Clusters of Behaviors and Beliefs Predicting Adolescent Depression: Implications for Prevention
Paunesku, David, Ellis, Justin, Fogel, Joshua, Kuwabara, Sachiko A., Gollan, Jackie, Gladstone, Tracy, Reinecke, Mark, Van Voorhees, Benjamin W., Journal of Evidence-Based Psychotherapies
Risk factors for various disorders are known to cluster. However, the factor structure for behaviors and beliefs predicting depressive disorder in adolescents is not known. Knowledge of this structure can facilitate prevention planning. We used the National Longitudinal Study of Adolescent Health (AddHealth) data set to conduct an exploratory factor analysis to identify clusters of behaviors/experiences predicting the onset of major depressive disorder (MDD) at 1-year follow-up (N=4,791). Four factors were identified: family/interpersonal relations, self-emancipation, avoidant problem solving/low self-worth, and religious activity. Strong family/interpersonal relations were the most significantly protective against depression at one year follow-up. Avoidant problem solving/low self-worth was not predictive of MDD on its own, but significantly amplified the risks associated with delinquency. Depression prevention interventions should consider giving family relationships a more central role in their efforts. Programs teaching problem solving skills may be most appropriate for reducing MDD risk in delinquent youth.
Keywords: adolescence, depression, prediction, prevention
Adolescence is a critical period for the onset of major depressive disorder (MDD), with as many as 24% of adolescents experiencing an episode by age 24 (Kessler & Walters, 1998; Klerman, 1988; Klerman & Weissman, 1989). It is also an important developmental period during which critical processes of socialization and educational development occur. Adolescents who experience a depressive episode during this period often have reduced educational attainment, greater relationship dysfunction, more job absenteeism, increased risk of substance abuse and tobacco use, and increased risk for MDD recurrence within 5 years (Bardone, Moffitt, Caspi, Dickson, & Silva, 1996; Bardone Moffitt, & Caspi, 1998; Binder & Angst, 1981; Breslau, Kilbey, & Andreski, 1991; Breslau, Kilbey, & Andreski, 1994; Christie, Burke, & Regier et al., 1988; Ernst, Foldenyi, & Angst, 1993; Hallowell, Bemporad, & Ratey, 1989; Horwitz & White, 1991; Kessler, Avenevoli, & Ries Merikangas, 2001; Kessler & Walters, 1998; Lewinsohn, Klein, Durbin, Seeley, & Rohde, 2003; Reinherz, Giaconia, Hauf, Wasserman, & Silverman, 1999; Runeson, 1989; Skodol, Schwartz, Dohrenwend, Levav, & Shrout, 1994). Furthermore, adolescent depression is a major contributor to suicide and is the third leading cause of death among older adolescents (Fombonne, Wostear, Cooper, Harrington, & Rutter, 2001b; Harris & Ammerman, 1986). Despite the public health impact of depressive disorders, little is known about how characteristics, experiences and behaviors related to onset of disorder may naturally cluster in community settings.
Multiple vulnerability characteristics and behaviors are associated with the onset of adolescent depression. This includes genetic (short allele of the serotonin transporter gene promoter region), personality (neuroticism), biological stress response (hypo-pituitary-adrenal axis changes), problem solving/attribution (negative inferential styles, dysfunctional attitudes, rumination, self-criticism), and family/interpersonal relations (low social support from peers and family) (Hankin, 2006; Reinecke, 2005). These characteristics and behaviors interact with adverse events to increase the risk of a depressive episode. Prevention interventions targeting primarily the problem solving/attribution domain have produced variable results with regard to efficacy, and these benefits often attenuate after six months (Merry, McDowell, Hetrick, Bir, & Muller, 2004). Inconsistent results from prevention studies suggest that our understanding of the organization of behaviors and characteristics relevant to the onset of depression in adolescence is insufficient.
Several reports advocate research on the development and evaluation of robust, practical public health strategies to reduce the burden of depressive disorders in youth (Bramesfeld, Platt, & Schwartz, 2006; Saxena, Jane-Llopis, & Hosman, 2006). …