Resilience and Depressive Symptomatology in Adolescents: The Moderator Effect of Psychosocial Functioning

Abstract

Depression is a serious health problem, especially in adolescence. Several variables can arise as risk or protective factors in different contexts, promoting a good or bad adjustment. The main goal is to identify if variables like resilience and psychosocial functioning are related to depression in adolescence. Additionally, gender differences in these variables are explored. This study aims to analyze the predictive effect of Resilience and Psychosocial Functioning on Depressive Symptoms, and verify the moderating effects of Psychosocial Functioning, and its areas, on Resilience in the same prediction. The sample consists of 406 adolescents. Two questionnaires were used: the Children's Depression Inventory (CDI, Kovacs, 1985; Portuguese version: Marujo, 1994), and the Resilience Scale-13 (Pinheiro & Matos, 2013), Portuguese version of the RS-14 (Wagnild & Young, 2009). The interview Adolescent Longitudinal Interval Follow-Up Evaluation (A-LIFE, Keller et al., 1993; Portuguese version: Matos & Costa, 2011) was also applied. Results revealed that both Resilience and Psychosocial Functioning were predictors of Depressive Symptomatology.

Keywords: Depression, resilience, psychosocial functioning, adolescence, moderation

Introduction

Depression is a mood disorder (APA, 2013) that presents itself with symptoms that impact the emotional, cognitive, motivational, behavioral, vegetative, and relational areas of the individual. It’s characterized by feelings of sadness and/or loss of pleasure in all or almost all activities, presenting a cognitive-emotional imbalance that affects the whole psychic life of the individual, associated with alterations in energy, sleep, appetite, concentration, and in adults, libido (Marujo, 2000).

Major Depression is the leading cause of disability in people aged 5 or higher, and the second main source of health costs, exceeding cardiovascular diseases, dementia, lung cancer and diabetes. However, despite the great impact that mood disorders have, few people get a proper monitoring (Merikangas & Knight, 2012).

For many, adolescence is a period of much stress, since it corresponds to a transition to adulthood, in which they are subject to a number of changes to their physical, emotional and cognitive level. Adolescents have to face difficult challenges when dealing with complex issues such as the construction of identity, self-concept, independence and intimacy. Although this transition is peaceful and relatively smooth for most, some young people go through great difficulties, either at the emotional or behavioral level (Alloy, Zhu & Abramson, 2003). One of the most prevalent issues among teenagers is depression. Contrary to the belief that it could not arise in childhood or adolescence, researchers found that depression is a significant mental health problem at this stage of life (Kessler, Avenevoli, & Ries Merikangas., 2001; Weissman et al., 1999). Many of the problems that were seen as normative distress expressions in adolescence, such as sadness, moodiness, self-critical thoughts and insecurity or social isolation, began to be looked at in another way, when it became clear that this condition may actually be a serious disturbance in this phase, often having a chronic or recurring course throughout adult life (Rudolph, Hammen & Daley, 2008; Mueller et al., 1999; Solomon et al., 2000). Concerning the chronic course of the condition, studies in clinical samples have revealed that about 40% of adults relapse into depression within two years, and more than 80% within 5 to 7 years (e.g. Solomon et al., 2000). Other studies with clinical samples of depressed adolescents, have very similar percentages (e.g. Birmaher et al., 1996). Additionally, an increasing number of studies conclude that in this age group, depression often occurs simultaneously with other psychiatric conditions (e.g. Angold, Costello, & Erkanli, 1999; Brady & Kendall, 1992; Kendall, 2000).

It is also important to note that other consequences arise when this condition emerges in adolescence. For example, the resolution of the depressive episode may be a lot more complicated due to the fact that teenagers don’t have the same skills as adults, particularly concerning how to deal with this kind of suffering, nor do they have the same control over their own lives (Marujo, 2000). Besides, adolescents generally do not seek treatment on their own. Usually, it’s the parents who seek an assessment by realizing some impairment in their children’s functioning (Emslie & Mayes, 1999; Wagner, 2003). Furthermore, this disorder can affect a youngster’s development, since, while being in a challenging period, depressed teenagers may not be able to master the typical key tasks of their age, and, being unable to master these tasks at this stage, they may not have another opportunity to develop these skills (Kendall, 2000).

