Journal o f Youth and Adolescence, Vol. 13, No. 6, 1984
Correlates of Depressive Symptoms in Adolescents Lawrence J. Siegel t'3 and Nora J. Griffin 2 Received January 25, 1983; accepted December 17, 1984
The relationship between a number o f social and cognitive variables and depressive symptomatology was evaluated in a sample o f public middleschool and high-school students. The variables measured included stressful life events, locus o f control, causal attributions, and means-ends problemsolving abilities. Higher levels o f depression were found to be associated with a more external locus o f control and a tendency to attribute outcomes to causes which are internal, stable, and global. Parental divorce and socioeconomic status were also found to be associated with higher levels of depression. No relationship was found to exist between either amount of life stress or problem-solving ability and depression. The implications of these results for delineating the underlying dimensions of depression in adolescents are discussed.
INTRODUCTION T h e l i t e r a t u r e o n d e p r e s s i o n in a d o l e s c e n t s is v e r y l i m i t e d a n d o f t e n c o n t r a d i c t o r y . Little i n f o r m a t i o n is a v a i l a b l e o n the i n c i d e n c e o f d e p r e s s i o n
tAssociate Professor, Department of Pediatrics, Child Development Division, University of Texas Medical Branch, Galveston, Texas. Previously Dr. Siegel was in the Department of Clinical Psychology at the University of Florida. Received his Ph.D. from Case Western Reserve University in 1975. Major interest is stress reactivity and coping processes in children and adolescents. zClinical psychology intern at the Dallas V.A. Medical Center and doctoral student in clinical psychology at the University of Missouri-Columbia. Major interest is adolescent psychopathology and self-esteem. 3To whom correspondence should be addressed at Department of Pediatrics, Child Development Division, University of Texas Medical Branch, Galveston, Texas 77550. 475 0047-2891/84/1200-0475 $03.50/0 © 1984 Plenum Publishing Corporation
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in the general adolescent population. There is also no agreement on the cliniced frequency of adolescent depression, and statistics vary widely (Albert and Beck, 1975; Carlson and Cantwell, 1979; Carlson and Strober, 1979; Hudgens, 1974). Given the frequent association between suicidal behavior in adolescents and depressive symptoms (Herjanic and Welner, 1980; Shaffer and Fisher, 1981), tile study of adolescent depression is particularly important. Suicide rates have increased significantly in this age group during the last decade. As a result, suicide ranks as the third leading cause of death in adolescents in the United States (Hawton, 1982; Holinger, 1979; Holinger and Offer, 1981). Research on depression in adolescents also has important preventive implications. Adult depression represents a major health problem, with as many as 20°70 of the population reporting clinically significant depressive symptomatology (Weissman and Myers, 1978). Most of the research in the area of adolescent depressive symptomatology is based on clinical case reports (e.g., Eason, 1977; Malmquist, 1971; Toolan, 1962). There have been few attempts to empirically investigate depression in this population (Inamdar et al., 1979; Mezzich and Mezzich, 1979; Strober et al., 1981; Teri, 1982a, b). The most important question which has not been adequately researched involves the "essential nature" of adolescent depression. Disagreement remains as to whether depression in adolescents differs from adult depression (Glaser, 1981; Hudgens, 1974; Carlson and Strober, 1979). Because of the lack of research in the area of adolescent depression, findings from the adult literature appear to provide a useful starting point for understanding the nature of this disorder in adolescents. One variable which has been identified as being an important etiological factor in adult depression is stressful life events (Brown et al., 1978; Johnson and Sarason, 1978; Paykel, 1974). Evidence for the role of environmental stressors in depression in adolescents is provided by Hudgen (1974), who found an increase in the number of stresful events associated with the onset of depression in 20 of 22 depressed adolescents. The factors most frequently related to depression in the subjects were having a psychiatrically disturbed parent and having a medical disorder whose probable outcome was chronic disability or death. Cognitive factors also have been implicated in the development and maintenance of depression in adults (Beck, 1967; Seligman, 1975). Cognifive variables that pertain to the "perceptual style" of the individual including attributional style and locus of control have been found to be associated with adult depression. Locus of control has been consistently shown to have a positive relationship with depression in adults, with external locus of con-
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trol being strongly associated with higher levels of depression (Calhoun et al., 1974; Johnson and Sarason, 1978). In addition, cognitive appraisal of the causes of stressful events and perceived controllability of these events has been investigated with adults. The learned helplessness model of depression postulates that the affective, cognitive, and behavioral components of depression are a result of learning that there is not a contingency between responses and outcomes (Abramson et al., 1978; Seligman, 1975). Depressed adults have been found to make more global, stable, and internal attributions for failure and more, specific, unstable, and external attributions for success than do nondepressed adults (Klein et al., 1976; Seligman et al., 1979). There are currently no reports of an investigation of locus of control or attributional style in a sample of depressed adolescents. Spivack et al. (1976) have discussed a group of interpersonal problemsolving skills that appear to mediate behavioral adjustment including the ability to conceptualize the means to solve a problem. It has been suggested in the literature that depression may adversely affect an individual's performance on cognitive tasks such as the ability to solve a variety of problems. Depression in an adult sample was found to be associated with a specific type of problem-solving deficiency: specifically a decreased ability to solve problems of an interpersonal nature (Gotlib and Asarnow, 1979). It remains to be demonstrated whether cognitive interpersonal problem-solving deficits are present in depressed adolescents. The purpose of this study was to investigate systematically the relationship among stressful life events, attributional style, interpersonal problemsolving ability, and depressive symptoms in a group of middle-school and high-school adolescents. An evaluation of variables known to be related to depression in other age groups would appear to provide an empirically valid starting point for this study. If the parameters of adolescent depression can be identified, even through strictly correlational means, hypotheses as to the etiology, symptomatology, prevention, and treatment of this disorder may evolve.
