Skip to main content
Log in

Depression Amongst Chinese Adolescents in Hong Kong: An Evaluation of a Stress Moderation Model

  • Published:
Social Indicators Research Aims and scope Submit manuscript

Abstract

Stress has an established association with depression. However, not all adolescents experiencing stressors become depressed and it is helpful to identify potential resilience factors. The current study tests a theoretical extension of a stress-diathesis model of depression in a Chinese context, with stress, coping, family relationships, and alexithymia as risk factors for depression. This community study involves 1,199 secondary school students (567 males and 632 females) aged between 14 and 20 from six high schools with different bandings in Hong Kong. The models tested confirm the relationship between stress and depression. Ability to identify of one’s feelings (alexithymia subscale), the adoption of problem solving coping and the rejection of non-productive coping all acted as protective factors (moderators) against depression in the presence of stress. Coping also partially mediated the relationship between alexithymia and depression. A stress-diathesis model received some support, however, a complex set of inter-relationship between all the explanatory variables was revealed. Problem solving coping and non-productive coping emerged as key factors in understanding adolescent depression.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  • Aggleton, P., Hurry, J., & Warwick, I. (Eds.). (2000). Young people and mental health. United Kingdom: Wiley.

    Google Scholar 

  • Anon, (2007). Practice parameter for the assessment and treatment of children and adolescents with depressive disorders. Journal of American Academy of Child and Adolescent Psychiatry, 46, 1503–1526.

    Article  Google Scholar 

  • Bagby, R. M., Parker, J. D. A., Taylor, G. J. (1994a). The twenty-item Toronto Alexithymia Scale I: Item selection and cross-validation of the factor structure. Journal of Psychosomatic Research, 38, 23–32.

    Article  Google Scholar 

  • Bagby, R. M., Taylor, G. J., Parker, J. D. A. (1994b). The twenty-item Toronto Alexithymia Scale–II. Convergent, discriminant, and concurrent validity. Journal of Psychosomatic Research, 38, 33–40.

    Article  Google Scholar 

  • Baron, R. M., & Kenny, D. A. (1986). The moderator-mediator distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51, 1173–1182.

    Article  Google Scholar 

  • Beck, A. T. (1967). Depression: Clinical, experimental, and theoretical aspects. New York: Harper & Row.

    Google Scholar 

  • Beck, A. T. (1983). Cognitive therapy of depression: New perspectives. In P. J. Clayton & J. E. Barrett (Eds.), Treatment of depression: Old controversies and new approaches (pp. 265–290). New York: Raven Press.

    Google Scholar 

  • Briggs, S. R., & Cheek, J. M. (1986). The role of factor analysis in the development and evaluation of personality scales. Journal of Personality, 54, 106–148.

    Article  Google Scholar 

  • Carpenter, K. M., & Addis, M. E. (2000). Alexithymia, gender, and responses to depressive symptoms. Sex Roles, 43, 629–644.

    Article  Google Scholar 

  • Chan, D. W. (1998). Stressful life events, cognitive appraisals of the impact and desirability of these events, and psychological symptoms were assessed in sample of 745 Chinese adolescents from six secondary schools in Hong Kong. Journal of Youth and Adolescence, 27(4), 457–473.

    Article  Google Scholar 

  • Chan, C. M., & Tsoi, M. M. (1984). The BDI and stimulus determinants of cognitive-related depression among Chinese college students. Cognitive Therapy and Research, 8, 501–508.

    Article  Google Scholar 

  • Chen, C. N., Wong, J., Lee, N., et al. (1993). The Shatin community mental health survey in Hong Kong. II. Major findings. Archives of General Psychiatry, 50, 125–133.

    Google Scholar 

  • Cicchetti, D., & Rogosch, F. A. (2002). A developmental psychopathology perspective on adolescence. Journal of Consulting and Clinical Psychology, 56, 131–136.

    Google Scholar 

  • Compas, B. E., Howell, D. C., Phares, V., Williams, R. A., & Giunta, C. T. (1989). Risk factors for emotional/behavioural problems in young adolescents: A prospective analysis of adolescent and parental stress and symptoms. Journal of Consulting and Clinical Psychology, 57, 732–740.

    Article  Google Scholar 

  • Dumont, M., & Provost, M. A. (1999). Resilience in adolescence: Protective roles of social support, coping strategies, self-esteem, and social activities on experience of stress and depression. Journal of Youth and Adolescence, 28, 343–363.

    Article  Google Scholar 

  • Ebata, A. T., & Moos, R. H. (1994). Coping and adjustment in distressed and healthy adolescents. Journal of Applied Developmental Psychology, 12, 33–54.

