how do adolescents define depression? - cIRcle - University of ...

Chapter II: Literature Review
unspecified period of time. It may be measured by self-report (Duffy, 2000; Garland, 1994,
1997). Depressive syndrome (Petersen et al., 1993) is defined as a set of depressive and other
symptoms occurring simultaneously (Cicchetti & Toth, 1998). Those symptoms may be
measured using adolescents,' parents,' or teachers' ratings. The boundaries of depressive
disorder are delineated according to specific, clinically-derived standards of diagnostic criteria
and involve a constellation of disturbances in depressed mood, behavior, somatic, and cognitive
functioning (APA, 2000). Depressed mood seems to be the core component being included in
both depressive syndrome and in clinical depression (Wichstrom, 1999). Hence, depressed mood
may precede a depressive episode and carry the risk of depressive disorder (Hankin &
Abramson, 2001; Harrington & Wood, 1995).
Further debate exists among researchers in distinguishing whether depression is
"threshold" (a case versus not a case) depression according to the criteria of the DSM-IV-TR
(APA, 2000) or depression exists on a continuum of increasing levels of depressive
symptomatology (Judd & Akiskal, 2000; Lewinsohn et al., 2000a; Lewinsohn et al., 2000b;
Ruscio & Ruscio, 2000; Skodol, Schwartz, Dohrenwend, Levav, & Shrout, 1994). Research
findings indicate that dimensional rather than "threshold" or categorical criteria seem to be the
more appropriate approach for a diagnosis (Goldberg, 2000; Slade & Andrews, 2005).
A number of researchers have shown that depressive symptoms exist on a continuum
(Judd & Akiskal, 2000; Lewinsohn et al., 2000a; Lewinsohn et al., 2000b; Ruscio & Ruscio,
2000; Skodol et al., 1994). Having examined the range of subthreshold depressive
symptomatology, they have found that it could be as low as two depressive symptoms lasting
two or more weeks (Fergusson et al., 2005; Judd & Akiskal, 2000; Judd, Rapoport, Paulus, &
Brown, 1994), which is below the required number to warrant a diagnosis of Major Depressive
Episode (MDE) or Major Depressive Disorder (MDD) (APA, 2000). The increasing levels of
subthreshold depressive symptoms, such as depressed mood, are associated with the increasing
levels of psychosocial impairment and the emergence of threshold or major depression (Angst &
Merikangas, 1997; Georgiades, Lewinsohn, Monroe, & Seeley, 2006; Lewinsohn et al., 2000b).
Classification of Depression
Prior to the development of the standardized DSM criteria, which allow researchers and
practitioners to identify, diagnose, and treat depression, there was an absence of a generally
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