METHOD
Subjects
The subjects were 99 adolescents, 12 to 18 years old, who attended a coeducational public middle school and high school in a middle-class community in central Missouri. The mean age of the subjects was 15.0 years. Subjects consisted of 20 students in the eighth grade, 19 students in the ninth
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grade, 20 students in the tenth grade, 21 students in the eleventh grade, and 19 students in the twelfth grade. Ninety-seven of the subjects were white and two were black. There were 46 females and 53 males in the sample. Seventy-seven percent of the subjects indicated that they were from either middle-class or upper-class families, with parents' vocations distributed as follows: 22% were blue-collar workers, 51% were white-collar workers, and 27% were shopkeepers, executives, and professionals. Regarding the marital status of their parents, 85.5% were married, 12.5% were divorced, and 2% were separated or widowed. Procedure
Informed consent was obtained from parents of all subjects prior to their participation in this study. The measures were administered to each classroom as a group. In each instance the experimenter introduced herself as someone who was interested in learning how teenagers feel about themselves currently and how they try to solve problems which they may face. They were told that there were no right or wrong answers to the questions and that she was interested in their ideas and not what they thought adults expected them to say. Finally, the subjects were informed that all of their responses would remain confidential. The measures were introduced and selfadministered in the following order: Beck Depression Inventory, Life Events Schedule, Nowicki-Strickland Locus of Control Scale, Social Means-Ends Problem-Solving Procedure (MEPS), Emotional MEPS, and Attributional Style Scale. MEASURES
The Beck Depression Inventory (BDI) The BDI is a standardized questionnaire which has weighted response categories from 0 to 3 for each of 2I items. BDI scores are classified according to cutoff points for severity of depression derived from psychiatric evaluations in two previous studies (Beck and Beck, 1972; Beck et at., 1974). This inventory taps cognitive, affecfive, motivational, vegetative, and physical manifestations of depression and has been shown to have excellent psychometric characteristics (Beck, 1967; Weckowicz et al., 1967). In addition, the validity of the BDI with adolescents has been demonstrated (Strober et al., 1981; Terri, 1982a, b).
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Coddington's Life Events Scale for Adolescents (CLESC) The CLESC was developed by Coddington (1971) to assess the impact of specific life events on adolescents. It is a 36-item scale. Each item has been assigned numerical life change units which tap the impact of these events on adjustment. Subjects are asked to indicate which events occurred within the past year (e.g., parents divorced, moved to a new neighborhood) and whether the event had a positive or negative impact on their life. Positive and negative ratings range from + 3 to --3.
The Nowicki-Strickland Locus Of Control Scale (NSLOC) This is a 40-item questionnaire which taps external-internal control of reinforcement expectancy and allows for a general assessment of the individuars feelings of control over the events in the environment (Nowicki and Strickland, 1973). The items describe reinforcement situations across interpersonal and motivational areas. Reliability estimates and construct validity information were obtained by administering the measure to 1017 elementary and highschool students. Estimates of internal consistency via the split-half method ranged from r = 0.68 to r = 0.74. Test-retest reliability ranged from 0.63 to 0.17.
A ttributional Style Scale for Adolescents (ASSA) The ASSA was developed for this study and is a modified version of the Attributional Style Scale developed by Seligman et al. (I 979) for adults. The ASSA consists of 12 hypothetical situations, 6 describing good outcomes and 6 describing bad outcomes. O f the 12 situations, 6 have an affiliation orientation and 6 have an achievement orientation. Thus, the scale consists of four subscales." (1) achievement situations with good outcomes, (2) achievement situations with bad outcomes, (3) affiliation situations with good outcomes, and (4) affiliation situations with bad outcomes. For each situation, subjects are asked to pick from four possible responses the most likely cause o f the outcome described. Finally, subjects are asked to rate how important each situation would be if it happened to them on a three-point scale from not at all important to very important.
The Social Means-Ends Problem-Solving Procedure (MEPS) The MEPS for adolescents was developed by P l a t t e t al. (1974) to assess means-ends thinking in 13-18 year olds. The measure consists of four
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stories that ask the subject to provide the means by which the character in the story arrives at a given end. All stories are o f an interpersonal nature. Scores on the MEPS are arrived at by totaling the number o f means stated toward a given story goal and the number o f obstacles that might be encountered on the way to that goal.
Emotional Means-Ends Problem-Solving Procedure (EMPS) The EMPS is a variation o f the MEPS which asks for problem solving of negative emotional situations such as relieving oneself from depression and overcoming anxiety. Siegel et al. (1974) developed four story situations to measure this aspect o f problem-solving ability in adolescents and adults. The E M P S is administered and scored in the same manner as the social MEPS.
RESULTS Demographic Variables and Depression
The mean score of the short form BDI for this study was 9.64. For purposes o f comparison across a number o f demographic variables, the BDI scores were classified according to cutoff points for severity o f depression derived from previous studies (Beck and Beck, 1972; Beck et al., 1974; Strober et aL, 1981). According to this method o f converting scores, 20.2°/o of the subjects fell into the range o f moderate to severe depressive symptomatology (Beck score, 16-39). Table I shows the distribution o f age, sex, and previous counseling experience as well as parents' marital and socioeconomic status of the depressive subsample and nondepressive subsample. Although 6007o of the depressive sample was female, this was not a statistically significant difference. The difference in age distribution between the two subsamples (showing a clear predominance o f 14 and 15 year olds over other age groups in the depressive subsample) was statistically significant (X 2 = 9.5, df = 2, p < 0.01). Previous counseling experience did not significantly differentiate the two subsamples. There were differences, however, in parents' marital and socioeconomic status. The depressed adolescents tended to come from middle- and lower-class families (X ~ = 14.16, df = 3, p < 0.01) with a higher incidence of divorce (An = 13.76, df = 3, p < 0.01).
