Prevention Science, Vol. 6, No.

2, June 2005 (

C 2005)

DOI: 10.1007/s11121-005-3407-2

Individual, Family, School, and Community Risk

and Protective Factors for Depressive Symptoms
in Adolescents: A Comparison of Risk Profiles
for Substance Use and Depressive Symptoms

Lyndal Bond,1,4 John W. Toumbourou,1 Lyndal Thomas,1,2

Richard F. Catalano,3 and George Patton1

This study examines the relationship between adolescent depressive symptoms and risk and
protective factors identified for substance use. A questionnaire, developed to measure these
factors in a young person’s community, family, school, peer group, and individual characteris-
tics for substance use, was used to assess associations with self-reported depressive symptoms.
Data were provided by a representative sample of 8984 secondary school students in Victoria,
Australia. The prevalence of depressive symptoms was 10.5% (95% CI 9.2,12.0) for males and
21.7% (95% CI 20.3,23.7) for females. Depressive symptoms were associated with factors in
all domains, with the strongest associations in the family domain. Strong relationships were
found between the number of elevated risk and protective factors and depressive symptoms,
maintained after adjusting for substance use. Patterns of associations were similar for users
and nonsubstance users. The findings indicate that prevention programs targeting factors for
substance use have the potential to impact on depression.
KEY WORDS: risk factors; protective factors; depressive symptoms; adolescents; substance use.

INTRODUCTION years by the adoption of the risk and protective ap-

With the growth in the understanding of the so-
cial and developmental factors linked to common
adolescent health risk and behavioral problems, it
becomes possible to adopt a risk and protective fac-
tor framework for considering preventive interven-
tions. Efforts to tackle adolescent health problems
and risk behaviors have been advanced in recent
1
Centre for Adolescent Health, Royal Children’s Hospital,
Murdoch Children’s Research Institute and Department of
Paediatrics, University of Melbourne, Australia.
2
Clinical Epidemiology and Biostatistics Unit, Murdoch Chil-
dren’s Research Institute and Department of Paediatrics, Univer-
sity of Melbourne, Australia.
3
Social Development Research Group, University of Washington,
Seattle, Washington.
4
Correspondence should be directed to Lyndal Bond, Centre for
Adolescent Health, 2 Gatehouse Street, Parkville 3052, Victoria,
Australia; e-mail: lyndal.bond@rch.org.au.
proach to prevention (Hawkins et al., 1992; Institute
of Medicine (IOM) Committee on Prevention of
Mental Disorders, 1994). The approach has been
used to identify risk factors and protective factors
for a range of adolescent health and behavior prob-
lems across all domains important to a young per-
son’s development. Thus, risk and protective factors
have been identified in terms of the broader commu-
nity, in school, in the family, peer group, and individ-
ual characteristics. Although much research has ap-
plied such frameworks to substance use, delinquent
behavior, and mental health problems, individually,
little research has been undertaken which assesses
the utility of a set of risk and protective factors, de-
veloped specifically to study substance use, for pre-
dicting depressive symptoms or mental health.
Longitudinal studies have identified risk fac-
tors for adolescent substance abuse and antisocial
behavior in terms of community, family and peer