To be diagnosed with Major Depressive Disorder, according to DSM-V (APA, 2013), the individual must present not only depressive symptoms but also impairment in psychosocial functioning. This impairment is described by some authors as a poor functioning in some of the following areas: academic performance, interpersonal relationships, recreational activities, work, family relationships, friendships outside of the family, sexual functioning, satisfaction and overall social adjustment (Bird et al., 2005; Keller et al., 1987). In adolescents, depression often causes significant damage in these areas.

In a study, psychosocial functioning was evaluated globally and through assessments of specific areas such as work/employment and relationship with spouse or partner. The results showed that with a significant increase in the degree of severity of depressive symptomatology, also occurred a significant increase in psychosocial impairment. This result was found for both the overall functioning and its specific areas (Judd et al., 2000). Solomon (2008) found that the presence of psychosocial impairment was also associated with a greater severity of depressive symptomatology, and a lower likelihood of recovery from the depressed state. They also found that an increase of a standard deviation in the psychosocial impairment was associated with a decrease of 22% in the probability of recovering from an episode of depression. In another study, researchers identified the reduction of depressive symptomatology as a potential mediator in improving psychosocial functioning, since the reductions in the severity of symptoms were responsible for many, if not all, concomitant improvement in psychosocial functioning (Hirschfeld et al., 2002; Vittengl, Clark, & Jarrett, 2004).

In similar circumstances, different people respond in different ways, and some end up succumbing to the depressive state as others exceed difficulties adaptively. In the latter case, we consider the presence of a personal trait,. This concept is defined as a dynamic psychological process that protects the individual from negative life events (Rutter, 1987), and through which a positive adaptation is achieved in the context of adversity (Luthar, Cicchetti, & Becker, 2000). It connotes strength of will, competence, optimism, flexibility and the ability to deal positively and recover when confronted with adversity and challenges (Wagnild & Collins, 2009). Rather than being viewed as an invariable trait that a person has or has not, resilience can be thought of as a part of normal healthy development that can be improved over time (Jackson, Born & Jacob, 1997). This capability is specific to each stage of development, is influenced by risk factors and protective factors in the person and the environment, and also contributes to the maintenance and improvement of health (Tusaie, Puskar & Sereika, 2007). In recent decades, interest in protective factors and the resilience construct has increased substantially. This increase has been driven by the possibility of identifying protective factors and mechanisms to prevent the development of psychiatric disorders such as depression (Hjmendal, Aune, Reinfjell, Stiles, & Friborg, 2007). There have been many protective factors identified as potential modulators of individual resilience, like cognitive factors such as reframing skills, problem solving skills, optimism, good intellectual abilities, good resourcefulness in seeking social support, and others; and environmental factors such as fewer negative life events, successful background, positive linking between parents and children, participation in school activities or expansion of the support system beyond the family environment (Werner & Smith, 1992 Tusaie, 2007, Rutter, 1993 Tusaie, 2007, Geanellos, 2005; Scheir & Carver, 1987).

Problem Statement, research question and purpose of the current study

The identification of risk factors for depression is essential to determine who should be a target for intervention. Also, there is a great need to understand the impact of depression and its treatment in functioning, given the evidence of the profound effect that ties them. Being known that even moderate depressive symptoms and subclinical depressions result in functional impairment and reduced quality of life (Gotlib, Lewinsohn, & Seeley, 1995; Judd, Akiskal, & Paulus., 1997; Judd et al., 2000; Judd Paulus, Wells, & Rapaport, 1996), and that residual depressive symptomatology untreated may result in a higher likelihood of relapse in Major Depression (Solomon et al., 2008), both clinicians and researchers need to broaden the focus of treatment, to equally include the specific symptoms of depression, and the consequences of functional impairment (Greer et al., 2010).

