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

Summary of Findings
Chapter 11: Literature Review
The evidence indicates that researchers and practitioners have trouble with definitions,
assessment and treatment tensions, ambiguities, and limitations involved in the concept of
depression. Depression is a growing burden in terms of indirect and direct costs, and the
incidence of mental health problems in developed nations is expected to increase. Virtually all
research and practice in North America are guided by the DSM-IV-TR (APA, 2000) criteria for
depression to assess, intervene, and treat depression in adolescents. However, it is not clear that
adolescents conceptualize depression within the same guidelines. The more important question
is: Which concepts of depression are meaningful to adolescents?
Adolescents' conceptions of depression can help bridge the present gap in knowledge.
According to Piaget's theory of cognitive development (Inhelder & Piaget, 1958), adolescents
can interpret, understand, and evaluate their own environment on a broad level and arrive at
possible solutions in terms of past and potential experiences. Adolescence is a time of testing:
marked by puberty, high rates of mental health concerns, and the emergence of harmful
behaviors. It is the time when family dynamics, social relationships, educational achievements,
and employment choices are the life events that are thrust upon the young people. For these
reasons, this study seeks to expand the understanding of adolescent depression by investigating
adolescents' conceptions of depression and differentiating those conceptions according to the
meanings adolescents attach to them.
Research findings indicate that a multitude of factors, including other disorders, are
associated with depression (Armstrong & Costello, 2002; Kreuger, 1999; Reynolds & Johnston,
1994a; Rutter & Sroufe, 2000). These factors include harmful behaviors, gender, mood
alterations, problems with emotional or social functioning, and lack of support. The risk that the
initiation of harmful behaviors (e.g., smoking) may be linked with depression in adolescents is
high (Patton et al., 1998). Moreover, studies indicate that comorbid diagnoses may increase the
risk of recurrent depression and the need for treatment (Birmaher et al., 1996a; Ciarrochi et al.,
2002; Klein et al., 1997). Gender is also associated with depression in adolescents; girls exhibit
depressed affect and symptoms at about twice the rate of boys (Hankin et al., 1998; Hankin &
Abramson, 1999, 2001; Nolen-Hoeksema & Girgus, 1994; Parker & Roy, 2001). The risk of
depression increases in the absence of social support (Brown & Harris, 1978; Wong & Wiest,
1999). Irritability, sadness, loneliness, alienation, (Gjerde et al., 1988) and lack of self-belonging
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