Download Bibliography #3 - University of Northern Iowa

Running head: SCHOOL THERAPY AND ADOLESCENT DEPRESSION
School Therapy and Adolescent Depression
Xxxxxx Xxxxxx
University of Northern Iowa
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Running head: SCHOOL THERAPY AND ADOLESCENT DEPRESSION
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Allen-Meares, P., Colarossi, L., Oyserman, D. & DeRoos, Y. (2003). Assessing depression in
childhood and adolescence: a guide for social work practice. Child and Adolescent
Social Work Journal, 20, 5-20. doi: 10.1023/A:1021411318609
Burns, J. & Hickie, I. (2002). Depression in young people: a national school-based initiative for
prevention, early intervention, and pathways for care. Australasian Psychiatry, 10, 134138. doi: 10.1046/j.1440-1665.2002.00421.x
Crisp, H. L., Gudmundson, G. R. & Shirk, S. R. (2006). Transporting evidence-based therapy
for adolescent depression to the school setting. Education and Treatment of Children, 29,
287-309. doi: 2006-09931-007
D’Acremont, M. & Linden, M. (2007). How is impulsivity related to depression in adolescence?
Evidence from a French validation of the cognitive emotion regulation questionnaire. ,
Journal of Adolescence, 30, 271-282. doi: 10.1016/j.adolescence.2006.02.007
Desha, L. N. & Ziviani, J. M. (2007). Use of time in childhood and adolescence: a literature
review on the nature of activity, participation and depression. Australian Occupational
Therapy Journal, 54, 4-10. doi: 10.1-05089-001
Ellonen, N., Kääriäinen, J. & Autio, V. (2008). Adolescent depression and school social support:
a multilevel analysis of a Finnish sample. Journal of Community Psychology, 36, 552567. doi: 10.1002/jcop.20254
Evans, J. R., Van Velsor, P. & Schumacher, J. E. (2002). Addressing adolescent depression: a
role for school counselors. Professional School Counseling, 5, 211-219. doi: 10.100564-008
Running head: SCHOOL THERAPY AND ADOLESCENT DEPRESSION
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Fröjd, S. A., Nissinen, E. S., Pelkonen, M. U. I., Marttunen, M. J., Koivisto, A. & Kaltiala-Heino,
R. (2008). Depression and school performance in middle adolescent boys and girls.
Journal of Adolescence, 31, 485-498. doi: 10.1016/j.adolescence.2007.08.006
In this Finnish study, depression was cited as being detrimental to youth because it slows
development of certain areas of cognitive functioning and carries a negative societal reaction
from peers, teachers, etc. Depression, in many previous studies, has been linked in school to
objective and subjective measures. An objective measurement was described as a way to
compare the students without their input. Poor GPA (grade point average) and GPA decline
were cited as examples of objective measurements. Subjective measurements, on the other hand,
were scales that the students placed upon themselves, such as the perceived school performance
of one’s self compared to peers. The stated purpose of the study was to compare depression and
its correlation with an objective measure (GPA/GPA decline) to a subjective measure (perceived
school performance). The researchers hypothesized that the subjective measurements would be
more highly correlated with depression than the objective measurements.
For the study, roughly 2500 Finnish middle school students (7th-9th grade) were given
questionnaires regarding depression. To gauge the levels of depression, the R-BDI was
used. The R-BDI is the Finnish version of the Beck Depression Inventory, a common and
reliable depression test. The objective measurements were measured by GPA and GPA decline,
with the decline being measured in increments of .5. The subjective measurements were rated on
a scale of 0-3 on several different questions regarding school load, perceived difficulty of
coursework, and perceived performance when compared to peers. If depression was detected in
a student, it was classified as either moderate or severe.
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18.4% of the girls and 11.1% of the boys were rated as having either severe or moderate
depression. Boys and girls rated in the moderate depression category showed little difference
gender wise, though both the objective and subjective measurements proved to be good
indicators of moderate depression. For those with severe depression, girls showed symptoms
highly correlated with the subjective measurements while boys showed the same with the
objective. The researchers warned this merely a correlation and not a causal effect. They stated
the need for more research to prepare controls and to try and discover the specifics of gender and
symptoms of depression. Also, they stated that because much of the study was based on selfreport, the results should not be over-generalized.
