Factors Responsible for the Adolescent Depression - Research Paper Example

Adolescence is a unique stage in life that is different from childhood. Research has shown that as children move into adolescence, depressive symptoms increase (Martens, Cox, Enns & Afifi, 2005). During this nurse´s clinical experience at a mental health department, many adolescents were diagnosed with clinical depression. It has been the interest of this nurse to understand the reasons behind the adolescent´s depression. It has been estimated that depression is twice as common in adolescence as compared to children. This serious disorder in adolescents is marked by a prevalence rate of approximately 5% along with significant rates of relapse and mortality. Increasing evidence indicates that female adolescents and adults are more likely than their male peers to become depressed, both clinically and sub clinically (Froh, DiGiuseppe & Li, 2006). Selected are six research studies that investigated the different reasons behind the adolescent´s depression. One question arising from the review of the literature is: What are the various predisposing factors responsible for the adolescent depression? Questions investigated in this study: Studies concerning depression found various factors responsible for this condition in adolescents. Researchers developed different types of questions as a hypothesis to investigate this area. In the study performed by Bifulco & Kwon, Jacobs, Moran, Bunn & Beer (2006) two non directional hypothesis were made. The first one was that there is a relationship between the insecure attachment and episodes of anxiety disorder and major depression. Sund & Wichstrom´s (2002) study investigated whether the insecure attachment predicts future depressive symptoms when demographics and psychosocial factors, and stress life events are controlled. Another study by Liu (2009) investigated how paternal and maternal attachments might relate to the adolescent´s peer support, social expectations of peer interactions, and depressive symptoms. Margolese, Mickiewicz & Doyle (2004) examined the relative importance of a working model of attachment with the mother, the father, the best friend and the romantic partner in the prediction of the adolescent´s depression. Different directional hypothesis were developed by Froh, DiGiuseppe & Li (2006) which included, the levels of the masculine and the feminine traits which predicted depression and masculinity was found to be positively associated with problems in focusing and distractive coping, and negatively related to ruminative coping. The study by Pullen, McCarthy & Graf (2003) investigated if there were differences in the adolescent´s depression using variables, such as, age, gender, smoking and alcohol. In three of the studies by Margolese et al (2004), Li & Froh (2006), and Bifulo et al (2006) the hypothesis was clearly stated and confirmed. Pullen & McCarth (2006) did not have a hypothesis but stated it as the purpose of the study. On the other hand studies by Sund & Wichstrom (2006) and Liu (2009) stated it as a research problem or aim of the study. All of these studies, the aim of the study by Bifulco, Kwon (2006), Saund & Wichstrom (2002) and Liu (2009) were similar as three of them investigated whether the insecure attachment predisposes adolescents to depression. Bifulco (2006) in addition investigated the reasons behind the insecure attachment (childhood neglect). Saund &Wichstrom (2002) investigated this under controlled demographic, psychosocial factors, and stressful life events. Many of the studies investigated the role of gender and age as predisposing factors towards the adolescent´s depression. In different quantitative and qualitative studies performed by Froh, DiGiuseppe & Li (2006), Pullen, McCarthy & Graf (2003), and Margolese et al. (2004) investigated the role of gender, sex, and coping in adolescents. This research problem will help the nurses identify the key factors responsible for the adolescent´s depression and to better assess and understand the clients with adolescent depression. Methods and Samples All the studies used correlation research designs to find out the role of attachment in the adolescent´s depression. The method used in the research by Bifulco et al (2006) is qualitative while Sund & Wichstron (2002) used quantitative but both of them used the longitudinal research design with panel studies. The sample used by Bifulco et al (2006) in the study is composed of 154 community women between the ages of 26 to 59, who had poor support (because of a partner or a child) and all of them lived with their children. The design used in the study was longitudinal with panel studies, as data were collected at more than one point first between 1990 to1995 and then follow up interviews with the same women 3 years after. The samples used by Saund & Wichstrom (2002) were school students from 12 to 14 years of age from two countries, in the north and south of Tronelog and in the middle of Norway during the years 1999 to 2000. The initial sample included 2,465 adolescents, 49.2% were boys and 58.2% were girls with the mean age of 13.7. The same students were reassessed after one year, but some of the participants were lost due to various reasons. The participants who participated both times were included in the final analysis (n=2366). The method used by Bifulco (2006) were interviews while the methods used by Sund & Wichstron were two types of questionnaires (IPPA – inventory peer and parent attachment, MFQ – mood