73
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C 2005 Springer Science+Business Media, Inc.
74
attitudes to drug use and antisocial behavior, com-
munity cohesiveness, academic commitment, and
family conflict (Hawkins et al., 1992, 1998; Kandel
et al., 1986; Labouvie & McGee, 1986; Leober et al.,
1991; Newcomb & Felix-Ortiz, 1992; Newcomb et al.,
1987; Werner & Smith, 1992; White et al., 1987).
On the other hand, protective factors, including
individual characteristics such as a positive social ori-
entation and a resilient temperament, social bonding
and healthy beliefs, and clear standards for behav-
ior, have been found to moderate the effects of expo-
sure to risk (Cowen & Work, 1988; Garmezy, 1985;
Hawkins et al., 1992; Institute of Medicine (IOM)
Committee on Prevention of Mental Disorders, 1994;
Rutter, 1985, 1987; Shedler & Block, 1990; Werner,
1989; Werner & Smith, 1992).
Multiple Risks
In terms of social prevention practices, two im-
portant points arise from these findings. Firstly, mul-
tiple problematic behavioral outcomes appear to be
predicted by overlapping sets of identifiable risk and
protective factors. In particular there appears to be
considerable commonality in risk factors for anti-
social behavior and substance abuse (Brewer et al.,
1995; White et al., 1987). And, from the work of
a number of groups (Institute of Medicine (IOM)
Committee on Prevention of Mental Disorders, 1994;
Lewinsohn et al., 1998; Rutter, 1985), it would ap-
pear that many of these are also implicated in mental
health outcomes as well. Secondly, but equally im-
portantly, exposure to multiple risk factors has been
shown to increase the likelihood of adverse outcomes
such as substance abuse (Newcomb & Felix-Ortiz,
1992) and psychiatric disorders (Harrington et al.,
1990).
The implications for prevention policy and prac-
tice of both shared risk and protective factors for
multiple adverse outcomes and the effect of expo-
sure to multiple risk factors are far-reaching (Pollard
et al., 1997). These findings have given rise to the
development of strategic, evidence-based, commu-
nity prevention systems. These multiple-component
community-based programs such as Communities
that Care (Arthur & Blitz, 2003; Farrington, 2002;
Hawkins & Catalano, 1993), provide a framework
in which the capacity for a community approach
to target common risk and protective factors which
will impact on multiple outcomes can be developed
(Arthur et al., 2002; Farrington, 2002). By consider-
Bond, Toumbourou, Thomas, Catalano, and Patton
ing a risk and protective factor framework, the focus
becomes one of reducing risk factors and promoting
protective factors in order to prevent the incidence
of mental and behavior problems (Arthur et al., 2002;
Farrington, 2002) rather than establishing the preva-
lence of these problems in the community and focus-
ing resources on those with the problems.
An essential element to the successful imple-
mentation of these models is the ability to assess
the levels of these common risk and protective fac-
tors within communities. The Communities that Care
Youth Survey, developed from the Student Survey of
Risk and Protective Factors (Pollard et al., 2003), has
been widely used in the USA (Arthur et al., 2002) and
adapted for use in Britain and Europe (Farrington,
2002). This tool was developed to provide scientif-
ically sound information for local communities on
the prevalence of risk and protective factors among
young people, and to be suitable for needs assess-
ment, prevention planning, and intervention plan-
ning at the local level. Through self-report this tool
assesses young people’s perceptions of risk and pro-
tective factors across school, community, and family
environments, as well as individual characteristics of
the students themselves that are known to predict
drug use, delinquency, and related youth problems.
In the development of this survey instrument, risk
and protective factors were only included where they
had been shown to predict drug use and/or delin-
quent behavior.
The utility of this set of risk and protective fac-
tors was assessed to determine the applicability of
these measures in an Australian setting, and to pro-
vide a needs assessment at the local community level
across the state of Victoria, Australia (Bond et al.,
2000). An important addition to the Australian in-
strument was the inclusion of other outcomes, espe-
cially measures of mental health outcomes. Besides
measuring risk and protective factors, therefore, the
survey also assessed the concurrent prevalence of
substance use and antisocial behavior in the com-
munity (as done elsewhere) and the young people’s
mental health.
Why Assess Adolescent Mental Health?
To date, community prevention work has
focused on the pressing social issues of drug
abuse, delinquent behavior and criminal activity
(Farrington, 2002; Hawkins et al., 1995). In Australia,
as in other western nations, there is increasing
Risk/Protective Factors for Adolescent Depression
recognition that a substantial contribution to the
burden of disease in young people is associated
with mental disorders and in particular, depression
(Moon et al., 1999). Depressive symptoms are known
to escalate through the adolescent years (Cicchetti
& Toth, 1998) and adolescents who experience an
episode of depressive disorder are at increased risk
of mental illness in adulthood (Harrington et al.,
1990). The question arises as to whether the risk
and protective factors as measured by the above
tools are equally useful for identifying prevention
priorities within communities as for internalizing
behaviors?
This is likely to be the case given what is
known about the risk factors for adolescent de-
pression. Adolescent depressive symptomatology
has been found to have comorbid relationships
with a range of adolescent health compromising
behaviors including tobacco, alcohol and other
drug use (Patton et al., 1996), antisocial behaviors
(Miller-Johnson et al., 1998), anxiety (Brady &
Kendall, 1992) and other mental health disorders
(Lewinsohn et al., 1994; Rutter, 1985). Longitudinal
studies have demonstrated that precursors of de-
pression or depressive symptoms include family and
peer support, family and peer conflict (Bond et al.,
2001; Lewinsohn et al., 1998), adverse life events
(Cicchetti & Toth, 1998), academic achievement
and antisocial behavior problems (Lewinsohn et al.,
1998).
The relationships found between substance use
and depressive symptoms (Bovasso, 2002; Kelder
et al., 2001; Patton et al., 1996, 1998) suggest that the
comprehensive set of risk and protective factors that
have been demonstrated to predict adolescent health
compromising behaviors may also be related to men-
tal health problems such as depression. Demonstrat-
ing such a relationship would have important impli-
cations for the integration of interventions that focus
on the prevention of adolescent onset of depres-
sive symptoms with interventions more specifically
designed to target health-compromising behaviors.
The aim of this study was to examine the concur-
rent relationship between risk and protective factors
of youth substance abuse and delinquent behavior,
and self-reported depressive symptoms in adoles-
cents. Specifically, we wished to examine the asso-
ciation of the aggregation of multiple risk and pro-
tective factors on self-reported depressive symptoms
and compare this risk profile with that for substance
use. Responses to a student survey developed to
measure risk and protective factors in a young per-
75
son’s community, family, school, peer group and in-
dividual characteristics and their substance use and
engagement in antisocial behaviors were examined
to assess associations with self-reported depressive
symptoms. Furthermore, to account for the known
co-occurrence of substance use and depression, these
associations were further examined adjusting for self-
reported substance use.
METHODS
Sample
The sampling frame comprised 535 secondary
schools in Victoria, Australia. Two-stage cluster sam-
pling was used. The first stage consisted of a strati-
fied random sample of government (public) and non-
government (Catholic and independent) schools with
geographic stratification. Schools were selected ran-
domly with a probability proportional to the number
of Year 7, 9, and 11 students in the school. In the sec-
ond stage, a random sample was taken of one class at
each year level.
Ethics approval was granted from the Royal
Children’s Hospital Ethics in Human Research Com-
mittee and relevant education authorities. Active
consent was required from parents for student par-
ticipation. Active consent from students was sought
on the day of the survey.
Measures
Depressive Symptoms
Depressive symptoms were measured using An-
gold and Costello’s Short Mood and Feelings (SMF)
self-report questionnaire (Angold et al., 1995) de-
signed for epidemiological survey research with ado-
lescents. This single dimension scale correlates sub-
stantially with the Children’s Depression Inventory
and the Diagnostic Interview Schedule for Chil-
dren (DISC) depression scale. The SMF has been
shown to discriminate between clinically referred
psychiatric subjects and DISC diagnosed children
from controls (Angold et al., 1995). As recom-
mended by the authors of the scale, high levels
of depressive symptomatology were defined by a
score of 12 or greater on the SMF (Angold et al.,
1995).
76 Bond, Toumbourou, Thomas, Catalano, and Patton