Despite these warnings, the researchers did make some conclusions. They saw
depression and school performance, both objectively and subjectively, as a cycle. Though
depression does not always relate to school performance, there was too high of a correlation to
ignore. They saw the objective and subjective measures as being part of the same
system. Students need to feel as though they are performing well in school to help battle
depressive symptoms, which in turn makes them more likely to perform well in school. The
researchers felt that students with depression may need targeted help for school
performance. Inversely, students not doing well in school may need education on depression,
such as coping techniques and motivational strategies.
Halfors, D. D., Waller, M. W., Baur, D., Ford, C. A. & Halpern, C. T. (2005). Which came first
in adolescence--sex and drugs or depression? American Journal of Preventative
Medicine, 29, 163-170. doi: 10.1016/j.amepre.2005.06.002
Running head: SCHOOL THERAPY AND ADOLESCENT DEPRESSION
Hankin, B. L., Abramson, L. Y. & Siler, M. (2001). A prospective test of the hopelessness
theory of depression in adolescence. Cognitive Theory and Research, 25, 607-632. doi:
10.1521/ijct.2008.1.4.313
Karevold, E., Roysamb, E., Ystrom, E. & Mathiesen, K. S. (2009). Predictors and pathways
from infancy to symptoms of anxiety and depression in early adolescence.
Developmental Psychology, 45, 1051-1060. doi: 10.1037/a0016123
Lee, A., Hankin, & B. L. (2009). Insecure attachment, dysfunctional attitudes, and low selfesteem predicting prospective symptoms of depression and anxiety during adolescence.
Journal of Clinical Child and Adolescent Psychology, 38, 219-231. doi:
10.1080/15374410802698396
This study stated that because depression and anxiety have high occurrence rates among
adolescents, it is important to know how they develop. Previous research was cited correlating
adolescent anxiety and depression with insecure attachment between infant and caregiver.
Insecure attachment was defined as either anxious or avoidant attachment on Bowlby’s Theory
of Attachment. To further this research, the authors looked for possible mediators between
insecure attachment and anxiety/depression. Dysfunctional attitudes and low-self esteem were
hypothesized as possible links from attachment to anxiety/depression.
Infantile attachment has received much research and is considered crucial to societal
development. The theory is that an infant learns what to expect from different relationships
based on caregiver interaction. Further research showed that attachment style (anxious or
avoidant) stays fairly consistent throughout a lifespan. Up to this point, no causal relationship
had been established between insecure attachment and adolescent anxiety/depression, but
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Running head: SCHOOL THERAPY AND ADOLESCENT DEPRESSION
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correlations existed. The researchers thought that finding possible mediators between the two
would help with establishing a causal relationship.
The researchers gathered 350 Chicago-area students between the ages of 11 and 17 years
(6th-10th grade). These kids were given different standardized tests, testing specifically
measures of attachment, dysfunctional attitudes, self-esteem, anxiety symptoms, and depressive
symptoms. Each facet had a separate test to go with it, of which each had credible validity,
reliability, and use in previous research. The tests were given over a five month period. There
were four testing sessions, roughly five weeks apart, with each test being given one-two times
throughout the four sessions.
As the researchers had predicted, there was a correlation between dysfunctional attitudes
and low self-esteem mediating insecure attachment and adolescent anxiety/depression. Kids that
showed insecure attachment style had high correlations with the mediating factors and eventually
anxiety/depressive symptoms. Though this did not yet prove a causal relationship, the
researchers felt it did further the research in the field. Reasons for not declaring causation were
possible 3rd variables. This research has a few implications for the field of psychology. Focus
on changing dysfunctional attitudes and self-esteem early can help prevent anxiety/depression
later in life. However, more research needs to be done both earlier and later in the lifespan to get
a clearer picture of anxiety/depression development.
MacPhee, A. R. & Andrews, J. J. W. (2006). Risk factors for depression in early adolescence.
Adolescence, 41, 435-466. doi: 10.2006-22303-003
Marcotte, D. (1996). Irrational beliefs and depression in adolescence. Adolescence, 31, 935-954.
