Chapter 2

This introduces some of this literature, its theories and findings in a way that will
inform about teen depression. This review was written so that the development of the
ideas is not only a reflection on the literature, but also on insights from the study.

In Egypt, young people between the ages of 15 and 24 represent 22.54 percent
of Egypt’s total population.This large and growing group faces problems and challenges
that are unique to them and that require interventions and information that address their
needs. In addition, depressed youth frequently have poor psychosocial, academic, and
family functioning, which highlights the importance of early identification and prompt
treatment. In Egypt, young people between the ages of 15 and 24 represent 22.54 percent
of Egypt’s total population (El-Ezaby, Elalem, El-Mowafy, 2015). The finding of present
study revealed that teenagers depression was high mainly among teens who were their
parent had primary level of education. It can be noticed that the higher level of parents'
education, the lower score of depression among their teenagers with statistical difference
between mother's level of education and the depression score among their teenagers.
This in agreement with .The finding of the current study revealed that teenagers who were
suffering from school problems had a high mean score of depression. This corresponds
with the results of who found that depression is more common among students who had
negative feelings toward school and suffering from school problems. This may be
because of pressure from parents to their teens to get the highest marks in the study. The
results of the present study highlight the importance of family role in the development of
teen's depression. The findings found high score of depression among those teens who
perceived that love and caring are lacking within their family members, suffering from high
domestic violence, and with decrease of family bounding and tolerance. Regarding
substance abuse the present study congruent with who reported that depressive
symptoms were positively associated with substance abuse and reported that substance
use may occur in attempts to improve mood in depressed subjects, however it is possible
that chronic substance use leads to neurobiological changes that increase vulnerability
for depression.

In a local study by Batar of 6,323 patients using Hospital Anxiety and

Depression Scale (HADS), nationwide prevalence of depression was 31%. Those aged
51 to 65 and 65 above, those on first visit and those earning monthly income of Php
50,000 and below were significantly more likely to be depressed. Prevalence rate of
depression was highest in Iloilo and Southern Luzon, while lowest in the National
Capital Region (NCR).
 The Great depression has been viewed is one of the major economic crisis during
the past century. It is agreed that it’s impact was profound, wide spread, deep and long
not only on the financial and monetary sectors, but also on the households
socioeconomic conditions. The extent in depth of the depression was further illustrated
by the collapse of the primary product prices (Lewis, 1949), and this extended the
damage to developing countries that exported primary commodities to the United
States, Europe and other related developing countries, which experience a contraction
of the demand.

Young adulthood is the stage where in transition from being a dependent to an

independent is imminent. It is in this stage that the youth start to find themselves a place
in the world be it to graduate, to continue their studies in a graduate program or to earn a
living. As such, there are plenty of mental health issues in which young adults can become
susceptible to. Among these mental health issues are suicide ideation and depression
(Dugas, Low, Rodriguez, Burrows, Contreras, Chaiton & O’Loughlin, 2012; Starr, 2012).
Suicide ideation is the thought of behavior that could end one’s life (Nock, Borges,
Bromet, Cha, Kessler & Lee, 2008). It could be a very complex plan with carefully outlined
steps or just a “fleeting consideration” of the very act of suicide (Nordqvist, 2016).
Consequently, one can deduce that people with suicide ideation do not always have to
appear to be depressed; even if a person seems to be “normal”, it cannot be determined
if they are having thoughts of ending their own life. Once persistent suicidal ideations
become attempts, the suicide victim can still affect his/her peers. Dr. Ian Colman of the
University of Ottawa revealed in his study that suicide ideation can be triggered by the
suicide of a schoolmate or friend (Swanson & Colman, 2013).