Substance Use factors and 10 measures of protective factors cov-

Two measures of three types of substance use
were used. Participants were asked if they had ever
used alcohol, cigarettes or cannabis and about their
use in the past 30 days. For analysis, use in the past
30 days was dichotomized to a yes/no variable. For
a summary substance use variable, participants were
classified as “never used substances” (no to all three
“’ever” used questions) or “substance user” (have
used at least one of these substances).
ering four domains: community, school, family, and
peer-individual. These factors are detailed in Table 1
with examples of items and the internal consistency
of the factors. Cognitive pre-testing and piloting
were undertaken to ensure questions and wording
were culturally appropriate for Australian adoles-
cents. The psychometric properties of the risk and
protective factor scales indicated reasonable to good
internal consistency with an average reliability mea-
sure (Cronbach’s alpha) of 0.73.

Risk and Protective Factors Defining Elevated Risk and Elevated Protective Factors

Risk and protective factors were assessed by Respondents were scored on each risk and pro-
student self-report using an adapted form of the tective factor by averaging responses to the items
Communities that Care Youth Survey (Arthur et al., comprising each factor. Respondents were defined
2002). This instrument includes 25 measures of risk as “elevated” on a risk or protective factor if they

Table 1. Internal Consistency of The Risk and Protective Factor Subscales

No. Cronbach’s No. Cronbach’s
Domain/Risk factors items alpha Protective factors items alpha
Community
Low neighborhood attachment 3 0.8 Opportunities for prosocial involvement 5 0.68
Community disorganization 5 0.74 Rewards for prosocial involvement 3 0.82
Personal transitions & mobility 4 0.53
Community transitions & mobility 1 —
Laws & norms favorable to drug use 6 0.77
Perceived availability of drugs 5 0.85
School
Academic failure 2 — Opportunities for prosocial involvement 5 0.7
Low commitment to school 2 0.76 Rewards for prosocial involvement 4 0.74
Family
Poor family management 6 0.72 Attachment 4 0.77
Poor discipline 3 0.77 Opportunities for prosocial involvement 3 0.73
Family conflict 3 0.81 Rewards for prosocial involvement 4 0.78
Family history of antisocial behavior 10 0.79
Parental attitudes favorable 4 0.82
toward drug use
Parental attitudes favorable towards 3 0.75
antisocial behavior
Individual/peer
Rebelliousness 3 0.78 Religiosity 1 —
Early initiation of problem behavior 8 0.72 Social skills 4 0.59
Antisocial behavior 8 0.73 Belief in the moral order 4 0.58
Favorable attitudes toward 5 0.84
antisocial behavior
Favorable attitudes toward drug use 5 0.88
Perceived risks of drug use 4 0.74
Interaction with antisocial peers 6 0.81
Friends’ use of drugs 4 0.81
Sensation seeking 3 0.78
Rewards for antisocial involvement 4 0.84
Gang involvement 3 0.85
Risk/Protective Factors for Adolescent Depression
scored in the upper third of the distribution of scores
for that specific risk or protective factor. The num-
ber of risk and protective factors for which a re-
spondent was in the “elevated” range for each do-
main and across domains was calculated. Across all
domains the maximum possible number of elevated
risk factors was 25 and 10 for elevated protective
factors.
Validity of Student Self-Report Data
Validity of student self-report was assessed us-
ing three criteria: student assessment of their hon-
esty in answering the questions, exaggeration of
drug use and unrealistic frequency of illicit drug
use. Data from students were excluded where they
had not answered questions honestly and/or had
reported the use of a fictitious drug “derbisol”
and/or had reported logically inconsistent patterns
of substance use. One hundred and fifty-one par-
ticipants (1.7%) were identified by at least one of
these three criteria and were excluded from further
analysis.
Method of Analysis
Statistical analysis was performed using Stata
(Statacorp, 2001). Prevalence estimates and univari-
ate and multivariate logistic regressions were per-
formed using robust “information-sandwich” esti-
mates of standard errors to account for clustering
with schools as the cluster variable (Carlin et al.,
2001).
RESULTS
Three hundred and twelve schools were sam-
pled, and 194 participated, providing a population of
12,816 Year 7, 9, and 11 students. Parents of 73% of
students gave consent for participation, 11% refused
permission and consent forms were not returned by
16%. Questionnaires were completed by 8984 stu-
dents being 70.1% of total sample and 96% of the
students whose parents consented. Excluding those
determined as invalid and/or missing important data
such as gender (124), the sample for the following
analyses was 8570. Forty-six percent of respondents
were males and 35, 36, and 29% were in Years 7, 9,
and 11 (average age 12, 14, and 16 years) respectively.
Thirty percent of the participants’ parents were born
77
overseas and 18% of families in the sample spoke a
language other than English at home. Fifteen percent
of parents were from Europe, 2.6% from the Middle
East, 8.6% were from Asia, and less than 2% were
from Pacific nations.
The associations between depressive symp-
tomatology and gender, sociodemographic variables
and respondents’ substance use are summarized in
Table 2. The prevalence of high depressive symp-
toms was 16.6% (95% CI 15.7, 18.0) with statisti-
cally significant differences between males (10.5%,
95% CI 9.2, 12.0) and females (21.7%, 95% CI, 20.3,
23.7), and across year levels. Given the differences
in prevalence of depressive symptoms between males
and females and across the year levels, interactions
between these two factors and the risk and protective
factors were examined. For year level there were no
significant interactions. For gender, statistically sig-
nificant interactions were found for about 30% of the
factors across all domains except school. Asterisks in
Table 3 indicate these factors. Given these interac-
tions, subsequent analyses are presented stratified by
gender.
Table 3 shows the association between depres-
sive symptoms and the elevated risk or protective fac-
tor scores for males and females. In almost all cases,
where there was a gender difference in the associa-
tion, these associations were somewhat weaker for
males.
The strongest associations with the risk factors
for both males and females were family conflict (OR
3.22, 95% CI 2.55, 4.07; OR 3.9, 95% CI 3.3, 4.7), re-
spectively. The family protective factors attachment
(OR 0.30, 95% CI 0.2, 0.4) and rewards (OR 0.30,
95% CI 0.2, 0.4) and opportunities (OR 0.33, 95%
CI 0.3, 0.4) for prosocial involvement were strongest
for females. Opportunities (OR 0.40, 95% CI 0.3, 0.5)
and rewards for prosocial involvement (OR 0.45 95%
CI 0.3, 0.6) were strongest for males.
Exposure to Multiple Risk and Protective
Factors Within Domains
To assess the impact of exposure to multiple
risk and protective factors within each domain, the
number of risk and protective factors for which a re-
spondent was in the “elevated” range for each do-
main was calculated (Table 4). For the community
and school domains the increased odds with greater
exposure to more factors are similar for males and
females. For the family and peer/individual domains,
78 Bond, Toumbourou, Thomas, Catalano, and Patton

