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

Chapter 11: Literature Review
weakness in their ability to adequately diagnose MDD in adolescents (Brooks & Kutcher, 2001).
There are also a number of weaknesses associated with the self-report instruments (e.g., RADS-
2). These weaknesses include the fact that the cut-off score, which is useful for identifying
individuals for further clinical evaluation, can affect the variability; and they do not have
sufficient psychometric information to allow best decisions (Myers & Winters, 2002). However,
the self-report measure has a number of advantages that are important to the focus of this study.
They include adolescents' perspectives and are efficient in terms of cost, time, and privacy
considerations, because data are collected from one source. Besides, adolescents are reliable
reporters of their depression (Weiner, Reich, Herjanic, Jung, & Amado, 1987; Yule, 1993).
Hence, the self-report measure RADS-2 was utilized in this study because adolescents'
perspectives were integral to the present investigation.
Treatment for Depression in Adolescents
Despite considerable research over the past half-century, there is no overriding agreement
regarding treatment approaches for adolescent depression (AACAP, 1998). Research findings
"cannot confidently provide an evidence-based explanation for how or why even our most
effective interventions produce change" (Kazdin & Nock, 2003, p. 1129) and "for whom a
particular treatment is well suited" (Kazdin, 2002, p. 58). Theoretical perspectives aside, the
choice of initial therapy depends on the expertise of the clinician, on the individual with the
presenting problem, and on the complexity of impacting psychosocial factors (Birmaher et al.,
1996b).
Most treatments fall under two general categories, psychotherapy and pharmacotherapy
(AACAP, 1998; Birmaher et al., 1996b; Compton, Burns, Egger, & Robertson, 2002; Michael &
Crowley, 2002). Psychotherapy is a learning process, done largely by verbal communication, in
which mental health practitioners strive to help individuals with mental health problems and
disorders (US Department of Health and Human Services, 1999). Psychotherapy has multiple
specific treatment parameters depending on the theoretical approach (AACAP, 1998; Kazdin &
Nock, 2003). For example, cognitive behavioral therapy, often used these days for treating
depression is based on Beck's coherent cognitive model of emotional disorder (Beck, Rush,
Shaw, & Emery, 1979; Fennel, 1989). Cognitive behavior therapy involves a directive, time-
limited, and structured approach, based on an underlying theoretical rationale that an individual's
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