Taking into account the magnitude of the consequences and repercussions of the above mentioned variables, with regard to psychological well-being and quality of life, the following objectives for this study are established: 1) assess Resilience and its relationship with Depressive Symptomatology; 2) study the relation between Psychosocial Functioning, and each of its areas, with Depressive Symptomatology; and 3) explore the moderating effect of the Psychosocial Functioning, and each of its areas, in the relationship between Resilience and that Symptomatology.

Research Methods

Findings

Analyses of the moderation effects

Hierarchical multiple regression analyses were made to ascertain if PF has a moderating effect in the relationship between Resilience and Depressive Symptomatology. Since gender, when controlled, proved to be a significant variable, separate analyses were made for each sex.

Total Psychosocial Functioning as moderator

In boys, as can be seen in Table 3, there was a significant interaction between PF and Resilience (β = .137, p = .050), although the former does not prove, in itself, significant (β = -. 001, p = .993). Resilience revealed to be significant (β = -. 596, p <.001). In girls, both the predictor variable (β = -. 636, p <.001) and the moderator (β = .176, p <.001) proved to be significant, but the interaction between the two did not reach statistical significance (β = -. 061, p = .170).

See Full Size >

See Full Size >

Figure 1 graphically represents the moderation found. The negative slope of the regression lines for the different levels of PF can be observed, which reveals one of the main effects. Thus, the more resilient adolescents are, the less depressive symptomatology they report. The moderating effect occurs for the various levels of PF, but is more significant at the highest level (as can be seen by the steeper slope line at that level). This means that a good PF potentiates the effect of the Resilience in the reduction of Depressive Symptomatology. Since PF revealed to be not significant (β = -.001, p = .993), the differences observed in this variable, at the lower levels of resilience, are not relevant.

Conclusions

In literature, studies that include Resilience and Depressive Symptomatology variables, appear to be consensual regarding the effect of the former over the latter. Resilience and Depressive Symptomatology are negatively correlated, that is, more Resilience means less Depressive Symptomatology (e.g. Wagnild & Young, 1993; Wagnild 2008 Wagnild & Collins, 2009). In this study, Resilience also proved to be a strong predictor of Depressive Symptomatology, in the negative direction.

Regarding Psychosocial Functioning (PF), most studies that connect it to Depressive Symptomatology refer to the impact of that symptomatology on functioning, referring that the first negatively affects the second, that is, higher levels of Depressive Symptomatology are associated with a worse PF (e.g. Weissman et al., 1999; Judd et al., 2000; Field et al., 2001; Hirschfeld et al., 2002; Judd et al., 2008;. Lewinsohn et al., 2003; Vitiello et al., 2011). However, knowing that PF similarly influences depressive symptomatology, there are already studies evaluating this relationship, which demonstrate that a poor PF is also a significant predictor of depressive symptomatology (e.g. Goldstein et al., 2009; Lewinsohn et al., 1998; Solomon et al., 2008). These studies consider PF as a whole, but others consider its specific areas. For example, Chen & Li (2000) and Fröjd. (2008) studied community samples of adolescents and found that depression was associated with difficulties in school performance. As for family relationships, a study of an adolescents’ sample revealed that there is a significant negative relationship between depression and satisfactory relations with their mother, father, and family unity (Mueller, Bridges & Goddard, 2011). Greca & Harrisson (2005) studied the association between relationships with peers and Depressive Symptomatology also during adolescence, in a community sample, and concluded that poor relationships with peers predict depressive symptomatology. As for recreational activities, a longitudinal study of a sample of adolescents revealed that leisure activities, including physical activity, and depressed mood co-vary inversely during adolescence (Birkeland, Torsheim & Wold, 2009). A study by Rissanen. (2011), which examined the relationship between satisfaction with life and depressive symptoms in a sample of the general population, concluded that the two variables are significantly related, and that poor satisfaction predicts worse depressive symptomatology and worse mental health.

