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Chapter 1

THE PROBLEM AND ITS BACKGROUND

Introduction

Teenage Depression is on the rise and is the most disturbing symptom of a border

psychological problem: a spectrum of angst that plagues 21st century teens, it is the most

alarming fact from all the research, affecting younger and younger of people. Instead of living

their lives and exploring the wonders of the world, they tend to lock themselves in their rooms

and be drowned by pessimism- something that is hindering them from growth and it is a threat to

the future.

To prevent the case of teenage depression from complication, determining the causes

could help most especially because untreated depression can result to various problems that can

affect every area of a teenage life. By also investigating this study, it will serve as a support

system for all of the people in the community, specifically the teens who are much affected and

inflicted by the situation

This inquiry will intend to determine the sociological and psychological causes of

teenage depression to selected students of Talamban National High School.

Background of the Study

According to the fall 2007 American College Health Association–National College

Health Assessment, a national survey of approximately 20,500 college students on 39 campuses,

43.2% of the students reported “feeling so depressed it was difficult to function” at least once in

the past 12 months. More than 3,200 university students reported being diagnosed as having

depression, with 39.2% of those students diagnosed in the past 12 months, 24.2% currently in

therapy for depression, and 35.8% taking antidepressant medication. Among the students

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surveyed, 10.3% admitted “seriously considering attempting suicide” within the past 12 months

and 1.9% actually attempted suicide during that period. According to the 2008 National Survey

of Counseling Center Directors, 95% of respondents believe that there has been a trend in recent

years of an increase in the number of students with serious psychological problems. Although the

above data may seem surprising to some, it is not to most mental health clinicians and

administrators at U.S. colleges. Many college administrators have begun to appreciate the effect

that a student’s depression can have on overall functioning in the college community. Depression

has been linked to academic difficulties as well as interpersonal problems at school, with more

severe depression correlated with higher levels of impairment. There are unique challenges of

providing treatment to college students. These challenges include significant academic pressure

in semester-based cycles, extensive semester breaks that result in discontinuities of care, and

heavy reliance on community supports that can be inconsistent. Given the prevalence and impact

of depression on college campuses and the varying services offered by university mental health

centers throughout the United States, there is a significant need to evaluate successful models of

treatment and their related outcomes.

Randy P. Auerbach conducts multidisciplinary research in children, adolescents and

young adults using a multimodal approach to determine why depressive symptoms unfold, how

self-injurious and suicidal behaviors develop, and what changes in the brain during treatment.

Depression in adolescents is a serious public health concern. Recent epidemiological data show

that approximately 11 percent of youth will experience depression (Avenevoli, Swendsen, He,

Burstein, & Merikangas, 2015), and these episodes are associated with downstream negative

consequences later in adolescence (e.g., academic difficulties, risky behavior engagement,

nonsuicidal self-injury) and adulthood (e.g., lower income levels, higher divorce rates,

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suicidality) (e.g., Auerbach, Kim, et al., 2014; Auerbach, Tsai, & Abela, 2010; Avenevoli,

Knight, Kessler, & Merikangas, 2008). Most notably, an alarming 75 percent of individuals

experiencing depression during adolescence will make a suicide attempt in adulthood (Nock,

Green, et al., 2013). Despite these unsettling statistics and associated negative consequences, the

etiological mechanisms contributing to the onset and maintenance of depression in adolescence

remain unclear. To address this key gap, research uses a multidisciplinary and multimodal

approach to determine why depressive symptoms emerge and how self-injurious and suicidal

behaviors develop in response to depression.

In a study of 40 depressed patients, Leff, Roatch and Bunney (1970) have found that each

patient had been subjected to multiple stressful events prior to early symptoms and to a

clustering of such events during the month preceding the actual break down in functioning.

Similar to the findings of Leff and her associates are those of Paykel (1983). He studied 185

depressed patients and found that comparable stressful events preceded the onset of the

depressive breakdown. The significant events are categorized as (a) marital difficulties, (b) work

moves or changes in work conditions, (c) serious personal illness, and death or serious illness of

an immediate family member. Adolescence is the age of stress and strains. Age related physical

changes and the resulting psychological disturbances may lead to greater maladjustment, stress

and lead to depression in adolescents (Indira and 57 Review of Related Literature Murthy,

1980a, 1980b, Jaiprakash and Murthy, 1981, 1982, Rangaswamy et al. 1982, Jamuna, 1984).

Death of a loved one as a stressful event is found as a precipitating cause leading to depression

(Renner and Birren, 1980). Evidences also indicate relationship between somatic symptoms,

depression and stress in adolescents. Depression was found to be the most significant factor in

the development of somatic complaints. Studies by Rozzine (1996), Schulz and Williamson

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(1993), Smallegan (1989) Ramamurti (1996), Ramamurti and Jamuna (1984, 1992) reveal that

stressful events are important co-factors in depression. An evaluation of the effectiveness of

Cognitive Behaviour Therapy for 12-14 year old school children was done by Habib, Seif

(2007). The sample comprised 198 boys and 136 girls. Students were assessed using the Child

Depression Inventory and the Coopersmith Self-Esteem Inventory. The 32 children with

depression were offered Cognitive Behaviour Therapy. They were assessed 3 months after the

intervention using the same tools and the results indicate the effectiveness of this therapy and

reduction in depressive symptoms.

The studies reviewed above clearly suggest that depression among adolescent children is

caused by a variety of factors. And more generally, it is not a single factor but a combination of

different factors that operate to produce and maintain depressive feelings in them.

Statement of the Problem

This inquiry will intend to determine the sociological and psychological causes to teenage

depression.

Particularly, this inquiry will examine to answer the following questions:

1. What are the common sociological and psychological causes associated in teenage depression?

2. In what aspect does depression affect the students

a. behavior

b.social interaction

b1. Friends

b2. Family

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b3. Romantic Relationship

Significance of the Study

Adequate to the rapid increase of teenage depression cases, this study entitled “Teenage

Depression: The Psychological and Sociological Causes to Students” will benefit the following:

Students or Teenagers- This will help the students or the teenagers help themselves from further

depth of depression and can prevent from suffering a major mental health disorder.

