Adolescent Depression and Risk Factors.
Field, Tiffany ; Diego, Miguel ; Sanders, Christopher 等
ABSTRACT
Seventy-nine high school seniors were administered the Center for
Epidemiological Studies Depression Scale (CES-D), as well as a
questionnaire on parent relationships, peer relationships, positive and
negative feelings including suicidal thoughts, and lifestyle variables
including academic performance, exercise, and drug use. The group of
adolescents who scored above the clinical cutoff for depression on the
CES-D (n = 29) had poorer relations with parents. Further, the incidence
of paternal depression in that group was greater. The depressed
adolescents also had less optimal peer relationships, fewer friends, and
were less popular. They experienced less happiness and more frequent
suicidal thoughts. They spent less time doing homework, had a lower
grade point average, and spent less time exercising. The depressed group
also reported more use of marijuana and cocaine. A stepwise regression indicated that physical affection with parents, homework, well-being,
exercise, happiness, and parent relations explained 55% of the variance.
Approximately 8% to 10% of adolescents score above the cutoff for
clinical depression on self-report measures, such as the Center for
Epidemiological Studies Depression Scale, and the percentage is
increasing (Fombonne, 1998; Lewinsohn et al., 1998). Adolescent
depression has been associated with poor psychosocial and academic
outcomes and increased risk for substance abuse and suicide (Birmaher et
al., 1996).
One of the most frequently studied risk variables is relationships
with parents. Parents of depressed adolescents have been reported to be
less caring (Rey, 1995), to be more negative (Pike & Plomin, 1996),
and to provide less support (Hoffman & Su, 1998). In one study in
which parent-adolescent interactions were videotaped, parents of
depressed adolescents increased their facilitative behavior in response
to their adolescents' depressed behavior, suggesting that these
parents may be inadvertently reinforcing depressive behavior (Sheeber et
al., 1998). Another frequently studied risk factor is parental
depression. In one recent study, a greater proportion of depressed
adolescents had depressed mothers (47% vs. 18% in the control group),
although the rates of paternal depression did not differ between the two
groups (Shiner & Marmorstein, 1998). In another study, parental
depression increased the risk for medical problems and hospitalization among depressed adolescents (Kramer et al., 1998).
A less frequently studied risk factor for adolescent depression is
peer relations, more specifically, loneliness. In a recent investigation
of multiple correlates of adolescent depression, higher levels of
depressive symptoms were associated with greater loneliness (r = .65),
and loneliness was the first and most significant variable to enter the
stepwise regression (Brage et al., 1995).
Invariably, strong relationships are reported between depression
and substance use (Aalto-Setaelae et al., 1998; Birmaher et al., 1996).
Depression and substance use, in turn, are related to poor academic
outcomes (Birmaher, 1996).
The purpose of the present study was to examine frequently explored
risk factors for adolescent depression, such as relationships with
parents, parental depression, and substance use, as well as less
frequently explored factors. The latter were as follows: peer
relationships, number of friends, popularity, and dating; feelings of
well-being, happiness, and anger; suicidal thoughts; time spent doing
homework, working, and exercising; and grade point average.
METHOD
Participants
The participants were 79 high school seniors recruited from a
suburban Florida high school. The distribution of participants was 76%
Caucasian, 11% Hispanic, 5% Asian, 3% African-American, and 5% other. On
average, they were of middle to upper middle socioeconomic status (M =
1.9 on the Hollingshead Two-Factor Index).
Measures
Participants completed a 181-item Likert-type questionnaire that
gathered information on multiple behavioral and psychological aspects of
adolescent life (Field & Yando, 1991). The questionnaires were
completed anonymously within a 45-minute time frame in a large assembly
room.
Depression. Scores on the Center for Epidemiological Studies
Depression Scale (CES-D; Radloff, 1977) can range from 0 to 60. The
CES-D has been standardized for high school populations (Radloff, 1991),
with a score of 19 or higher indicating depressed mood. It has
demonstrated adequate test-retest reliability, internal consistency, and
concurrent validity (Schoenbach, Kaplan, Wagner, Grimson, & Miller,
1983; Wells, Klerman, & Deykin, 1987).
Relationships with parents / friends. Twenty-four questions
assessed relationships with mother, father, and best friend (Blyth &
FosterClark, 1987). Questions included: "How much do you go to your
mother for advice/support?" and "How much does your best
friend accept you no matter what you do?" Each question was rated
on a 5-point Likert scale ranging from "not at all" to
"very much."
Verbal intimacy with parents. Participants were asked to rate their
verbal intimacy with parents on 5-point Likert scales. For example:
"How good do you think your conversations are with your
mother/father?"
Physical affection with parents. Participants were asked to rate
physical affection with parents on 5-point Likert scales (Field et al.,
1995). For example: "How often do you hug or show physical
affection toward your mother?"
Peers. Participants were asked to rate, on 5-point Likert scales,
their popularity, the number of close friends they had, and their dating
frequency.
Feelings. Participants were asked to rate, on 4-point Likert
scales, their feelings of well-being and happiness. In addition, they
were asked to respond (yes/no) to the following statement:
"Sometimes I get so angry that I worry I will become violent."
There was also a 4-point Likert item on the frequency of their suicidal
thoughts.
Lifestyle. Participants indicated the number of hours per week
(ranging from less than 2 to more than 7) that they spent working, doing
homework, and exercising. They were also asked to report their grade
point average (A to D).
Drug use. Participants were asked to rate, on a 4-point Likert
scale ranging from "never" to "regularly," their
frequency of cigarette, alcohol, marijuana, and cocaine use in the past.
RESULTS
Analysis of Variance
A multivariate analysis of variance was conducted on the
questionnaire data. This was followed by univariate analyses of variance
on the individual variables.
