Journal o f Youth and Adolescence, 1Iol. 23, No.

6, 1994

Adolescent Depression in a School-Based

Community Sample: Preliminary Findings on
Contributing Social Factors
Allan H. McFarlane, 1 Anthony Bellissimo, 2 Geoffrey R. Norman, 3 and
Phil Lange 4

A two wave survey carried out on a large community sample of ado-

lescents with increased risk for problems with social functioning is de-
scribed. In this paper we report the prevalence of depression in this
population and social factors that contribute to it. The prevalence of de-
pression is twice that in other studies. Stress is both a risk and causal factor
in depression while relatively low social self-efficacy moderately increases
risk. Being female is a risk factor for depression. The perception of parents
and siblings as a source of support appears to be a key factor in protection
from the onset of depression.

INTRODUCTION

Over the past decade attention has turned to understanding the na-
ture, significance, and impact of depression in adolescents. Concurrently,
interest in the resilient child has led to a desire to know more about factors
that either protect or incase risk for psychiatric disorder, including depres-
sive illness. In this paper we describe research that addresses both of these
issues.

1professor, Department of Psychiatry, McMaster University, 1200 Main Street West, Hamilton,
Ontario, L8N 3Z5 Canada. Received M.D. from Queen's University. Research interests
include developmental experiences that influence adolescent and adult social functioning,
and mechanisms of mortality rates in post coronary depressed subjects.
2Associate Professor, Department of Psychiatry, McMaster University. Received Ph.D. from
University of Waterloo. Research interests are risk factors affecting depression in adolescents
and young adults and social factors associated with chronic pain.
3professor, Epidemiology and Biostatistics. Received Ph.D. from McMaster University.
Research interests are psycho-social factors that influence adolescent well being,
measurement of clinical competence, and research design.
4Research Coordinator, McMaster University. Received M.A. from McMaster University.

601
0047-2891/94/1200-0601507.00/09 1994Plenum PublishingCorporation
602 McFarlane et al.

PURPOSE OF THE PRESENT RESEARCH

The present paper is part of a larger study, the main objective of

which is to improve our understanding of the influence of childhood and
family experiences on adolescent social functioning. The purpose of this
present paper is to explore the etiology and natural history of depression
among adolescents and to examine the role of social stress, social support,
social self-efficacy, and gender in the onset of it.
Specific research questions are as follows:
What is the point prevalence of self-reported depression on a
standardized instrument in a midadolescent population of high
school students?
- - What is the incidence of new episodes over a six-month interval?
What proportion of subjects who initially report major depressive
disorder will resolve their disorder over a six-month interval?
What are the roles of social stress, social self-efficacy, social sup-
port, and gender in the onset and resolution of symptoms?

OVERVIEW OF DEPRESSION AND VULNERABILITY

There is now substantial information about both the existence and

prevalence of depressive morbidity in adolescent populations. Whether de-
fined as a symptom (painful emotion and negative mood), a syndrome
(negative mood and negative cognition), or psychiatric disorder (charac-
teristic pattern of symptoms and duration with dysfunction), affective dis-
order in adolescent subjects is a major health concern. Rutter (1979) found
40% of 14-15-year-olds reported depression and dysphoria. Kandel and
Davies (1982) reported the prevalence of depressed mood to be 25% in
high school students. The Ontario Child Health Study (Offord et al., 1989)
has found that 55% of girls and 37% of boys in the age range of 4-16
years have symptoms of depression. The Ontario Child Health Study also
indicates that 2.5% of boys and 7.2% of girls in the age range of 4-16
years have had a depressive disorder. Using a community sample of ado-
lescents, Kashani et al. (1987) found 2.5% of boys and 13.3% of girls had
a depressive disorder.
The beginning of adolescence coincides with a rise in the prevalence
of depression and the presence of depression disrupts young people's lives
through its impact on social and educational function and on developmen-
tal tasks unique to adolescence. The evidence is that major depressive dis-
order appears to slow down some aspects of cognitive development and to
Adolescent Depression 603

interfere with the acquisition of verbal skills in children (Kovacs, 1989).

This in turn leading to "dropping out" of school.
Garber et al. (1988) found that the recurrence rate in adolescents
with depressive disorders is 64% with the result that in the long term, there
is an increased risk for disorder and dysfunction in young adulthood. Not
only is adolescent depression the most significant predictor of adult de-
pression, it also predicts an increased risk in females of higher divorce rates
and estrangement from parents, while in males there is an increased risk
for higher rates of unemployment and car accidents. Both males and fe-
males are at increased risk for decreased intimacy with spouses and for
illegal activities.