Table 2. Associations Between Depressive Symptoms, Sociodemographic Characteristics and Respondents’ Substance use
Depressive symptoms (1424)
Total (8570) n (%)a Odds ratio 95% CI p-Value
Gender
Male 3917 412 10.5 1
Female 4653 1012 21.7 2.38 2.0, 2.8 <.001
School year level
Year 7 2982 349 11.7 1
Year 9 3105 564 18.2 1.74 1.5, 2.1 <.001
Year 11 2481 511 20.6 2.06 1.7, 2.4 <0.001
Language spoken at home
English only 6942 1160 16.7 1
Other language(s) 1593 257 16.1 1.00 0.9,1.3 1.000
Family
Parents living together 6535 1, 009 15.4 1
Parents separated or divorced or otherb 1986 409 20.6 1.40 1.2, 1.6 <0.001
Parental paid employment
Mother
Full or part time paid work 5959 955 16.0 1
No paid work 2443 443 18.1 1.15 1.0, 1.4 0.084
Father
Full or part time paid work 7060 1140 16.1 1
No paid work 1268 250 19.7 1.20 1.0, 1.4 0.035
Parent level of education
Mother
Not complete secondary school 1748 357 20.4 1
Completed secondary school 1759 302 17.2 0.84 0.7, 1.0 0.065
Tertiary 2340 354 15.1 0.70 0.6, 0.8 <0.001
Don’t know 2723 411 15.1 —
Father
Not complete secondary school 1609 344 21.4 1
Completed secondary school 1358 215 15.8 0.76 0.6, 1.0 0.039
Tertiary 2518 376 14.9 0.69 0.6, 0.8 <0.001
Don’t know 3085 489 15.9
Respondents’ substance use
Ever drunk alcohol
No 2294 215 9.4 1
Yes 5786 1182 20.4 2.40 2.0, 2.8 <0.001
Drunk alcohol in last 30 days
No 4345 548 12.6 1.00
Yes 3903 870 22.3 1.86 1.6, 2.1 <0.001
Ever smoked cigarettes
No 3715 400 10.8 1.00
Yes 4508 1027 22.8 2.38 2.1, 2.7 <0.001
Smoked in last 30 days
No 6325 870 13.8 1.00
Yes 2027 558 27.5 2.29 2.0, 2.6 <0.001
Ever used cannabis
No 6630 980 14.8 1.00
Yes 1700 456 26.8 2.02 1.7, 2.4 <0.001
Used cannabis in last 30 days
No 7600 1217 16.0 1.00
Yes 742 215 29.0 2.17 1.8, 2.6 <0.001
a
Percents calculated on valid responses.
b
Includes one parent dead, never lived together, and other (unspecified) arrangements includes not working, retired, or parent not
living with respondent.
Risk/Protective Factors for Adolescent Depression 79

