Copyright 1990 by the American Psychological Association, Inc. 0021-843X/90/W0.75
Journal of Abnormal Psychology 1990, Vol. 99, No. 1,55-63
Sex Differences and Adolescent Depression Betty Allgood-Merten and Peter M. Lewinsohn University of Oregon and Oregon Research Institute
This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
Hyman Hops Oregon Research Institute This study investigates the role of certain psychosocial variables—sex, age, body image/self-esteem, self-consciousness, stressful life events, and the degree to which an individual identifies with the cultural stereotype of masculinity—as correlates and antecedents to depression in adolescents and explores possible intraindividual mediators of the stress-depression relationship in adolescents. A battery of self-report measures was administered to public high school students in Grades 9-12 in their classrooms at two different times 1 month apart. Female adolescents reported more depressive symptoms, self-consciousness, stressful recent events, feminine attributes, and negative body image and self-esteem; no age effects were obtained. Results suggest a model of adolescent depression in which body/self-esteem and stressful recent events are significant contributors.
Although depression is quite prevalent in the adult population, its existence during childhood, though now recognized, is relatively uncommon. Somewhere between childhood and adulthood its prevalence is assumed to increase dramatically (Rutter, 1986; Rutter, Graham, Chadwick, & Yule, 1976). Moreover, girls do not appear to predominate among the depressed very early in the lifespan (Garrison, C, personal communication, 1989; Weissman & Klerman, 1977), yet women clearly are preponderate among depressed young adults (Lewinsohn, Duncan, Stanton, & Hautzinger, 1986). Thus, an investigation into depressive symptoms during adolescence may shed some light not only on what appears to be a developmental increase in the prevalence of depression but also on the female preponderance assumed to emerge during that period. Moreover, little is known about depression during adolescence. Until very recently, depression research largely focused on adult populations. We thus do not know to what extent the multitude of findings that have emerged from the adult literature in the recent past are generalizable to adolescents. The growing literature on adolescent depression suggests that adolescents are substantially more depressed than children (Angold, 1988; Rutter, 1986) and that they may be more depressed than adults (Garrison, Shoenbach, & Kaplan, 1984; Schoenbach, Garrison, & Kaplan, 1984; Schoenbach, Kaplan, Grimson, & Wagner, 1982). From a preventive perspective, given the sharp rise in adolescent suicide (e.g., Frederick, 1985) and the
This research was supported in part by Research Grant MH40501 from the National Institute of Mental Health and by a grant from the Center for the Study of Women in Society at the University of Oregon, Eugene, Oregon. We gratefully acknowledge the assistance of Richard Langford and his students at Oregon State University and of the faculty, staff, and students of Crescent Valley High School in Corvallis, Oregon, in the data collection, and of Judy Andrews in the data analysis. Correspondence concerning this article should be addressed to Betty Allgood-Merten, Oregon Research Institute, 1715 Franklin Boulevard, Eugene, Oregon 97403. 55
finding that being depressed substantially increases the likelihood of having further episodes (Amenson & Lewinsohn, 1981), it is critically important that clinical investigators turn their attention to the study of depression in this age group. The purpose of the present study is to explore psychosocial factors hypothesized to be associated with depressive symptoms in adolescents and with the female preponderance thought to emerge during this period. We look first at the contributions of sex and age, then at contributions of certain variables that have been shown to be associated with depression in adults—i.e., self-esteem (e.g., Beck, 1967) and stressful recent events (e.g., Lewinsohn, Hoberman, & Rosenbaum, 1988; Paykel et al., 1969)—and finally at variables hypothesized to be of particular importance to depression in adolescents—i.e., body image, selfconsciousness, and the degree to which an adolescent self-reports attributes associated with masculine stereotypes. We hypothesize that these will be associated with depression in adolescents as both correlate and antecedent and, moreover, that the greater female vulnerability to depression begins during adolescence with critical age-related changes in the variables of interest. Considerable evidence has accumulated in the adult literature that stressful life events often precede an episode of depression (Brown & Harris, 1978; Lewinsohn, Hoberman, & Rosenbaum, 1988; Lewinsohn ATalkington, 1979; Lloyd, 1980; Paykel et al., 1969) and, more recently, that recent events, or "hassles," are more strongly associated with depression than major life events (DeLongis, Coyne, Dakof, Folkmanm, & Lazarus, 1983). Whereas there has been some investigation of stress and psychopathology in adolescents (e.g., Compas, Wagner, Slavin, & Vannatta, 1986; Peterson & Spiga, 1982), no studies, to our knowledge, have attempted to identify stressful recent events as antecedent to depression in adolescents. It is further hypothesized that adolescence is a more stressful developmental period for girls than for boys (Hops, Sherman, & Biglan, 1989; Rutter, 1986) and that this makes girls more likely to become depressed. A number of recent studies suggest that positive body image