FACTORS ASSOCIATED WITH DEPRESSION

Social Stressors

The concept of stressor refers to the experiential circumstances that

give rise to stress (Pearlin, 1989). The relationship between stressors and
depression has been a focus of enquiry for well over 20 years. Paykel et
al. (1969) described exit events or the loss of relationships in the period
prior to the onset of depression. (Depressed subjects had a relative risk of
6.5 for such losses.) Roy (1985) found that permanent separation from the
mother before age 17 is associated with nonendogenous depression in
women. Brown and Harris (1978) found that stressors can bring about de-
pression in the presence of certain risk factors. While controversy exists
about Brown's 1978 and 1986 findings, many studies have confirmed that
stressors play a significant role in the onset of depression.
Goodyer and Altham (1991) have shown that a particular class of
events, called Lifetime Exit Events, results in some degree of risk for later
disorder. Their findings are that both lifetime exit events, and family and
friendship adversities exert independent effects on the risk of depression
and anxiety. The mechanism by which these act, while unknown, is pro-
posed to be due to a deleterious impact on a personal attribute such as
self-esteem or self-efficacy. In those found to be resilient in the face of
these risk factors, the nature of the resilience is unclear. Both intrinsic (for
example, good physical health) and extrinsic factors (positive family and
good peer relations) have been suggested as buffers, acting by encouraging
a positive self view under stressful conditions.
A survey of adult women (Brown et al., 1986) showed that stressors
involving impaired relationships are associated with lower self-esteem, but
not necessarily with depression. Onset of depression was best predicted by
604 McFarlane et al.

an interaction between total stress and low self-esteem. This suggests that
depression results from preexisting low self-esteem on which life stress im-
pacts rather than life stress leading to low self-esteem. Current evidence
is that low self-esteem on its own does not predict near future illness.

Self-Efficacy

Another variable that has been related to depression is self efficacy;

an individual's judgments about how w e l l - - t h a t is efficiently and effec-
t i v e l y - he/she will deal with specific situations in future time. Measures
of self-efficacy have been shown to be good predictors of a variety of be-
haviors. Self-efficacy is a central construct in the cognitive-behavioral for-
mulation of depression because the perceived inability to influence life
events and social conditions may give rise to futility and despondency.
While the empirical study of the role of self-efficacy is in its early stages,
Kanfer and Zeiss (1983) showed that depressed individuals see their self-
efficacy as falling short of personal standards of performance. Fleming et
al. (1993) found that adolescents with major depressive disorder had lower
self-esteem four years later than did those without major depressive disor-
der. Similarly, Hetherington et al. (1992), in an 18-year follow-up study
found depressed adolescents had lower self-esteem. Correlations between
self-esteem and self-efficacy are moderate (R = 0.47). Self-efficacy can be
broken down into physical, academic, and social self-efficacy. Because we
are interested in the role of social factors in depression we have relied on
the construct of social self-efficacy,
Ehrenberg and Cox (1991) showed that social self-efficacy has an im-
portant role in adolescent depression. They investigated the relationship of
physical, academic, and social self-efficacy to depression in adolescents. The
regression coefficients for social self-efficacy (defined as an expectation of
success in different social tasks that relate to success in social relationships)
on depression as measured by the Beck Depression Inventory were -.41
and -.42 for middle and late depressed adolescents, respectively. Both
physical and academic self-efficacy, while also being related to depression,
were not as significant as social self-efficacy.
Kovacs (1989) urges studies to address the impact of adolescent de-
pression on the development of social competence and long-term academic
achievement, arguing that mood disorders adversely affect social abilities
by disrupting the formation of friendships and peer relationships. Similarly,
she argues for the impact of affective disorders on learning and academic
achievement. In sum, then, depression negatively influences eventual inter-
personal success and opportunities for higher education and careers.
Adolescent Depression 605

Social Support

The nature and the quality of social attachment to family and peers
and its contribution to individual well-being has long been a question of
interest to developmental psychologists. According to Rutter (1985) there
is some evidence for both a direct and a buffering effect of social support
on psychological functioning; secure, stable, and affectionate relationships
act as a protective factor promoting resilience in the face of adversity.
Whether adequate support is a function of personality, environment or per-
son-environment interaction remains unanswered. Perhaps social self-effi-
cacy acts as a critical variable to mediate the individual's access to a
supportive person-environment. Sarason et al. (1985), for example, found
that individuals high in social support score higher in their knowledge of
socially skilled behavior than those low in social support, and Brown et al.
(1986) suggested a reciprocal relationship between social support and self-
esteem.

Gender

Gender is relevant to adolescent disorder in several ways but espe-

cially in regard to responses to stress, in that boys appear to suffer more
ill effects than girls from family discord. These effects are predominantly
in the direction of externalizing behaviors. Epidemiological studies of chil-
dren and adolescents, however, report considerably higher rates of depres-
sion in females than males. The evidence also suggests, then, that male
and female responses to stressors are different, with males more likely to
engage in maladaptive behaviors such as drug abuse and females to respond
with depressive symptoms. Another example of gender differences is in
Sarason et al. (1985), who reported women to be more socially skilled than
men in a sample of college students.