Parents or Family- This study can provide a signal and a warning to parents as sign of awareness

to how disturbing depression rates are on a steady rise. This study could make parents wonder

what they could be doing to better help their kids navigate the waters of adolescent years.

School- This study will encourage the school as a support network that will hold programs to

lessen the cases and to encourage students that the school is much willing and open to address

any problem since a customized, multi prolonged intervention at school can be highly effective.

Community-They wil be the one who will participate in this depression research in which it will

be “Help Us, Help You” advocacy, They will provide invaluable sights into the research process,

making incredibly constructive suggestions that the researchers shouk be looking in a depression

story that they have not thought about before.

The Researchers– The study will serve as the basis for the future study to develop.

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Scope and Limitations of the study

The study will direct to determine the causes of teenage depression specifically its

sociological and psychological causes. The researchers will also look into the effects of teenage

depression to the students’ behaviour, social interaction, and the contribution of this study or

what the study has to offer to different families or home, to the school and to its community.

The study will use the students of Talamban National Highschool S.Y.2017-2018 as the

respondents. They will interview those students who are suffering from the depression and

inquire to what are the causes that lead them to suffer from this rising mental health.

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Chapter 2

REVIEW OR RELATED LITERATURE AND STUDIES

The researchers have found the following studies and literature as relevant to the system

being proposed:

According to Gitanjali Saluja, PhD et. al (2004) Depression is a substantial and largely

unrecognized problem facing young adolescents, and more intervention is needed at the middle

school level. From his study, two sets of depression response items were collapsed: the dealing

with lack of sleep and excess sleep (sleep disturbance) and the dealing with weight loss and

weight gain (weight disturbance). After depressive symptom status was determined, the

prevalence of depressive symptoms for all grade, sex, and racial/ethnic subgroups were

calculated. There is 95% confidence intervals for the estimated prevalence ratio to compare

prevalence of depressive symptoms across bullying behaviors, substance use, and somatic

ailments. A higher proportion of females (25%) reported depressive symptoms than males

(10%).Among American Indian youths, 29% reported depressive symptoms, as compared with

22% of Hispanic, 18% of white, 17% of Asian American, and 15% of African American youths.

Youths who were frequently involved in bullying, either as perpetrators or as victims, were more

than twice as likely to report depressive symptoms as those who were not involved in bullying. A

significantly higher percentage of youths who reported using substances reported depressive

symptoms as compared with other youths. Similarly, youths who reported experiencing somatic

symptoms also reported significantly higher proportions of depressive symptoms than other

youths. Major depressive disorder accounts for greater mortality, morbidity, and financial costs

than any other psychiatric disorder. In the United States, studies estimate the prevalence of

depression among older adolescents to be as high as 8.3%. The anonymous survey includes

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questions on family structure, diet, exercise, self-image, injuries, safety behaviors, academic

performance and pressures, attitudes about school, fighting and bullying, and substance use.

Klein JP1, et al (2015) asserted the association of childhood trauma and personality

disorders with chronic depression. It was discovered that chronic depression has often been

associated with childhood trauma. There may, however, be an interaction between personality

pathology, childhood trauma, and chronic depression. This interaction has not yet been studied.

DSM-IV-defined chronic depression was the primary outcome. The association between chronic

depression, childhood trauma, and personality disorders was analyzed using correlations. The

presence of avoidant personality disorder, but no CTQ-SF scale, was associated with the

chronicity of depression (odds ratio [OR] = 2.20, P = .015). The emotional abuse subscale of the

CTQ-SF did, however, correlate with avoidant personality disorder (OR = 1.15, P = .000). The

level of emotional abuse had a moderating effect on the effect of avoidant personality disorder

on the presence of chronic depression. The interaction of the presence of avoidant personality

pathology with the effect of childhood trauma in the development of chronic depression has to be

confirmed in a prospective study.

David M. Fergusson, PhD et.al (2002) examined the extent to which young people with

depression in mid adolescence (ages 14-16) were at increased risk of adverse psychosocial

outcomes in later adolescence and young adulthood (ages 16-21). Measures included

assessments of DSM-III-R major depression (at age 14-16); psychiatric disorders, educational

achievement, and social functioning (at age 16-21); social, familial, and individual factors; and

co morbid disorders. Thirteen percent of the cohort developed depression between ages 14 and

16. Young people with depression in adolescence were at increased risk of later major

depression, anxiety disorders, nicotine dependence, alcohol abuse or dependence, suicide

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attempt, educational underachievement, unemployment, and early parenthood. These

associations were similar for girls and boys.

Luby, J. et.al (2017) investigated the neurodevelopment trajectory of the association

between early ACEs and adolescent general and emotional health outcomes. An increase from 0

to 3 early ACEs was associated with 15% and 25% increases in depression severity and physical

health problems, respectively. Results from this longitudinal prospective neuroimaging study

suggest that early childhood adversity negatively affects the volume of a subregion of the

prefrontal cortex, the inferior frontal gyrus, resulting in impairments in emotional competence

and increased risk for adolescent depression and poor health outcomes. Study findings highlight

1 putative neurodevelopmental mechanism by which the association between early ACEs and

later poor mental and physical health outcomes may operate.