In line with suicide ideation is depression, a medical condition not to be

interchanged with sadness. Dr. Randy Dellosa, Quezon City’s resident psychiatrist in the
Philippines, explained that sadness is temporary and does not cause dysfunction on the
person. On the other hand, Clinical Depression can be a biological factor of chemical
imbalances in the brain that can be treated with psychotherapy or medication (Buan,
2013). However, effective treatment in the country can be hard to come by. According to
the World Health Organization’s (WHO) Mental Health Atlas of 2011, most mental health
care personnel in the Philippines “have not received official in-service training on mental
health within the last five years”. This disregard for proper training of mental health care
personnel may be due to the fact that there is still no existing mental health law despite
urges to pass the Mental Health Bill as early as 1983 (Rodriguez, 2015a; Senate Bill No.
2450 - Philippines Mental Health Act of 2014; Rodriguez, 2015b; Alvarez, 2016; WHO,
2011; Legarda.

In 2010, among 1,249 first year college students, 40% were depressed or showing
symptoms of depression (Aria, O’Grady, Caldeira, Vincent, Wilcox & Wish, 2010). A
history of depression in the family can be the cause of depression, although marital,
familial, and parental factors or familial discord make way for it to happen as well
(Hammen, 2009). The significant relationship of family dysfunction and depression is
proven among 140 college students from Iran in a study by Ghamari (2012).
Using a one-way analysis of variance on the Smilkstein’s family APGAR and
Kovac’s children’s depression inventory, a sample population of 5th and 6th grade
students in Korea also proves the role of family in the causality of depression;
respondents with the lower depression reported better conversation and atmosphere
during meals than those with higher depression scores (Kim, Lee, Suh & Kim, 2013).
These studies focused on the different Asian countries (Korea and Iran), however
significant in their society, according to the researcher’s knowledge, is yet to be proven
in the Philippines. Difference in culture, especially in meal etiquette, is evident. Do these
cultural differences matter when it comes to mental health? Will the results from Korea
and Iran differ or be supported by the data that will be obtained by this study on Filipino
young adults? The third research question then asks: Is depression related to the
frequency of family meals? WHO warns depression is one of the strongest risk factors to
suicide ideation (Keilp, Grunebaum, Gorlyn, LeBlanc, Burk, Galfalvy, Oquenso & Mann,
2012). Depending on its severity, depression can definitely result to suicide ideation (Keilp
et al., 2012).

Adolescent depression is a serious problem affecting 10.7% of all teens and

29.9% of high school students; 17% of high school students have contemplated suicide.
Yet, depression in teens is often unrecognized (Nurses Christian, 2016). Teenage
depression is a growing problem in today’s society and is often a major contributing factor
for a multitude of adolescent problems. Teenagers have always been vulnerable to
depression for a variety of reasons (Anton, 2010).
 Depression is the result of a complex mix social, psychological, physical, and
environmental factors. Teen with depressed parents are two to three times more likely to
develop major depression. Key indicators of adolescent depression include a drastic
change in eating and sleeping patterns, significant loss of interests in previous activity
interests (Black man, 1995).

Research with depressed adults, for example, consistently shows that

depression is associated with marital discord and parenting problems.This study indicate
that difficulties in peer relations during adolescence are also problematic and associated
with depression, with significantly higher levels of peer stress and greater depressive
reactions among girls compared to among boys (Shihet al., 2006). In our Australia
community study, difficulties in parent–child relationships were both more common in,
and significantly more predictive of depression in, youth with depressed mothers than
they were with depression in youth with nondepressed mothers (Hammen,Brennan, &
Shih, 2004).

According to Irish Association of Suicidology teen depression is medically no

different to depression in adults. It isn’t just bad moods and occasional melancholy. It is
a serious condition that can affect emotions, thought processes and behaviours.
Teenagers have unique challenges and symptoms such as peer pressure, academic
expectations and changing bodies, which can bring a lot of ups and downs. For some
teens, the lows are more than just temporary feelings and may be a sign of depression.
It can be difficult to tell the difference between the ups and downs that are just part of
being a teenager and teen depression. Talk with your teen to ascertain if their feelings
are overwhelming and if they need help to deal with them. If the depressive symptoms
persist or begin to interfere in multiple areas of your teen’s life then they may be suffering
from depression and professional help should be sought.

A recent systematic review reported that depression in university student is much

higher compared to the general population. The study concluded tha students from
families with a low level of income and parental occupation have a tendency toward
depression (Ibrahim, 2013). Moreover, the financial problems of students and their
families have a negative impact on depression in students (Andrews and Wilding, 2004).