This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
56
B. ALLGOOD-MERTEN, P. LEWINSOHN, & H. HOPS
is an important negative correlate of depression in high school and college students (Cash, Winstead, & Janda, 1986; Noles, Cash, & Winstead, 1985; Teri, 1982). However, it is not known whether body image represents a unique construct as it relates to depression or is merely an aspect of self-esteem. It is also not known whether negative body image is antecedent to the onset of depression. Because depressive cognitions appear to be mood-state dependent (Lewinsohn, Steinmetz, Larson, & Franklin, 1981), one might expect negative body image to be merely a correlate of depression that waxes and wanes with depressed mood. However, information-processing theory postulates relatively stable cognitive structures by which information is attended to, interpreted, stored, and retrieved and behavior is organized and guided (Markus, 1977;Markus&Wurf, 1987). Thus, one could hypothesize that a negative self-schema, indicated by poor body image and low self-esteem, may be an antecedent vulnerability factor that interacts with stress to make an individual more likely to become depressed (Beck, 1967; Cichetti & Schneider-Rosen, 1986). Furthermore, because it is during adolescence that girls begin to report lower body image than boys (Rosenberg & Simmons, 1975; Simmons & Blyth, 1987; Simmons, Rosenberg, & Rosenberg, 1973), we hypothesize that poor body image may contribute to the female preponderance of depression thought to emerge during this developmental period. It is further hypothesized that a deficit in masculine attributes will be correlated with and antecedent to depression in adolescents and may also contribute to the expected female preponderance in this age group. Whereas boys are culturally reinforced for learning active, instrumental behaviors, girls are not (Dweck, Davidson, Nelson, & Enna, 1978); as a consequence, women are likely to develop a less active coping style than men and to perceive themselves as less resourceful and self-efficacious (Blechman, 1985; Nolen-Hoeksema, 1987). Because with menarche girls tend to drop culturally prescribed masculine attributes (Hill & Lynch, 1983), adolescent girls may be more vulnerable to depression. Given the substantial body of literature that has shown heightened self-consciousness to be associated with self-criticism (Duval & Wicklund, 1972), negative self-evaluation and affect (Fenigstein, 1979), and behavioral withdrawal (Carver, Blaney, & Scheier, 1979), it is plausible that the increased capacity for self-reflection that occurs during adolescence (Piaget, 1972; Inhelder & Piaget, 1972) is related to the increased prevalence of depression in this age group. It has been suggested (Lewinsohn, Hoberman, Teri, & Hautzinger, 1985) that those who are highly predisposed to be self-conscious may be more vulnerable to becoming depressed when under stress. That is, a highly self-conscious individual may be more likely than a person low in self-consciousness to self-focus and ruminate in the face of stressful events and to thereby set in motion a chain of depressogenic reactions. On the basis of reports in the literature that a sex difference in self-consciousness emerges during adolescence (e.g., Rosenberg & Simmons, 1975), we expect adolescent girls will report higher self-consciousness than boys and that this will place them at greater risk for depression. Finally, the construct of depression itself requires some discussion. Notwithstanding the diversity of its symptomatology, depression is recognized as an identifiable syndrome. It is typically measured either by self-report instruments such as the
Beck Depression Inventory (BDI; Beck, Ward, Mendelson, Mock, & Erbaugh, 1961) and the Center for the Epidemiological Studies-Depression Scale (CES-D; Radloff, 1977) or by diagnostic interview. Although the self-report measures cannot claim to give a clinical diagnosis of depression, they have been found to be substantially correlated with each other and with diagnoses based on clinical interviews with adults (Lewinsohn & Teri, 1982; Myers & Weissman, 1980; Roberts & Vernon, 1983) and adolescents (Lewinsohn, Hoberman, & Rosenbaum, 1988). It is with this caveat that the present study uses the CESD to measure depression (i.e., depressive symptomatology) in adolescents. Because it was not possible to interview the participants in this large public high school sample, two additional measures of psychopathology were included on a priori grounds: anxiety, which was assumed to be highly correlated with self-reported depressive symptoms, and behavior problems usually associated with conduct disorders, which were assumed to be only moderately correlated with those symptoms.