Development and Individual Difference

In the stress literature there is an interest in the social origins of in-

dividual difference. Both research and contemporary theorizing have sup-
ported Adolf Meyer's emphasis on the role of life experiences in personality
development and in the genesis of psychiatric disorder (Rutter, 1986). In-
dividual differences in response to stressors do indeed have their origins
in earlier life experiences. These vulnerabilities and resistances are influ-
enced by social mediators in the person-environment interaction.
606 McFarlane et al.

In summary, there is abundant evidence that social stress, social self-

efficacy, social support, and gender all have a relationship with depression
at least in adults. There are indications that these variables are relevant in
the depressed adolescent, and need to be examined.

METHOD

The project is a survey of all general level students in the 11 high

schools of the Hamilton Board of Education in Hamilton, Ontario, Canada
(population > 400,000) who entered Grade 10 in 1989. General level stu-
dents are those who are not taking academic level subjects necessary for
admission to university. Because school drop-out rates are highest in the
General Stream, these students were chosen on the basis that they are a
risk population for other problems associated with social functioning. The
mean age of this population was 17.1 years with a standard deviation of
1.0 year. An extensive series of questionnaires was administered to these
students in December-January of 1989-1990 (Time 1). A more abbreviated
set of questionnaires was administered in May-June 1990 (Time 2) to the
same sample for purposes of investigating those variables subject to change
over time.
It was possible to include all of the students in this survey due to the
fact the project was carried out in partnership with the Research Depart-
ment of the Hamilton Board of Education. As such, the project was carried
out as one aspect of the academic curriculum having been cleared by the
Board of Trustees. The policy of the board in such instances is to not re-
quire parental consent. Nevertheless, consent was sought in the classrooms
from the students by the investigative team. After detailed explanation of
the goals of the study to subjects, those wishing not to be included were
encouraged to leave the classroom. Selected demographic characteristics
of the total sample can be seen in Table I.

PROCEDURES

The administration of the questionnaires at Time I was carried out

in the classroom over a 90-minute time period by the investigators with
the cooperation of the school administration and classroom teachers. The
second administration at Time 2 was carried out similarly in the school
during school hours in places of convenience, such as at libraries and cafe-
terias, since the initial group had dispersed into different classrooms in the
Adolescent Depression 607

Table I. Selected Demographic Characteristics of the Total

Sample
Age 17.1 (1.0)
Gender
Male 53%
Female 47%
Family income
< 10,000 5.3%
11-20,000 14.6%
21-30,000 27.1%
31-40,000 17.4%
>40,000 35.1%
Family occupation (Blishen Code) a
<20 1.8%
20-29.9 10.2%
30-39.9 41.7%
40-49.9 22.8%
50-100 23.5%
Family structure
Both biological parents 57%
Single parent 22%
Stepparent and natural parent 16%
Other 5%
aThe Blishen code is based on an index of occupational status
(Blishen et al., 1987).

second semester. Although approximately 1000 students were enrolled in

10th-grade general mathematics, the number who met our criteria was
somewhat lower. These criteria were age 19 years or younger, sufficient
English to understand and answer the questions, and responses that were
noncontradictory and credible. This resulted in 801 individuals (378 females
and 423 males) for the first administration. After the second administration,
the number of students with valid questionnaires for both Time 1 and Time
2 was 694 (331 females and 363 males), because some students were absent
from school on that day on follow-up, had filled in faulty responses, or had
dropped out of school in the interim. Extensive validation procedures were
carried out on a questionnaire by questionnaire basis. This activity dealt
with questionnaires that were "trashed" by subjects as well as extensive
within questionnaire validity, cross-checking items for inconsistencies. As
well, some subjects did not complete all sections of the questionnaires, thus
excluding that particular section from a particular analysis, which resulted
in a sample size of 648 (338 males and 310 females).
Because it is an underlying hypothesis of the larger study that psy-
chosocial factors, in particular depression, may have a causative role in aca-
608 McFarlane et al.

Table II. Selected Demographic Variables Measured at Time 1 Based on Completion of

Second Questionnaire
Completed Did not
Variable Time 2 Complete Time 2 p
n 694 107
Age 17.1 year 17.5 year .001
IDD score 13.72 16.13 ns
MDD (%) 9.9% 15.5% ns
Ultimate drop-out status 9% 64% .0001

demic failure and dropout, it is of course possible that the students who
were not available for the second administration had already dropped out
of school as a result of depression, or other factors; thus the "at-risk" popu-
lation had already been eliminated from the sample prior to the second
analysis. To assess this possibility, we examined the Time I variables of the
group who did, and did not, complete the second questionnaire. The results
are shown in Table II.
It is apparent that a large proportion of the group who did not com-
plete Time 2 questionnaires eventually became confirmed drop-outs from
the school system (64%), and not surprisingly they were slightly older than
the group who completed both sets of questionnaires. However, depression,
as assessed by both Inventory to Diagnose Depression (IDD) score and
the Major Depressive Disorder (MDD) algorithms, although slightly higher
in this group, was not significantly different.