Table 3. Association Between Depressive Symptoms and Elevated (Highest Tertile) Risk and Protective Factor Scores
Females (1,012) Males (412)
OR 95% CI OR 95% CI
Community
Risk factors
Laws & norms favorable to drug usea 2.43 2.11, 2.80 1.88 1.48, 2.38
Perceived availability of drugsb 2.41 2.03, 2.85 1.62 1.30, 2.01
Community disorganization 1.96 1.64, 2.34 2.19 1.66, 2.89
Low neighborhood attachmenta 1.81 1.55, 2.12 1.37 1.10, 1.70
Community transitions & mobility 1.47 1.24, 1.75 1.30 1.04, 1.62
Personal transitions & mobility 1.26 1.08, 1.47 1.54 1.24, 1.91
Protective factors
Opportunities for prosocial involvement 0.70 0.59, 0.84 0.87 0.69, 1.11
Rewards for prosocial involvement 0.55 0.46, 0.67 0.71 0.51, 0.99
Family
Risk factors
Family conflict 3.92 3.27, 4.70 3.22 2.55, 4.07
Poor discipline 2.57 2.16, 3.07 1.96 1.53, 2.52
Family history of antisocial behavior 2.23 1.89, 2.64 1.77 1.40, 2.25
Poor family managementb 2.23 1.89, 2.63 1.43 1.13, 1.82
Parental attitudes favorable to anti-social behavior 1.68 1.43, 1.96 1.64 1.31, 2.07
Parental attitudes favorable toward drug usea 1.73 1.47, 2.05 1.22 0.92, 1.61
Protective factors
Attachmentb 0.30 0.23, 0.38 0.59 0.43, 0.81
Opportunities for prosocial involvement 0.33 0.26, 0.42 0.40 0.30, 0.52
Rewards for prosocial involvementa 0.30 0.23, 0.38 0.45 0.34, 0.60
School
Risk factors
Low commitment to school 1.96 1.69, 2.28 1.89 1.50, 2.37
Academic failure 2.92 2.48, 3.42 2.73 2.14, 3.48
Protective factors
Opportunities for prosocial involvement 0.48 0.40, 0.59 0.54 0.38, 0.76
Rewards for prosocial involvement 0.38 0.30, 0.48 0.49 0.36, 0.69
Peer-individual
Risk factors
Rebelliousness 2.68 2.24, 3.20 2.79 2.17, 3.58
Sensation seeking 2.90 2.42, 3.48 2.56 2.08, 3.16
Friends’ use of drugs 2.29 1.97, 2.67 1.99 1.59, 2.51
Early initiation of problem behavior 2.63 2.25, 3.08 2.32 1.82, 2.95
Antisocial behavior 2.80 2.35, 3.34 2.67 2.14, 3.33
Favorable attitudes toward antisocial behavior 2.10 1.79, 2.46 2.03 1.64, 2.51
Favorable attitudes toward drug use 2.00 1.71, 2.34 1.79 1.42, 2.25
Gang involvement 2.43 1.96, 3.01 2.02 1.59, 2.56
Interaction with antisocial peers 2.37 1.97, 2.86 2.01 1.59, 2.54
Rewards for antisocial involvement 1.74 1.50, 2.01 1.89 1.54, 2.33
Perceived risks of drug use 1.42 1.21, 1.67 1.42 1.10, 1.83
Protective factors
Religiosity 0.91 0.73, 1.13 1.08 0.86, 1.37
Social skillsb 0.36 0.29, 0.45 0.66 0.48, 0.91
Belief in the moral ordera 0.45 0.38, 0.54 0.62 0.48, 0.79
a
p < .05, significant interaction between gender and factor.
b
p < .01, significant interaction between gender and factor.

the impact of exposure to multiple elevated risks is
greater for females than males. Exposure to an in-
creased number of elevated protective factors has
less impact on males than females in these two
domains.
Exposure to Multiple Risk and Protective
Factors Across Domains
Given that depressive symptoms were associ-
ated with factors in all four domains and that the
80 Bond, Toumbourou, Thomas, Catalano, and Patton