    Article  Google Scholar 

  • Evans, G. W. (2003). A multimethodological analysis of cumulative risk and allostatic load among rural children. Developmental Psychology, 39, 924–933.

    Article  Google Scholar 

  • Evans, G. W., Brauchle, G., Haq, A., Stecker, R., Wong, K., & Shapiro, E. (2007). Young children’s environmental attitudes and behaviors. Environment and behavior. Retrieved 20 March 2009, from http://eab.sagepub.com/cgi/reprint/39/5/635.

  • Fakiri, S. (2004). Deliberate self-harm in adolescents: Family problems and alexithymia. Dissertation, University of London.

  • Fergusson, D. R., Boden, J. M., & Horwood, L. J. (2007). Recurrence of major depression in adolescence and early adulthood, and later mental health, educational and economic outcomes. British Journal of Psychiatry, 191, 335–342.

    Article  Google Scholar 

  • Frydenberg, E., & Lewis, R. (1993a). Manual: The adolescent coping scale. Melbourne: Australian Council for Educational Research.

    Google Scholar 

  • Frydenberg, E., & Lewis, R. (1993b). Boys play sport and girls turn to others: Age, gender and ethnicity as determinants of coping. Journal of Adolescence, 16, 253–266.

    Article  Google Scholar 

  • Frydenberg, E., & Lewis, R. (1996). What concerns young people and how they cope? Journal of Peace Psychology, 2, 271–283.

    Article  Google Scholar 

  • Hampel, P., & Peterman, F. (2005). Age and gender effects on coping in children and adolescents. Journal of Youth and Adolescents, 34, 73–83.

    Article  Google Scholar 

  • Hart, K. E. (1991). Coping with anger-provoking situations. Journal of Adolescent Research, 6, 357–370.

    Article  Google Scholar 

  • Haviland, M. G., Hendryx, M. S., Cummings, M. A., Shaw, D. G., & MacMurray, J. P. (1991). Multidimensionality and state dependency of alexithymia in recently sober alcoholics. Journal of Nervous and Mental Disease, 179, 284–290.

    Article  Google Scholar 

  • Haviland, M. G., Shaw, D. G., MacMurray, J. P., & Cummings, M. A. (1988). Validation of the Toronto Alexithymia Scale with substance abusers. Psychotherapy and Psychosomatics, 50, 81–87.

    Article  Google Scholar 

  • Hendryx, M. S., Haviland, M. G., & Shaw, D. G. (1991). Dimensions of alexithymia and their relationships to anxiety and depression. Journal of Personality Assessment, 56, 227–237.

    Article  Google Scholar 

  • Herman-Stahl, M. A., Stemmler, M., & Petersen, A. C. (1995). Approach and avoidant coping: Implications for adolescent mental health. Journal of Youth and Adolescence, 24, 649–665.

    Article  Google Scholar 

  • Hinshaw, S. P. (2002). Intervention research, theoretical mechanisms, and causal processes related to externalizing behavior patterns. Development and Psychopathology, 14, 789–818.

    Article  Google Scholar 

  • Honkalampi, K., Hintikka, J., Tanskanen, A., Lehtonen, J., & Viinamaki, H. (2000). Depression is strongly associated with alexithymia in the general population. Journal of Psychosomatic Research, 48, 99–104.

    Article  Google Scholar 

  • Iancu, I., Horesh, N., Offer, D., Dannon, P. N., Lepkifker, E., & Kotler, M. (1999). Alexithymia, affect intensity and emotional range in suicidal patients. Psychotherapy and Psychosomatics, 68, 276–280.

    Article  Google Scholar 

  • Ireland, J. L., Boustead, R., & Ireland, C. A. (2005). Coping style and psychological health among adolescent prisoners: A study of young and juvenile offenders. Journal of Adolescence, 28, 411–423.

    Article  Google Scholar 

  • Johnson, J. H., & McCutcheon, S. M. (1980). Assessing life stress in older children and adolescents: Preliminary finding with the life events checklist. In I. G. Saranson & C. D. Spielberger (Eds.), Stress and anxiety (pp. 111–125). Washington, DC: Hemisphere.

    Google Scholar 

  • Jose, P. E., & Ratcliffe, V. (2004). Stressor frequency and perceived intensity as predictors of internalising symptoms: Gender and age differences in adolescence. Stressors and Stress Intensity in Adolescence, 33, 145–154.

    Google Scholar 

  • Kessler, R. (1997). The effects of stressful life events on depression. Annual Review of Psychology, 48, 191–214.

    Article  Google Scholar 

  • Kliewer, W., Lepore, S. J., Oskin, D., & Johnson, P. D. (1998). The role of social and cognitive processes in children’s adjustment to community violence. Journal of Consulting and Clinical Psychology, 66, 199–209.