In 2010, among 1,249 first year college students, 40% were depressed or showing
symptoms of depression (Aria, O’Grady, Caldeira, Vincent, Wilcox & Wish, 2010). A
history of depression in the family can be the cause of depression, although marital,
familial, and parental factors or familial discord make way for it to happen as well
(Hammen, 2009). The significant relationship of family dysfunction and depression is
proven among 140 college students from Iran in a study by Ghamari (2012). Using a one-
way analysis of variance on the Smilkstein’s family APGAR and Kovac’s children’s
depression inventory, a sample population of 5th and 6th grade students in Korea also
proves the role of family in the causality of depression; respondents with the lower
depression reported better conversation and atmosphere during meals than those with
higher depression scores (Kim, Lee, Suh & Kim, 2013).

Unfortunately, anxiety, depression, and hopelessness are often dismissed as

developmentally normal components of a teenager’s life (Price & Ingram, 2001). This
perception may explain the lack of existing research about sub-clinical emotional
difficulties in adolescence. For example, if an adolescent reports four out of five targeted
symptoms they would not be diagnosed with clinical anxiety or depression. Rather, they
may represent an intermediate anxiety or depressed mood state in which symptoms are
present but do not meet clinical criteria. Therefore, a conceptualization of sub-clinical
maladjustment and psychopathology is also necessary to understand the difference
between natural emotional variation in adolescents and the role of sub-clinical symptoms
in the etiology of clinical anxiety and depression (Price & Ingram, 2001).

It is apparent that devastating consequences are placed on depressed individuals

impairing their ability to function and ultimately lowering quality of life. The impact of
depression also has vast costs on society given that depression is the most common
presenting concern in the mental health community (Dozois & Westra, 2004). Sub-clinical
levels of depression are often dismissed as normal parts of an individual’s life.
Unfortunately, sub-clinical levels of depression have a devastating impact on
adolescents, increasing the risk for severe psychiatric condition (Gotlib & Hammond,
2002).

In a related study by Lewinsohn, Soloman, Seeley and Zeiss (2000), subsyndromal

depressive symptoms were investigated in adults, older adults and adolescents. They
found that clinical depression could be understood on a continuum with other degrees of
depressive symptoms. Furthermore, they found that adolescents did not need to exhibit
clinical levels of depression to be at risk for substance abuse disorder, and the
subsyndromal depressive symptoms predicted future MDD.

In the research article by Milne and Lancaster (2001), they investigate the
processes that are related to depression. The main focus was to create a model that
included parent representations, parent attachment, peer attachment, separation-
individuation, interpersonal concerns, and self-critical concerns and demonstrate how,
when combined, they can predict symptoms of depression in adolescents. The sample
consisted of 59 females, ages 14-16, from secondary schools. It is predicted that past
parenting will be related to attachment felt to parent currently, that maternal control and
care will be related to attachment and the process of separation-individuation, that
adolescent attachment will be directly related to parent attachment. The results indicate
that female adolescent symptoms of depression are explained by interpersonal concerns,
self-critical concerns, parent and peer attachment, perceived parenting, and separation-
individuation. The results indicate that female adolescents are more vulnerable to
depressive symptoms if the have low levels of maternal care, expe-rience feelings of guilt,
dependence, and self-criticism, and have poor parent and peer attachments. Both
maternal care and control predicted parent attachment. In regards to this finding, too
much maternal care predicts high levels of depression. This is contrary to what is
hypothesized and believe to be true because there is a point where too much maternal
care can have negative effects (Milne & Lancaster, 2001).

Depression rate for those students who live with both parents was significantly lower
than that for those with other living situations. Living with father caused the most
depression with respect to other students. Parents’death or divorce usually damages
mental health and feelings of the children. Feeling of loosing parents support could be
risk factor for future depression. Persons who loss one of his or her parents at the age of
13 or before have greater chance of depression (Sadock and Sadock, 2010).