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Correlates of Adolescent Depression Table 1. Demographic Variables Depressive subsample (N = 20) Age (mean years) 16-18 14-15 12-13 Sex Female Male Parents' marital status Divorced Married Separated Widowed Socioeconomic status Upper Middle Lower Previous counseling Yes No
Nondepressive subsample (N = 79)
15.15 7 13 0
15.35 41 24 14
12 8
34 45
6 14 0 0
6 71 I 1
2 9 9
25 42 12
5 15
9 70
Independent Variables and Depression Table II presents the zero-order correlations between selected independent variables and the dependent variable depression.
Life: Stress and Depression N o c o r r e l a t i o n w a s f o u n d b e t w e e n a n a d o l e s c e n t ' s level o f d e p r e s s i o n and his or her subjective rating of life stress. However, the correlation be-
Table I1. Zero-Order Correlations Between Independent Variables and Beck Depression Inventory Scores Independent variable Life stress Negative life stress Positive life stress Neutral life stress Total life stress Problem solving Social MEPS total Emotional MEPS total Attributional style Depressive attributions Weighted depressive attributions Nowicki-Strickland locus of control
Coefficient
p
0.13 0.01 0.18 0.15
ns ns ns ns
-0.06 0.01 0.32 0.35 0.51
x
ns ns 0.001 0.001 0.001
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tween ratings of neutral life stress (events rated as having neither a negative nor a positive impact) and ratings of depression approached significance (r = 0.18, p = 0.07).
Problem-Solving Ability and Depression There was no correlation found between depression and overall social and emotional means-ends problem-solving scores. However, some o f the individual story scores from each of these tasks did correlate with depression. There was a small but significant relationship found between depression and the number of irrelevant means given for the dating problem from the Social MEPS (r = 0.21, p = 0.04). Higher levels o f depression were associated with difficulty in solving the social-dating problem. T w o o f the Emotional MEPS story scores were correlated with depression. There was a significant positive relationship between depression and the number of relevant active means given to solve the depression problem (r = 0.22, p = 0.03). There was also a significant correlation between depression and the frequency of no means given to solve the sleeplessness problem (r = 0.24, p = 0.02). Higher depression scores were therefore associated with ability to solve the depression problem and inability to solve the sleeplessness problem.
Attributional Style and Depression A positive correlation was found between level of depression and tendency to attribute outcomes to causes which are internal, stable, and global (r = 0.32, p = 0.001). When attributions were weighted by the subjective significance o f the attributional situation for the individual, there was a slightly higher correlation with depression (r = 0.34, p = 0.001).
Locus of Control and Depression O f the independent variables examined, locus of control had the highest correlation with depression (r = 0.51, p = 0.001). Thus, higher levels o f depression were associated with a more external locus o f control.
Prediction of Depression from Independent Variables Depression was regressed on life stress, problem solving, attributional style, locus of control, and a number of other variables which were significantly or highly correlated with it. The procedure involved the con-
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struction of a regression model for depression with the various independent variables treated as predictor variables. A stepwise regression was computed such that variables which accounted for the greatest amount of variance based on the regression were chosen in a stepwise fashion from those entered in the model. Independent variables which did not exceed a regression coefficient of 0.20 were dropped from the model and the regression equation was recalculated. Of the variables entered, the Nowicki-Strickland locus of control measure accounted for the most variance (31%). In terms of contributions to explaining depression, the other variables were as follows: Social MEPS-dating problem, number of irrelevant means, 4%; Emotional MEPS-depression problem, number of relevant active means, 4%; Emotional MEPS -- sleeplessness problem, no means, 3%; socioeconomic status, 2°7o; and depressive attributions, 2%. These six variables explained a total of 46% of the variance in depression scores.
