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.

REFERENCES

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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