MEASURES

Inventory to Diagnose Depression

This is a self-completion instrument that covers all Diagnostic Statis-

tical Manual's (DSM-III) criteria for Major Depressive Disorder, developed
by Zimmerman and Coryell (1987). Inventory to Diagnose Depression uses
thresholds to determine presence/absence of symptoms, each item being
graded as to severity as well as duration. This instrument is highly reliable
and has a sensitivity of 81% to detect MDD, correlates with the Beck De-
pression Inventory 0.87, the Hamilton Rating Scale (0.80), and has a kappa
coefficient with the Depression Interview Schedule of 0.8 and DSM III of
0.66. When compared to the SADS the sensitivity is 86% and specificity
76%, positive predictive value 84%. The instrument is useful in measuring
severity of depressive symptoms, is sensitive to change, and therefore still
Adolescent Depression 609

demonstrate change in scores over time. Two separate algorithms are used
to generate a diagnosis of major depressive disorder, the first algorithm
determines if part A of DSM-III's criteria are met and the second if part
B of D S M - I l r s criteria are met. The IDD was administered at both Time
1 and Time 2.

An Adolescent Stress Measure

The Adolescent Stress Measure, developed by Newcomb et al. (1981),

was administered at Time 1 and Time 2. This consists of 39 events suitable
for adolescents and scored by a simple sum of either all events or just
undesirable events. The scale was developed on 1018 male and female ado-
lescents who were part of a study of adolescent growth and development.
Because the weight of research evidence is that undesirable or negative
events are most harmful to people, we have used negative events as the
measure of stressor exposure. (McFarlane et al., 1983). Stress scores were
obtained for both the year prior to administration and the year before.
Test-retest reliability of the scale over one year is 0.5. Newcomb et al.
(1981) demonstrated that both controllable and uncontrollable events were
relevant to distress. Correlation between the scale and health functioning
was highly significant (R = -0.24).

Social Support (SSQ)

The summary scale of the SSQ (Social Support Questionnaire) devel-

oped by Sarason et al. (1983) on college students was used to characterize
the nature and quality of social support. Subject are instructed to report
both the initials of the supportive person and the class of relationship in six
aspects of support. Relationships are classes as parent, sibling, friend, rela-
tive, or "other." "Others" would include individuals in the neighborhood, at
school, or at work who are seen as helpful. In this way the comprehensive-
ness of support on six critical dimensions of support, a helpfulness score, as
well as size of the support system are determined. In addition, we examined
the classes of relationship that contributed to support. The reliability and
validity of the SSQ have been reported in a series of experiments (Sarason
et al., 1987). The instrument demonstrated a high degree of internal con-
sistency, stability over four weeks, freedom from a social desirability bias,
and a high degree of convergent and discriminate validity.
610 McFarlane et al.

Adolescent Social Self-Efficacy Scale (A-SSE)

This scale was developed by Connolly (1989) and has been found to
significantly correlate with aspects of self-concept, such as perceived social
acceptance, (R = 0.61) general self-worth (R = 0.44), cognitive (R = 0.35),
physical competence (R = 0.23), and self-esteem (R = 0.47). The validity
of the construct is supported by its relations to ratings of social adjustment.
(Social withdrawal, R = 0.39, and social competence, R = 0.23). Results
of research also provide support for the importance of the SSE construct
in the study of social competence in adolescence. (Connolly, 1989). A meas-
ure of SSE was taken at both Time 1 and Time 2.
In this article we present findings from the Time 1, Time 2, or two-
wave portion of the study in which we examine relationships among social
support, social self-efficacy, social stress, and depression.

ANALYSIS

In this analysis four groups were identified. First, the IDD was scored
using two algorithms to create the MDD, Then the subjects were identified,
based on this index, as following:
1. A group not depressed at either Time 1 or Time 2 which is de-
scribed as the "never-depressed" (N = 535).
2. A group not depressed at Time 1 and depressed at Time 2, the
"deteriorating group" (N = 45).
3. A group that was depressed at Time 1 and not depressed at Time
2, the "healing group" (N = 29).
4. A group with major depressive disorder at both Time 1 and Time
2 (N = 39). This is the "always depressed" group.
Individual variables were then analyzed using repeated measures
analysis of variance, with the individual group, as defined above, as a group-
ing (between subjects) factor and Time 1-Time 2 as a within-subjects fac-
tor. This analysis then results in three possible tests of significance: a main
effect of group, which demonstrates consistent difference across both time
periods and suggest that the variable is a consistent risk factor for depres-
sion; a main effect of time, which amounts to a drift up or down over time
across all groups, and is of little primary interest; and an interaction be-
tween group and time, suggesting that the variable is related to depression
in a reciprocal manner. All tests of significance were F-tests, with 1 and
646 degrees of freedom.
Adolescent Depression 611

Prevalence, Incidence, and Duration of Major Depressive Disorder

Prevalence (total number of cases) of major depressive disorder in a

sample of general level high school adolescents was 10.5%, for Time 1 and
11.4% for Time 2. The six-month incidence of depression is 7.8% or ex-
trapolating to a one-year period, the incidence of new cases in one year is
15.6%. The prevalence in males for MDD was 5%; for females it was 17%,
roughly a 3:1 ratio. Incidence for males was 10.4% and for females 22%.
Using the formula: Prevalence = incidence x duration (Streiner and Nor-
man, 1989) we can thus determine the average duration of a depressive
episode in this sample, equal to 8.4 months for the entire sample, 9.4
months for females, and 6 months for males.