DISCUSSION The overall results of this study indicate that the level of self-reported depressive symptoms in adolescents is significantly related to the external locus of control, attributional style, socioeconomic status, and parental marital status. Of all the variables under consideration in this study, external locus of control emerged as the most significant variable, accounting for the most variance in the adolescents' depression scores on the Beck Depression Inventory. Therefore, adolescents who perceived outcomes as beyond their control were more likely to score high on the depression measure. The finding of a strong positive correlation between external locus of control and depression parallels findings from both the adult and the childhood depression literature (Abramowitz, 1969; Calhoun el al., 1974; Moyal, 1977; Lefkowitz and Tesiny, 1980). Similarly, results from the attribution literature with adults were supported in the current study by the relationship found between a depressive attributional style and depression (Klein e! al., 1976; Kuiper, 1978; Rizley, 1978; Seligman et at., 1979). Depressed adolescents tended to attribute outcomes to internal, stable, and global factors as predicted by the reformulated hypothesis of learned helplessness and depression (Seligman et al., 1979). The seeming paradox in finding both external locus of control and internal (as well as global and stable) attributions to be related to depression reflects the current stage of development in depression theory. The present study supports the notion that depressive cognitions have features of both external control (helplessness) and internal control (self-blame). In the literature, both locus of control and attributional style have been shown to be related to depression; yet in the present study, locus of control accounted
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for the most variance in depression scores. The locus of control measure may be tapping a more cogent dimension of the cognitive processes associated with depression in this age group than does the attributional style measure. In the present study, a relationship between stressful life events, as measured by the Coddington Life Events Scale, and depression was not obtained. Life stress has previously been noted to be related to depression in adults (Brown et ai., 1978; Johnson and Sarason, 1978; Paykel, 1974). The only other study which examined life stress and depression in adolescents (Hudgens, 1974) found that an increase in stressful events was associated with the onset of depression in 20 of 22 depressed adolescents. The discrepancies noted between these two studies could be due to differences in the subject populations or differences in the measures used. The adolescents in Hudgen's study were from a psychiatric facility and may have been more seriously depressed and, therefore, more likely to have experienced a greater number of stressful life events than the subjects in this study. In addition, Hudgen assessed life stress through an interview with the adolescents rather than with a self-report measure. He found that the onset of depression was associated with having a chronic medical disorder or a parent with a psychiatric disorder. It is possible that the Coddington Life Events Scale was not as sensitive as an interview might be to the kinds of stressful life events which are related to depression in a general adolescent population. However, there were a number of indications from sources other than the life stress measure which suggest a possible relationship between stressful life events and depression. In the present study, there was a strong relationship between parental divorce and depression. There is evidence that marital conflict and/or divorce can be significant stressors for adolescents (McDermott, 1970; Wallerstein and Kelly, 1974). An additional finding was that level of self-reported depressive symptoms was related in an inverse fashion to socioeconomic status, suggesting that economic and social stresses may play a role in adolescent depression. Given the apparent relationship among depressive symptomatology, external locus of control, and low socioeconomic level, it would appear that an adolescent's dysphoric responses may in large part be determined by reality-based problems in the environment. Longitudinal studies which periodically assess these variables would be necessary in order to determine whether such factors actually contribute to the development and/or maintenance of depression in adolescents. No significant relationship was found between level of depression and overall ability to generate solutions to social or emotional problems. The finding that both depressed and nondepressed children share the same cognitive ability to generate solutions to interpersonal problems presents some conceptual problems in that one would expect adolescents with higher
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levels of depressive symptoms to be deficient in these skills. It is possible that there is a discrepancy between the cognitive and the performance aspects of problem-solving skills. This is most clearly evident from the finding of a positive correlation between ability to solve the depression problem (from the Emotional MEPS) and high depression scores. Depressed adolescents would seem to be aware of the means to alleviate depression but do not utilize these means. This cognitive-performance discrepancy may also be functioning with respect to social problem-solving ability. These findings point to the need for studies which examine the performance component of problem solving to determine if there are performance deficits in either social or emotional problem sol.ving in real-life situations. A possible explanation for a performance deficit in problem solving is that depressed adolescents feel "helpless" to effect changes in their environment and hence do not attempt to utilize problem-solving skills. It may be that depressed adolescents attribute the difficulties they face to factors beyond their control. The present study's finding of a strong positive correlation between locus of control and depression is consistent with this notion. While this study provides useful information about the relationship between a number of cognitive and demographic variables and depressive symptoms in a nonclinical sample of adolescents, it remains for further research to evaluate whether these findings will generalize to clinical populations. In particular, it would be important to determine whether these findings would be replicated with a more severely depressed sample of adolescents. In the course of this discussion a number of directions for future research in adolescent depression have been indicated. An examination of problem-solving performance was suggested. No research has attempted to link verbal problem-solving ability to actual performance of the skills tapped by both the social and the emotional problem-solving measures. Past research has linked cognitive problem-solving deficits to depression, and a demonstration of performance deficits related to depression may provide information concerning the development and/or maintenance of this disorder in adolescents. External locus of control or "helplessness" appears to be accounting for much of the variance in depression scores. The implication of this finding, however, is not clear. Studies which further delineate the nature of this cognitive set may provide implications for cognitive intervention strategies which would be useful with adolescents.
ACKNOWLEDGMENT
The authors wish to thank Kay Kline Hodges, Ph.D., for her helpful comments on an early draft of the manuscript.