Table 4. Association Between Depressive Symptoms and the ing depressive symptoms to the number of elevated
Number of Elevated Factors in Each Domain risk factors depicts a linear relationship, similar to
Females Males that for alcohol use. The profile for males, as would
OR 95% CI OR 95% CI be expected from the prevalence of depressive symp-
Community
toms overall for males, is somewhat flatter than for
Risk factors females. Figure 2 shows an inverse relationship be-
0 1.00 1.00 tween depressive symptoms and the number of ele-
1–2 2.58 2.00, 3.32 2.72 1.59, 4.68 vated protective factors, again similar to the profile
3–4 5.17 3.95, 6.77 4.07 2.47, 6.71 for substance use.
5–6 8.12 5.32, 12.39 7.66 3.93, 14.94
Protective factors
0 1.00 1.00
1 0.71 0.60, 0.84 0.86 0.66, 1.11 Multivariate Analysis Adjusting
2 0.39 0.30, 0.50 0.62 0.38, 1.01 for Possible Confounders
Family
Risk factors
0 1.00 1.00
Given the comorbidity of depressive symp-
1–2 2.75 2.27, 3.34 1.93 1.38, 2.71 toms and substance use, multivariate logistic re-
3–4 5.16 4.10, 6.51 3.04 2.10, 4.39 gression was performed to further examine the re-
5–6 9.96 7.34, 13.50 4.51 2.65, 7.66 lationships between depressive symptoms and the
Protective factors number of elevated risk and protective factors ad-
0 1.00 1.00
1 0.43 0.34, 0.53 0.62 0.47, 0.83
justing for substance use and socio-demographic
2 0.29 0.21, 0.40 0.38 0.26, 0.57 variables (Table 5) and stratified by gender. The
3 0.14 0.09, 0.22 0.34 0.21, 0.56 associations between the number of elevated risk
School factors and depressive symptoms remained signif-
Risk factors icant for females but less so for males. Exposure
0 1.00 1.00
1 2.33 1.95, 2.79 2.09 1.65, 2.64
to four or more elevated protective factors had a
2 3.77 3.08, 4.63 3.69 2.72, 5.00 significant independent association with depressive
Protective factors symptoms for females but not for males. No sub-
0 1.00 1.00 stance use variables remained as independent sig-
1 0.61 0.50, 0.75 0.84 0.64, 1.10 nificant factors for either males or females in these
2 0.30 0.22, 0.40 0.29 0.18, 0.45
Peer-individual
models.
Risk factors
0 1.00 1.00
1–2 2.60 1.97, 3.43 1.11 0.70, 1.75 Comparison of Substance Users
3–4 4.69 3.59, 6.12 2.10 1.27, 3.49 and Nonsubstance Users
≥5 7.99 6.13, 10.41 4.17 2.67, 6.53
Protective factors
0 1.00 1.00 To further examine the associations between ex-
1 0.65 0.54, 0.79 0.83 0.65, 1.05 posure to multiple risks and protective factors and
2 0.36 0.27, 0.46 0.75 0.52, 1.09 depressive symptoms and the possible confounding
3 0.26 0.17, 0.41 0.42 0.20, 0.89 of substance use, the multivariate analysis was re-
peated stratified by substance use (as defined above).
About 76% of the sample were defined as ever hav-
ing tried alcohol, cigarettes or cannabis (75% for
risks associated with exposure to multiple risk fac- females and 77% for males). There was no signifi-
tors increased almost uniformly within domains. The cant interaction between substance use and gender
number of risk and protective factors for which re- (p = 0.282 for levels of risk and p = 0.392 for levels
spondents were in the ‘elevated’ range across do- of protective factors). As expected the proportion of
mains was calculated and used for further analysis. substance users who reported depressive symptoms
Figures 1 and 2 show the percentage of participants was significantly higher than for nonsubstance users
with depressive symptoms categorized by the num- (20.7% vs. 8.5% respectively). However, as for the
ber of elevated risk and protective factors for males other analyses, as exposure to the number of elevated
and females. These figures also present percentages risk factors increased, so did the risk of depressive
for recent substance use (30 days). The profiles relat- symptoms (Table 6). For nonsubstance users, these
Risk/Protective Factors for Adolescent Depression
Fig. 1. Percentage (95% CI) of females and males with depressive symptoms and recent
substance use (30 days) by the number of elevated risk factors.
odds were two to three times higher than those for
substance users. Exposure to an increasing number
of protective factors remained significant at the high-
est levels (>4) for substance users, whereas the pro-
tective effect was only significant at the highest level
(>7 protective factors) for those who had never used
alcohol, cigarettes, or cannabis (Fig. 3).
DISCUSSION
This study has found that a questionnaire de-
signed to assess a wide range of risk and protective
factors for youth substance abuse demonstrated sub-
stantial concurrent prediction of depressive symp-
toms in a representative sample of high school stu-
dents, sampled in the southern Australian state of
Victoria. Depressive symptoms were associated with
81
risk factors across all four domains: community,
school, family, and the individual-peer. Similarly, the
10 protective factors also demonstrated significant
relationships with the report of depressive symp-
toms. These associations were, in general, stronger
for females than for males. Exposure to multiple risk
and protective factors, irrespective of specific fac-
tors, was associated with greater prevalence of de-
pressive symptoms both within and across the do-
mains. Again, the cumulative effect of exposure to
multiple risk and protective factors was stronger for
females than for males in the domains of family
and peer-individual factors. However, the cumula-
tive impact of multiple factors for community and
school were similar for both sexes. Importantly, the
relationship between these risk and protective fac-
tors and depressive symptoms was maintained after
controlling for participants’ substance use. In fact,
82 Bond, Toumbourou, Thomas, Catalano, and Patton

Fig. 2. Percentage (95% CI) of females and males with depressive symptoms and recent
substance use (30 days) by the number of elevated protective factors.

although the prevalence of depressive symptoms was
higher for substance users overall, the odds of re-
porting depressive symptoms as exposure to a num-
ber of risk factors increased was significantly greater
for nonsubstance users. For this group, levels of pro-
tective factors had little impact on these increased
risks. For substance users, on the other hand, expo-
sure to multiple elevated protective factors remained
protective.
This study also confirms a substantial cross-
sectional association between substance use and de-
pression in adolescence. Existing research suggests
the causal direction of these relationships is likely
to be complex. Although a number of longitudinal
studies have identified mental health problems such
as depression to be prospective risk factors for ado-
lescent substance abuse (Dembo et al., 1990; Henry
et al., 1993; Kandel et al., 1978; McGee et al., 2000),
others have not found this relationship (Brook et al.,
1998; Kandel et al., 1986; Pedersen, 1991). McGee
et al. (2000) found in the New Zealand Dunedin co-
hort that mental disorder at age 15 increased the
risk of cannabis use at age 18, while from 18 to 21,
cannabis use increased the risk of later mental dis-
order. In some studies, a univariate relationship be-
tween mental health symptoms and later substance
use has been found, however this relationship has
been shown to be confounded by earlier substance
Risk/Protective Factors for Adolescent Depression 83

