Predicting Adolescent Depression: Self-Acceptance, Self-Esteem, and Negative Emotions, Study Guides, Projects, Research of Psychotherapy

Download Predicting Adolescent Depression: Self-Acceptance, Self-Esteem, and Negative Emotions and more Study Guides, Projects, Research Psychotherapy in PDF only on Docsity! Journal of Experiential Psychotherapy, vol. 20, n o 4 (80) December 2017 30 Unconditional Self-Acceptance, Functional and Dysfunctional Negative Emotions, and Self-Esteem as Predictors for Depression in Adolescents: a Brief Pilot Study Conducted in Romania Geanina Cucu-Ciuhan* i , Ioana Elena Dumitru* *University of Pitești, Romania Abstract Introduction: Depression has a high prevalence in adolescents, as they are passing important biological, cognitive and social changes, and are more vulnerable to negative emotions. Although the relationship between the unconditional self-acceptance, self-esteem, and depressive symptoms has been extensively studied over the past decades, there is not enough evidence about the exact way these variables can lead to depression in adolescents. Objectives: The aim of this study was to examine the relationship between the unconditional self-acceptance, self-esteem, functional and dysfunctional negative emotions, as predictors for the level of depression in Romanian adolescents. Methods: We ran the study on a sample of 300 Romanian adolescents, aged 14 to 17, in order to examine the predictors for the level of depression, taking into account the level of the subjects’ unconditional self-acceptance, their self-esteem, and their functional and dysfunctional negative emotions. The measures were the Unconditional Self-Acceptance Questionnaire, the Rosenberg Self-esteem Scale, the Emotional Distress Profile, and Beck’s Depression Inventory. Results: The results show that the variance of the level of depression (F(1; 298) = 473, p = .0001) is significantly explained by the level of unconditional self-acceptance (ΔR2= .614, p = .0001), by the level of self-esteem (ΔR2= .615, p = .022), and by the level of emotional distress (ΔR2= .653, p = .0001). Limitations: Due to the lack of financial support, the sample was representative only for one region of Romania, the South Muntenia Region. Conclusions: We identified significant correlations between unconditional self-acceptance, self-esteem, and functional and dysfunctional negative emotions and the level of adolescent’s depression, and we also described the prediction equation for depression by considering these three variables. Keywords: depression in adolescents, unconditional self-acceptance, self-esteem, functional emotions, dysfunctional emotions i Corresponding author: Geanina Cucu-Ciuhan, University of Pitești, Târgu din Vale no. 1, Pitești, Romania. Email: [email protected]. Journal of Experiential Psychotherapy, vol. 20, n o 4 (80) December 2017 31 1. Introduction In adolescence, the depressive symptoms and depression diagnosis prevalence is increasing and it is usually associated with self-harm, academic failure and poor mental health in adulthood (Kilford & all, 2015). In 2013, the National Institute of Mental Health in USA reported that 2.8% of children (8–11 YO) and 4.8% of adolescents (12–15 YO) are affected by depression (Keith, 2013). This means that as many as one in every 33 children and one in eight adolescents undergo depression. Unfortunately, an important number of children with mental health problems do not get the help they need. In USA, suicide is the third leading cause of death for 15–24 year-olds (NIMH, 2013). The 2014 data published by the European Health for all Databases (HFA-DB) puts Romania on the second place in Europe when it comes to the incidence of mental disorders, with over 1400 cases diagnosed per 100.000 habitants (HFA-DB, 2014). Among this, depression is the most common diagnosis, about 6.66% of Romanian adults suffering from major depression. There are no recent national studies about the occurrence of the depression diagnosis in the Romanian adolescent population, but the number of teenage patients referred to by the psychiatric clinics for suicide attempt has dramatically increased, media reporting about almost 200% in the past decade. In 2010, the NGO “Save the Children” conducted in Romania a complex study about the mental health services for children in our country. According to their data, at that moment, there were 880,709 children registered with a psychiatric disorder, out of which 154,124 were diagnosed with depression (Grădinaru & Stănculescu, 2010). Particularities