UNIVERSITY OF THE PUNJAB, LAHORE

FINAL PROGRESS / COMPLETION REPORT OF THE RESEARCH PROJECT For Fiscal Year 2007-2008 SUMMARY Name and Designation of the Researcher: Ms Shazia Khalid (Lecturer)

Department: PSYCHOLOGY & APPLIED PSYCHOLOGY, UNIVERSITY OF THE PUNJAB, LAHORE. Title of the Project: Incidence and Consequences of Adolescent Depression Total grant allocated: 100,000/Total grant released: 100,000/Total expenditure and balance available: Expenditure Completed Signature: Balance Nil

Date: 4th December 2008

UNIVERSITY OF THE PUNJAB, LAHORE

DETAILED REPORT Name and Designation of the Researcher: Ms Shazia Khalid (Lecturer) Funding Year: 2007-2008 Title of the Project: Incidence and Consequences of Adolescent Depression Objectives of the Approved Project: The current research purports to explore incidence of depression among adolescents and the aftermaths that it produces in their academic, social and academic life or more generally speaking on their overall life circumstances. The primary objective of this research was to explore the prevalence or incidence of depression among adolescents who seem to be attending

their schools as normal children but who harbor in them the poor quality of mental health and the debilitated states which they cannot make their elders and parents be known. The adolescent depression has grown so prevalent that it goes unnoticed in adolescence due to the fact that the parents assume the affect related changes in adolescence as the out product of hormonal changes in their bodies. Whatever the claim there may be for neglecting this phenomenon, a harsh fact is that such adolescents are forced to stifle their psychological and emotional health and they have to behave as other children do and the result is lower self-esteem, shattering of confidence and production of the states of utter dismay and distress in them. Secondary objective of this research stems from this and that is the review of the possible setbacks and problems these adolescents suffer due to states of depression. Since children at this transitional phase of development are not so expressive, they suffer in their selves and souls the dejected state of depression. In essence, the propagation of the awareness of this harsh reality that depression can positively appear in the phase of adolescence on one hand and exposition of the consequences of depression on the other hand is the main focuss of the current research.

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Details of the research work done: Abstract The present study purports to investigate the incidence and consequences or cost of depression in the sensitive and crucial phase of life known as. The primal objective is to develop this insight that depression can essentially exist during different phases of childhood. The study included a sample of 300 school children going through the stage of storm and stress and that is adolescence. Purposive sampling was used with due consideration to the inclusion/ exclusion criterion. Only those adolescents were selected who scored scores above the cut off point. Children depression Inventory with due permission from its author was used for screening students for possible incidence of depression. The Questionnaire for assessing outcomes of depression on the life of adolescents were developed and executed extensively like they were inquired on such issues as their health status, risk behaviors, and school performance so on and so forth. Respondent demographic and socioeconomic information was also reported. This included age, sex, race, region, urban or suburban residence, and family financial status. Cronbachs alpha for these two measures revealed reliability of .87 and .71 respectively. Inferential analyses were conducted by means of
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and t tests for bivariate relationships between

depression, incomes, factors, and problem indicators. Multivariate logistic and linear regressions were used in order to assess multivariate relationships. The prevalence of major depression in adolescents has been examined in limited population. It has been observed by Herrington that the prevalence in the community is approximately 5%, although there is variability across studies, depending on the stringency of the applied impairment threshold and the measure used to make the diagnosis. The current findings provide direction to health professionals especially to

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psychologists to work on spreading awareness to parents and professional community about presence of depression among adolescence and also to devise effective strategies for handling it since therapeutic implications towards it could be starkly different from the adult measures. Timely intervention last but not the least is the crux idea that this research wants to disseminate.