Stress Exposure

The number of negative stressors at Time 1 and Time 2 is shown in

Fig. 1. There was a significant main effect of group (F = 24.3, p < .0001)
as expected, and a significant interaction between group and time (F =
4.11, p < .02). There was also a small but significant main effect of time
(F = 5.69, p < .02).
Stress exposure was highest in the "always" depressed" group and low-
est in the "never depressed" group, with the ranking of the "healing" and
"deteriorating" groups consistent with the concurrent state of depression.
In addition, the onset of depression in the deteriorating group was accom-
panied by an increase in reporting of stressful events at Time 2. The healing
group reported essentially the same stress exposure at both times. Presum-
ably, this indicates that the stressful events leading to the onset of depres-
sion continued to occur even after the resolution of the episode at the
second assessment.
Stressful events were then grouped into one of five classes. These
event classes are social, antisocial, family, school, and sexual. Analysis con-
trasting the relative frequency of event types comparing the never de-
pressed to the three depressed groups reveals a greater frequency of
stressors of all kinds n the depressed groups.

Social Self-Efficacy

The SSE scores are shown in Fig. 2. Group differences in social self-
efficacy were significant (F = 6.87, p < .001); however the interaction with
time was not. The ordering of scores was such that the never depressed
scored the highest and always depressed the lowest. The deteriorating
612 McFadanedaL

Time 1 Time 2
Never Depraaed ~ Deteriorating
Healing -E~ Always Depressed

Fig. 1. Number of stressful events.

group had the next highest scores followed by the healing group. The Time
2 SSE scores were higher in all groups when compared with their Time 1
SSE scores. This likely represents subjects increased comfort in social situ-
ations in the school environment as the school year has progressed. These
findings are consistent with social self-efficacy being relatively lower in de-
pressed subjects but does not appear to change with the depressive episode.

Social Support

A number of variables were generated from the support measures:

A. An overall measure of satisfaction with support did not reveal any
significant differences among the four groups, nor did any changes in sat-
isfaction emerge from Time 1 to Time 2. Therefore, satisfaction with sup-
port appears not to vary with depression either between groups or over
time. The finding that satisfaction is not altered by the onset of depression
informs us that the magnitude of satisfaction is not a function of the de-
pressed state.
Adolescent Depression 613

140

J
130

120

110

100
Time 1 Time 2
Never Depresed ~ Deteriorating
Healing ~ Always Depressed

Fig. 2. Social self-efficacy.

B. Similarly, the size of the support system or the number of indi-

viduals listed as being in the support system did not vary significantly from
group to group and over time, therefore suggesting no relationship between
size of system and depression.
Thus, there was no differences in size or satisfaction with the support
system comparing the nondepressed and depressed groups.
C. We did, however, find significant differences in structure. These
differences were as follows:
(a) Depressed subjects were less likely to report parents contributing
to support. The always depressed group reported parents the least
often (F = 9.63, p < .0001). This amounts to these parents mak-
ing a smaller contribution to all aspects of support. The interac-
tion with time was significant (F = 4.35, p < .005), indicating a
reduced perception of parental support with the onset of depres-
sion.
(b) Differences in the number of times siblings were listed as mem-
bers of the support system was significant (F = 2.76, p < .05),
the always depressed reporting the fewest and never depressed
614 McFarlane et al.

the most. This difference reflects access rather than family com-
position, separate analysis having not revealed differences in po-
tentially available siblings. All groups reported significantly less
endorsement of siblings with the second administration. The in-
terpretation of this is speculative but, as with SSE, may reflect
greater school integration at Time 2, there being a reduced need
for sibling support. There was no evidence of interaction, the ef-
fect being no reduction in sibling support with the onset of de-
pression.
(c) Depressed subjects did not report a reduction in the overall num-
ber of times family members were mentioned in the support sys-
tem. The number of distinct family members mentioned was,
however, significantly different, with the always depressed having
the lowest mean value (2.39), the never depressed the highest
(3.49), and the deteriorating and healing groups intermediate. It
follows from this that while depressed subjects have fewer family
members in their support system than the nondepressed, the ones
they have are endorsed more frequently. Since the availability of
family members does not interact with the resolution of depres-
sion it may be appropriately viewed as a risk factor for depression.
To summarize the influence of parents, siblings and family, depressed
subjects