of adolescent’s depression in Romania Adolescents with major depression display symptoms such as: low self-esteem, decreased energy, loss of interest in regular activities and/or in activities he/she once enjoyed, feelings of excessive guilt, persistent feelings of sadness, feelings of helplessness or hopelessness, feelings of being inadequate, changes in appetite or weight, difficult concentrating, sleep problems, irritability, aggression, hostility, frequent complaints of headache, fatigue, and stomach pains. If the depression is criticized, the adolescent may experience more serious and critical symptoms as feelings of wanting to die and suicidal thoughts or attempts, or other self-destructive behavior. The main causes of adolescent depression in Romania are: family stress, lack of communication with the parents, physical and emotional abuse, trauma, the teenagers’ inability to cope with the dominant attitude of their parents, the parents’ constant pressure for high standard school performances, low economic status, etc. One specific national cause is the lack of parental presence, in the families where the child is raised by relatives (grandparents or others) when the parents are abroad, to work. In these cases, the adolescent sees his/her parents only a few times per year and this situation goes like this starting with early childhood. Another specific local phenomenon associated with adolescent depression is the running away behavior. Over the past few years, in Romania, there were an important number of mediatized cases of teenagers running away from home. Most of them were girls aged 13 to 16 and their running away destination was the orthodox monasteries. Usually, the teenager who is physically and/ or emotionally abused in the family, feels like he/she has no one to talk to and finds willingness in a confessional relationship. All these facts and observations emphasize the role of parent- child relationship in the young person’s development and, implicitly, in the onset of depression in adolescents. Adolescents’ vulnerability to depression The cognitive theories of depression postulate that depressive disorders in adolescence result from an interaction between the teenager’s individual vulnerability to depression and environmental stressors that activate the disorder (Abela & Hankin, 2008). Depressed and depression- vulnerable adolescents have the tendency to exhibit attentional, interpretation, inferential, and memory biases for salient stimuli (Hankin & all, 2009). Beck’s cognitive theory postulates that social and affective information is biased by the individual’s rigid negative schema and dysfunctional attitudes (Beck, 1987). The hopelessness theory talks about the individual’s negative cognitive style – the person has the tendency to make negative inferences about the causes of his life events and about his/ her implication in these events (Abramson, Metalsky, & Alloy, 1989). For example, the adolescent has the tendency to catastrophize and interprets his school achievements as “I am at the bottom of my class, so it is normal to have low grades. No matter how much I try to learn, I will never achieve more than a passing grade”; or he interprets his inability to socialize as “I am one of the freaks in my class, so no matter what I do, I will never get more popular.” Journal of Experiential Psychotherapy, vol. 20, n o 4 (80) December 2017 34 4. Results Descriptive analysis Mean scores and standard deviations for each measure are presented in Table 2. Analysis was conducted to determine the distribution of scores in the study sample, for each variable of the present study. The scores on unconditional self-acceptance indicate a medium to high level of self-acceptance among the adolescents in the study, with a mean of 75.99 and a median of 70.50, suggesting that most of the adolescents in the study sample have a positive opinion about themselves. The SD is 26.92, which indicates a high variability of the scores. The scores on self-esteem indicate a medium level of self-esteem among the adolescents in the study, with a mean of 27.94 and a median of 27.50. The SD is 8.06, which indicates a slight variability of the scores. The scores on emotional distress indicate that the adolescents in the study sample have a medium to high level of emotional distress, but with a high variability of the scores. For the functional negative emotions – sadness, lowness, the mean is 26.81 and SD is 13.15, for the dysfunctional negative emotions – sadness, lowness, the mean is 26.20 