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Introduction Incidence and Outcomes of Adolescent Depression Adolescent depression is a phenomenon that has been overlooked in all societies under the impression that this phase of human development is marked as a phase of turbulence (Santrock, 1980). The stage of human development, known as adolescence entails massive psychophysical changes and consequently in this scenario, mood instability is nothing but a normal aspect of this development. Due to this limitation and inability to detect it, massive

problems are created not only for adolescents but also this turns out to be a major issue for those who confront its aftermaths like the parents, significant others, siblings health professionals and their educational institutes. Such adolescents turn out to be school dropouts who occasionally end up in self-destructive behaviors and that would be as horrible as taking away of their own or others lives (Anderson, 2008). Depression may affect their whole well-being. They experience more behavioral and emotional disturbances and may also fall a prey to infectious diseases or may suffer from plenty of psychosomatic disorder. Adolescence has been termed by many health psychologists as a phase of mystery and turbulence. This has been so because at this crucial phase of life, adolescents behave like adults while they have not completely left the childhood immaturity. If we review the relics of history, we come to know that children and adolescents were not considered candidates for depression lately (Whitley, 1996). Freud spread the notions about the unconscious conflicts and childhood based suppressed urges that find their way out to conscious level in forms of psychosomatic complaints or as in states of depression (Bolger, 2008). If we review the research literature in the recent past about depression, the reality vividly comes out that the adolescents and teens were not admitted as

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having or ever in experiencing the depression in their developing years of life. The hormonal upheaval was generally associated with the phasic changes in affect and moods. However this understanding has been expanded and today, childhood and adolescent depression is widely recognized and health professionals see depression as a serious condition effecting both adolescents and young children (Bird, 1988). Childhood and adolescent depression is no longer viewed as a mask to phasic changes in physical states due to hormonal alterations rather its presence due to various psychosocial factors has been accepted (Cohen, 1993). The parents successfully fulfill physical needs and demands of the children whereas the

mental health is usually ignored. According to the National Mental Health Association (NMHA), "It is easy for parents to identify their child's physical needs: nutritious food, warm clothes when it's cold, bedtime at a reasonable hour. However, a child's mental and emotional needs may not be as obvious. Depression has been considered to be the major psychiatric disease of the 20th century evident in children and teens that has been amply ignored due to lack of awareness or due to rigid patterns towards its acknowledgement. Large this problem of ignoring the adolescent depression occurs because people rely on prevalent misconceptions that adolescent and teen years are problematic years. People with these notions forget that if adolescent was really a period of chaos then how comes few cope with it in a befitting manner (Dubois, 2008). They neglect this fact that occasional bad moods in seclusion or at the other end acting out must not become habitual (Goodyer, 1996). They also dont realize and admit that depression is not just the occurrence of bad mood rather it is a prevalent pattern and something different from occasional tantrums. A hard reality about adolescent depression is that such individuals hardly report their sufferings with others rather they are at the behest of other like parents, teachers or of other

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caregivers who could eventually identify or recognize their problems so that some timely management is sought. Children may not have the vocabulary to talk about such feelings and so may express their feelings through behavior (Ferguson, 1994). Recent research findings indicate that Younger individuals with depression are more likely to show phobias, separation anxiety disorder, somatic complaints and behavior problems.

Adolescents express it with the behavior oddities, impulsivities and with emotional reactions that are more intense, frequent and lasting than a typical adolescent moody episode. Fritz (1995), writes that depression may often be detected in somatic complaints such as allergies, digestive problem, sleep disorders or persistent boredom. Gould (1998) considers that in children and adolescents, depression may often be mistaken for other conditions such as attention deficit disorder, aggressiveness, physical illness, sleep and eating disorders and hyperactivity. Although depression in children may be confused with attention deficit hyperactivity disorder (ADHD), ADHD must begin before the age of 7 (Garber, 2003). Many writers view adult depression as being systematically different from adolescent and children depression. Still other writers prefer to move past the philosophy of masked depression and view adolescent depressive symptoms as similar to those of adults (Jaskulski, 1993). The term "depression" connotates a normal human emotion but in some cases depending on its intensity and extensity, this can be referred to as a mental health illness. The term "depression" can be fiddly as this narrates a normal human emotion as experienced almost by all as a low down state, but it also can refer to a mental illness. In order to understand the exact limits of the concept adolescent depression, its literal definitions can be reviewed. Depressive illness in children and teens is defined when the feelings of depression is carried on beyond a certain time span and specifically when it interferes with a child or adolescent's ability