In one study, adolescent patients hospitalised in psychiatric unit for different reasons
were interviewed (Clarke, Cook, Coleman, & Smith, 2006). All of them described
themselves as depressed, sad or having low morale. However the patients that were
actually depressed described experiences such as "having to think about a lot of things",
"being unable to sleep", "having to rely on others", "being a burden to others", "not getting
better" and "being abandoned.” These results suggest that the most severe episodes of
depression in hospital setting are experienced as a demoralising experience. This
demoralisation was characte-rised by the feeling of being unable to cope with a given
situation, in particular a stressful situation, feelings of powerlessness and despair,
accompanied by diminished self-esteem. Thus being demoralised appeared as the
criterion that best characterised adolescent depression in a medical hospital environment.
Another study interviewing adolescents (Woodgate, 2006) highlighted the fact that
being depressed is an experience of a very singular type, and that depressed
adolescents, among other things, find themselves "living in the shadow of fear.” The study
evidenced that the adolescents all experienced suffering on account of the illness. The
main feelings were sadness, anger, fatigue and loneliness, which the adolescents lumped
together in the category of "bad feelings", and which they saw as having a negative impact
on their daily lives. These "bad feelings" were however not considered to be the only
cause of distress, since the adolescents also reported experiencing fear when they could
no longer control their depression. The study concluded that it was this aspect that led
adolescents to realize the impact of the pathology on their daily lives. "Living in the
shadow of fear" appears here as the aspect that is the most representative of what it
means for adolescents to be living with depression.

A new study of the American Journal of Public Health underscores the importance
of helping teens, especially girls, avoid feeling isolated from friends. The research is
based on the largest survey of adolescents and their attitudes and experiences- a project
known as the National Longitudinal Study of Adolescent Health. Dr. Peter S. Bearman,
professor of sociology and director of Columbia University's Institute for Social and
Economic Research reasoned that Adolescent girls who are isolated from peers or whose
social relationships are troubled are at greater risk for suicidal thoughts than are girls with
close relationships to other adolescents. The new study involved analyzing information
from 13,465 adolescents and found out that having a friend who committed suicide
significantly increased the likelihood of suicidal thoughts and attempts for both boys and
girls. Bearman also mentions that socially isolated females were more likely to have
suicidal thoughts, as were females whose friends were not friends with each other. In a
two-year longitudinal study (Kraut et al., 1998), randomly selected families were given
computers and instruction on Internet use. After 1 to 2 years, increased use of the Internet
was associated with decreased family communication and reduced size of local social
circle. In addition, the participants experienced increased loneliness and depression. In
depression individual is slowed down in their speech and body movements, they feel
unable to act or to make decision, they appear to have “given up” and to suffer from
paralysis of will. Depression is a real illness and carries with it a high cost in terms of
relationship problems, family suffering, and lost work productivity. Depression is more
than just sadness. People with depression may experience a lack of interest and pleasure
in daily activities, significant weight loss or gain, insomnia or excessive sleeping, lack of
energy, inability to concentrate, feelings of worthlessness or excessive guilt and recurrent
thoughts of death or suicide. Depression in teens is often described as the invisible illness.
Statistically in a school of 1000 students, as many as 100 may experience depression
sever enough to warrant a psychiatric diagnosis. Adolescents are less likely to feel
depressed or anxious if the peer group provides emotional support (Buhrmester, 1992).

In the study of Tiwari and Ruhela (2012) it show that the higher incidence of
depression in females’ adolescence is because of roles and expectations change
dramatically. The stresses of adolescence include forming an identity, confronting
sexuality, separating from parents, and making decisions for the first time, along with
other physical, intellectual, and hormonal changes. These stresses are generally different
for boys and girls, and may be associated more often with depression in females. Some
researchers have suggested that men and women differ in their expression of emotional
problems. In adolescence, boys are more likely to develop behavioral and substance
abuse problems, while girls are more likely to become depressed. Kessler, et al (1994)
reported in his findings that 21.3% of females and 12.7% of males suffer from depression
at sometimes during their lives. The fact that females have traditionally had lower status,
power and income than males, must worry more than males about their personal safety
and are the victims of sexual harassment and assault much more often than males.