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Nowicki, S., and Strickland, B. R. (1973). A locus of control scale for children. J. Consult. Clin. PsychoL 40: 148-155. Paykel, F. S. (1974). Life stress and psychiatric disorder. In Dohrenwend, B. S., and Dohrenwend, E. P. (eds.), Stressful Life Events: Their Nature and Effects, Wiley, New York. Plait, J. J., Spivack, G., Altman, N., and Altman, D. (1974). Adolescent problem-solving thinking. J. Consult. Clin. PsychoL 42: 787-793. Rizley, R. (1973). Depression and distortion in the attribution of causality. J. Abnorm. Psychol. 87: 32-48. Seligman, M. E. P. (1975). Helplessness." On Depression, Development, and Death, Freeman, San Francisco. Seligman, M.E.P., Abramson, L. Y., Semmel, A., and yon Baeyer, C. (1979). Depressive attributional style. J. Abnorm. Psychol. 77: 242-247. Shaffer, D., and Fisher, P. (1981). The epidemiology of suicide in children and young adolescents. J. Am. Acad. Child Psychiat. 20: 545-565. Shure, M., and Spivack, G. (1972). Means-ends thinking, adjustment and social class among elementary school-aged children. J. Consult. Clin. Psychol. 38: 348-353. Siegel, J. M., Platt, J. J., and Peizer, S. B. (1974). Emotional and social real-life problem solving thinking in adolescent and adult psychiatric patients. J. Clin. Psychol. 32: 230-232. Spivack, G., Plait, J. J., and Shure, M. B. (1976). The Problem Solving Approach to Adjustmerit: A Guide to Research and Intervention, Jossey-Bass, San Francisco. Strober, M., Green, J., and Carlson, G. (1981). Utility of the Beck Depression Inventory with psychiatrically hospitalized adolescents. J. Consult. Clin. PsychoL 49: 482-483. Teri, L. (1982a). Depression in adolescence: lts relationship to assertion and various aspects of self-image. J. Clin. Child Psychol. 2: 101-106. Teri, L. (1982b). The use of the Beck Depression Inventory with adolescents. J. Abnorm. Child Psychol. 2: 277-284. Toolan, J. M. (1962). Depression in children and adolescents. Am. J. Orthopsyehiat. 32: 404-415. Wallerstein, J., and Kelly, J. (1974). The effects of parental divorce: The adolescent experience. In Anthony, E. J., and Koupernich, C. (eds.), The Child in His Family: Children at Psychiatric Risk, Wiley, New York. Weckowicz, T. E., Muir, W., and Cropley, A. (1967). A factor analysis of the Beck Depression Inventory. J. Consult. Clin. Psychol. 31: 23-28. Weissman, M. M., and Meyers, J. (1978). Affective disorders in a U.S. urban community: The use of Research Diagnostic Criteria in an epidemiological survey. Arch. Gem Psychiatr. 35: 1304-I311.
Correlates of Depressive Symptoms in Adolescents Lawrence J. Siegel t'3 and Nora J. Griffin 2 Received January 25, 1983; accepted December 17, 1984
The relationship between a number o f social and cognitive variables and depressive symptomatology was evaluated in a sample o f public middleschool and high-school students. The variables measured included stressful life events, locus o f control, causal attributions, and means-ends problemsolving abilities. Higher levels o f depression were found to be associated with a more external locus o f control and a tendency to attribute outcomes to causes which are internal, stable, and global. Parental divorce and socioeconomic status were also found to be associated with higher levels of depression. No relationship was found to exist between either amount of life stress or problem-solving ability and depression. The implications of these results for delineating the underlying dimensions of depression in adolescents are discussed.
INTRODUCTION T h e l i t e r a t u r e o n d e p r e s s i o n in a d o l e s c e n t s is v e r y l i m i t e d a n d o f t e n c o n t r a d i c t o r y . Little i n f o r m a t i o n is a v a i l a b l e o n the i n c i d e n c e o f d e p r e s s i o n
tAssociate Professor, Department of Pediatrics, Child Development Division, University of Texas Medical Branch, Galveston, Texas. Previously Dr. Siegel was in the Department of Clinical Psychology at the University of Florida. Received his Ph.D. from Case Western Reserve University in 1975. Major interest is stress reactivity and coping processes in children and adolescents. zClinical psychology intern at the Dallas V.A. Medical Center and doctoral student in clinical psychology at the University of Missouri-Columbia. Major interest is adolescent psychopathology and self-esteem. 3To whom correspondence should be addressed at Department of Pediatrics, Child Development Division, University of Texas Medical Branch, Galveston, Texas 77550. 475 0047-2891/84/1200-0475 $03.50/0 © 1984 Plenum Publishing Corporation
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in the general adolescent population. There is also no agreement on the cliniced frequency of adolescent depression, and statistics vary widely (Albert and Beck, 1975; Carlson and Cantwell, 1979; Carlson and Strober, 1979; Hudgens, 1974). Given the frequent association between suicidal behavior in adolescents and depressive symptoms (Herjanic and Welner, 1980; Shaffer and Fisher, 1981), tile study of adolescent depression is particularly important. Suicide rates have increased significantly in this age group during the last decade. As a result, suicide ranks as the third leading cause of death in adolescents in the United States (Hawton, 1982; Holinger, 1979; Holinger and Offer, 1981). Research on depression in adolescents also has important preventive implications. Adult depression represents a major health problem, with as many as 20°70 of the population reporting clinically significant depressive symptomatology (Weissman and Myers, 1978). Most of the research in the area of adolescent depressive symptomatology is based on clinical case reports (e.g., Eason, 1977; Malmquist, 1971; Toolan, 1962). There have been few attempts to empirically investigate depression in this population (Inamdar et al., 1979; Mezzich and Mezzich, 1979; Strober et al., 1981; Teri, 1982a, b). The most important question which has not been adequately researched involves the "essential nature" of adolescent depression. Disagreement remains as to whether depression in adolescents differs from adult depression (Glaser, 1981; Hudgens, 1974; Carlson and Strober, 1979). Because of the lack of research in the area of adolescent depression, findings from the adult literature appear to provide a useful starting point for understanding the nature of this disorder in adolescents. One variable which has been identified as being an important etiological factor in adult depression is stressful life events (Brown et al., 1978; Johnson and Sarason, 1978; Paykel, 1974). Evidence for the role of environmental stressors in depression in adolescents is provided by Hudgen (1974), who found an increase in the number of stresful events associated with the onset of depression in 20 of 22 depressed adolescents. The factors most frequently related to depression in the subjects were having a psychiatrically disturbed parent and having a medical disorder whose probable outcome was chronic disability or death. Cognitive factors also have been implicated in the development and maintenance of depression in adults (Beck, 1967; Seligman, 1975). Cognifive variables that pertain to the "perceptual style" of the individual including attributional style and locus of control have been found to be associated with adult depression. Locus of control has been consistently shown to have a positive relationship with depression in adults, with external locus of con-