and SD is 13.34, for the functional negative emotions – fear, the mean is 21.13 and SD is 10.95, and for the dysfunctional negative emotions – fear, the mean is 43.78 and SD is 22.67. The results show that the adolescents participants in the study have a medium to high level of dysfunctional negative emotions, especially fear. The scores on depression indicate that the adolescents in the study sample have a medium level of depression, with a mean of 19.26. The SD of 12.89 shows that the scores have a high variability, an important number of subjects obtaining clinically significant high scores on depression. Correlational analysis Table 3 presents the correlations between variables. The first hypothesis was supported by significant correlation that indicates small to moderate effect sizes. A high level of depression was associated with a low level of unconditional self-acceptance (r = -.783; p = .0001), low self-esteem (r = -.624; p = .0001), high functional negative emotions – sadness, lowness (r = .234; p = .0001), high dysfunctional negative emotions – sadness, lowness (r = .332; p = .0001), and low dysfunctional negative emotions – fear (r = -.187; p = .0001). There was no significant correlation between the level of depression and the functional fear. This means that the adolescents participants in the present study who have a high level of depression manifest high functional and dysfunctional sadness and lowness, but a low level of dysfunctional fear. Multiple linear regression for the prediction of depression We used the multiple linear regression model in order to explore the relationship between three explanatory variables (unconditional self-acceptance, self-esteem, and the four dimensions of the emotional distress) and the criterion variable represented by the level of depression. Our goal was to find out if the unconditional self-acceptance, self-esteem, and emotional distress significantly predict depression in adolescents. Table 4 presents the results of the linear regression model. The results show that the variance of the level of depression (F(1; 298) = 473, p = .0001) is significantly explained by the level of unconditional self-acceptance (ΔR 2 = .614, p = .0001), by the level of self-esteem (ΔR 2 = .615, p = .022), and by the level of emotional distress (ΔR 2 = .653, p = .0001). In table 5 we present the significant differences between the three prediction models of the level of depression. The results show that there are significant differences between: a. Prediction model 2 (F(2; 297) = 237.69 and p = .0001) and 1 (F(1; 298) = 473.77 and p = .0001), stating the inferiority of the model that predicts the level of depression depending on the level of unconditional self-acceptance; b. Prediction model 3 (F(6; 293) = 91.98 and p = .0001) and 2 (F(2; 297) = 237.69 and p = .0001), stating the inferiority of the model that predicts the level of depression depending on the level of unconditional self-acceptance and on the self-image. The comparison between the three prediction models shows the superiority of the prediction model 3 (F(6; 293) = 91.98 and p = .0001), which predicts the level of depression depending on the level of unconditional self-acceptance, on the self-image and on the degree of emotional distress. In Table 6 we present the standardized and non-standardized coefficients for the prediction of depression level. By analyzing the final prediction model, we can see that all the predictors taken into account in the current study are significant: unconditional self-acceptance (β = -.306, p = .0001), self-esteem (β = -.149, p = .008), functional negative Journal of Experiential Psychotherapy, vol. 20, n o 4 (80) December 2017 35 emotions – sadness, lowness (β = .030, p = .040), dysfunctional negative emotions – sadness, lowness (β = .185, p = .0001), functional negative emotions – fear (β = -.341, p = .043), dysfunctional negative emotions – fear (β = -.077, p = .0001). Therefore, the data can support the idea that depression occurs when the level of unconditional self- acceptance and self-esteem gets low, when the level of functional and dysfunctional negative emotions of sadness and lowness increases, and when the level of functional and dysfunctional negative emotions of fear decreases. The prediction equation in standard scores is: Ylevel of depression = (-0,638) unconditional self- acceptance + (-0,093) self-esteem + 0,031 functional negative emotions – sadness, lowness + 0,192 dysfunctional negative emotions – sadness, lowness + (-0,029) functional negative