(i) mention parents less often as a source of support,

(ii) mention siblings less often as a source of support,
(iii) have fewer family members in the support system, and
(iv) mention the family members who are supportive more often.
D. Differences in the number of friends listed in the support system
was significant (F = 2.62, p < .05). In contrast to family relationships, al-
ways depressed reported the most, and never depressed the least. No dif-
ferences were found within group over time or intergroup over time,
indicating that friends support is not altered by the onset of depression. A
trend was noted for reduction of friends support with depression onset in
both the healing and deteriorating groups.
E. The category of support referred to as "others" would include
teachers, guidance counselors, school nurses, etc.; 57% of others were
someone in the school system. There were significant between group dif-
ferences in the number of others listed (F = 2.8, p < .05) with always
depressed endorsing a larger formal support system than the never de-
pressed. It is perhaps reasonable to assume that formal supports have been
Adolescent Depression 615

Table III. Summary of Findings of Relationship of Social Variables to Depression

Main effect Interaction
Variable (risk factor) (covariate) Time
Stress (+)a a b
Social self-efficacy (_)a ns a
Social support
Satisfaction ns ns ns
Size ns ns ns
Siblings (_)a ns a
Parents (_)a a ns
Family (_)a ns a
Friends (+)a ns ns
Others (+)a ns ns
On one + ns ns
astatistical significance.
bNot significant.

proscribed for needy individuals who are already troubled and who lack
a t t a c h m e n t figures in their support systems.
F. T h e depressed group was twice as likely to endorse " o n e - o n e " in
some aspect of support as the never depressed (F --- 2.17, p < .09).
T o summarize the influence of friend, "others," and "no ones," de-
pressed subjects

(i) mention friends more often as a source of support,

(ii) mention "others" more often as a source of support, and
(iii) are more likely to endorse "no support" in one of the six dimensions
of support, although this did not reach statistical significance.

T h e results of all these individual analyses are summarized in Table

III.
It is apparent that depression is associated positively with stress and
negatively with self-efficacy. Overall measures of social support did not dif-
fer a m o n g groups; however the structure of the support system showed
large and significant differences, with depressed individuals drawing m o r e
support from friends and others, and less support from parents and siblings.
This finding replicates the results of McFarlane et al. (1985), who showed
that social support is primarily an issue of close family support. As well,
depressed subjects had deficits in some aspects of support, being m o r e
likely not to have a supportive person they could nominate.
616 McFarlane et aL

Gender Differences and Correlates of Depression

Analyses of gender differences were approached by including gender"

as a second between-subjects factor in the analysis of variance. Females
had significantly larger support systems than males (F = 4.97, p < .0001);
however, this difference was primarily due to more friends or others being
endorsed in the support network. Females did, however, report more stres-
sors than males (F = 2.84, p < .005). However, the essential issue is
whether gender differences interact with the remaining variables as predic-
tors (stable or dynamic) or depression. Of the 32 possible relations, there
was only one significant interaction between gender and depression group.
Thus, there is no evidence that the identified protective and risk factors
for depression were mediated or altered by gender.

DISCUSSION AND SUMMARY

Prevalence and Duration of Major Depressive Disorder

Previous estimates of the actual prevalence of depression in early to

middle adolescence, an age range similar to the present study, based on
large scale epidemiologic surveys of community samples, are 2.5% for boys
and 7-13% for girls. Thus, the female to male ratio is approximately 4:1.
In the present study, sampled from adolescent high school students at high
risk for social and educational dysfunction, prevalence is somewhat higher
at 10.9%, roughly doubling the prevalence rates found in random commu-
nity samples. Interestingly, the female to male ratio was approximately the
same, with an upward shift to male prevalence rates of 5% and females
of 17%.
The average duration of depression in the present study has been
calculated to be approximately 8.4 months. This finding, that adolescent
depression is not a brief experience, and according to Keller et al. (1988),
may be recurrent, provides ample evidence of the importance of the find-
ings.

Relationship of Stressors to Major Depressive Disorder

The never depressed group reported low exposure to stressors at

Time 1 to Time 2. Similarly, the always depressed group reported the great-
est exposure to negative events at both Time 1 and Time 2, showing con-
siderable continuity in stressor exposure. This finding can be interpreted
Adolescent Depression 617

as supportive of Pearlin's (1989) conclusion that events are surrogate indi-

cators of noneventful ongoing social or life circumstances that give rise to
events. Brown et al. (1986) have shown that life events capable of bringing
about depression are of two types: severe long-term threat or major diffi-
culties lasting for at least two years. They have referred to these events as
"provoking agents."
Groups depressed at either Time 1 or Time 2, but not both, reported
stressors intermediate in magnitude between those neither depressed a t
Time 1 or Time 2 and those depressed at both of these times, consistent
with the notion that stressor exposure is a risk factor for major depressive
disorder. The findings that the deteriorating group reported more stressors
at Time 2 than Time 1 and that the healing group reported no change is
in keeping with stressors as being causal in the onset of depression in ado-
lescents. Stressors from all domains appear to be related to depression.
The emphasis in some research that stressors involving impaired re-
lationships are clearly associated with lower self-esteem suggest a model
that has been proposed by others (Brown et a t , 1986). This is that loss of
resources act to trigger depression through an impact on an already shaky
self-esteem. Our data do not support this model since SSE did not change
in the presence of depression.