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to function (Johnson, 1999). Adolescent depression is a disorder occurring during the teenage years marked by persistent sadness, discouragement, loss of self-worth, and loss of interest in usual activities. It has been put forward by Klein (1997) as Adolescent depression is a disorder occurring during the teenage years marked by persistent sadness, discouragement, loss of selfworth, and loss of interest in usual activities. The major characteristics of adolescent depression could be quite varied across the cases but generally speaking they are the symptoms quite similar to those of adult depression. In the DSM-IV, the criteria for childhood and adult Major Depression are the same. Children may not have the vocabulary to talk about such feelings and so may express their feelings through behavior (Kapphahn, 1999). Younger individuals with depression are more likely to show phobias, separation anxiety disorder, somatic complaints and behavior problems. Older adolescents and adults with psychotic depression are more likely to have delusions. (Delusions require more advanced cognitive functioning than simple hallucinations). However, one might observe the following external signs in a depressed child or adolescent ( Lewis, 1977; 1987).. Thus the young elementary age a child might look serious or vaguely sick. He or she might be less bouncy or spontaneous. While other children would become tearful or irritable when

frustrated, this child may show these states spontaneously. He/she may say negative things about himself and may be self-destructive. Older elementary school through adolescence comes out with different semblence of depression (Rende, 1997). Here one can assess adolescent depression through academic decline, disruptive behavior, and problems with friends. Sometimes one can also see aggressive behavior, irritability and suicidal talk (Cshoen, 1997). The parent may say that the adolescent hates himself and everything else. This is very important to distinguish a typical adolescence moody episode

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from adolescent depression. According to Hayward et. al (1999) In children and adolescents, depression is not always characterized by sadness, but instead by irritability, boredom, or an

inability to experience pleasure. Depression is a chronic, recurrent, and often familial illness that frequently first occurs in childhood or adolescence. Any child can be sad, but depression is characterized by a persistent irritable, sad, or bored mood and difficulty with familial relationships, school, and work (Schraedeley, 1999). In the absence of treatment, a major depressive episode lasts an average of eight months (Shaffer, 1996). The risk of recurrence is approximately 40 percent at two years and 72 percent at five years (Jaskulski1993). As far as the incidence and prevalence of adolescent depression is concerned, it has increased markedly in past forty years. Not just this, rather its age of onset has also fallen greatly in past two decades. Researchers have tended to record the statistics concerning the prevalence of depressive disorders among adolescents but the output findings have been rare and imprecise (Kashani et al 1987). In the United States, it is reported that between 3 and 40% of adolescents present anxio-depressive symptoms (Tamplin, 1998). In addition to this, the severity of depressive symptoms is hard to evaluate (Garrison et al 1998). However if careful analysis of the reported data is carried on, the findings are revealed that a predominance of girls suffering from it is always prominent. The average age of onset has fallen. During childhood the number of boys and girls affected are almost equal. In adolescence, twice as many girls as boys are diagnosed. (Similar to adult rate) Adolescence is an unsettling time especially for girls, with the many physical, emotional, psychosocial changes that accompany this stage of life. Major depression affects 3 to 5 percent of children and adolescents. At least 20 percent of those with early-onset depressive disorders (those beginning in childhood or adolescence) are at risk for bipolar disorder, particularly if they have a family history of