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trol being strongly associated with higher levels of depression (Calhoun et al., 1974; Johnson and Sarason, 1978). In addition, cognitive appraisal of the causes of stressful events and perceived controllability of these events has been investigated with adults. The learned helplessness model of depression postulates that the affective, cognitive, and behavioral components of depression are a result of learning that there is not a contingency between responses and outcomes (Abramson et al., 1978; Seligman, 1975). Depressed adults have been found to make more global, stable, and internal attributions for failure and more, specific, unstable, and external attributions for success than do nondepressed adults (Klein et al., 1976; Seligman et al., 1979). There are currently no reports of an investigation of locus of control or attributional style in a sample of depressed adolescents. Spivack et al. (1976) have discussed a group of interpersonal problemsolving skills that appear to mediate behavioral adjustment including the ability to conceptualize the means to solve a problem. It has been suggested in the literature that depression may adversely affect an individual's performance on cognitive tasks such as the ability to solve a variety of problems. Depression in an adult sample was found to be associated with a specific type of problem-solving deficiency: specifically a decreased ability to solve problems of an interpersonal nature (Gotlib and Asarnow, 1979). It remains to be demonstrated whether cognitive interpersonal problem-solving deficits are present in depressed adolescents. The purpose of this study was to investigate systematically the relationship among stressful life events, attributional style, interpersonal problemsolving ability, and depressive symptoms in a group of middle-school and high-school adolescents. An evaluation of variables known to be related to depression in other age groups would appear to provide an empirically valid starting point for this study. If the parameters of adolescent depression can be identified, even through strictly correlational means, hypotheses as to the etiology, symptomatology, prevention, and treatment of this disorder may evolve.
METHOD
Subjects
The subjects were 99 adolescents, 12 to 18 years old, who attended a coeducational public middle school and high school in a middle-class community in central Missouri. The mean age of the subjects was 15.0 years. Subjects consisted of 20 students in the eighth grade, 19 students in the ninth
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grade, 20 students in the tenth grade, 21 students in the eleventh grade, and 19 students in the twelfth grade. Ninety-seven of the subjects were white and two were black. There were 46 females and 53 males in the sample. Seventy-seven percent of the subjects indicated that they were from either middle-class or upper-class families, with parents' vocations distributed as follows: 22% were blue-collar workers, 51% were white-collar workers, and 27% were shopkeepers, executives, and professionals. Regarding the marital status of their parents, 85.5% were married, 12.5% were divorced, and 2% were separated or widowed. Procedure
Informed consent was obtained from parents of all subjects prior to their participation in this study. The measures were administered to each classroom as a group. In each instance the experimenter introduced herself as someone who was interested in learning how teenagers feel about themselves currently and how they try to solve problems which they may face. They were told that there were no right or wrong answers to the questions and that she was interested in their ideas and not what they thought adults expected them to say. Finally, the subjects were informed that all of their responses would remain confidential. The measures were introduced and selfadministered in the following order: Beck Depression Inventory, Life Events Schedule, Nowicki-Strickland Locus of Control Scale, Social Means-Ends Problem-Solving Procedure (MEPS), Emotional MEPS, and Attributional Style Scale. MEASURES
The Beck Depression Inventory (BDI) The BDI is a standardized questionnaire which has weighted response categories from 0 to 3 for each of 2I items. BDI scores are classified according to cutoff points for severity of depression derived from psychiatric evaluations in two previous studies (Beck and Beck, 1972; Beck et at., 1974). This inventory taps cognitive, affecfive, motivational, vegetative, and physical manifestations of depression and has been shown to have excellent psychometric characteristics (Beck, 1967; Weckowicz et al., 1967). In addition, the validity of the BDI with adolescents has been demonstrated (Strober et al., 1981; Terri, 1982a, b).
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Coddington's Life Events Scale for Adolescents (CLESC) The CLESC was developed by Coddington (1971) to assess the impact of specific life events on adolescents. It is a 36-item scale. Each item has been assigned numerical life change units which tap the impact of these events on adjustment. Subjects are asked to indicate which events occurred within the past year (e.g., parents divorced, moved to a new neighborhood) and whether the event had a positive or negative impact on their life. Positive and negative ratings range from + 3 to --3.
The Nowicki-Strickland Locus Of Control Scale (NSLOC) This is a 40-item questionnaire which taps external-internal control of reinforcement expectancy and allows for a general assessment of the individuars feelings of control over the events in the environment (Nowicki and Strickland, 1973). The items describe reinforcement situations across interpersonal and motivational areas. Reliability estimates and construct validity information were obtained by administering the measure to 1017 elementary and highschool students. Estimates of internal consistency via the split-half method ranged from r = 0.68 to r = 0.74. Test-retest reliability ranged from 0.63 to 0.17.
A ttributional Style Scale for Adolescents (ASSA) The ASSA was developed for this study and is a modified version of the Attributional Style Scale developed by Seligman et al. (I 979) for adults. The ASSA consists of 12 hypothetical situations, 6 describing good outcomes and 6 describing bad outcomes. O f the 12 situations, 6 have an affiliation orientation and 6 have an achievement orientation. Thus, the scale consists of four subscales." (1) achievement situations with good outcomes, (2) achievement situations with bad outcomes, (3) affiliation situations with good outcomes, and (4) affiliation situations with bad outcomes. For each situation, subjects are asked to pick from four possible responses the most likely cause o f the outcome described. Finally, subjects are asked to rate how important each situation would be if it happened to them on a three-point scale from not at all important to very important.
