, 79//(11), 1076-1084. Retrieved from []

Nadeenadd. (2009). The Red Paintings – Mad world [Video file]. Retrieved from []

National Institute on Alcohol Abuse & Alcoholism. (2000). Medical consequences of alcohol abuse [Electronic version]. //Alcohol Research & Health, 24//(1), 27-32. Retrieved from [|http://web.ebscohost.com.ezp01.library.qut.edu.au/ehost/detail?sid=2143d715-cb40-4b6c-b5da-a82f5cd5d0c7%40sessionmgr110&vid=1&hid=119&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=afh&AN=3983168]

Ruzicka, L. & Choi, C. Y. (1999). Youth suicide in Australia [Electronic version]. //Journal of the Australian Population Association, 16,// 29-45. Retrieved from []

Saffer, H., & Dave, D. (2005). Mental illness and the demand for alcohol, cocaine, and cigarettes. //Economic Enquiry, 43//(2), 229-246. doi: 10.l093/ei/cbi016

Sartorius, N. (2007). Stigma and mental health. //Lancet, 370//(9590), 810-811. doi: 10.1016/S0140-6736(07)61245-8

Skegg, K. (2005). Self-harm [Electronic version]. //Lancet, 366,// 1471-1483. Retrieved from []

Tears For Fears Unofficial Fan Page. (2010). Mad world. Retrieved November 2, 2011 from []

Wellbery, C. (2006). Cognitive therapy reduces subsequent suicide attempts [Electronic version]. //American Family Physician, 76//(6), 1088-1090. Retrieved from []

World Health Organisation. (2011). //Depression.// Retrieved from []

**Reflections**

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