According to Lora D. Doom et al (2007), from his study ‘Association of Depressive

Symptoms and Anxiety With Bone Mass and Density in Ever-Smoking and Never-Smoking

Adolescent Girls’. He examined (1) the association of depressive and anxiety symptoms with

bone mass and density in adolescent girls and (2) to examine this association in subgroups of

those who have ever or never smoked. He also examined (1) the association of depressive and

anxiety symptoms with bone mass and density in adolescent girls and (2) to examine this

association in subgroups of those who have ever or never smoked. Prospective study using

baseline reports were made with Two hundred seven girls (aged 11, 13, 15, and 17 years) from

urban teenage health center and the community. Higher depressive symptoms were associated

with lower total body BMC and BMD but not hip or spine BMC and BMD. Only in white

adolescents was higher state anxiety associated with lower total body BMC and hip BMC and

BMD. Ever-smokers were not significantly different than never-smokers in age-adjusted BMC or

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BMD, but they had higher depressive and anxiety symptoms. This is the first study to report that

higher depressive and anxiety symptoms are associated with lower total body BMC during

adolescence in girls. Knowing that this association is present at a young age is worrisome, as

peak bone mass is attained in adolescence. Findings may aid in identifying girls who are at risk

for low bone mass and developing intervention/prevention strategies during adolescence.

Importantly, mechanisms that explain these associations and the effect of smoking on bone

health need longitudinal examination.

Frances Rice PhD et al. (2017) emphasized the developmental pathways that lead to

first-episode adolescent-onset MDD (incident cases) in those at high familial risk and to

postulate a theoretically informed model that enables simultaneous testing of different pathways

to incident adolescent-onset MDD composed of contributions from familial/genetic and social

risk factors, as well as effects via specific clinical antecedents.Ninety-two percent (279 of 304)

of families completed the follow-up. On average, children and adolescents had a mean (SD) of

1.85 (1.74) (range, 0-8.5) DSM-IV symptoms of MDD at follow-up. Twenty (6 males and 14

females) had new-onset MDD, with a mean (SD) age at onset of 14.4 (2.0) years (range, 10-18

years). Irritability (β = 0.12, P = .03) and fear and/or anxiety (β = 0.38, P < .001) were significant

independent clinical antecedents of new adolescent-onset MDD, but disruptive behavior

(β = −0.08, P = .14) and low mood (β = −0.03, P = .65) were not. The results were similar for the

DSM-IV symptom count at follow-up. All the measured familial/genetic and social risk

indicators directly influenced risk for new-onset MDD rather than indirectly through acting on

dimensional clinical antecedents. This investigation was a 4-year longitudinal study among

offspring of depressed parents in the general community. In a theoretically informed model that

simultaneously tested different pathways, irritability and fear and/or anxiety were the clinical

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antecedents of new-onset major depressive disorder, and social and familial risk factors directly

affected new-onset major depressive disorder. Irritability and fear/anxiety may be additional

clinical phenomena to be included as targets in primary preventive interventions focusing on the

child. In addition to targeting these phenomena in parents and children, depression prevention

methods in high-risk groups may need to take into consideration social risks, such as poverty and

psychosocial adversity.

From the study of Riittakerttu Kaltiala-Heino, et. al (2007) entitled ‘Bullying, depression,

and suicidal ideation in Finnish adolescents: school survey’. This study was to assess the relation

between being bullied or being a bully at school, depression, and severe suicidal ideation. A

school based survey of health, health behaviour, and behaviour in school which included

questions about bullying and the Beck depression inventory, which includes items asking about

suicidal ideation was conducted in Secondary schools in two regions of Finland with 16410

adolescents aged 14-16. Depression was equally likely to occur among those who were bullied

and those who were bullies. It was most common among those students who were both bullied

by others and who were also bullies themselves. When symptoms of depression were controlled

for, suicidal ideation occurred most often among adolescents who were bullies. Adolescents who

are being bullied and those who are bullies are at an increased risk of depression and suicide. The

need for psychiatric intervention should be considered not only for victims of bullying but also

for bullies. The role of the adolescent remains constant in the long process of being bullied or

being a bully.

The Mediating Role of Rumination in the Relation Between Quality of Attachment

Relations and Depressive Symptoms in Non-Clinical Adolescents

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Tamara Ruijten et.al (2011) states that adolescent depression is a serious disorder with

prevalence rates ranging between 2.5 and 8.3% and a high risk of suicidality, recurrence and

chronicity. In the past decade, the role of family factors in the development of depressive

symptoms has received increased attention in research (Sander and Mc Carty 2005). One such

factor is attachment. When caregivers are available to their child and respond in a loving and

responsive way, the child develops a secure attachment bond with the caregivers and

experiences confidence in self and others. A lack of protective and sensitive responding of the

caregivers leads to a sense of insecurity and to an increase in levels of distress. Moreover, the

child may develop an insecure attachment to the caregiver over time (Bowlby 1973, 1988).

Self-report measures of attachment have been utilized to assess the quality of attachment

relations in adolescence in comparison with the observational measures utilized in infancy

(Gullone and Robinson 2005). Armsden et al. (1990) have found that depressed adolescents

reported significantly less secure parent and peer attachment relations in terms of trust,

communication, and alienation than their non-depressed counterparts (see also Green and

Goldwyn 2002; Greenberg 1999). Recently, there has been interest in gaining a better

understanding of the mechanisms by which attachment relationships are related to depressive

symptoms. A good candidate here might be rumination. A ruminative response style can be

defined as the tendency to engage in repetitive thinking about the depressive symptoms, as

well as the causes and consequences of these symptoms (Nolen-Hoeksema 1991, 1998).

A recent meta-analysis has shown that rumination is significantly associated with

symptoms of depression in youth (Rood et al. 2009). There have been relatively few attempts

to examine developmental antecedents of rumination. There is some evidence suggesting that

people who report having psychologically over controlling parents, tend to engage in

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rumination in response to depressed mood (Spasojevic and Alloy 2002). For attachment,

rumination has been found to mediate the pathway to depression in insecurely-attached

adolescents, when confronted with stress involving romantic relationships (Margolese et

al. 2005). Thus, the quality of the relationship between caregivers and children might

determine to what extent the child becomes a ruminator.