The Social Means-Ends Problem-Solving Procedure (MEPS) The MEPS for adolescents was developed by P l a t t e t al. (1974) to assess means-ends thinking in 13-18 year olds. The measure consists of four
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stories that ask the subject to provide the means by which the character in the story arrives at a given end. All stories are o f an interpersonal nature. Scores on the MEPS are arrived at by totaling the number o f means stated toward a given story goal and the number o f obstacles that might be encountered on the way to that goal.
Emotional Means-Ends Problem-Solving Procedure (EMPS) The EMPS is a variation o f the MEPS which asks for problem solving of negative emotional situations such as relieving oneself from depression and overcoming anxiety. Siegel et al. (1974) developed four story situations to measure this aspect o f problem-solving ability in adolescents and adults. The E M P S is administered and scored in the same manner as the social MEPS.
RESULTS Demographic Variables and Depression
The mean score of the short form BDI for this study was 9.64. For purposes o f comparison across a number o f demographic variables, the BDI scores were classified according to cutoff points for severity o f depression derived from previous studies (Beck and Beck, 1972; Beck et al., 1974; Strober et aL, 1981). According to this method o f converting scores, 20.2°/o of the subjects fell into the range o f moderate to severe depressive symptomatology (Beck score, 16-39). Table I shows the distribution o f age, sex, and previous counseling experience as well as parents' marital and socioeconomic status of the depressive subsample and nondepressive subsample. Although 6007o of the depressive sample was female, this was not a statistically significant difference. The difference in age distribution between the two subsamples (showing a clear predominance o f 14 and 15 year olds over other age groups in the depressive subsample) was statistically significant (X 2 = 9.5, df = 2, p < 0.01). Previous counseling experience did not significantly differentiate the two subsamples. There were differences, however, in parents' marital and socioeconomic status. The depressed adolescents tended to come from middle- and lower-class families (X ~ = 14.16, df = 3, p < 0.01) with a higher incidence of divorce (An = 13.76, df = 3, p < 0.01).
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Correlates of Adolescent Depression Table 1. Demographic Variables Depressive subsample (N = 20) Age (mean years) 16-18 14-15 12-13 Sex Female Male Parents' marital status Divorced Married Separated Widowed Socioeconomic status Upper Middle Lower Previous counseling Yes No
Nondepressive subsample (N = 79)
15.15 7 13 0
15.35 41 24 14
12 8
34 45
6 14 0 0
6 71 I 1
2 9 9
25 42 12
5 15
9 70
Independent Variables and Depression Table II presents the zero-order correlations between selected independent variables and the dependent variable depression.
Life: Stress and Depression N o c o r r e l a t i o n w a s f o u n d b e t w e e n a n a d o l e s c e n t ' s level o f d e p r e s s i o n and his or her subjective rating of life stress. However, the correlation be-
Table I1. Zero-Order Correlations Between Independent Variables and Beck Depression Inventory Scores Independent variable Life stress Negative life stress Positive life stress Neutral life stress Total life stress Problem solving Social MEPS total Emotional MEPS total Attributional style Depressive attributions Weighted depressive attributions Nowicki-Strickland locus of control
Coefficient
p
0.13 0.01 0.18 0.15
ns ns ns ns
-0.06 0.01 0.32 0.35 0.51
x
ns ns 0.001 0.001 0.001
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tween ratings of neutral life stress (events rated as having neither a negative nor a positive impact) and ratings of depression approached significance (r = 0.18, p = 0.07).
Problem-Solving Ability and Depression There was no correlation found between depression and overall social and emotional means-ends problem-solving scores. However, some o f the individual story scores from each of these tasks did correlate with depression. There was a small but significant relationship found between depression and the number of irrelevant means given for the dating problem from the Social MEPS (r = 0.21, p = 0.04). Higher levels o f depression were associated with difficulty in solving the social-dating problem. T w o o f the Emotional MEPS story scores were correlated with depression. There was a significant positive relationship between depression and the number of relevant active means given to solve the depression problem (r = 0.22, p = 0.03). There was also a significant correlation between depression and the frequency of no means given to solve the sleeplessness problem (r = 0.24, p = 0.02). Higher depression scores were therefore associated with ability to solve the depression problem and inability to solve the sleeplessness problem.
Attributional Style and Depression A positive correlation was found between level of depression and tendency to attribute outcomes to causes which are internal, stable, and global (r = 0.32, p = 0.001). When attributions were weighted by the subjective significance o f the attributional situation for the individual, there was a slightly higher correlation with depression (r = 0.34, p = 0.001).
Locus of Control and Depression O f the independent variables examined, locus of control had the highest correlation with depression (r = 0.51, p = 0.001). Thus, higher levels o f depression were associated with a more external locus o f control.
Prediction of Depression from Independent Variables Depression was regressed on life stress, problem solving, attributional style, locus of control, and a number of other variables which were significantly or highly correlated with it. The procedure involved the con-
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struction of a regression model for depression with the various independent variables treated as predictor variables. A stepwise regression was computed such that variables which accounted for the greatest amount of variance based on the regression were chosen in a stepwise fashion from those entered in the model. Independent variables which did not exceed a regression coefficient of 0.20 were dropped from the model and the regression equation was recalculated. Of the variables entered, the Nowicki-Strickland locus of control measure accounted for the most variance (31%). In terms of contributions to explaining depression, the other variables were as follows: Social MEPS-dating problem, number of irrelevant means, 4%; Emotional MEPS-depression problem, number of relevant active means, 4%; Emotional MEPS -- sleeplessness problem, no means, 3%; socioeconomic status, 2°7o; and depressive attributions, 2%. These six variables explained a total of 46% of the variance in depression scores.