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bipolar disorder, psychotic symptoms, or a manic response to antidepressant treatment. Anxiety, particularly social phobia, may be a precursor of depression. Depression is more common in persons with chronic illnesses such as diabetes and epilepsy and after stressful life events such as the loss of a friend, parent, or sibling. As far as the co morbid patterns are concerned, depression is very widespread in teenagers. Repeated episodes of depression can take a great toll on a young mind (Zima, 1996). Well over half of depressed adolescents have a recurrence within seven years. Children with Major Depression have an increased incidence of Bipolar Disorder and recurrent Major Depression. Current research data however gives us a partial and derisory picture and the literature is still not so transparent about incidence of adolescent depression due to certain factors and these are the evaluations modes are inadequate and insufficient that measure adolescence depression and secondly the difference between temporary depressive symptoms and persistent depressive syndrome is difficult issue to be tackled. Also significant is the matter that the frequency of depression in adolescence is so varied that its hard to chalk out a clear picture. Multitude factors may contribute to adolescent depression. Stress from the pressure to have good grades, be a star athlete, or from peers can result in adolescent or teenage depression. Parentchild discord, abuse, and neglect increase the risk of depression. Alterations in central serotonergic and noradrenergic neurotransmission are associated with and may antedate childhood depression. It is difficult to assess the consequences of depressive symptoms since depression in adolescents is often associated with many other factors that raise the risk of undesirable behaviors and outcomes. Depression negatively impacts growth and development, school performance, and peer or family relationships and may lead to suicide. Biomedical and

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psychosocial risk factors include a family history of depression, female sex, childhood abuse or neglect, stressful life events, and chronic illness(Williamson, 1995). THE DIRECT COSTS of medical care utilization and the morbidity and mortality costs of mental health problems for children younger than 15 years has been estimated at $2 billion in 1985, but estimates for youth younger than 19 years that include all related costs, including costs of juvenile justice and educational programs, have ranged as high as $20 billion. Two factors relatively common in adolescence, smoking cigarettes and having a mother who suffers from depression, both increase the adolescent's own susceptibility to depression. Depression in adolescence might also generate important nonmedical costs in several ways. First, depression may lead girls and boys to miss school or to fall behind in school. Education is a critical determinant of adult earnings, so if school attendance and performance are substantially affected by depression, adolescents may lose earnings in the future. Depression may inhibit school performance of children and adolescents; just as such symptoms reduce work performance among adults. Second, depression may affect other aspects of well-being. Such effects could occur through a connection between depression and dangerous behaviors, such as alcohol and drug use, bingeing, and smoking. Children with emotional and behavioral disorders in general are significantly more likely to experience substance use and are at higher risk of involvement with the juvenile justice system. There is also a suggestion that adolescent depression affects susceptibility to infectious disease. Risky behaviors are quite prevalent among youth. Data from the 1999 Youth Risk Behavior Surveillance Survey indicate that more than one third of youth in grades 9 through 12 currently smoke cigarettes, one half currently use alcohol, and more than one fourth currently use marijuana. Further, depression may raise the risk of suicide in children and adolescents, as it does in adults. According to data from the Youth Risk

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Behavior Surveillance Survey, nearly 20% of youth seriously considered attempting suicide during the preceding year. It is difficult to assess the consequences of depressive symptoms

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because depression in adolescents is often associated with many other factors that also raise the risk of undesirable behaviors and outcomes. Mental health problems in adolescents tend to be concentrated in the most disadvantaged groupschildren from minority groups, from singleparent families, and from low-income families. Furthermore, family studies suggest that the prevalence of depression is higher among adolescents from families that include a parent with depression, and these children may be at risk for other poor outcomes as well. Adolescent depression may also be associated with environmental adversity. The relationship between depression and extreme stress has been demonstrated in children subjected to natural disasters, children who are homeless, and children subjected to physical or sexual abuse. While these studies consistently note associations between depression and extreme adversity, the findings are limited by the nature of the generally nonrepresentative samples in most studies. The relationship between adolescent depression and other, less extreme life events has been examined primarily in clinic-based samples. While these studies consistently note an association between life events and adolescent depression, the findings are limited by the referred nature of these samples. This relationship has been examined in 3 epidemiological samples, with each study noting a consistent relationship between the 2 constructs. In this article, we examine the prevalence and incidence of depressive symptoms among children and adolescents. We then turn to the consequences of depression in adolescence: the degree to which depressive symptoms are correlated with school performance and with dangerous behaviors, particularly alcohol and drug use and eating problems. We examine the

