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前些日子，有兩個中學階段的孩子選擇用跳樓的方式離開這個世界，大好年華正要開展，讓人對他們的離去感到惋惜。又讓我不禁想到，2018年台灣出現了一部探討青少年與家長關係的迷你劇集《你的孩子不是你的孩子》，劇集裡面既寫實又魔幻，點出「青少年面對成長需要脫離父母，但卻又因為文化與教養的關係，需要依賴父母的矛盾情緒」，如此血淋淋地呈現父母與孩子的間的矛盾親子關係，在我的朋友圈裡掀起了一陣討論。

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青少年憂鬱症：不只是少年維特的煩惱

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在青少年階段，大腦與身體都逐漸邁入成熟，同時也慢慢地形塑出與周遭他人互動的模式，並嘗試思考自己的喜好，對於部分事物也會抱持疑惑。這個時候出現的行為反應，有時常會被家長或是學校老師們認為他們是反常、難以理解的，像是有時會發現家中或是周遭的青少年朋友，脾氣似乎總是陰晴不定，想要對他們關心時，又總擺出一副生人勿近的姿態；但有需求時，卻又鮮少直接明說，反倒透過頭痛、肚子痛、較晚起床等生理不適進行表達，而常讓周遭的家人感覺頭大。有時候甚至會戲稱這樣的反覆行為是「少年維特的煩惱」。

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但事實上，這樣的情緒變化其來有自，而假如孩子生活在家教甚嚴的家庭中，則有一定的機率會被家人譴責他故意裝病、逃避課業等，長期下來，孩子與家人間的關係勢必會產生無形的裂縫。

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青少年做出某些行為而嚐到甜頭後，下一次往往會重複同樣的行為達到目的，像是謊稱生病，家人就會幫忙請假讓他待在家中，而多次下來，青少年學到自己若想待在家中不上課，裝病一下就可以達成目的。

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但是，假使做了這件事卻不會有甜頭呢？如果，說謊並不會為青少年帶來任何好處，為何他需要說謊、需要假裝呢？青少年的問題行為，不可否認地，有時的確是會協助他達成特定目的；然而有時這些問題行為的背後，卻很可能是青少年憂鬱症來臨的前奏。

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青少年憂鬱 VS. 成人憂鬱：同為憂鬱，各自表述

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由於語言與心智發展的成熟度不同，「青少年」與「成人」罹患憂鬱症雖然都經歷情緒上的憂鬱狀態，但症狀表現卻不盡相同。

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青少年的憂鬱症狀多是以容易對他人發脾氣為情緒表達的手段，因此，易怒的青少年較容易被師長認為孩子正經驗叛逆期，覺得度過該階段情緒就會自然好轉；另外，頭痛、四肢無力、嗜睡、沒胃口等不舒服的生理症狀，通常也易出現在青少年憂鬱症患者身上，而抱怨身體不適有時更容易被師長們忽略，覺得他們只要多休息就會康復，容易讓周遭的師長們忽略患者的「情緒困擾」。

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尤其，青少年憂鬱症自殘的比例相較成人憂鬱症患者來得高。由於青少年憂鬱症的症狀表現不同於成人憂鬱症，有時較不容易被師長們所被辨識，而可能錯失青少年憂鬱就醫的黃金時間。

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青少年憂鬱症解藥：早期發現早期治療

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因此，周遭師長、親友們若能更敏感的辨識出青少年憂鬱症的精神與行為症狀，越能早期發現、早期治療，避免青少年憂鬱症的影響範疇擴大。像是近年來藥物濫用、網路成癮、飲食障礙等問題行為，皆可能是青少年憂鬱症所伴隨的負面影響，針對行為本身矯正，收到的效果不僅不大，有時候也會有反效果。

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青少年族群的憂鬱症雖不脫離憂鬱症的本質及範疇，但在情緒層面的表達上，易怒、情緒不穩定相較成人憂鬱症的心情低落，就可能為一個需要被辨識出的指標；生理層面上，睡眠過多、胃口減退等，皆是青少年憂鬱症的警訊；行為層面上，就學期間經常缺曠課、出現偏差行為，甚至在炎熱的天氣突然穿著長袖遮掩自傷痕跡，或是身上已具明顯的傷疤時，此時，都需要青少年周遭的師長們保有耐心與愛心，主動關懷這群青少年。

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而每當青少年落入疾病的風險時，周邊支持系統的系統性合作，在這個時候就顯得更為重要，舉例來說：「仍在學校就學的青少年階段，最容易暴露在自殘的風險當中，然而，僅是在學校安排該青少年進行心理諮商，並無法實際地觸接到青少年的生活經驗，效果可能有限。」

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面對青少年憂鬱症：傾聽與包容，不要說教

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青少年的生活經驗，很可能就是青少年當下最主要的壓力源，因此，第一線與青少年接觸的專業工作者就扮演了相當重要的角色，他們不僅需初步進行評估，並進一步聯繫青少年其他重要且可進行介入的資源，從不同面向進行預防。

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例如，學校導師一旦發現學生缺曠課嚴重，而學生難得到校時，卻觀察到其在遇到特定課堂主題或集會顯得暴躁難解，此時，導師能夠做的事情就是先站在學生的角度聆聽其抱怨或是心聲，盡可能包容學生的行為，不要先入為主地說教。另外，也需多留心學生的課堂表現與情緒狀況，甚至連結學生在校熟悉的友人給予協助與陪伴，會是很大的支持與協助。

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另外，多數學生較不傾向導師與家長進行聯繫，因此與學生溝通的過程中，盡可能在不破壞彼此關係的情況下，引入其他可運用的資源，例如：轉介校內輔諮中心、建議就醫、通報自殺防治中心等，讓不同專業與了解該生的人都可以留心學生的狀態，讓學生周遭的系統得以穩定並擁有適當的支援，有助於幫助青少年從憂鬱症中康復。

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Reference

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陳信昭、林維君（譯）(2005)。我的孩子得了憂鬱症：給父母、師長的實用指南(原作者：F. M. Mondimore)。心靈工坊。

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Calear, A. L., & Christensen, H. (2010). Systematic review of school-based prevention and early intervention programs for depression. Journal of adolescence, 33(3), 429-438.

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Bhatia, S. K., & Bhatia, S. C. (2007). Childhood and adolescent depression. American family physician, 75(1), 73-80.

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Hankin, B. L. (2006). Adolescent depression: Description, causes, and interventions. Epilepsy & behavior, 8(1), 102-114.

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作者：臨床心理師  董仲薇

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