Social Self-Efficacy

The ordering of self-efficacy scores among the groups establishes so-

cial self-efficacy as a promising predictor of depression. As noted above,
the findings are in favor of stressors acting on an already low social self-
efficacy to lead to depression rather than stressors lowering social self-ef-
ficacy and then resulting in depression. The cognitive behavioral
formulation of depression identifies SSE as an important individual attrib-
ute when faced with adversities. The possession of high SSE in the face of
stressors should lead to greater effort to master the circumstance. On the
other hand, low SSE should lead to a decreased effort or a "giving up"
when challenged with stressors. In this way, the construct is perhaps similar
to Kobassa's idea of hardiness (Kobassa et al., 1981) and Rutter's (1985)
notion of resilience. Rutter (1985) has described research that suggests the
main protective factors likely to lead to such a cognitive set are secure,
stable, affectionate relationships and experiences of success and achieve-
ment. We have already seen that depressed adolescents report less parent
and sibling support and they also have less success in the school environ-
ment. They appear to be put at risk by sources that could be p r o t e c t i v e -
618 McFarlane et aL

stable close relationships at home and experiences of social and academic

success in the school environment.
Hartup (1989) suggests that a young person's effectiveness in dealing
with the social world arises largely from experience in close relationships.
Peer relationships quite possibly provide opportunities for acquiring social
skills such as those subsumed under the construct of SSE. The question
concerning the linkage of the quality of the child-parent to the child-peer
relationship currently is a matter of some debate.

Social Support

Hartup (1989) asserts that the construction of well-functioning rela-

tionships may be the most significant achievement in a child's socialization.
While depressed adolescents do not assess the overall quality or size of
the support system differently than nondepressed adolescents, there are
nevertheless marked differences in the structure of their support systems.
It appears that if one's siblings are seen as supportive, this provides some
protection from depression when exposed to stressors. The analysis clarifies
the concern that this is a confound with the depressed state, since with the
onset of depression, siblings are not seen as less supportive. Having access
to parents who are supportive in multiple areas of support reduces the risk
of the onset of depression. With the onset of depression, parents are seen
as less supportive, presumably as a result of a change in perception sec-
ondary to lowered mood. It seems clear that the risk of the onset of de-
pression in adolescence is significantly reduced by supportive parents and
siblings.
The more frequently an adolescent endorses somebody other than
family in the support system, the more at risk that individual is when ex-
posed to stressors. Supportive individuals such as teachers, doctors, and
counselors may be helpful or protective in regard to certain substantive
issues but not to depression. Adolescents who are vulnerable to depression
have less access to family members for multiple areas of support and in
an attempt to compensate, they increase the size of the support system by
including nonfamily in their support system.
While their overall support satisfaction scores were similar to nonde-
pressed individuals, they reported more areas where support was unavail-
able to them. It is this configuration of reduced parental and sibling support
along with other unmet support needs that characterizes the supports of
at-risk adolescents. It seems that some essential function, perhaps the pro-
vision of security, is missing in this type of support structure.
Adolescent Depression 619

LIMITATIONS OF THE STUDY

A potential limitation of the study is that it is taken from a school-

based population of students in general level studies. This sample was cho-
sen because of its higher risk for premature school withdrawal, a marker
for social dysfunction. As a consequence, the findings may not be repre-
sentative of a random community sample. Nevertheless, the higher risk
characteristics of this sample provides an opportunity to investigate relevant
variables in depression.

IMPLICATIONS FOR RESEARCH, PRACTICE, AND POLICY

The study of nonclinical yet higher risk populations yields useful find-
ings that may have application to an understanding of psychopathology, in
both community samples and clinical practice. The prevalence of depres-
sion in this sample was considerably higher than that found in general
population samples, presumably reflecting the high-risk nature of the popu-
lation selected. Future research on the etiology of depression in high-risk
populations seems warranted.
As in adults, stressors have a significant association with depression
in adolescents, implying that there might be continuity in social factors that
are associated with depression. Social self-efficacy holds promise as a vari-
able that deserves more study in understanding vulnerability to depression.
The role of the family in protection from depression underlines its
importance and points to a potential focus of intervention. Intervention
during this part of the life cycle could result in decreased vulnerability to
depression during adolescence and beyond. Social policy that enhances op-
portunities for effective family functioning should influence the prevalence
of depression in adolescents.