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extent to which these negative outcomes associated with depression persist after controlling for sociodemographics and other risk factors that are associated with both higher rates of depression and higher risk of problem indicators. Previous research has shown associations between depression and some of these risk behaviors. This analysis broadens the range of behaviors considered to include school performance as well as a range of unhealthy behaviors. It describes these associations in a large community sample. Assessing the relationship between depression and adverse outcomes is complicated by the fact that depression is also correlated with other factors that raise the risk of adverse outcomes, such as life events and abuse. Moreover, some correlates of adolescent depression, such as abuse or adverse life circumstances, may carry independent risks for adverse consequences, such as excessive alcohol use. Timely psychological interventions can help improve the quality of life in adolescents with depression. Otherwise its severity could get coupled with other psychiatric or psychosomatic diseases by the age such children step on the ladder of the adulthood. Ultimate focus as expounded by the current research is effective management of adolescent depression so that the toll that the adolescents have to pay heavily through impaired patterns of their life could be decreased. This would be extremely beneficial for such individuals will be extremely beneficial for reduction of the impact and economic burden of treatment that they have to pay in adult life. This research study has explored various hypotheses and multiple research questions. Keeping into consideration the brevity of the contents, some of them are mentioned on the following page.

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Following hypotheses are proposed. Hypotheses: Hypothesis 1: There are gender differences in adolescent depression. Hypothesis 2: There are age differences in severity of adolescent depression. Hypothesis 3: Adolescent depression causes multiple physical and psychosocial consequences. METHOD Research design The current research employs ex-post facto research design as the characteristics of the population to be studied were already present. Sampling strategy In the current research, purposive sampling was used due to the fact that the sample to be taken had to be having certain characteristics and there was specific inclusion and exclusion criterion. Sample A total of 360 adolescents were screened and examined by the researcher out of a sample of 950 that were found to be having moderate to severe depression. Those who responded to the symptoms of depression significantly were included in the sample. Those who were taking some medication due to asthma like medical problems were excluded from the sample with the reservation that their medication might have produced a particular affect state. The assent and consent of the respondents was also sought carefully and those who refused to cooperate and extend their opinions or who refused to share data about their family was excluded from the final sample. The remaining samples that fulfilled al the requisites consisted of 300 respondents.

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Measures The current research study has used Depressive symptoms with Children's Depression Inventory (CDI) with due permission of the author. Kovacs (1985) originally developed this selfreport questionnaire in 1985 as a screening measure for the diagnosis of major depression in children. The questionnaire consists of a series of forced-choice items, for which an adolescent marks one of the statements most consistent with his or her current mental state. This allows a rating of depressive symptoms to be made on a 3-point scale, from absent to definitely present. These questions rate current depressive symptoms that had been present during the preceding 2 weeks. The CDI exists as both a 26-item and a 10-item questionnaire, with the 10-item version being used to screen for major depression. The measure exhibits satisfactory internal reliability and test-retest reliability, as well as satisfactory predictive validity for the clinical diagnosis of major depression in children (Carlson & Cantwell, 1980). Cronbachs alpha for these two measures revealed reliability of .87 and .71 respectively. There were no exact standardized measures available on assessment of the consequences of depression. It was only through indicator determination that the questionnaire to assess possible problems of adolescents with depression was devised. The questionnaire asked adolescents extensive questions about their health status, risk behaviors, and school performance. Respondent demographic and socioeconomic information was also sought. This included age, sex, race, region, urban or suburban residence, and family financial status. Family finances were assessed on the basis of whether the family had money problems frequently, occasionally, rarely, or never. One question was also asked concerning parental history of depression. The survey

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asked adolescents whether they engaged in risk behaviors (overeating, smoking, and drinking alcohol), how many days of school they missed because of illness in the preceding month, and their grade level. We used the information on age and grade to assess whether the child was

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below the age-appropriate grade level. The survey also asked adolescents whether they engaged in risk behaviors when experiencing stress. The format of the questions was multiple choice, with responses grouped into categories.