Method Subjects The participants in the present study were adolescents in Grades 9 through 12 at a public high school in Oregon. This school serves a largely White, middle to upper-middle socioeconomic status, suburban community. Participants were representative of the student population in their distribution across grade level; however, proportionally more girls participated. Participants' ages ranged from 13.26 years to 18.8 years (M = 16.14). They were tested at two times 1 month apart in order to reliably identify correlates and antecedents of depression symptoms in adolescents. Students became participants in the study through parental passiveconsent and student active-consent procedures. Letters describing the study and informing parents of the risks and benefits of participation were mailed to the parents of all students along with self-addressed, postage-paid cards for those parents not wanting their children to participate. Of the 1,041 letters mailed prior to the first assessment, 802 students completed the questionnaire. Six hundred eighty-six students agreed to participate at Time 2 (T2) following a mailing of 944 letters. Analyses were conducted on three different samples: (a) The Time 1 (T1) sample (n = 802) comprised all adolescents who agreed to participate in the first assessment and was used to determine the internal reliabilities (Cronbach's alpha) of the measures at Tl; (b) the T2 sample (n = 686) comprised all adolescents who participated in the second assessment and was used to determine the internal reliabilities (Cronbach's alpha) of the measures at T2; and (c) the T1/T2 restricted sample (n = 664; i.e., those who participated in both assessments) was used to compute the test-retest stability (Pearson r) of the measures and for all subsequent analyses.1 To determine whether the adolescents who were assessed at Tl and
1
These sample sizes represent the numbers of participants who began the assessments. Because participants had different rates of completion, the ns for the various measures within each sample vary, with higher participation on the earlier measures and lower participation on the later ones. Sample size was further reduced by decision rules concerning invalid data. A participant's data on a particular measure were not counted if 20% of the items were missing on a scale of greater than five items or two items were missing on a scale equal to or less than five items. A participant's entire data set was excluded if three or more items of the Infrequency Scale (Jackson, 1978) were endorsed.
SEX DIFFERENCES AND ADOLESCENT DEPRESSION T2 were different from those who were assessed only at T1, comparisons were conducted on grade, father's education, sex, age, and vocabulary. The results showed that the two groups were similar in age and grade distribution and father's education, but different in sex and vocabulary. More boys than girls dropped out after Tl, x2(l, N = 138) = 4.36, p < .05, and the mean vocabulary score of students who participated in both assessments was higher than that of the students who participated only atTl,f(694) = 2.91,,p
Journal of Abnormal Psychology 1990, Vol. 99, No. 1,55-63
Sex Differences and Adolescent Depression Betty Allgood-Merten and Peter M. Lewinsohn University of Oregon and Oregon Research Institute
This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
Hyman Hops Oregon Research Institute This study investigates the role of certain psychosocial variables—sex, age, body image/self-esteem, self-consciousness, stressful life events, and the degree to which an individual identifies with the cultural stereotype of masculinity—as correlates and antecedents to depression in adolescents and explores possible intraindividual mediators of the stress-depression relationship in adolescents. A battery of self-report measures was administered to public high school students in Grades 9-12 in their classrooms at two different times 1 month apart. Female adolescents reported more depressive symptoms, self-consciousness, stressful recent events, feminine attributes, and negative body image and self-esteem; no age effects were obtained. Results suggest a model of adolescent depression in which body/self-esteem and stressful recent events are significant contributors.