Riittakerttu Kaltiala-Heino (2010) had a study that has an objective to analyses whether

involvement in bullying at school predicts depression, and whether depression predicts

involvement in bullying in middle adolescence. Involvement in bullying was elicited by three

questions focusing on being a bully, being a victim to bullying, and being left alone by peers

against one’s wishes. The results summarized that, both being a victim to bullying and being a

bully predicted later depression among boys. Among girls, depression at T1 predicted

victimization at T2. Depression at T1 predicted experience of being left alone at T2 among both

sexes. It was concluded that victimization to bullying may be a traumatizing event that results in

depression. However, depression also predicts experience of victimization and of being left alone

against one’s wishes. Depression may impair an adolescent’s social skills and self-esteem so that

the adolescent becomes victimized by peers. However, depression may also distort and

adolescent’s experiences of social interactions.

From the study of Pine, D. MD (2010) entitled ‘The Risk for Early-Adulthood Anxiety

and Depressive Disorders in Adolescents with Anxiety and Depressive Disorders’ it shows the

relationship among anxiety and depressive disorders of adolescence and adulthood. This study

prospectively examines the magnitude of longitudinal associations between adolescent and adult

anxiety or depressive disorders. In simple logistic models, adolescent anxiety or depressive

disorders predicted an approximate 2- to 3−fold increased risk for adulthood anxiety or

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depressive disorders. There was evidence of specificity in the course of simple and social phobia

but less specificity in the course of other disorders. Results from the analyses using latent

variables suggested that while most adolescent disorders were no longer present in young

adulthood, most adult disorders were preceded by adolescent disorders. An anxiety or depressive

disorder during adolescence confers a strong risk for recurrent anxiety or depressive disorders

during early adulthood. Most anxiety and depressive disorders in young adults may be preceded

by anxiety or depression in adolescence. Because anxiety and depressive disorders are some of

the most common psychiatric conditions afflicting adolescents it is important to study

relationships between anxiety and depressive disorders in adolescents and adults. Such

relationships have been explored from various perspectives, including family-based, biological,

pharmacologic, and longitudinal approaches. Only longitudinal research directly quantifies the

risk for adult anxiety or depressive disorders faced by adolescents with anxiety or depression.

The main goal of the report is to test 4 hypotheses on the nature of associations among

adolescent and adult disorders. First, family studies and the low rate of clinical impairment in

children with simple phobia suggest that adolescent simple phobia will predict simple phobia but

not other adult anxiety or depressive disorders. Second, extensive research reviewed elsewhere

suggests that separation anxiety disorder will relate to panic disorder but not to other disorders.

Third, prior longitudinal research among adults suggests that episodes of spontaneous panic in

adolescence will predict the onset of panic disorder in adulthood. Fourth, family studies and

cross-sectional data suggest that adolescent major depression, overanxious disorder, and social

phobia will exhibit broad associations with adult major depression, generalized anxiety disorder,

and social phobia. While the main goal of this study is to test these 4 hypotheses, we also provide

data that can be compared with data from other prospective epidemiological studies. Hence, we

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examine the course of broadly defined internalizing disorders, and we consider the effects of age,

sex, and comorbidity on course.

As asserted by the study of Benedetto Vitiello, M.D.,et.al (2011) the long-term outcome

of participants in the Treatment of SSRI-Resistant Depression in Adolescents (TORDIA) study

was examined. For the current study, patients were reassessed 48 (N=116) and 72 (N=130)

weeks from intake. Data were gathered from February 2011 to February 2007. Randomly

assigned treatment (first 12 weeks) did not influence remission rate or time to remission, but the

group assigned to SSRI's had a more rapid decline in self-reported depressive symptoms and

suicidal ideation than those assigned to venlafaxine (p<.05). Participants with more severe

depression, greater dysfunction, and alcohol/drug use at baseline were less likely to remit. The

depressive symptom trajectory of the remitters diverged from that of non-remitters by the first 6

weeks of treatment (p<.001). Of the 130 participants in remission at week 24, 25.4% relapsed in

the subsequent year. While most adolescents achieved remission, more than one-third did not,

and one-fourth of remitted patients experienced a relapse. More effective interventions are

needed for patients who do not show robust improvement early in treatment.

According to the 2007 American College Health Association-National College Health

Assessment, a national survey of approximately 20,500 college students on 39 campuses, 43.2%

of the students reported "feeling so depressed it was difficult to function" at least once in the past

12 months. More than 3,200 university students reported being diagnosed as having depression,

with 39.2% of those students diagnosed in the past 12 months, 24.2% currently in therapy for

depression, and 35.8% taking antidepressant medication. College students and treatment

outcome by using the following terms: "depression," "college or university or graduate or junior

college or community college students," "colleges," "community colleges," "treatment and

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prevention," "empirical study," and "peer reviewed journal." Sixty college students (66%

Caucasian, 57% female) with major depression were followed for nine weeks without any

treatment to assess for sudden gains (that is, precipitous improvements in depressive

symptomatology), remission of depressive symptoms, and reversal of improvements.

In 2007, Pace and Dixon conducted a four- to seven-week randomized controlled trial to

assess the treatment effectiveness of individual cognitive therapy for college students with

depressive symptoms. The authors concluded that brief individual cognitive therapy may

effectively reduce mild to moderate depressive symptoms as well as depressive self-schemata

among college students. Whereas Kelly and colleagues ( 8 ) and Lara and colleagues ( 9 ) used

the Structured Clinical Interview for DSM-IV to diagnose participants with major depressive

disorder, Geisner and colleagues ( 10 ) and Pace and Dixon ( 11 ) used self-report scales to

measure depressive symptoms for study inclusion and Pace and Dixon excluded students with

severe levels of depressive symptoms. Because major depression can be a chronic recurring

condition, future research needs to evaluate the effectiveness of the various treatment modalities

used to treat college students with depression. In light of the high prevalence of depression

among college students today and the risks and sequelae this illness poses if not diagnosed and

treated early and effectively, it is imperative that research funding be increased for both

naturalistic and intervention studies of depression and treatment outcomes in the college health

setting.