Procedure Institutional consent from six major reputed schools was duly sought. Out of this three schools were from private sectors while the other three were from government sector. In order to access students from all financial status, schools from private and public sectors were deliberately selected. Not only the institutional permission was taken rather the students were individually questioned about their willingness to participate and written consent of this was received from their parents. The screening of depressive symptoms was done in class administered Survey oriented Questionnaire since in our traditional school set ups, mental health of the children has never been the area of concern. Demographic information was also take after the sample has been short listed on the basis of the incidence of symptoms of depression from moderate to severe. The children who manifested mild to moderate symptoms were excluded from the sample. The Self- constructed questionnaire to assess problems caused due to their depressive symptoms was also administered in school settings. This was done individually so that the information sought was complete and accurate. Data obtained through these measures was analyzed by using SPSS version 14. the findings have been displayed below followed by its analyses in discussion section.

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Analysis Statistical Package for Social Sciences Version 14 was used to analyze the data conducted the analysis with Software for Statistical Analysis of Survey Data.
2

and t tests for

bivariate relationships between depression, incomes, factors, and problem indicators were used. The prevalence of major depression in children and adolescents has been examined in many relatively large surveys that have relied on standardized interviews. As reviewed by Sohail and Shaw (2004) the prevalence in the community is approximately 5%, although there is variability across studies, depending on the stringency of the applied impairment threshold and the measure used to make the diagnosis.

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Results Demographic Characteristics of the sample (N= 300) Table 1 Descriptive Features Important in the Findings

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_____________________________________________________________________________ _ Variable N Percentage

_____________________________________________________________________________ _ (I) Age 9-11 12-14 Total (11) Gender Male Female Total 150 150 300 50% 50% 100% 150 150 300 50% 50% 100%

(11I) Type of Institution with reference to number of students taken Private sector Government sector Total (IV) Education/ Grade 150 150 300 50% 50% 100%

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Class 5 Class 6 Class 7 Class8 Total 80 78 300 70 72 26.66% 26% 100% 23.3% 24%

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(V) Socioeconomic status Lower Class (income range 5000-8000) Middle Class (income range 10000-25000) Upper Class (income range 26000-50000) Total 120 130 50 300 40% 43% 17% 100%

_____________________________________________________________________________ _

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Table 2 Prevalence of Depression across Socioeconomic Characteristics _____________________________________________________________________________ _ Prevalence Boys-------------------------Girls _____________________________________________________________________________ _ Family Type Single Parent Both Parents Divorced Family History of Depression Yes No Income No Money Problems Few Money Problems Scanty Money 0.03 0.06 0.04 0.06 0.08 0.17 0.04 0.02 0.09 0.07 0.05 0.03 0.08 0.07 0.05 0.16

Bold figures clearly show marked differences across Male and Females

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Table 3 Mean difference of the Gender on Depression _____________________________________________________________________________ _ N Mean Sd df t p

_____________________________________________________________________________ _ Male Female 150 150 6.06 22.7 2.80 3.95 299 4.76 0.00

_____________________________________________________________________________ Results are significant since p < .05. Table 3 represents the results from independent sample t-test, indicating that there is significant difference in depression between both of the gender. So second research hypothesis is also supported, t (58) = -7.462, p < .05. This shows that there is greater likelihood for girls to suffer from severity of depression symptomology as compared to boys.

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Table 4. Problems Outcomes and Depression ________________________________________________________________________ Boys with Depression Girls with Depression

_____________________________________________________________________________ Days Missed from school Binging Smoking Poor grade performance Suicidal thoughts 7.60 0.4 0.7 0.9 0.3 8,2 0.7 o.1 0.76 0.9

_____________________________________________________________________________

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Table 5 Two age groups were compared using independent sample t-tests. Results are shown in table below. Mean difference between the two age groups on Depression _____________________________________________________________________________ _ N Mean SD df t p

_____________________________________________________________________________ 9-11 years 12-14years 150 150 20.03 24.193 3.95 3.97 299 4.81 0.00

_____________________________________________________________________________ Results are significant at p < .05. Table 4 represents the results from independent sample t-test, indicating that there is significant difference in depression between the two age groups adolescents with depression. So first research hypothesis is supported, t (299) = 3.818, p < .05. This clearly represents that the as children are advancing in years in terms of adolescent phases, the depression increases.