and feeling questionnaire). Using a cross sectional design Liu (2006) showed through the quantitative study that the secure attachments to the fathers and to the mothers had direct correlations with depressive symptoms. The study was conducted in Taiwan with 8th graders, 1,289 students participated in the study. They were administered questionnaires to be evaluated for factors such as children depression inventory (CDI), perceived social support and child’s perception of security from friends and parents (76.7%). Margolese et al (2004) conducted a quantitative study to examine related working models of attachment with the father, the mother, the romantic partner and the best friend to predict the adolescent´s depression. The participants in this study ranged from age 16 to 19. There was a total sample of 134 adolescents. Nearly all the participants (96.3%) reported having a romantic relationship. The length of the relationships varied from several years to a couple of months. The majority of the sample reported that they had a best friend (83.6%). The study conducted by these authors used the traditional questionnaire based techniques for evaluation of depression due to different relationships among the adolescents. It was unique in the sense that it incorporated a novel design of evaluations where vignettes were used to assess the participants. The children were provided with hypothetical situations from real life and their responses were evaluated in a computer based study. The qualitative study by Li, Froh & DiGiuseppe (2006) showed relationships with higher rates of depression are found among adolescents as compared to boys because of coping and masculinity. A model was designed through a path analysis which involved variables such as gender, sex distraction, and problem focusing on coping. The participants ranging in age from 14 to 18 years participated with a total sample of 246 adolescents. All of them were students (9th through 12th grades) attending public schools in metropolitan areas. The instruments of measurement used were the Reynolds´ Adolescent Depression Scale (RADS) to measure the depressive symptoms and Bem´s Sex Role Inventory (BSRI) to measure the masculine and the feminine traits and other coping scales for distractive coping in regards to general stressors. A comparative descriptive survey design was used by Pullen et al (2000). It included a demographic questionnaire, the Children Depression Inventory (CDI), and the Beck Depression Inventory (BDI) to determine if there wass any gender role, age, alcohol, or smoking in the adolescent depression. The sample size of 217 adolescents between the ages of 12 to19 years participated in this study. In the quantitative study performed by Patricia, Cox, Enns & Afifi (2005) showed the role of health as determinant in the adolescent depression. A stratified sample design was used with 17,557 adolescents (8,848 males and 8,709 females) using the Canadian Community Health Survey (CCHS). The individuals included in the study were 12 to 19 years of age. The Composite International Diagnostic Interview - Short Form (CIDI-SF) was used to assess the number of depressive symptoms expressed by each respondent based on the statistical manual -1V (DSM-IV diagnostic) and diagnostic criteria. From the six studies, the sample size used by Margolese (2004), Froh (2000), Pullen (2000) and by Bifulo (2006) was small as compared to the sample size used by Sund (2002) and Liu (2009). The IPPA questionnaires were only filled by students (Sund, 2002), but if the investigation with siblings and parents were parallel, the observations and the interviews could have given more clarification about ongoing relationships. Uncertainty remains concerning the findings, in terms of knowing if the findings are valid for depressive disorders. In another study Bifulco (2006) selected high risk women (with low peer support) and the men were not included in the study, which decreases generalizing the study findings. Interestingly, all of the participants in the research studies were students from the ages between 12 and 19, except in one study performed by Bifulo et al (2006), where the participants were the community women between the ages of 26 and 59. Two of the studies by Liu (2009) and Pullen & McCarth (2006) used the Children Depression Inventory (CDI) to measure the depressive symptoms. Results: The results (Margolese et al, 2004) provided an understanding of the links between attachment to specific figures (mother, father, best friend and romantic partner) to adolescent depression. The results showed that the maternal attachment was more important in the girls as compared to the boys. Their gender role expectations were attuned with their mothers and they showed a tendency towards relying more on them for emotional support as they aged. It was discovered that females who attributed themselves as a negative model in relation to the conceptualization of their mother’s identity had more chances of suffering from depression (Margolese et al, 2004). The Bifulco (2006) study showed that both depression and anxiety outcomes are part of the insecure attachment. The security is shown by a logistic regression, which is related with disorders. The hypothesized relationship between the insecure attachment and the childhood neglect/abuse was confirmed. Liu (2009) found that the secure attachments to the mother as well as to the father were negatively correlated with social expectations of peer interactions and depressive symptoms ( Read More