On the study of Hoffman, S. (2010) entitled ‘The Effect of Mindfulness-Based Therapy

on Anxiety and Depression: A Meta-Analytic Review” The most common disorder studied was

cancer (n = 9), followed by generalized anxiety disorder (n = 5), depression (n = 4), chronic

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fatigue syndrome (n = 3), panic disorder (n = 3), fibromyalgia (n = 3), chronic pain (n = 2),

social anxiety disorder (n = 2), attention-deficit hyperactivity disorder (n = 1), arthritis (n = 1),

binge eating disorder (n = 1), bipolar disorder (n = 1), diabetes (n = 1), heart disease (n = 1),

hypothyroidism (n = 1), insomnia (n = 1), organ transplant (n = 1), stroke (n = 1), and traumatic

brain injury (n = 1). A total of 10 studies used MBT in patients without a clinically defined

anxiety or mood disorder, but met our criteria for elevated levels of anxiety at pre-treatment: two

studies in cancer populations (Tacon, Caldera, & Ronaghan, 2004; Tacon, Caldera, & Ronaghan,

2005), four studies in populations with pain (Grossman, Tiefenthaler-Gilmer, Raysz, & Kesper,

2007; Lush et al., 2009; Sagula & Rice, 2004; Rosenzweig et al., 2009), three studies in

populations with other medical problems (Schulte, 2007; Surawy, Roberts, and Silver, 2005

Studies 1 and 2), and one study using a sample with Binge Eating Disorder (Kristeller & Hallett,

1999). In order to examine whether MBT for patients with anxiety disorders and depression

results in greater reductions of symptoms of anxiety and depression than MBT for other patients,

we compared effect sizes for continuous measures of anxiety and depression symptoms across

the following 4 diagnostic categories: anxiety disorders, mood disorders, cancer, and pain. MBT

showed significant effects for reducing anxiety symptoms in individuals with anxiety disorders

(n = 7 studies; Hedges' g = 0.97, 95% CI: 0.72-1.22, p < .01), followed by individuals with

cancer (n = 8 studies; Hedges' g = 0.64, 95% CI: 0.45-0.82, p < .01), and pain disorders (n = 5

studies; Hedges' g = 0.44, 95% CI: 0.21-0.68, p < .01). Similarly, MBT was effective for

reducing depressive symptoms in individuals with a diagnosis of depression (n = 4 studies;

Hedges' g = 0.95, 95% CI: 0.71-1.18, p < .01), followed by individuals with an anxiety disorder

(n = 6 studies; Hedges' g = 0.75, 95% CI: 0.58-0.92, p < .01), pain (n = 6 studies; Hedges' g =

0.51, 95% CI: 0.39-0.63, p < .01), and cancer (n = 7 studies; Hedges' g = 0.45, 95% CI: .34-0.56,

p < .01). In addition, effect sizes for depression and anxiety symptoms in populations with

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cancer, pain, or other medical conditions may be smaller than effect sizes in populations with

anxiety or mood disorders due to a floor effect: that is, patients with a low level of anxiety or

depression at pre-treatment may show a relatively smaller degree of improvement after treatment

than those with a high level at pre-treatment.

According to Marshal, M et al (2011), obesity is a deeply stigmatizing attribute that

prompts negative stereotyping and discrimination in others, which, in turn, causes depression and

other negative psychological and social outcomes (Brownell, Puhl, Schwartz, & Rudd, 2005;

Puhl & Brownell, 2006). A second, alternative causal model recognizes that depression can exert

causal effects on obesity. The value of longitudinal research for extending knowledge about the

relationship between depression and weight control has been acknowledged in a recent review

(Faith, Matz, & Jorge, 2002). Effect size Z scores ranged from –3.35 to 20.22, with most (18 out

the 23) samples providing data that depression leads to weight gain.This yielded a significant

population effect size estimate of 1.47 (95% CI: 1.16, 1.85), indicating that depressed people at

baseline measurement are about 1.8 times more likely than non depressed people to have obese

status or weight gain at follow-up measurement. Subject sex and age were also analyzed as

moderating variables. Using a fixed effects analysis, male (n = 4, odds ratio: 1.34, 95% CI: 1.14,

1.58) and female (n = 11, odds ratio: 1.26, 95% CI: 1.20, 1.32) did not generate significantly

different estimates. A similar analysis investigated the moderating influence of sample age and

found that adolescent (n = 12, odds ratio: 2.31, 95% CI: 2.06, 2.58) and adult (n = 11, odds ratio:

1.08, 95% CI: 1.03, 1.13) samples differed in the effect of depression on obesity status. This

difference, as well as the odds ratios for each group, was essentially unchanged when only

samples reporting adjusted effect size statistics were analyzed.

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Thapar, A. et al. (2012) states that depression in pre pubertal children is less common

than depression in adolescents or adults, and seems to differ from these disorders with respect

tosome causative, epidemiological, and prognostic features clinical outcomes of depression in

adolescents. Longitudinal studies of community and clinic based population samples suggest that

60-90% of episodes of depression in adolescents remit within a year. However, in follow-up

studies 50-70% of patients who remit develop subsequent depressive episodes within 5 years.

However, such findings in relation to depression and depression-related brain mechanisms seem

to vary not only by genotype, but also by age, sex, and severity of symptoms, and are also reliant

on good quality measures of adversity and depression. The broader social context also needs to

be considered because quality of peer support seems especially predictive of resilience to

depression in thecontext of child maltreatment and maternal depression. Longitudinal studies of

adolescents with sub-syndromal depression showed that they are at increased risk of later full-

blown depressive disorder. Almost 20% of adolescents with depression also meet diagnostic

criteria for generalized anxiety disorder with reported lifetime rates of 50-70%. Depression can

also complicate eating disorders, autistic spectrum disorders, and ADHD. Comorbidity is

especially increased in adolescents with severe depression and predicts severe impairment, poor

long-term outcome and complicates treatment.