    Article  Google Scholar 

  • Kooiman, C. G., Spinhoven, P., & Trijsburg, R. W. (2002). The assessment of alexithymia: A critical review of the literature and a psychometric study of the Toronto Alexithymia Scale-20. Journal of Psychosomatic Research, 53, 1083–1090.

    Article  Google Scholar 

  • Landis, D., Gaylord-Harden, N. K., Malinowski, S. L., Grant, K. E., Carleton, R. A., & Ford, R. E. (2007). Urban adolescent stress and hopelessness. Journal of Adolescence, 30, 1051–1070.

    Article  Google Scholar 

  • Lazarus, R., & Folkman, S. (1984). Stress, appraisal, and coping. New York: Springer.

    Google Scholar 

  • Lewinsohn, P. M., Rohde, P., & Seeley, J. R. (1998). Major depressive disorder in older adolescents: Prevalence, risk factors, and clinical implications. Clinical Psychology Review, 18, 765–794.

    Article  Google Scholar 

  • Martin, J. B., & Pihl, R. O. (1985). The stress-alexithymia hypothesis: Theoretical and empirical considerations. Psychotherapy and Psychosomatics, 43, 169–176.

    Article  Google Scholar 

  • Matud, M. P. (2004). Gender differences in stress and coping styles. Personality and Individual Differences, 37, 1401–1415.

    Article  Google Scholar 

  • Mikulincer, M. (1989). Coping and learned helplessness: Effects of coping strategies on performance following unsolvable problems. European Journal of Personality, 3, 181–194.

    Article  Google Scholar 

  • Murberg, T. A., & Bru, E. (2007). The role of neuroticism and perceived school-related stress in somatic symptoms among schools in Norwegian junior high schools. Journal of Adolescence, 30, 203–212.

    Article  Google Scholar 

  • Parker, J. D. A., Bagby, R. M., & Taylor, G. J. (1991). Alexithymia and depression: Distinct or overlapping constructs? Comprehensive Psychiatry, 32, 387–394.

    Article  Google Scholar 

  • Parker, J. D. A., Taylor, G. J., & Bagby, R. M. (1993). Alexithymia and the processing of emotional stimuli: An experimental study. New Trends in Experimental and Clinical Psychiatry, 9, 9–14.

    Google Scholar 

  • Parker, J. D. A., Taylor, G. J., & Bagby, R. M. (1998). Alexithymia: Relationship with ego defense and coping styles. Comprehensive Psychiatry, 39, 91–98.

    Article  Google Scholar 

  • Pennebaker, J. W., & Beall, S. K. (1986). Confronting a traumatic event: Toward an understanding of inhibition and disease. Journal of Abnormal Psychology, 95, 274–281.

    Article  Google Scholar 

  • Pennebaker, J. W., & O’Heeran, A. (1984). Confiding in others and illness rate among spouses of suicide and accidental death victims. Journal of Abnormal Psychology, 93, 473–476.

    Article  Google Scholar 

  • Pennebaker, J. W., & Traue, H. C. (1992). Inhibition and psychosomatic processes. In H. C. Traue & J. W. Pennebaker (Eds.), Inhibition and health (pp. 146–164). Seattle: Hogrefe & Huber.

  • Petersen, A. C., Compas, B. E., Brooks-Gunn, J., Stemmler, M. E. S., & Grant, K. E. (1993). Depression in adolescence. American Psychologist, 48, 155–168.

    Article  Google Scholar 

  • Porcelli, A. M., Ghelli, A., Zanna, C., Valente, P., Ferroni, S., & Rugolo, M. (2003). Staurosporine induces apoptotic volume decrease (AVD) in ECV 340 cells. Annals of the New York Academy of Sciences, 1010, 342–346.

    Article  Google Scholar 

  • Rief, W., Heuser, J., & Fichter, M. M. (1996). What does the Toronto Alexithymia Scale TAS-R measure? Journal of Clinical Psychology, 52, 423–429.

    Article  Google Scholar 

  • Rodham, K., Hawton, K., & Evans, E. (2004). Reasons for deliberate self-harm: comparison of self-poisoners and self-cutters in a community sample of adolescents. Journal of American Academy of Child and Adolescent Psychiatry, 43(1), 80–87.

    Article  Google Scholar 

  • Rutter, M. (2005). Environmentally mediated risks for psychopathology: Research strategies and findings. Journal of the American Academy of Child and Adolescent Psychiatry, 44, 3–18.

    Article  Google Scholar 

  • Saarijarvi, S., Salminen, J. K., Tamminen, T., & Aarela, E. (1993). Alexithymia in psychiatric consultation-liaison patients. General Hospital Psychiatry, 15, 330–333.