doi: 10.1996-07024-015
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Moor, S., Maguire, A., McQueen, H., Wells, E. J., Wrate, R. & Blair, C. (2005). Improving the
recognition of depression in adolescence: can we teach the teacher? Journal of
Adolescence, 30, 81-95. doi: 10.1016/j.adolescence.2005.12.001
Nilzon, K. R. & Palméros, K. (1997). The influence of familial factors or anxiety and depression
in childhood and early adolescence. Adolescence, 32, 935-943. doi: 10.1997-38349-014
Philips, J. H., Corcoran, J. & Grossman, C. (2003). Implementing a cognitive-behavioral
curriculum for adolescents with depression in the school setting. Children and School,
25, 147-158. doi: 10.2005-07471-003
Selfhout, M. H. W., Branje, S. J. T. & Meevs, W. H. J. (2008). Developmental trajectories of
perceived friendship intimacy, constructive problem solving, and depression for early to
late adolescence. Journal of Abnormal Child Psychology, 37, 251-264. doi:
10.1007/s10802-008-9273-1
Shochet, I. M., Dadds, M. R., Holland, D., Whitefield, K., Harnett, P. H. & Osgorby, S. M.
(2001). The efficacy of a universal school based program to prevent adolescent
depression. Journal of Clinical Child Psychology, 30, 303-315. doi: 10.2004-22211-002
Sweeting, H., Young, R., West, P. & Der, G. (2006). Peer victimization and depression in earlymid adolescence: a longitudinal study. British Journal of Educational Psychology, 76,
577-594. doi: 10.1348/000709905X49890
Running head: SCHOOL THERAPY AND ADOLESCENT DEPRESSION
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Literature Review
For many people, the memory of the time between elementary and high school is a
difficult one. We grow, often unstably, in the emotional, physical, and mental realms. Our
hormones are raging, making relationships complicated. Acne, growth spurts, changing voices,
and general awkwardness cause anxiety in everyday life. Our minds suddenly consider new
viewpoints, take in large amounts of new information, and begin to shape a new self-identity for
ourselves. All of these changes add stress to the different social environments in which we may
find ourselves. Parents, peers, siblings, and adult figures all must be reevaluated in order to meet
the new terms by which we live. These frustrations and more add to the already difficult timeperiod known as adolescence. It is easy to see how any additional nuisances might push us over
the top. This is the exact problem humans face with adolescent depression. Depression is a
psychological disorder that affects every facet of life for those who have it. What’s more, it
often becomes the main focus of those affected. For this reason, much research has been done
on the possible causes, consequences, and treatments of depression. Yet, depression continues to
affect a sizeable portion of the population each year. The thought is that if depression can be
diagnosed and prevented early, then the outlook might improve. I argue that the best option for
the world of adolescent depression is more countermeasures in school environments.
Depression is described as lack of growth, concentration problems, fatigue, feelings of
worthlessness, thoughts of suicide, and decreased interest/pleasure in everyday activities, among
other things (Allen-Meares, Colarossi, Oyserman, & DeRoos, 2003). Among the many
characteristics that depression envelops, two diagnoses exist in the DSM-IV-TR: Dysthymic
Disorder (DD) and Major Depressive Disorder (MDD) with MDD being the more severe of the
two (Allen-Meares et al., 2003). With these descriptions, one can ascertain why adolescent
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depression affects all aspects of life. In many cases, depression presents itself as the main factor
in a child’s life. In other words, everything is seen through the scope of depression. This
outlook has been described as a poor self-view, bleak world outlook and no hope for the future
(Evans, Van Velsor, and Schumacher, 2002). Thoughts like this develop into a self-fulfilling
prophecy among depressed adolescents: the past is viewed as worthless, making the present
seem pointless, in turn presenting the future as unlikely to present any change (Evans et al.,
2002).
Though estimates vary, roughly 0.4-7.3% of adolescents have diagnosable depression
(Allen-Meares et al., 2003). However, some studies have shown that these numbers are likely to
be low, as many adolescents never ask for help or receive a diagnosis (Burns & Hickie, 2002).
This lack of assessment is owing to many different factors. The first involves the settings in
which adolescents are naturally placed. One half of an adolescent’s waking hours are spent in
school (Burns et al., 2002.) This means that teachers, school administrators, and other staff share
the responsibility of recognizing the symptoms of depression in their students. Though our
teachers are adept at many skills, this one remains lacking (Moor, Maguire, McQueen, Wells,
Wrate, & Blair, 2005). Most school setups do not allot enough time or money to properly
recognize and deal with depression. What’s more, the people that are supposed to be in charge
of such tasks (school counselors) often receive additional job responsibilities such as making
schedules, supervising leisure activities, or coaching (Crisp, Gudmundson, & Shirk, 2006).
Another reason for the small percentage of assessment owes to society’s traditional thought.