REFERENCES

Blishen, B. R., Carroll, W., and Moore, C. (1987). The 1981 Socioeconomic Index for Occu-
pations in Canada. Canadian Rev. Social Anthropol. 24(4).
Brown, G., and Harris, T. (1978). Social Origins of Depression. Tavistock, London.
Brown, G., Andrews, B., Harris, T., Adlers, Z., and Bridge, L. (1986). Social support, self
esteem and depression Psychol. Med. 16: 813-833.
Connolly, J. (1989). Social self efficacy in adolescence Can. Z Behav. Sci. 21: 250-268.
Ehrenberg, M., and Cox, A. (1991). The relationship between self efficacy and depression in
adolescents. Adolescence 102: 361-374.
Fleming, J., Boyle, M., and Offord, D. R. (1993). The outcome of adolescent depression in
the Ontario Child Health Study follow-up. J. Am. Acad. Child Adoles. Psych. 32: 28-33.
620 McFarlane et al.

Garber, J., Kriss, M., Koch, M., and Lindholm, L. (1988). Recurrent depression in adolescents:
A follow up study J. Am. Acad. Child Adoles. Psych. 39: 49-54.
Goodyer, M., and Ahham, T. (1991). Lifetime exit events and recent social and family ad-
versities in anxious and depressed school age children and adolescents--II. J. AffecL
Disor~ 21: 229-238.
Hartup, W. (1989). Social relationships and their developmental significance. Am. Psychol.
120-129.
Hetherington, E. M., Cox, M., and Cox, R. (1992). Effects of divorce on parents and children.
In Lamb, M. (ed.), Non-Traditional Families. Lawrence Erlbaum, Hillsdale, NJ.
Kandel, D., and Davies, M. (1982). Epidemiology of depressive mood in adolescents. Arch.
Gen. Psych. 39: 1205-1212.
Kanfer, D., and Zeiss, A. (1983). Depression, interpersonal standard setting and judgment of
self efficacy. Z Abnorm. Psych. 92: 319-329.
Kashani, J., Carlson, G., Beck, N., Hoeper, E., Corcoran, C., McAIlister, J., Fallali, C., Rosen-
berg, T., and Reid, J. (1987). Depression, depressive symptoms and depressed mood
among a community sample of adolescents. Am. J. Psych. 144: 931-934.
Keller, M., Beardslee, W., Lavori, P., Wunder, J., Drs, D., and Samuelson, H. (1988). Course
of major depression in non-referred adolescent. J. Affect. Disord. 15: 235-243.
Kobassa, S., Madd, S., and Courington, S. (1981). Personality and constitution as mediators
in the stress-illness relationships. J. Health $oc. Behav. 22: 368-278.
Kovacs, M. (1989). Affeetive disorders in children and adolescents. Am. Psych. 44: 209-215.
McFarlane, A. H., Norman, G. R., Streinger, D. L., and Roy, R. G. (1983). The process of
social stress: Stable, reciprocal and mediating relationship J. Health Soc. Behav. 24: 160-
173.
McFadane, A. H., Norman, G. R., Streiner, D. L., and Roy, R. G. (1985). Characteristics
and correlates of effective and ineffective social supports. J. Psychosomatic Res. 28: 6:
501-510.
Newcomb, M., Huba, G., and Bentler, P. (1981). A multidimensional assessment of stressful
life events among adolescents J. Health Soc. Behav. 22: 400-425.
Offord, D., Boyle, M., Szatmari, P., Rae-Grant, N., Links, P., Cadman, D., Byles, J., Crawford,
J., Munroe-Blum, H., Thomas, H., and Woodward, C. (1989). Ontario Child Health Study
II: A six month prevalence and disorder rates of service utilization. Arch. Gen. Psych.
44: 832-836.
Paykel, E. S., Mayers, J., Dierrelt, M., Klerman, G., Lindenthal, J., and Pepper, M. (1969).
Life events and depression: A controlled study. Arch. Gen. Psych. 21: 753-760.
Pearlin, L. (1989). The sociological study of stress J. Health Soc. Behav. 30: 241-256.
Roy, A. (1985). Early parental separation and adult depression. Arch. Gen. Psych. 42: 987-991.
Rutter, M. (1979). Changing Youth in a Changing Society: Patterns of Adolescent Development.
Nuffield Province Hospital Trust, London.
Rutter, M. (1985). Resilience in the face of adversity. Br. J. Psych. 147: 598-611.
Rutter, M. (1986). Meyerian psychobiology, personality development and the role of life ex-
periences. Am. Z Psych. 143: 1077-1087.
Sarason, I., Sarason, B., Levine, H., and Basham, R. (1983). Assessing social support: The
social support questionnaire. J. Personal Soc. Psychol. 44: 127-139.
Sarason, B., Sarason, I., Hacker, T., and Basham, R. (1985). Concomitants of social support:
Social skills, physical attractiveness and gendcr. J. Personal Soc. Psychol. 49: 469-480.
Sarason, B., Sarason, I., Shearin, E., and Pierce, G. (1987). Interrelations of social support
measures: Theoretical and practical limitations. J. Personal Soc. PsychoL 52: 813-832.
Streiner, D., and Norman, G. (1989). PDQ Epidemiology. Philadelphia, PA, B. C. Decker.
Zimmerman, M., and Coryell, W. (1987). Inventory to diagnose depression. Z Consult Clin.
PsychoL 55: 55-59.