emotions – fear + (-0,135) functional negative emotions – fear. 5. Discussion In this study, we used a representative sample of 300 Romanian adolescents, aged 14 to 17, in order to examine the predictors for the level of depression, taking into account the level of the subjects’ unconditional self-acceptance, their self-esteem, and their functional and dysfunctional negative emotions. We identified significant correlations between the three variables considered and the level of depression in adolescents, and we also described the prediction equation of the depression. Our findings add to the current evidence about the way in which, in the case of children and adolescents, symptoms of depression correlate with the variables analyzed here, and they can also play an important role in predicting depression during adolescent years. The correlational study found that a high level of depression is associated with a low level of unconditional self-acceptance, low self-esteem, high functional and dysfunctional sadness and lowness, but a low level of dysfunctional fear. These findings are in consensus with the scientific evidence in the field. The negative correlation between unconditional self- acceptance and depression is highly emphasized on in REBT studies (Chamberlain & Haaga, 2001), and a low self-esteem level predicts the high level of depressive symptoms (Sowislo & all, 2014). The role of functional or dysfunctional emotions in depression, mediated by the individual’s unconditional self-acceptance, is illustrated by Ellis, who talks about the role of unconditional self- acceptance when the person goes through a situation of failure or rejection. If the person unconditionally accepts himself/herself, he/she may have healthy adaptive emotions of frustration and regret, but if he/she doesn’t unconditionally accepts himself, he/she will rather develop dysfunctional emotions of failure or complete incompetence (Ellis, 2003). The prediction equation of depression taking into account the three variables, unconditional self- acceptance, self-esteem, and functional and dysfunctional negative emotions, has important implications in practice, both in designing prevention programs for depression in adolescents, and in designing evidence-based psychotherapy programs for intervention. Acknowledgements There was no technical support for writing this article. We thank all the adolescents and their parents for the agreement to voluntarily participate in our research. Table 1 The sample distribution by age and gender Age Gender Total Male Female 14 37 37 74 15 37 37 74 16 37 37 74 17 39 39 78 Total 150 150 300 Journal of Experiential Psychotherapy, vol. 20, n o 4 (80) December 2017 36 Table 2 Means and standard deviations Unconditional self- acceptance Self- esteem Functional negative emotions – sadness, lowness Dysfunctional negative emotions – sadness, lowness Functional negative emotions – fear Dysfunctional negative emotions – fear Depression Mean 75.99 27.94 26.81 26.20 21.13 43.78 19.26 Median 70.50 27.50 23.00 22.00 19.00 54.00 19.00 Mod 96 a 40 24 21 19 65 2 Standard Deviation 26.925 8.062 13.152 13.346 10.955 22.673 12.890 Variance 724.976 65.000 172.975 178.127 120.002 514.077 166.141 Skewness .065 -.321 2.658 2.658 3.403 -.070 .317 Kurtosis -1.565 -.331 6.102 6.085 12.593 -1.671 -.333 Minim 33 10 12 10 10 10 1 Maxim 121 40 83 83 83 83 55 Table 3 Pearson correlation coefficients among study variables Variables Depression Unconditional self-acceptance r -.783 ** Self-esteem r -.624 ** Functional negative emotions – sadness, lowness r .234 ** Dysfunctional negative emotions – sadness, lowness r .332 ** Functional negative emotions – fear r -.037 + Dysfunctional negative emotions – fear r -.187 ** Note: ** p < .01, + p = .552 Table 4 Multiple linear regression for the prediction of depression Model R R Square Adjusted R Square Std. Error of the Estimate Change statistics R Square Change F Change df1 df2 Sig. F Change 1 .783 a .614 .612 8.026 .614 473.077 1 298 .000 2 .785 b .615 .613 8.020 .002 1.508 1 297 .022 3 .808 c .653 .646 7.668 .038 7.971 4 293 .000 a. predictors: (constant), unconditional self-acceptance b. predictors: (constant), unconditional self-acceptance, self-esteem c. predictors: (constant), unconditional self-acceptance, self-esteem, the four dimensions of the emotional distress (functional negative emotions – sadness, lowness, dysfunctional negative emotions – sadness, lowness, functional negative emotions – fear, dysfunctional negative emotions – fear) d. criterion: depression