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Table 6 Problems Indicators and Consequences of Depression _____________________________________________________________________________ _ Days of School missed (n=300) Behind grad (n=300) Smoking Suicidal (n=300)

(n=300)

_____________________________________________________________________________ _ Depressed Family History Sexual Abuse Physical Abuse Life tragedies/ loss/death Aggression/ violence 0.97 1.64 0.88 0.10 0.06 0.18 1.69 1.05 1.02 1.12 1.09 1.03 1.87 1.35 1.11 1.78 1.12 1.03 15.43 1.62 2.14 1.92 2.09 2.13

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_____________________________________________________________________________ _

Discussion The Prevalence of Depression has significantly been found to be higher among girls as compared to the boys during adolescence phase. Anderson reports the prevalence of depression in boys was 5%, whereas that in girls was 9%. As expected, rates were quite low among 10-yearold girls and boys. Rates for girls rapidly rose above those for boys and were much higher by age 14 years. Table 1 provides prevalence rates for boys and girls by race, family structure, family history of depression, and family income. In these data, rates of depression do not vary substantively or significantly among grades though this difference becomes prominent when ages are considered by ignoring grades. Previous studies have shown higher rates of mental health problems among children from divorced or single-parent families. In these data there was an increased prevalence of depression

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in boys with divorced parents. Among those who responded to the question (three fourths of the full sample), nearly one third reported that a family member had had depression. Adolescents from such families were much more likely to meet criteria for depression than were those who did not report a family history of depression. Finally, rates of depression were much higher half of the time higher in girls and boys in very-low-income families than among girls and boys in high-income families. This finding suggests that environmental factors may contribute to depression risk. As far as the prevalence rates for depression in girls and boys is concerned, by history of physical or sexual abuse, and by the number of life events experienced in the preceding year. For convenience, the report for quartiles of life events. Nearly 20% of girls and 8% of boys in the sample reported a history of sexual abuse. 23% of girls and 7% of boys in the sample reported a history of physical abuse. For both girls and boys, a history of sexual or physical abuse was strongly related to depressive symptoms. Indeed, almost one fourth of girls with a history of either type of abuse met criteria for depression. The survey asked whether violence at home had ever been so serious that an adolescent contemplated leaving home. About one fourth of girls and boys reported this high level of violence. Again, a history of violence was strongly and significantly related to depression in both girls and boys. The relationship between life events and depression was positive in both girls and boys. Consistent with previous studies, girls and boys who had experienced severe life stresses in the year before the interview were much more likely to meet criteria for depression than were those whose lives had been less stressful. The correlations between depressive symptoms and problem indicators has been found to be high. In order to explore phenomenon, 2 measures of school performance: days of school missed because of illness and whether a child was in the expected grade level (age minus 6). We

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examined the measure of problem behaviors including alcohol use, drug use, smoking, and

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bingeing etc were used. Finally, it was examined whether a girl or boy reported suicidal ideation. reports rates of these problem indicators and behaviors among depressed and nondepressed adolescent girls and boys. Depression was correlated with a significant increase in the number of school days missed. Depressed adolescent girls were also almost twice as likely to be behind a grade in school as those who were not depressed. Both girls and boys who were depressed reported much higher rates of use of alcohol, drugs, smoking, and bingeing. Indeed, more than 75% of depressed girls and boys engaged in at least 1 of these risk behaviors. Finally, suicidal ideation was substantially more frequent among depressed adolescents than among those who were not depressed. As e noted already, depression is correlated with environmental risk factors that occur disproportionately in families that are also socioeconomically disadvantaged. Risk behaviors that are associated with depression may, instead, be a consequence of socioeconomic disadvantage or of environmental risk factors. Final Comments While depression may increase the risk of any or all of these negative outcomes, the outcomes themselves may place adolescents at risk of depression. For example, girls and boys who are doing badly at school may become depressed in consequence. Alternatively, these negative outcomes, and depression, may be a consequence of other underlying problems. For example, those who use drugs or cigarettes or engage in self-destructive behavior may also be depressed. Finally, suicidal thoughts are a marker of depression (so that the relationship between depression and suicidal thoughts cannot be separated). Depressed girls were more likely than