.Justification of the Study

The studies aforementioned above are the studies related to our topic. They may be varied but

there are factors that made them similar. Most especially that it tackles about depression on all

those different causes that can affect one’s mental health. Effects were also mentioned for the

reason that the impact on depression would be a great help for the researchers to further analyze

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the topic. But the difference that made the study unique was the place and the causes that the

researchers were looking up to.

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Chapter 3

RESEARCH METHODOLOGY

This section includes the design and procedure of the study.

Research Design

Case Study, a Qualitative Design was utilized in this study, to determine the

Psychological and Sociological Causes of Teenage Depression

Research Locale

The study was conducted from the residence of the interviewee located in Borbajo, Street

Talamban Cebu City.

Research Participants

The informant was chosen from the selected junior and senior high school students in

Talamban National High School that showed signs of depression and age ranges from 15-18.

Research Instruments

The instruments used were interview guide and audio recorder. The researchers used a

list of questionnaires that are less detailed which allows the researcher to freely ask questions

about the topic. The whole interview was recorded in an audio recorder.

Research Procedure

First, the researchers asked permission to the principal for approval. Second, the

researchers gained informed consent to the informat. Then, the researchers made the

21
questionnaires and the schedule of the date of the interview. Lastly, the researchers analyzed the

answers from the interview.

Data Analysis

For the data analysis to be done, the researchers went back and viewed the statement of

the problem and tried to analyze if we got the expected answers. An interview was transcribed

verbatim in preparation for the data analysis. Coding techniques and pseudonames were utilized

to maintain confidentiality. In keeping with the intended methodology, qualitative content

analysis inspired by In Vivo Coding was utilized to explicate the essence of the phenomenon.

Sample and Sampling Design

The sampling design used was Snowball Sampling, this sampling method was used

because this method does not give a specific set of samples involving unspecified group of

people.

Data Gathering and Processing Method

The data were gathered through an interview method, the researchers found the perfect

informant for their study. After the data were gathered, the researchers collated the results.

22
Chapter 4

Results and Discussions

Results

Upon realizing the intended data analysis approach, eight (8) emergent themes were

generated – three (3) for sociological causes and five (4) for psychological causes. For

sociological causes: ‘parents’, ‘fake friends, and ‘unhealthy relationship with someone or

partner’. For psychological causes: ‘operant conditioning’, ‘cognitive triad’, ‘anxiety disorder’

and ‘learned helpfulness’. Additionally, emergent themes will be discussed in relation to live

experiences of the participants supported through the review of related literature.

Sociological Causes

Parents

Many people suffer from depression at one point in their life. It is inevitable, the feeling

of hopelessness, sorrow, or being alone. These are all common emotions associated with

depression. For a select few, depression can be hard to overcome, and this is where depression

becomes a disorder that requires active treatment. Yet the question remains, why did these

people become depressed? How did they become depressed? One of the answers that lead to the

cause of depression would be a person's interpersonal relationship with their surroundings and

the people around them. One could argue that out of all the interpersonal cases that can

contribute on the onset of a depressive disorder, the ambiance of a family has the most weight

and impact on a depressed individual.

23
The first theme cluster derived is ‘emotionally and physically abused by parents’. If

you're going to take action against depression, then you need to understand that child abuse

commonly underpins adult depression. In almost every case of significant adult depression, some

form of abuse was experienced in childhood, either physical, sexual, emotional or, often, a

combination. Scientists know that traumatic experiences such as child abuse or neglect change

the chemistry and even the structure of the brain. They sensitize the stress response system so

that those who are abused become overly responsive to environmental pressures. They shape

wiring patterns in the brain and reset the sensitivity level of the machinery. Informant X

mentioned: The main reason of why I am depressed is because of my parents, especially mom.

Even my slightest mistake, she nags immediately. The slaps that I receive are just okay (or maybe

not) but what hurt the most are the words coming from her. She kicked me out and the reason

was ‘kauwaw ra ko sa ilang pangan’. I was also accused that I am a slut because I always go

with boys.

Rejection by parent is the second sub-theme cluster which emerges from this emergent

theme. It has been well documented that adolescents run a heightened risk for developing

depression and aggression when they feel rejected by their parents. Rejection by either parent, or

both, has a huge effect on children’s personality. They tend to become more anxious and

insecure. Informant X described the rejection she gets when her parents say that they are always

busy and that they won’t listen. She further described: I really am not open. As a kid, they are not

always there. They are always busy. They just let me do things that I want. They provide

financially but not mentally and emotionally- and that’s missing. And if they think I did

something wrong and I know I’m right, they won’t listen. They would really insist the things that

I don’t do which make it harder for me to share to them.

24
The third theme cluster derived from this theme is ‘parents imposing conditions of

worth’. Conditions of worth are the messages we take on board about what we have to do to be

valued. Conditions of worth are often very subtle. Nevertheless, this subtlety is all the more

powerful, since it can render us unaware of what our conditions of worth are. . Conditions of

worth are not in and of themselves a bad thing. It’s when they are overused that they begin to be

a problem. A child will seek to satisfy the condition of worth imposed by their parents. And

without realizing, parents may create more complex conditions for their attention then may want

to. From Informant X, she highlighted: I told them I’m already tired. They want me to be perfect.

They compare me to my parents. I told them why I was not enough.

Fake Friends

The second emergent theme is entitled “Fake Friends”. A lot of the people described

having difficult and complex relationships and many felt depression had affected their

friendships one way or another. Many said they had never “fitted in” and making friends had

been “hard work” for them throughout their lives. Several people had also experienced physical,

mental or emotional bullying in the past. Thus a verbalization from Informant X states: I always

felt that I am left behind and this was confirmed by someone. That someone said that “libakon

raman ka ana nila” and I noticed that every time my friends say something about me, nobody

will defend me

Unhealthy relationship with someone or partner

One of the most important social causes for depression is a stressful relationsip. Gregory

S. Beattie, the author of Social Causes of Depression, acknowledged this as a factor but did not

stress its importance. When a relationship is not working it turns into a stressor, which often

25
causes depression among females and leads males to alcohol abuse. Stressful relationship is the

leading cause for depression among women (Whisman, 2001). Even though this is not a social

factor, it is important to point it out as a possible predisposition to depression based on social

factors. Informant X spoke about the state of what she experienced:

“And about my relationship, my parents don’t know about us and I think it is

inevitable in a way that I lack attention from them. At first, our relationship was good but as

times goes by, it was already shaky and his honesty faded. Months later, I decided to end our

relationship because I also found out that he likes my cousin. But we get back together thinking

that he already changed.”