Table 5. Multivariate Analysis Predicting Depressive Symptoms From Levels of Elevated Risk and Protective Factors Stratified
by Gender and Adjusting for Sociodemographic Variables and 30-Day Substance Use
Females Males
Adj OR 95% CI p-value Adj OR 95% CI p-value
Number of elevated risk factors
0–1 1.00
2–3 2.53 1.58, 4.01 <0.001 1.28 0.64, 2.57 0.477
4–6 4.78 3.86, 7.41 <0.001 2.28 1.05, 4.94 0.037
7–9 7.06 4.56, 10.93 <0.001 3.42 1.59, 7.35 0.002
10 or more 12.11 7.25, 20.20 <0.001 6.70 3.26, 13.75 <0.001
Number of elevated protective factors
0 to 1 1.00 1.00
2 to 3 0.99 0.81, 1.21 0.884 1.04 0.80, 1.37 0.760
4 to 6 0.68 0.50, 0.93 0.017 0.99 0.71, 1.40 0.963
7 to 10 0.26 0.13, 0.50 <0.001 0.41 0.15, 1.18 0.099
Year level
Year 7 1.00 1.00
Year 9 1.12 0.87, 1.41 0.384 0.73 0.55, 0.96 0.024
Year 11 1.04 0.82, 1.33 0.734 0.74 0.53, 1.01 0.059
Family background
Parents separated or divorceda 1.02 0.81, 1.29 0.860 1.14 0.81, 1.61 0.813
Max. parent level of education
(At least one parent with tertiary education) 0.79 0.65, 0.97 0.021 0.90 0.70, 1.15 0.389
Employment
Mother not in paid employment 1.18 0.95, 1.45 .130 1.11 0.85, 1.46 0.436
Father not in paid employment 0.97 0.75, 1.25 .815 0.69 0.48, 0.99 0.046
Substance use in last 30 days
Alcohol 0.92 0.76, 1.12 0.421 0.92 0.73, 1.17 0.505
Cigarettes 1.03 0.84, 1.27 0.770 0.92 0.69, 1.22 0.569
Cannabis 1.00 0.75, 1.32 0.995 1.23 0.81, 1.86 0.334
a
Includes other (unspecified) living arrangements.

use (Coffey et al., 2000; Jackson et al., 2000). For ex-
ample, in their study Jackson et al. (2000) found that
chronic alcohol dependence from ages 18 to 25 was
predicted by age 18 depressive symptoms, however
this relationship no longer applied after controlling
for attitudes to alcohol at an earlier age. The analy-
sis stratified by substance use presented in this study
presents a strong indication that at this developmen-
tal point at least substance use and self-reported de-
pressive symptoms share common factors. The simi-
larity of the profiles of elevated risk and protective
factors for substance users and nonsubstance users
who report depressive symptoms is remarkable.
Protective factors measured in this study were
based on the Social Development Model (SDM)
(Catalano & Hawkins, 1996) which was itself devel-
oped from theories of attachment, social learning
and social control. This model proposes that so-
cial relationships influence child and adolescent be-
haviors and beliefs through identification processes
with significant people in the family, school, com-
munity and peer groups. The model posits a cen-
tral role for social bonding which, it argues, is pre-
dicted by the interaction of opportunities, skills and
rewards. The findings from this study are congru-
ent with these theories. Strong protective associ-
ations were evident for attachment to family and
school, and for rewards and opportunities for proso-
cial behavior in the family, school and to a lesser
extent the community. At the individual level, pro-
tective factors included social skills and a frame-
work of moral beliefs. However, the relationship be-
tween the protective factors across the domains for
males and females differed. Within domains, cumula-
tive exposure to multiple elevated protective factors
was associated with decreased odds of self-reported
depressive symptoms for females, especially in the
family domain. This cumulative effect of increased
exposure to protective factors was less evident in
males.
The differences in the strength of associations
between males and females are congruent with other
studies. A number of sociobiological explanations
have been proposed. Pubertal transition has been
84 Bond, Toumbourou, Thomas, Catalano, and Patton

Table 6. Multivariate Analysis of the Relationship Between Depressive Symptoms and Levels of Elevated Risk and
Protective Factors, Stratified By Substance Use (Have or Have Never Used Alcohol, Cigarettes, or Marijuana) and
Adjusting for Sociodemographic Factors
Nonsubstance users (1841) Substance users (5928)
Adj OR 95% CI p-value Adj OR 95% CI p-value
Number of elevated risk factors
0 to 1 1.00 1.00
2 to 3 2.51 1.28, 4.91 .008 1.37 0.75, 2.51 0.304
4 to 6 5.41 2.74, 10.67 0.000 2.28 1.39, 3.73 0.001
7 to 9 11.94 5.55, 25.71 0.000 3.12 1.85, 5.26 0.000
10 or more 13.87 5.93, 32.44 0.000 5.73 3.39, 9.67 0.000
Number of elevated protective factors
0–1
2–3 0.92 0.52, 1.63 0.785 1.02 0.86, 1.21 0.852
4–6 0.79 0.41, 1.53 0.491 0.75 0.57, 0.99 0.040
7–10 0.34 0.12, 0.97 0.044 0.20 0.09, 0.43 0.000
Year level
Year 7 1.00 1.00
Year 9 1.01 0.61, 1.66 0.981 0.88 0.72, 1.09 0.243
Year 11 1.73 1.08, 2.77 0.024 0.80 0.66, 0.98 0.032
Gender
Female 2.47 1.57, 3.88 0.000 2.90 2.40, 3.51 0.000
Family background
Parents separated or divorceda 1.22 0.73, 2.03 .440 1.01 0.83,1.25 0.892
Max. parent level of education
(at least one parent with tertiary education) 0.97 0.63, 1.47 0.872 0.82 0.70, 0.96 0.012
Employment
Mother not in paid employment 1.04 0.69, 1.57 .861 1.21 1.02, 1.44 0.030
Father not in paid employment 1.31 0.74, 2.31 .349 0.84 0.66, 1.08 0.168
a
Includes other (unspecified) living arrangements.