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nondepressed girls to report that they ate when stressed. Both depressed girls and depressed boys were more likely than their nondepressed counterparts to report that they stopped eating when stressed. This means that they smoked when stressed. These results suggest that depression does, indeed, raise the risk of engaging in high-risk behaviors. The present study draws on observational cross-sectional data. Thus, it is too haphazard that the correlations observed herein are necessarily causal. Adolescents may become depressed because they are performing poorly in school or are using drugs. We cannot exclude the possible effects of reverse causality on the current results.

CONCLUSIONS There are multiple significant findings that have been divulged from the current study. This has been reflected clearly from the current research that the adolescents who have been subject to traumatic life events and to abuse (sexual or physical) are at significantly higher risk of depression. These results hold equally well for both girls and boys. Depressed adolescents are at much higher risk of poor performance at school, of using drugs or smoking and of bingeing. Together, these findings suggest that depression is an especially serious problem among children who live in risky environments and that depression is, in turn, associated with other serious risks. The results of this study show that school attendance, smoking, bingeing, and suicidal ideation are significantly correlated with depression. Information about these indicators and behaviors as well as the presence of traumatic life events could be powerful tools for physicians in the difficult task of identifying adolescent depression and initiating treatment. Overall, studies show that

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about 1 in 20 adolescents currently suffer from depression, suggesting that routine screening for depression has considerable merit. In this study, among adolescents who missed more than 10 days of school in the preceding month, smoked, engaged in bingeing, or had suicidal thoughts, rates of elevated depressive symptoms were more than twice as high. Thus in determining the predictors for adolescent depression and in outlining the possible outcomes of depression, this research study has shown valuable findings. What This Study Adds to existing findings? Previous research has documented the high prevalence of depression among adolescents without highlighting the factors that become nurturing grounds for depression. Assessing the relationship between depression and adverse outcomes is complicated by the fact that depression is also correlated with other factors that raise the risk of adverse outcomes, such as life events and abuse. This study used data collected through main streamed schools and not on the clinical population since the population at clinics is stigmatized. The data also contained measures of family background, abuse, and life events, so we were able to control for these factors. We found evidence that, after controlling for these factors, depressive symptoms are correlated with missing school, smoking, bingeing, and suicidal ideation.

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References Anderson JC, Williams SM, McGee RO, Silva PA. DSM-III disorders in preadolescent children: prevalence in a large sample from the general population. Arch Gen Psychiatry. 1987;44:69-76. Retrieved October 19,2008 From The NYU Child Study Center at www.AboutOurKids.org/ http://www.aboutourkids.org/articles/about_anxiety_disorders/ NYU Child Study Center

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To what extent, the Objectives of the Proposed Research have been achieved? The results of the study have pointed in the horizon of exploring the dynamics of adolescent depression in a large sample. Children in the middle adolescent phase seem to be more depressed than the beginning phase that suggests that the depression if not properly attended and acknowledged increases with the time span. Chronicity, morbidity are not only the ultimate outcomes of adolescent depression rater many other achievement related aspect of individuals suffer and their life is affected badly psychologically, socially and emotionally. The study objectives have prospectively been achieved. On the basis of findings of the current study, awareness campaigns cum programs could be devised with the collaboration of school counselors to save such children from malady of depression. Environmental risk factors can be

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controlled for such individuals who appear to be the possible victims of depression in the advancing age. This could also save a large part of psychiatric population to be identified at a

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younger age due to which their management plans and recovery picture would become strongly optimistic.

Research Grant allocation made and the expenditure incurred Total grant allocated: 100,000/Total expenditure: 100,000/-