Research reportCharacteristics of adolescent girls with depressive symptoms in a so-called "normal" sample
Introduction
As many as ten percent of adults have met DSM-III-R criteria for Major Depressive Disorder (MDD) within a given twelve-month period (Kessler et al., 1993). The disorder is also diagnosed with increasing frequency in adolescents, among whom prevalence rates for current MDD are estimated to range from 0.4 to 6.4 percent (Fleming and Offord, 1990). Females are at particular risk for the disorder; numerous studies document higher rates of depression in adolescent and adult females than males (for reviews see Weissman and Klerman, 1985Weissman et al., 1984). Leon et al. (1993), for instance, found a nearly doubled risk for MDD in females in recent decades, with first onset most common in late adolescence or early adulthood. Additionally, Lewinsohn et al. (1993)found a lifetime prevalence of 22.3% in adolescent females, age 14 to 18 years and 11.4% in adolescent boys. Female adolescents have been found to be at increased risk for more severe and prolonged depressive episodes than their male peers (McCauley et al., 1993).
Research suggests that prevention of adolescent MDD episodes is possible when populations at elevated risk for the disorder are targeted for psychosocial interventions (Beardslee et al., 1992, Clarke et al., 1995). Promising outcomes have been obtained in programs developed for children of depressed parents (Beardslee et al., 1992) and adolescents with subclinical depressive symptomatology (Clarke et al., 1995). Identification and treatment of individuals in the latter category is of particular importance, as more than 50% of first episodes of MDD occur in individuals who have had prior depressive symptoms (Horwath et al., 1994).
Little is known about subclinical depression in adolescents, however, despite estimated prevalence rates as high as 46% for boys and 59% for girls (Roberts et al., 1990). Most research regarding depression in this population has focused on behaviors and features associated with MDD (Kovacs et al., 1984McCauley et al., 1993Kashani et al., 1980Carlson and Cantwell, 1980Mitchell et al., 1988Puig-Antich and Rabinovich, 1986Deykin et al., 1987Harter, 1989Marton et al., 1993Ryan et al., 1987). Gotlib et al. (1995)compared false positive (subjects with depressive symptoms but not meeting criteria for major depression), with true-positives and true-negatives on measures of clinical and psychosocial functioning. False-positive and true-positive participants did not differ on most measures of psychosocial dysfunction.
Cognitive deficits, particularly in memory (Burt et al., 1995) and visuospatial/visuomotor skill (Cassens et al., 1990) have been well documented in adults with MDD. Less research, however, has examined cognitive correlates of MDD in younger populations and the majority of existing work has focused on preadolescent children rather than adolescents. Lewinsohn et al. (1994a)found no relationship between vocabulary level and depresssion in adolescents, which is consistent with findings of minimal associations between depression and verbal skill in children (Kaslow et al., 1983, Kaslow et al., 1984) and adults (Cassens et al., 1990). Several studies have revealed statistically significant, but modest correlations between severity of depression and IQ in preadolescent children (Lefkowitz and Tesiny, 1985, Tesiny et al., 1980), however, no significant differences in IQ have been revealed in comparisons of depressed and nondepressed children. MDD in children is associated with poorer performance on measures of attention, coordination and psychomotor speed (Kaslow et al., 1983Kaslow et al., 1984). Memory deficits are less evident than in depressed adults; in a study of inpatient and outpatient 9–12 year olds, Lauer et al. (1994)found immediate recall deficits on the Children's Auditory Verbal Learning Test in a severely depressed MDD/dysthymia group relative to less depressed MDD/dysthymia and non-depressed children. The less depressed group earned the highest scores on this measure, which led the researchers to hypothesize that memory impairment in childhood depression varies as a function of symptom severity with only the severely depressed exhibiting memory impairment. Thus, although verbal knowledge is preserved in depressed adolescents, little is known about other cognitive characteristics of MDD or subclinical depression in this age group.