Parents. As can be seen in Table 1, the group of depressed
adolescents (GES-D = 19 or above; n = 29) had less optimal parent
relations (lower scores are optimal), their verbal intimacy with parents
was inferior, they experienced less physical affection with their
parents, and they reported more paternal depression as compared with the
nondepressed group (n = 50).
Peers. The depressed adolescents also had inferior peer relations.
They reported having fewer friends and being less popular. However,
there were no significant differences in regard to dating frequency.
Feelings. The depressed group scored worse on the measures of
wellbeing and happiness, but did not significantly differ from the
nondepressed group in terms of anger. In addition, the depressed group
reported more frequent suicidal thoughts.
Lifestyle. The depressed adolescents spent less time doing homework
and less time exercising. Their self-reported grade point average was
also lower. There was no significant difference between groups in the
amount of time they spent working.
Drug use. The groups did not significantly differ regarding
frequency of past cigarette and alcohol use. However, the depressed
group reported more frequent use of marijuana and cocaine in the past.
Stepwise Regression for Depression
A stepwise regression was then conducted. As can be seen in Table
2, six variables entered the equation. Physical affection with parents
entered the equation in the first step, explaining 13% of the variance.
Homework then contributed an additional 13%, followed by feelings of
well-being (11%), engaging in exercise (5%), happiness (10%), and parent
relations (3%), for a total of 55% of the variance.
DISCUSSION
As in previous studies with other samples (Field et al., 1995),
parent relations were found to be an important contributor to the
psychological health (in this case, depression) of adolescents. Physical
affection with parents explained 13% of the variance in depression
scores. Further, there were significant differences between depressed
and nondepressed adolescents in terms of parent relations, verbal
intimacy with parents, and physical affection with parents. Similar to
the findings of other researchers (Kramer et al., 1998; Shiner &
Marmorstein, 1998), parental depression was more frequent in the
depressed adolescent group. However, in the present study, paternal
depression was the salient risk factor, rather than maternal depression
(Shiner & Marmorstein, 1998). This inconsistency may be due to the
greater incidence of divorce noted in the Shiner and Marmorstein study,
with divorce more often being associated with maternal depression than
with paternal depression.
The results regarding peer relations highlight the need to further
investigate this variable. Here, peer relations, number of friends, and
popularity were less optimal for depressed adolescents, findings that
are consistent with the literature on loneliness (Brage et al., 1995).
Adolescents' scores on the emotional state variables were
highly consistent with their scores on the CES-D. The depressed
adolescents reported less happiness and less optimal well-being,
although they did not report more anger. Similar to other reports in the
literature on the relationship between depression and suicide, depressed
adolescents also experienced more frequent suicidal thoughts (Birmaher
et al., 1996).
The lifestyle variables also differentiated the depressed and
nondepressed adolescent groups. The lesser time spent on homework in the
depressed group probably contributed to their lower grade point average.
A variable that has been somewhat ignored in the adolescent depression
literature is exercise, and the depressed group was found to engage in
less physical activity. Interestingly, exercise is noted to increase
levels of serotonin, the body's naturally produced antidepressant
(Nash, 1996). Thus, schools may be able to decrease depression in
adolescents by improving physical activity programs.
The more frequent use of marijuana and cocaine among the depressed
adolescents was not surprising inasmuch as marijuana and cocaine are
considered depressogenic substances. Many studies have documented the
increased risk of substance use among depressed adolescents
(Aalto-Setaelae et al., 1998; Birmaher et al., 1996).
The extremely high incidence of adolescents in this study who
scored above the cutoff for depressed mood (37%) highlights the need for
further research on depression in middle to upper middle socioeconomic
status samples. Depression appears to be related to several aspects of
adolescents' lives, including relationships with parents and peers,
lifestyle, and emotional well-being. Some obvious steps could be taken,
including offering more assistance with homework and providing more
opportunities for exercise. However, improving peer and parent relations
and adolescents' sense of well-being may require more intensive
interventions. More extensive substance use education may also be
required. The association between depression and the problem of suicidal
thoughts highlights the need for further investigation.
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Table 1
Mean Scores for Nondepressed and Depressed (CES-D = 19+) Groups
Nondepressed Depressed p
(n = 50) (n = 29)
Parent Relations 23.02 27.36 .05
Verbal Intimacy with Parents 30.76 34.30 .05
Physical Affection with Parents 14.82 16.66 .05
Paternal Depression (*) 1.71 1.32 .05
Maternal Depression (*) 1.67 1.43 NS
Peer Relations 28.76 32.07 .05
Number of Friends 3.98 4.69 .01
Popularity 2.82 3.32 .01
Dating (*) 1.81 1.59 NS
Well-Being (*) 1.98 1.38 .001
Happiness (*) 1.94 1.24 .001
Anger (*) 1.40 1.24 NS
Suicidal Thoughts (*) 2.00 1.21 .001
Homework 2.04 2.41 .05
Grade Point Average 2.88 3.38 .05
Work (*) 1.85 1.56 NS
Exercise 2.98 3.76 .05
Cigarettes (*) 2.34 2.00 NS
Alcohol (*) 2.82 2.59 NS
Marijuana (*) 2.60 2.00 .05
Cocaine (*) 1.62 1.14 .05
(*)Higher scores are optimal
Table 2
Stepwise Regression on Adolescent Depression
Step Variable Entered R [R.sup.2] F Sig.
1 Physical Affection .36 .13 9.09 .005
with Parents
2 Homework .51 .26 10.72 .001
3 Well-being .61 .37 12.25 .001
4 Exercise .65 .42 11.16 .001
5 Happiness .72 .52 12.57 .001
6 Parent Relations .74 .55 11.97 .001