    Article  Google Scholar 

  • Sandler, I. N., Tein, J. Y., & West, S. G. (1994). Coping, stress, and the psychological symptoms of children of divorce: A cross-sectional and longitudinal study. Child Development, 65, 1744–1763.

    Article  Google Scholar 

  • Seiffge-Krenke, I., & Klessinger, N. (2000). Long-term effects of avoidant coping on adolescents’ depressive symptoms. Journal of Youth and Adolescence, 29, 617–630.

    Article  Google Scholar 

  • Shek, D. T. L. (1990). Reliability and factorial structure of the Chinese version of the Beck depression inventory. Journal of Clinical Psychology, 46, 35–43.

    Article  Google Scholar 

  • Shucksmith, J., Hendry, L., & Glendinning, A. (1995). Models of parenting: Implications for adolescent well-being within different types of family contexts. Journal of Adolescence, 18, 253–270.

    Article  Google Scholar 

  • Sifneos, P. E. (1973). The prevalence of ‘alexithymic’ characteristics in psychosomatic patients. Psychotherapy and Psychosomatics, 22, 255–262.

    Article  Google Scholar 

  • Siu, A. C., & Watkins, D. (1997). Coping with stress in Hong Kong: an investigation of the influence of gender, age, and the self-concept. Psychologia, 40(2), 59–66.

    Google Scholar 

  • Stewart, S. M., Betson, C., Lam, T. H., Chung, S. F., Ho, H. H., & Chung, T. F. C. (1999). The correlates of depressed mood in adolescents in Hong Kong. Journal of Adolescent Health, 25, 27–34.

    Article  Google Scholar 

  • Stewart, S. M., Lewinsohn, P. M., Lee, P. W. H., Ho, L. M., Kennard, B., Hughes, C. W., et al. (2002). Symptom patterns in depression and ‘subthreshold’ depression among adolescents in Hong Kong and the United States. Journal of Cross-Cultural Psychology, 33, 559–576.

    Article  Google Scholar 

  • Taiminen, T. J., Saarijarvi, S., Helenius, H., Keskinen, A., & Korpilahti, T. (1996). Alexithymia in suicide attempters. Acta Psychiatrica Scandinavica, 93, 195–198.

    Article  Google Scholar 

  • Tamres, L. K., Janicki, D., & Helgson, V. S. (2002). Sex differences in coping behaviour: A meta-analytic review and an examination of relative coping behaviour. Personality and Social Psychology Review, 6, 2–30.

    Article  Google Scholar 

  • Taylor, G. J. (1999). Introduction. In G. J. Taylor, R. M. Bagby, & J. D. A. Parker (Eds.), Disorders of affect regulation (pp. 1–6). Cambridge: Cambridge University Press.

  • Taylor, G. J., Bagby, R. M., & Parker, J. D. A. (2003). The 20-item Toronto Alexithymia Scale IV. Reliability and factorial validity in different languages and cultures. Journal of Psychosomatic Research, 55, 277–283.

    Article  Google Scholar 

  • Van Voorhees, B. W., Paunesku, D., Gollan, J., Kuwabara, S., Reinecke, M., & Basu, A. (2008). Predicting future risk of depressive episode in adolescents: The Chicago adolescent depression risk assessment (CADRA). Annals of Family Medicine, 6, 503–511.

    Article  Google Scholar 

  • Vingerhoets Ad, J. J. M., Van Heck, G. L., Grim, R., & Bermond, B. (1995). Alexithymia: A further exploration of its nomological network. Psychotherapy and Psychosomatic, 64, 32–42.

    Article  Google Scholar 

  • Wise, T. N., Jani, N. S., Kass, E., Sonnenschein, K., & Mann, L. S. (1988). Alexithymia: Relationship to severity of medical illness and depression. Psychotherapy and Psychosomatics, 50, 68–71.

    Article  Google Scholar 

  • Yip, P. S. F., & Lee, J. (2002). The impact of the changing marital structure on fertility of Hong Kong. Social Science and Medicine, 55, 2159–2169.

    Article  Google Scholar 

  • Yip, P. S. F., Lee, J., Chan, B., & Au, J. (2001). A study of demographic changes under sustained below-replacement fertility in Hong Kong SAR. Social Science & Medicine, 53, 1003–1009.

    Article  Google Scholar 

  • Zubin, J., & Spring, B. (1977). Vulnerability: A new view of schizophrenia. Journal of Abnormal Psychology, 86, 103–126.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Catalina S. M. Ng.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ng, C.S.M., Hurry, J. Depression Amongst Chinese Adolescents in Hong Kong: An Evaluation of a Stress Moderation Model. Soc Indic Res 100, 499–516 (2011). https://doi.org/10.1007/s11205-010-9626-3

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11205-010-9626-3

Keywords

Navigation