Low self-esteem is a well-documented feature of MDD in adolescents (Harter, 1989, Marton et al., 1993, Ryan et al., 1987). Inpatient depressed adolescents have been found to differ significantly from normal adolescents on measures of self-perceived behavioral conduct and global self-worth. Additionally, the severity of depression correlated negatively with self-perception of social acceptance, romantic appeal, close friendships and global self-worth (King et al., 1993). In a normal sample of young adolescents, Renouf and Harter (1990)found a significant negative relationship between global self-worth and depressive affect.
Few studies have examined relationships between motivational orientation and depression, and we could find no research addressing such relationships in adolescents. Children with extrinsic motivational orientations (those who perform tasks for reasons external to the individual such as grades), however, have been found to experience more depressive symptomatology than those with an intrinsic motivational orientation (those who perform tasks for the inherent pleasure of mastery) (Boggiano and Barrett, 1992). In the same study, girls were found to be more extrinsically motivated than boys, and thus more vulnerable to feelings of helplessness and depression. Boggiano and Barrett (1992)also cite an unpublished study in which they found similar relationships between extrinsic motivation and depressive symptomatology in college students.
MDD in adolescence has been closely examined and characterized. A similarly thorough understanding of the features of subclinical depression is important for several reasons. First, because of the association between subclinical depressive symptomatology and future development of MDD, a thorough description of cognitive and behavioral features associated with subclinical depression in adolescence may aid in early identification of those at risk. Second, information about subclinical depression may help provide a better understanding of the nature of MDD as a syndrome, particularly whether it is of a continuous or dichotomous nature.
We have been engaged in a study of neuropsychological development in normal adolescent females. Potential participants were screened for the presence of psychopathology to eliminate the potential confound of neuropsychological deficits associated with depression. Individuals with no history of diagnosis with or treatment for a psychiatric disorder were enrolled in the study. Participants were subsequently administered a more thorough psychiatric interview and several self-report questionnaires to confirm the absence of disorders. During the evaluation process, we found that an unexpectedly large number of participants (44% of the total sample) reported current or past depressive symptoms. Of this subgroup, however, only two participants exhibited symptoms of sufficient severity to warrant referral for further evaluation or treatment. In light of the lack of research describing characteristics associated with subclinical depression and of cognition in depressive disorder in adolescence, we elected to study these participants' patterns of cognition, self-perception and motivation. Differences, if found, would hold important implications regarding the nature of depressive disorders, as well as for research on normal populations.
Section snippets
Participants
Thirty-one adolescent females, ranging in age from 12 to 17 years (M=13.8; SD=1.3), were recruited from a local school district to participate in the study. We excluded individuals with a history of diagnosed psychiatric disorder. The recruitment process began with random selection of female students from enrollment lists provided by three local schools within a cooperating school district. Letters describing the study were mailed to a total of 88 female students and their parents, who were
Comparison of groups on clinical measures
As a means of validating the interview results, the two groups were compared on the DSRS, a self-report measure of depressive symptomatology, the results of the parent interview using the DISC and the Child Behavior Checklist. The Depressed group obtained significantly higher scores on the DSRS, t=−4.29, p<.0002. Although markedly higher scores were found for the Depressed group, only four members of the Depressed group obtained scores that exceed the cutoff for clinical significance.
Discussion
Forty-four percent of the adolescent girls who entered the study had at least mild depressive symptoms, even though a parent reported no disorder during the telephone screening interview. Given the high frequency of subclinical and clinical depression in adolescent girls, Roberts et al. (1990)estimated 59% of adolescent girls had subclinical depression and (Lewinsohn et al., 1993) found a lifetime prevalence of clinical depression of 22% in girls ages 14 to 18 – the adolescent and the parent
References (59)
- Achenbach, T.M. and Edelbrock, C.S. (1983) Manual for the Child Behavior Checklist and Revised Child Behavior Profile....
- Beardslee, W.R., Hoke, L., Wheelock, I., Rothberg, P.C., van de Velde, P. and Swatling, S. (1992) Initial findings on...