Teachers may mistake some symptoms of depression as simply the traits of troublemaking
(Philips, Corcoran, & Grossman 2003). This lack of distinction addresses the need for more
education among educators with regards to depression. A third reason is the attitude that many
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adolescents and parents take with depression and its stigmas. Because of the view that therapy is
for repairing a problem instead of a naturally occurring event, both parties are unwilling to
commit to going, or even admitting there is a problem. Furthermore, like the teachers, students
and parents are unlikely to recognize depressive symptoms when they see them (Crisp et al.,
2006).
Along with the habit of being underreported, depression in adolescents is also
undertreated. A large reason for this is that current treatment plans do not target the specific
causes of the disorder. Just as depression affects all aspects of life, so too are its causes varied.
One place to start looking is even earlier in life, childhood. Insecure attachment style has been
linked to depression in adolescence (Lee & Hankin, 2009). The implication with this finding is
that early familial relationships play an important role in depression development. Taking such
early development into account, researchers have also considered the role of mediators from
childhood to depression. Mediators are described as factors present in the adolescent life that
make developing depression easier. Some possible mediators include shyness, emotionality, low
self-esteem, familial adversity, and social support (Karevold, Roysamb, Ystrom, & Mathiesen,
2009). Among these, low self-esteem stands out. Macphee and Andrews (2006) did research
that established a correlation between low self-esteem and depression. Their research looked at
many risk factors in early childhood and tried to determine which ones would most likely trigger
depression. The thought was that if these risk factors could be identified earlier, then they could
also be treated more efficiently. Their findings suggested that self-esteem acted similarly to the
self-fulfilling prophecy mentioned earlier: once developed, the depressive cycle keeps low-self
esteem reoccurring (Macphee et al., 2006).
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Factors similar to self-esteem present problems for researchers (and, by extension,
therapists) in determining causal relationships with depression. Because it develops so early in
life, with that pace increasing in adolescence, most factors related to depression can only be
stated as correlations (Halfors, Waller, Baur, Ford, & Halpern, 2005). However, these
correlations lead to many theories about the possible causes of depression in adolescents. One
such study pertains to the time-period of adolescence itself. As stated in my introduction, this is
quite obviously a difficult time for people in general, especially those with depression. Hankin,
Abramson, and Siler (2001) theorized that during adolescence, humans associate a new meaning
with failures in life. With new challenges presenting themselves daily, this failure can
accumulate on the psyche of the individual, changing the way he thinks of himself. With the
new self-identity of a failure, depression sets in (Hankin et al., 2001). Another theory relates
depression to lack of impulse control. D’Acremont and Linden (2007) found that depression
might stem from adolescents having trouble controlling their emotions. A correlation
demonstrated that kids lacking the ability to control negative emotions, such as anger or shame,
also had a tough time controlling depressive emotions. They theorized this inability prevents
them from battling depressive symptoms. A study by Ellonen, Kääriäinen, and Autio (2008) also
implicated the time-period of adolescence as having a major role but this time in a different light.
Because this time in life involves unprecedented changes in humans, these researchers saw the
need for social support to help humans cope with stressors, learn relational roles, and develop
social skills for the future. They described social support as a sense of importance to others and
something that gives us self-identity (Ellonen, et al., 2008). Without such support, our learning
does not develop correctly, putting us at risk for depression. Along with environmental
correlations, there are also genetic factors at play in adolescent depression. Nilzon and Palméros
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(1997) stated that mothers with maternal depression were more likely to have children develop
adolescent depression. These findings are not rare. Yet, even with some ideas as to what causes
depression to develop before and during adolescence, we still are faced with the struggle of
treating the disorder. Obviously, logic would point to possible treatments dealing with the
correlated risk factors mentioned above. However, if we keep in mind the problems with
recognizing the signs of depression, the difficulty in administering treatment, and the stigmas
associated with being treated, we are forced to come up with intuitive models to have a chance at
success. That being said, I will now discuss current treatments before making the case for
revised school therapy.
Treatment for depression follows the model already established in the preceding
paragraphs. Depression is multifaceted, its causes are multifaceted; it only makes sense to cover
the different aspects of the disorder when attempting to treat it. With this in mind, I am going to
omit the medication aspect of treatment. Though important and common in treating depression
among adolescents, I feel the focus of this paper is therapy and will continue with that in
consideration. When cognitive-behavioral therapists take adolescent depression into account,
they must fulfill their job titles. This means that they must look at both the cognitive and
behavioral processes of their patients for the best chance of success. This process makes for a
wide range of possible treatments. This is especially true because most treatment is done on an
individual level. With each person being different, treatments must be custom fit for the best
results.