Although depression is quite prevalent in the adult population, its existence during childhood, though now recognized, is relatively uncommon. Somewhere between childhood and adulthood its prevalence is assumed to increase dramatically (Rutter, 1986; Rutter, Graham, Chadwick, & Yule, 1976). Moreover, girls do not appear to predominate among the depressed very early in the lifespan (Garrison, C, personal communication, 1989; Weissman & Klerman, 1977), yet women clearly are preponderate among depressed young adults (Lewinsohn, Duncan, Stanton, & Hautzinger, 1986). Thus, an investigation into depressive symptoms during adolescence may shed some light not only on what appears to be a developmental increase in the prevalence of depression but also on the female preponderance assumed to emerge during that period. Moreover, little is known about depression during adolescence. Until very recently, depression research largely focused on adult populations. We thus do not know to what extent the multitude of findings that have emerged from the adult literature in the recent past are generalizable to adolescents. The growing literature on adolescent depression suggests that adolescents are substantially more depressed than children (Angold, 1988; Rutter, 1986) and that they may be more depressed than adults (Garrison, Shoenbach, & Kaplan, 1984; Schoenbach, Garrison, & Kaplan, 1984; Schoenbach, Kaplan, Grimson, & Wagner, 1982). From a preventive perspective, given the sharp rise in adolescent suicide (e.g., Frederick, 1985) and the
This research was supported in part by Research Grant MH40501 from the National Institute of Mental Health and by a grant from the Center for the Study of Women in Society at the University of Oregon, Eugene, Oregon. We gratefully acknowledge the assistance of Richard Langford and his students at Oregon State University and of the faculty, staff, and students of Crescent Valley High School in Corvallis, Oregon, in the data collection, and of Judy Andrews in the data analysis. Correspondence concerning this article should be addressed to Betty Allgood-Merten, Oregon Research Institute, 1715 Franklin Boulevard, Eugene, Oregon 97403. 55
finding that being depressed substantially increases the likelihood of having further episodes (Amenson & Lewinsohn, 1981), it is critically important that clinical investigators turn their attention to the study of depression in this age group. The purpose of the present study is to explore psychosocial factors hypothesized to be associated with depressive symptoms in adolescents and with the female preponderance thought to emerge during this period. We look first at the contributions of sex and age, then at contributions of certain variables that have been shown to be associated with depression in adults—i.e., self-esteem (e.g., Beck, 1967) and stressful recent events (e.g., Lewinsohn, Hoberman, & Rosenbaum, 1988; Paykel et al., 1969)—and finally at variables hypothesized to be of particular importance to depression in adolescents—i.e., body image, selfconsciousness, and the degree to which an adolescent self-reports attributes associated with masculine stereotypes. We hypothesize that these will be associated with depression in adolescents as both correlate and antecedent and, moreover, that the greater female vulnerability to depression begins during adolescence with critical age-related changes in the variables of interest. Considerable evidence has accumulated in the adult literature that stressful life events often precede an episode of depression (Brown & Harris, 1978; Lewinsohn, Hoberman, & Rosenbaum, 1988; Lewinsohn ATalkington, 1979; Lloyd, 1980; Paykel et al., 1969) and, more recently, that recent events, or "hassles," are more strongly associated with depression than major life events (DeLongis, Coyne, Dakof, Folkmanm, & Lazarus, 1983). Whereas there has been some investigation of stress and psychopathology in adolescents (e.g., Compas, Wagner, Slavin, & Vannatta, 1986; Peterson & Spiga, 1982), no studies, to our knowledge, have attempted to identify stressful recent events as antecedent to depression in adolescents. It is further hypothesized that adolescence is a more stressful developmental period for girls than for boys (Hops, Sherman, & Biglan, 1989; Rutter, 1986) and that this makes girls more likely to become depressed. A number of recent studies suggest that positive body image
This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
56
B. ALLGOOD-MERTEN, P. LEWINSOHN, & H. HOPS
is an important negative correlate of depression in high school and college students (Cash, Winstead, & Janda, 1986; Noles, Cash, & Winstead, 1985; Teri, 1982). However, it is not known whether body image represents a unique construct as it relates to depression or is merely an aspect of self-esteem. It is also not known whether negative body image is antecedent to the onset of depression. Because depressive cognitions appear to be mood-state dependent (Lewinsohn, Steinmetz, Larson, & Franklin, 1981), one might expect negative body image to be merely a correlate of depression that waxes and wanes with depressed mood. However, information-processing theory postulates relatively stable cognitive structures by which information is attended to, interpreted, stored, and retrieved and behavior is organized and guided (Markus, 1977;Markus&Wurf, 1987). Thus, one could hypothesize that a negative self-schema, indicated by poor body image and low self-esteem, may be an antecedent vulnerability factor that interacts with stress to make an individual more likely to become depressed (Beck, 1967; Cichetti & Schneider-Rosen, 1986). Furthermore, because it is during adolescence that girls begin to report lower body image than boys (Rosenberg & Simmons, 1975; Simmons & Blyth, 1987; Simmons, Rosenberg, & Rosenberg, 1973), we hypothesize that poor body image may contribute to the female preponderance of depression thought to emerge during this developmental period. It is further hypothesized that a deficit in masculine attributes will be correlated with and antecedent to depression in adolescents and may also contribute to the expected