Psychological Causes

Operant Conditioning

Skimmer believed that the best way to understand behavior is to look at the causes of an

action and its consequences. He called this approach operant conditioning. Operant conditioning

can be described as a process that attempts to modify behavior through the use of positive and

negative reinforcement. Through operant conditioning, an individual makes an association

between a particular behavior and a consequence (Skinner, 1938).

Operant conditioning states that depression is caused by the removal of positive

reinforcement from the environment (Lewinsohn, 1974). Certain events, such as losing your job,

induce depression because they reduce positive reinforcement from others (e.g. being around

people who like you).

The first theme cluster is the ‘low academic performance in school’. Aremu (2003)

identifies poor academic performance as a performance that is adjudged by the examiner and

26
some other significant as falling below an expected standard. With reference to academic failure

there are many causes related to psychological reasons such as Major Depression Disorder. It is

common that depression as a disease caused by failing in exams but it is more frequent that

depression often proceeds the exams' period. Depression can cause inability and weakness in

concentration of the patient. Informant X mentioned: I was out of focus, mainly in school. I don’t

want to listen, I just want to write because nothing (no lessons) will sink in my mind.

Loss of friends is the second sub-theme cluster which emerges from this emergent theme.

Depression is a thief. It'll rob you of your time, your thoughts, and your sense of self. But before

all of that, it'll take your friends. A lot of friends have told that when you are depressed you bring

this sadness upon yourself. Unfortunately with every accusation and advice, this has only gotten

farther from people. It will be like “If your own thoughts sound alien to you, how would

someone else understand them?” These are clear evidences that teenagers who are depressed

really feel like no one can understand them. Thus, a verbalization from Informant X states: I also

lost friends because if I am upset I shut people out. No one could really help me. My friends tell

me that they will always be there but they just ‘come and go’. All my friends just show fake love

The last theme cluster derived from this theme is ‘loss of interest on things’ or

Anhedonia. Anhedonia is one of the main symptoms of major depressive disorder (MDD). It is

the loss of interest in previously rewarding or enjoyable activities. People suffering from clinical

depression lose interest in hobbies, friends, work--even food and sex. It's as if the brain's

pleasure circuits shut down or short out. Depression reduces that hedonic capacity. Informant X

uttered this statement: To the hobbies that I do, I don’t enjoy them anymore. I lost the will to

continue my life.

27
Cognitive Triad

The second emergent theme is entitled “Cognitive Triad”. One major cognitive theorist is

Aaron Beck. He studied people suffering from depression and found that they appraised events

in a negative way. Beck (1967) identified three mechanisms that he thought were responsible for

depression and one of them is the cognitive triad (of negative automatic thinking).

The cognitive triad are three forms of negative (i.e. helpless and critical) thinking that

are typical of individuals with depression: namely negative thoughts about the self, the world and

the future. These thoughts tended to be automatic in depressed people as they occurred

spontaneously.

As these three components interact, they interfere with normal cognitive processing,

leading to impairments in perception, memory and problem solving with the person becoming

obsessed with negative thoughts.

The first cluster theme is Negative View of Self. Depressed individuals tend to view

themselves as helpless, worthless, and inadequate. They interpret events in the world in a

unrealistically negative and defeatist way. Beck's main argument was that depression was

instituted by one's view of oneself, instead of one having a negative view of oneself due to

depression. As described by Informant X: I always think ‘Asa ko nagkuwang?’

‘Negative View of the World and Future’ is the second cluster theme, inwhich they see

the world as posing obstacles that can’t be handled. They also see the future as totally hopeless

because their worthlessness will prevent their situation improving. A characteristic feature of

many depressed individuals is a pessimistic and negative view of their personal future. This

28
clinical observation is covered in several conceptualizations of depression (e.g., Beck, Rush,

Shaw, & Emery, 1979; Abramson, Alloy, & Metalsky, 1989; Klinger, 1993)

According to Klinger (1993), negative view of the world and future in depressed persons

often concerns future periods when the wished for goal seems to be out of reach (e.g., “I will

never get married”). Melges and Bowlby (1969) argued that hopelessness is about reduced

expectancy of success. In sum, several authors have argued the expectancies about the future is a

central component in depression. As described by Informant X:

“I didn’t realize my purpose here on Earth. I can say that I am good, I am being

myself, I help people, I try to be there for the people around me but I realize that no matter how

good I am, things would never be in my favor.”

Anxiety Disorder

Everyone has feelings of anxiety at some point in their life. Anxiety is when those

feelings don't go away, they’re extreme for the situation, and you can’t seem to control them.

When anxiety is severe or there all the time, it makes it hard to cope with daily life. One specific

disorder is what you call OCD. Obsessive Compulsive Disorder (OCD) is when a person has

unwanted, intrusive, persistent or repetitive thoughts, feelings, ideas, or sensations (obsessions)

which cause anxiety. So they then carry out actions to reduce the anxiety or get rid of those

thoughts.

They may know these thoughts are unreasonable but be unable to stop them. When OCD

is severe and left untreated, it can be very distressing, and get in the way of work, school and

normal life at home. Informant X spoke about her experience:

29
“I over think and it never stop, most especially if I sleep late. The problems that I

have been going through are always on my mind. Recently, my panic attacks are getting worse I

experience chills and I could hardly breathe every time I over think. Sometimes, if I want to cry,

my tears won’t fall.”