associated with an increased risk for depression in
girls (Patton et al., 1996), and the difference in
the social meaning of this event for males and fe-
males, rather than the biological fact, has been sug-
gested as an explanation for the differential devel-
opment of depressive symptoms (Petersen et al.,
1991). For example, differences between gender have
been explained in terms of coping styles, particularly
emotion-focused coping styles (Windle & Windle,
1996), which may lead to focusing on or ruminat-
ing about negative events (Nolen-Hoeksema et al.,
1999), sex role identity (Hill & Lynch, 1983), and gen-
der differences in affiliate style with females indicat-
ing preferences for emotional intimacy and respon-
sive interpersonal relationships (Cyranowski et al.,
2000).
As the current research is cross-sectional, the di-
rection of effect between these factors and depres-
sive symptoms cannot be teased out. It is plausi-
ble that depressed mood may negatively influence
perceptions of the environment, attachment and op-
portunities and for the reasons described above this
effect may be greater for females than for males. Al-
though findings from this study provide some support
or corroboration that some risk and protective fac-
tors for substance abuse and youth depression may
be shared (Patton et al., 1998), further research is
required to determine which factors are causal and
which are indicators of other factors.
This study has focused on depressive symptoms
rather than depression, and hence these findings may
not generalize to a diagnosis of major depression.
However, given the morbidity attached to the ex-
perience of depressive symptoms, the relationship
between depressive symptoms and subsequent de-
pression and the prevalence of depressive symptoms
in adolescents (1 in 5), it is arguably as important
to focus preventive interventions to reduce depres-
sive symptoms, as interventions aimed at reducing
depression.
A further limitation of the study is that a range
of specific risk and protective factors for depression
were not included in this present study. Retrospec-
tive interviews with depressed adolescents commonly
reveal that depressive episodes have been preceded
by an earlier history of childhood anxiety problems
Risk/Protective Factors for Adolescent Depression 85

Fig. 3. Percentage (95% CI) of substance users and nonsubstance users reporting de-
pressive symptoms by the number of elevated risk and protective factors by the number
of elevated protective factors.

(Cicchetti & Toth, 1998). The aim of the study
however, was not to determine etiological differences
between depression and substance use, which can-
not be addressed with a cross-sectional design, but
to examine the associations of a broad range of risk
and protective factors, as defined by a widely used
community needs assessment tool, with adolescent
mental health.
The assessment of depressive symptoms, sub-
stance use, and risk and protective factors in this
study is limited to some extent by the reliance on
self-report. However, as this study sought to exam-
ine the relationship between young people’s percep-
tions of their environment, skills and attributes and
their behavior, it is perhaps less important to know if
these perceptions of the environment were “correct”
or not.
A further possible limitation to the analysis
was the method of assessing levels of elevated risk.
To the authors’ knowledge there is no standard
method of assessing elevated levels of risk and cer-
tainly little empirical basis for specifying cut-points.
These data in themselves provide us with some mea-
sure of population-based estimates. As the focus of
the paper was the comparison of profiles of depres-
sive symptoms with risk and protective factors to pro-
files for substance use, the actual choice of cut-points
is of lesser importance to this study.
The limitations of the study are offset by two
major strengths. The study sample was large and
86
representative of secondary students in Victoria,
Australia and the findings associating risk and pro-
tective factors with substance use and depressive
symptoms were congruent with previous research.
This large, representative sample allowed us to in-
vestigate, with sufficient power and precision, differ-
ences between subgroups, and to be able to adjust for
multiple, possible confounders. Furthermore, these
findings appear to have considerable internal and ex-
ternal validity. The measures used in the study ap-
pear reliable and the measure of depressive symp-
toms has been validated against a range of alternative
measures.
In terms of the associated morbidity and costs to
both the individual and society, preventing the de-
velopment of emotional problems such as depres-
sion is as important as preventing substance abuse
and delinquent and criminal behavior. This study has
demonstrated moderate to strong associations be-
tween young people’s emotional well-being and ex-
posure to multiple risk and protective factors as as-
sessed by a widely used community needs assessment
tool for the prevention of substance use and antiso-
cial behavior. The findings from this study of both
shared risk and protective factors for multiple ad-
verse outcomes and the effect of exposure to multiple
risk factors have important implications for preven-
tion policy and practice. It has demonstrated the util-
ity of a community needs assessment tool that allows
assessment and monitoring of risk and protective fac-
tors shown to be associated with both health risk be-
haviors and emotional well-being of young people.
Importantly, these tools allow communities to assess
and therefore target risk and protective factors rather
than preexisting problems, thereby enhancing the ca-
pacity to prevent the development of problems. Al-
though comprehensive, this set of risk and protective
factors assessed in this study is not necessarily com-
plete. Given the importance of school environments
for young people where a substantial amount of their
time is spent and where many universal preventive
interventions are conducted, we would argue that the
assessment of the school domain could be expanded.
Clearly for depressive symptoms, a focus on family
risk and protective factors would be important. How-
ever, the most important finding from this study is
not which specific factors are associated with depres-
sive symptoms, but that exposure to multiple risk and
protective factors across domains impacts on both
well-being and health risk behaviors of young peo-
ple. Indeed, programs that address a number of risk
and protective factors have been identified as most
Bond, Toumbourou, Thomas, Catalano, and Patton
likely to succeed in promoting positive youth devel-
opment (National Research Council and Institute of
Medicine, 2002). Findings from this study, therefore,
suggest that prevention programs targeting risk and
protective factors for youth substance abuse should
be assessed for their potential to also benefit public
health targets relevant to the prevention of depres-
sion. Similarly, those addressing well-being have the
capacity to impact on substance use.
ACKNOWLEDGMENTS
This project was funded by the Department of
Human Services, Victoria. We thank all the school
communities and young people who participated in
the study.
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