female preponderance in this age group. Whereas boys are culturally reinforced for learning active, instrumental behaviors, girls are not (Dweck, Davidson, Nelson, & Enna, 1978); as a consequence, women are likely to develop a less active coping style than men and to perceive themselves as less resourceful and self-efficacious (Blechman, 1985; Nolen-Hoeksema, 1987). Because with menarche girls tend to drop culturally prescribed masculine attributes (Hill & Lynch, 1983), adolescent girls may be more vulnerable to depression. Given the substantial body of literature that has shown heightened self-consciousness to be associated with self-criticism (Duval & Wicklund, 1972), negative self-evaluation and affect (Fenigstein, 1979), and behavioral withdrawal (Carver, Blaney, & Scheier, 1979), it is plausible that the increased capacity for self-reflection that occurs during adolescence (Piaget, 1972; Inhelder & Piaget, 1972) is related to the increased prevalence of depression in this age group. It has been suggested (Lewinsohn, Hoberman, Teri, & Hautzinger, 1985) that those who are highly predisposed to be self-conscious may be more vulnerable to becoming depressed when under stress. That is, a highly self-conscious individual may be more likely than a person low in self-consciousness to self-focus and ruminate in the face of stressful events and to thereby set in motion a chain of depressogenic reactions. On the basis of reports in the literature that a sex difference in self-consciousness emerges during adolescence (e.g., Rosenberg & Simmons, 1975), we expect adolescent girls will report higher self-consciousness than boys and that this will place them at greater risk for depression. Finally, the construct of depression itself requires some discussion. Notwithstanding the diversity of its symptomatology, depression is recognized as an identifiable syndrome. It is typically measured either by self-report instruments such as the
Beck Depression Inventory (BDI; Beck, Ward, Mendelson, Mock, & Erbaugh, 1961) and the Center for the Epidemiological Studies-Depression Scale (CES-D; Radloff, 1977) or by diagnostic interview. Although the self-report measures cannot claim to give a clinical diagnosis of depression, they have been found to be substantially correlated with each other and with diagnoses based on clinical interviews with adults (Lewinsohn & Teri, 1982; Myers & Weissman, 1980; Roberts & Vernon, 1983) and adolescents (Lewinsohn, Hoberman, & Rosenbaum, 1988). It is with this caveat that the present study uses the CESD to measure depression (i.e., depressive symptomatology) in adolescents. Because it was not possible to interview the participants in this large public high school sample, two additional measures of psychopathology were included on a priori grounds: anxiety, which was assumed to be highly correlated with self-reported depressive symptoms, and behavior problems usually associated with conduct disorders, which were assumed to be only moderately correlated with those symptoms.
Method Subjects The participants in the present study were adolescents in Grades 9 through 12 at a public high school in Oregon. This school serves a largely White, middle to upper-middle socioeconomic status, suburban community. Participants were representative of the student population in their distribution across grade level; however, proportionally more girls participated. Participants' ages ranged from 13.26 years to 18.8 years (M = 16.14). They were tested at two times 1 month apart in order to reliably identify correlates and antecedents of depression symptoms in adolescents. Students became participants in the study through parental passiveconsent and student active-consent procedures. Letters describing the study and informing parents of the risks and benefits of participation were mailed to the parents of all students along with self-addressed, postage-paid cards for those parents not wanting their children to participate. Of the 1,041 letters mailed prior to the first assessment, 802 students completed the questionnaire. Six hundred eighty-six students agreed to participate at Time 2 (T2) following a mailing of 944 letters. Analyses were conducted on three different samples: (a) The Time 1 (T1) sample (n = 802) comprised all adolescents who agreed to participate in the first assessment and was used to determine the internal reliabilities (Cronbach's alpha) of the measures at Tl; (b) the T2 sample (n = 686) comprised all adolescents who participated in the second assessment and was used to determine the internal reliabilities (Cronbach's alpha) of the measures at T2; and (c) the T1/T2 restricted sample (n = 664; i.e., those who participated in both assessments) was used to compute the test-retest stability (Pearson r) of the measures and for all subsequent analyses.1 To determine whether the adolescents who were assessed at Tl and
1
These sample sizes represent the numbers of participants who began the assessments. Because participants had different rates of completion, the ns for the various measures within each sample vary, with higher participation on the earlier measures and lower participation on the later ones. Sample size was further reduced by decision rules concerning invalid data. A participant's data on a particular measure were not counted if 20% of the items were missing on a scale of greater than five items or two items were missing on a scale equal to or less than five items. A participant's entire data set was excluded if three or more items of the Infrequency Scale (Jackson, 1978) were endorsed.
SEX DIFFERENCES AND ADOLESCENT DEPRESSION T2 were different from those who were assessed only at T1, comparisons were conducted on grade, father's education, sex, age, and vocabulary. The results showed that the two groups were similar in age and grade distribution and father's education, but different in sex and vocabulary. More boys than girls dropped out after Tl, x2(l, N = 138) = 4.36, p < .05, and the mean vocabulary score of students who participated in both assessments was higher than that of the students who participated only atTl,f(694) = 2.91,,p