We have mentioned factors such as low self-esteem and impulse control as factors related
to depression. One thing that connects these factors and others like them, are irrational beliefs.
Marcotte (1996) thought that an important aspect of cognitive therapy for adolescents battling
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depression was attacking the core of such beliefs. During adolescence, humans develop an
increasing amount of egocentrism, the process of concentrating the majority of attention on one’s
self (Marcotte, 1996). This egocentrism can lead to increased worry, distorted perceptions, and
low self-esteem. Adolescents worry that everyone is focused on them, when in reality everyone
is most likely focused on themselves. Marcotte believed that forcing patients to work their way
through these beliefs, while providing competing, more accurate beliefs, would help teens gain a
more accurate view of their situation. Desha and Ziviani (2007) took a related but different
approach. They felt that, relating back to social relationships, adolescents learned much of their
behavior and societal roles from exposure to group activities. Their research showed a positive
correlation between singular activities (i.e. reading) and depression. In short, the larger
proportion of singular-to-group activities a child comprised, the more likely depression would
develop. Treatment in their minds therefore, involved having the patients participate in group
activities while providing information on how this would be beneficial to the patient. With
increased social interaction, inaccurate beliefs are less likely to develop. Not only can group
activity be used as therapy, but so can the increase of intimate, personal friendships. We have
discussed the fact that relationship roles grow in adolescence. Selfhout, Branje, and Meevs
(2008) performed a study on the relationship between depression and personal relationships.
They viewed therapy as needing to build on the close relationships patients already had
developed in their lives. Such relationships not only teach lessons for later on in life, they also
help alleviate stress during this difficult time-period. An aspect to consider at this point is how
non-depressed individuals view those with depression. A study done by Sweeting, Young, West,
and Der (2006) showed that individuals suffering from depression were often the victims of
bullying. They described bullying as name calling, teasing, and/or physical confrontation. The
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therapeutic implications here are more difficult. As with the stigmas associated with depression
and therapy, the fact remains that the public needs more awareness on depression in order to be
more accepting of it.
However, these views on therapy have their limits. Because depressed individuals
already find it difficult to pursue friendships or join in on group activities, simply providing these
outlets is not enough. Therapists must also consider the consequences of depression and treat
those, with the hope that latter will help the former. Academics are a perfect example of this
phenomenon. Fröjd et al. (2008) performed an experiment that included both irrational beliefs
and self-fulfilling prophecies. In it, they compared both how kids felt about their grades as well
as their actual grade performance with depression correlations. The results showed that both
kids that performed poorly in school as well as those who felt as though they were performing
poorly were more likely to suffer from depression. This implied that not only did cognitive
distortions need to be treated, so too did academic behaviors. The researchers felt that targeting
kids who performed poorly in school with information on depression and coping techniques (and
vice versa) could lead to reductions on both fronts. These are only a few of the factors and
strategies taken into account when treating adolescent depression. Difficulties remain to find
answers to this ever-growing, world-wide problem (Moor et al., 2005).
I feel that a school setting is the answer to renewing the fight against depression. In
many of the studies I looked at, researchers normally concluded their experiments in similar
fashion: by calling for more research in their fields. In many cases this call was specifically for
continued use of longitudinal research formats (Karevold et al., 2009). I am inclined to agree
with them and feel that school therapy is the place for this to happen. Schools provide a
structured basis for learning over a course of time. Along with parents, most of our education
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comes from our schooling. In order to change the stigmas associated with depression and
psychological disorders in general, the movement needs to start in the schools. Furthermore,
with most children staying in school for twelve years or more in the United States, longitudinal
research would be easier to record. Problems already stated with this model include lack of
funding, time, and education among administrators. However, in a study by Shochet, Dadds,
Holland, Whitefield, Harnett, and Osgorsby (2001), a universal program (where all students
receive depression therapy) was put in place for a trial period. Results indicated that such a
program might lead to increased participation in therapy, exposure to depression education, and a
reduction in social stigmas. Though this model might prove more costly short-term, the long
term results can only be speculated. Depression is often a chronic disorder that is highly comorbid (Evans et al., 2002). Considering the lifelong costs of such a disorder, both fiscally and
emotionally, it is my opinion that all that can be done in adolescence should be. We owe that
effort to ourselves and the generations to come.