Learned Helpfulness

Martin Seligman (1974) proposed a cognitive explanation of depression called learned

helplessness. According to Seligman’s learned helplessness theory, depression occurs when a

person learns that their attempts to escape negative situations make no difference. As a

consequence they become passive and will endure aversive stimuli or environments even when

escape is possible.

This led Seligman (1974) to explain depression in humans in terms of learned

helplessness, whereby the individual gives up trying to influence their environment because they

have learned that they are helpless as a consequence of having no control over what happens to

them. Informant X described her experience: I think negative thoughts about myself that no

matter how hard you reach for that certain goal, it’s not really meant for you, not really meant

for me

30
Discussions

The entire emergent theme reflected the lived experiences of the informant in the causes

of teenage depression.

The first theme in the sociological causes is parents being emotionally and physically

abusive. Child abuse commonly underpins adult depression. In almost every case of significant

adult depression, some form of abuse was experienced in childhood, either physical, sexual,

emotional or, often, a combination. Scientists know that traumatic experiences such as child

abuse or neglect change the chemistry and even the structure of the brain.

Second emergent theme is entitled “Fake Friends”. A lot of the people described having

difficult and complex relationships and many felt depression had affected their friendships one

way or another. Many said they had never “fitted in” and making friends had been “hard work”

for them throughout their lives.

The third emergent them is unhealthy relationship with someone o partner. One of the

most important social causes for depression is a stressful relationship. When a relationship is not

working it turns into a stressor, which often causes depression among females and leads males to

alcohol abuse. Stressful relationship is the leading cause for depression among women.

We also have the emergent themes in the psychological causes. The first emergent theme

is operant conditioning. Operant conditioning can be described as a process that attempts to

modify behavior through the use of positive and negative reinforcement. Through operant

conditioning, an individual makes an association between a particular behavior and a

consequence. Operant conditioning states that depression is caused by the removal of positive

reinforcement from the environment.

31
Second emergent theme is the cognitive triad. The cognitive triad are three forms of

negative (i.e. helpless and critical) thinking that are typical of individuals with depression:

namely negative thoughts about the self, the world and the future. These thoughts tended to be

automatic in depressed people as they occurred spontaneously.

The third emergent theme is anxiety disorder. Everyone has feelings of anxiety at some

point in their life. Anxiety is when those feelings don't go away, they’re extreme for the

situation, and you can’t seem to control them. When anxiety is severe , it makes it hard to cope

with daily.

The last emergent theme is learned helpfulness. Martin Seligman (1974) proposed a

cognitive explanation of depression called learned helplessness. According to Seligman’s learned

helplessness theory, depression occurs when a person learns that their attempts to escape

negative situations make no difference. This led Seligman (1974) to explain depression in

humans in terms of learned helplessness, whereby the individual gives up trying to influence

their environment because they have learned that they are helpless as a consequence of having no

control over what happens to them.

32
Chapter V

Conclusions and Recommendations

Conclusion

The over-all proposition of the study evolves with the essence of ‘teenage depression’.

Although teenage depression is very relevant to our society today, this serves as an eye-opener to

other individuals that teenage depression is a serious matter that needs a serious action. It is a

mental illness that takes over the brain and inner feeling of teen boys and girls. If they experience

depression, they always feel that they are alone and talking to someone about their serious

condition can be very embarrassing. Teen depression is not an illness that can’t just go away on

its own. In an actual fact, sociological causes can be easily seen during teen depression, this

includes fake friends, being physically abused by parents and unhealthy relationship with

someone or partner. In addition, this study also presents psychological causes such as operant

conditioning, cognitive triad and anxiety disorder.

Recommendation

This research yields the following research recommendations.

It is further recommended that the informants must be more than one for more factual

evidences.

Examining relationship between multiple levels of adolescents' interpersonal functioning,

including general peer relations (peer crowd affiliations, peer victimization), and qualities of

family best friendships and romantic relationships as predictors of symptoms of depression and

social anxiety and psychological causes is also further recommended.

33
This study also recommends implication for practice. As many as one in every five teens

experience depression at some point during adolescence, but they often go undiagnosed and

untreated, sometimes because of a lack of access to mental health specialists. Recognizing that

pediatricians and other primary care providers are often in the best position to identify and help

struggling teens.

34
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36
APPENDICES

37
APPENDIX A1
Transmittal letter for the principal

38
APPENDIX A2
Informed Consent Release

39
APPENDIX A3
Informed Consent Form

40
APPENDIX A4
Interview Guide

41
Curriculum Vitae

Personal Data

Name: Jhael Hazel Marie L. Abucejo

Address: VLT-F blk. 3 lot 6 Bacayan, Cebu City

Contact Information: 09436170828

Email Address: jhael.abucejo@yahoo.com

Educational Background:

Elementary: Talamban Elementary School

Borbajo St., Talamban Cebu City

2006-2013

High School: Talamaban National High School

Borbajo St., Talamban Cebu City

2013-2017

Senior High School: Talamban National High School

2017-present

42
Curriculum Vitae

Personal Data

Name: Abby Jill L. Caya

Address: NasipitTalamban Cebu City

Contact Information: 09254419010

Email Address: labbyjill@yahoo.com

Educational Background:

Elementary: Banilad Elementary School

Banilad Cebu City

2007-2013

High School: Talamban National High School

Borbajo St., Talamban Cebu City

2013-2017

Senior High School: Talamban National High School

Borbajo St., Talamban Cebu City

2017-present

43
Curriculum Vitae

Personal Background:

Chrisheell Ann C. Codezar

Address: KalubihanTalamban Cebu City

Contact Information: 09336213006

Email Address: Codezarchrisheell69@gmail.com

Educational Background:

Elementary: Talamban Elementary School

Borbajo St., Talamban Cebu City

2006-2013

High School: Talamaban National High School

Borbajo St., Talamban Cebu City

2013-2017

Senior High School: Talamban National High School

Borbajo St., Talamban Cebu City

2017-present

44