DISCUSSION The overall results of this study indicate that the level of self-reported depressive symptoms in adolescents is significantly related to the external locus of control, attributional style, socioeconomic status, and parental marital status. Of all the variables under consideration in this study, external locus of control emerged as the most significant variable, accounting for the most variance in the adolescents' depression scores on the Beck Depression Inventory. Therefore, adolescents who perceived outcomes as beyond their control were more likely to score high on the depression measure. The finding of a strong positive correlation between external locus of control and depression parallels findings from both the adult and the childhood depression literature (Abramowitz, 1969; Calhoun el al., 1974; Moyal, 1977; Lefkowitz and Tesiny, 1980). Similarly, results from the attribution literature with adults were supported in the current study by the relationship found between a depressive attributional style and depression (Klein e! al., 1976; Kuiper, 1978; Rizley, 1978; Seligman et at., 1979). Depressed adolescents tended to attribute outcomes to internal, stable, and global factors as predicted by the reformulated hypothesis of learned helplessness and depression (Seligman et al., 1979). The seeming paradox in finding both external locus of control and internal (as well as global and stable) attributions to be related to depression reflects the current stage of development in depression theory. The present study supports the notion that depressive cognitions have features of both external control (helplessness) and internal control (self-blame). In the literature, both locus of control and attributional style have been shown to be related to depression; yet in the present study, locus of control accounted
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for the most variance in depression scores. The locus of control measure may be tapping a more cogent dimension of the cognitive processes associated with depression in this age group than does the attributional style measure. In the present study, a relationship between stressful life events, as measured by the Coddington Life Events Scale, and depression was not obtained. Life stress has previously been noted to be related to depression in adults (Brown et ai., 1978; Johnson and Sarason, 1978; Paykel, 1974). The only other study which examined life stress and depression in adolescents (Hudgens, 1974) found that an increase in stressful events was associated with the onset of depression in 20 of 22 depressed adolescents. The discrepancies noted between these two studies could be due to differences in the subject populations or differences in the measures used. The adolescents in Hudgen's study were from a psychiatric facility and may have been more seriously depressed and, therefore, more likely to have experienced a greater number of stressful life events than the subjects in this study. In addition, Hudgen assessed life stress through an interview with the adolescents rather than with a self-report measure. He found that the onset of depression was associated with having a chronic medical disorder or a parent with a psychiatric disorder. It is possible that the Coddington Life Events Scale was not as sensitive as an interview might be to the kinds of stressful life events which are related to depression in a general adolescent population. However, there were a number of indications from sources other than the life stress measure which suggest a possible relationship between stressful life events and depression. In the present study, there was a strong relationship between parental divorce and depression. There is evidence that marital conflict and/or divorce can be significant stressors for adolescents (McDermott, 1970; Wallerstein and Kelly, 1974). An additional finding was that level of self-reported depressive symptoms was related in an inverse fashion to socioeconomic status, suggesting that economic and social stresses may play a role in adolescent depression. Given the apparent relationship among depressive symptomatology, external locus of control, and low socioeconomic level, it would appear that an adolescent's dysphoric responses may in large part be determined by reality-based problems in the environment. Longitudinal studies which periodically assess these variables would be necessary in order to determine whether such factors actually contribute to the development and/or maintenance of depression in adolescents. No significant relationship was found between level of depression and overall ability to generate solutions to social or emotional problems. The finding that both depressed and nondepressed children share the same cognitive ability to generate solutions to interpersonal problems presents some conceptual problems in that one would expect adolescents with higher
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levels of depressive symptoms to be deficient in these skills. It is possible that there is a discrepancy between the cognitive and the performance aspects of problem-solving skills. This is most clearly evident from the finding of a positive correlation between ability to solve the depression problem (from the Emotional MEPS) and high depression scores. Depressed adolescents would seem to be aware of the means to alleviate depression but do not utilize these means. This cognitive-performance discrepancy may also be functioning with respect to social problem-solving ability. These findings point to the need for studies which examine the performance component of problem solving to determine if there are performance deficits in either social or emotional problem sol.ving in real-life situations. A possible explanation for a performance deficit in problem solving is that depressed adolescents feel "helpless" to effect changes in their environment and hence do not attempt to utilize problem-solving skills. It may be that depressed adolescents attribute the difficulties they face to factors beyond their control. The present study's finding of a strong positive correlation between locus of control and depression is consistent with this notion. While this study provides useful information about the relationship between a number of cognitive and demographic variables and depressive symptoms in a nonclinical sample of adolescents, it remains for further research to evaluate whether these findings will generalize to clinical populations. In particular, it would be important to determine whether these findings would be replicated with a more severely depressed sample of adolescents. In the course of this discussion a number of directions for future research in adolescent depression have been indicated. An examination of problem-solving performance was suggested. No research has attempted to link verbal problem-solving ability to actual performance of the skills tapped by both the social and the emotional problem-solving measures. Past research has linked cognitive problem-solving deficits to depression, and a demonstration of performance deficits related to depression may provide information concerning the development and/or maintenance of this disorder in adolescents. External locus of control or "helplessness" appears to be accounting for much of the variance in depression scores. The implication of this finding, however, is not clear. Studies which further delineate the nature of this cognitive set may provide implications for cognitive intervention strategies which would be useful with adolescents.
ACKNOWLEDGMENT
The authors wish to thank Kay Kline Hodges, Ph.D., for her helpful comments on an early draft of the manuscript.
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