- Benton, A.L. and des Hamsher, K. (1976) Multilingual Aphasia Examination. University of Iowa, Iowa City,...
- Benton, A.L., des Hamsher, K., Varney, N. and Spreen, O. (1983) Contributions to Neuropsychological Assessment. Oxford...
- Birleson, P. (1981) The validity of depressive disorder in childhood and the development of a self-rating scale: A...
- Birleson, P., Hudson, I., Buchanan, D.G. and Wolff, S. (1987) Clinical evaluation of a self-rating scale for depressive...
- Boggiano, A.K. and Barrett, M. (1992) Gender differences in depression in children as a function of motivational...
- Burt, D.B., Zemba, M.J. and Niederehe, G. (1995) Depression and memory impairment: A meta-analysis of the association,...
- Buschke, H. (1973) Components of verbal learning in children: Analysis of selective reminding. J. Exp. Child Psychol....
- Carlson, G.A. and Cantwell D.P. (1980) Unmasking masked depression in children and adolescents. Am. J. Psychiatry 137,...
Cited by (27)
The abnormal brain activation pattern of adolescents with major depressive disorder based on working memory tasks: A fNIRS study
2024, Journal of Psychiatric ResearchEffect of depressive symptoms on the evolution of neuropsychological functions over the course of adolescence
2018, Journal of Affective DisordersCitation Excerpt :Indeed, some studies suggest a lack of such deficits among adolescents and young adults. The first study comparing the neuropsychological functioning of adolescent girls with depressive symptoms to a control group highlighted a lack of between-group differences in measures of visual memory, verbal memory or executive function, despite the significantly poorer visual-spatial perception in the case group (McClure et al., 1997). Likewise, other case-control studies of adolescents with clinical and subclinical depression indicated a lack of significant between-group differences in working memory, subjective memory and general cognition (Korhonen et al., 2002), attention and decision making (Kyte et al., 2005), short-term memory and target detection (Baune et al., 2012; Maalouf et al., 2011), verbal and visual short-term memory, verbal long-term memory, attention and processing speed (Castaneda et al., 2008), as well as no difference in verbal memory functioning (Wang et al., 2006).
Neuropsychological functioning in adolescents and young adults with major depressive disorder - A review
2014, Psychiatry ResearchCitation Excerpt :The selected studies employed case-control designs with generally small total sample sizes ranging from 97 of the largest study to the smallest with 28 participants. Two of the studies investigated female participants only (McClure et al., 1997; Matthews et al., 2008). In total across the seven studies, 431 participants were studied with N=170 MDD cases, N=12 cases of minor depression, N=21 cases of BSD and N=228 controls.
Internalizing Disorders in Early Childhood: A Review of Depressive and Anxiety Disorders
2009, Child and Adolescent Psychiatric Clinics of North AmericaCitation Excerpt :Notably, impairment in social development was found in this sample of depressed preschoolers, as demonstrated by significantly lower scores on the Vineland socialization subscale in comparison with that of healthy controls.39 Similar to findings of specific cognitive deficits in older children and adults suffering from depression,49–51 this subsample also showed impairments in cognitive functioning—specifically visual spatial skills. In comparison with healthy controls, preschoolers identified as depressed performed more poorly on a block construction task than healthy controls.52
Preschool Depression
2006, Child and Adolescent Psychiatric Clinics of North AmericaAre child-, adolescent-, and adult-onset depression one and the same disorder?
2001, Biological PsychiatryCitation Excerpt :In contrast, depressed children do not appear to have difficulties in the performance of delayed memory tasks. Although there is a need for more work in this area, preliminary data suggests that deficits in visual-spatial reasoning are more prominent than memory deficits in youngsters with depression (Frost et al 1989; McClure et al 1997; McGee et al 1986). Neuroimaging studies have yet to examine the structure and function of the dorsolateral prefrontal cortex in pediatric depressed cohorts.