In the present study, we considered the effect of PF as a whole, as well as each of its areas. The PF total score proved to be a significant predictor of Depressive Symptomatology, which is consistent with previously reported findings (e.g. Goldstein et al., 2009; Lewinsohn et al., 1998; Solomon et al., 2008). Family Relations (FR) and Satisfaction (S) with life also proved significant in predicting Depressive Symptomatology. These data are in line with the results obtained in other studies (e.g. Mueller, Bridges & Goddard, 2011; Rissanen et al., 2011). As described by Fröjd. (2008) and Chen and Li (2000), a significant relationship between School Performance (SP) and Depressive Symptomatology was found. Similarly, significant relationships between Relationships with Friends (RF) and Depressive Symptomatology and between the Recreational Activities (RA) and Depressive Symptomatology were found, replicating the results found by Greca & Harrison (2005) and Birkeland, Torsheim & Wold (2009). There were also found significant differences between genders, for some variables investigated in this study. With regard to Resilience, boys showed higher scores, replicating Tusaie. (2007) results. As for Depressive Symptomatology, girls exhibited higher values, in accordance with previous studies (Essau et al., 2010; Galambos et al., 2004; Saluja et al., 2004). In the RF and S variables, girls had also higher values. However, it should be noted that in variables measured by A-LIFE, higher scores are equivalent to a worse functioning. In the other variables, no significant differences between genders were found.

Regarding the interactions analyses, several significant results were found, revealing the presence of moderating effects of PF, or its areas, on Resilience, in the prediction of Depressive Symptomatology. There were some interesting results concerning gender differences, as certain variables had a moderating effect on Resilience in just one gender. One of these cases was the total PF, which only revealed to be a significant moderator of Resilience in males. In this case, a good PF acted as an enhancer of Resilience. So, having better scores on PF seems to function as a protective factor regarding Depressive Symptomatology. Correspondingly, poorer PF may be a risk factor for the development of Depressive Symptomatology. These results show that a good PF enhances the impact of Resilience in Depression, although in this study, this was only significant for males.

Contrarily to PF total score, SP significantly moderated Resilience for females only, potentiating the effect of Resilience, in the prediction of Depressive Symptomatology, especially in its lower levels. So, in lower levels of Resilience, better SP corresponds to lower Depressive Symptomatology; in higher levels of Resilience, this difference is no longer noticeable. Thus, a good SP arises as a possible protective factor from depression, although only for females.

The FR variable revealed also to be moderating Resilience, only in females. Its effect is similar to that of SP, acting as an enhancer of Resilience on Depressive Symptoms, especially at Resilience’s lower levels. Thus, those with the lowest degree of Depressive Symptomatology are the female teenagers who are more resilient and simultaneously refer better family relationships. Good FR alone seems to also function as a protective factor regarding Depressive Symptomatology. These results relate only to females, and conclusions cannot be drawn for the male gender.

The S variable, which corresponds to the adolescent’s overall satisfaction with life, proved to be a moderator of Resilience in both genders. The moderator variable has a potentiating effect on Resilience, which becomes quite evident in the lower levels of this variable, i.e., teens who are less resilient but have a high S, show significantly less Depressive Symptomatology than teenagers with poor resilience and low S. Thus, young people who have a lower degree of Depressive Symptomatology are those which exhibit a higher degree of resilience and simultaneously a good satisfaction with life. S arises, then, as another possible protective factor against Depression.

The RF and RA variables were not moderators of Resilience for any gender, and so, there appears to be no significant interaction between each of them and Resilience. However, they may still be possible protective factors regarding Depressive Symptomatology in adolescents, since the analysis of the correlations between the variables showed that both are associated with such symptoms in a statistically significant manner.

Considering that a good PF helps maintain improvements during the recovery of Depressive Symptomatology and, likewise, an improvement in the depressive state also helps improve functioning, it is important to develop not only strategies to prevent and recover from Depressive Symptomatology, but also specific strategies to improve and promote PF and its specific areas, as well as Resilience skills, such as self-compassion, acceptance or optimism.

This research, which studies the moderating effect of PF (and their areas) in the relationship between Resilience and Depressive Symptomatology of adolescents, is an important and completely innovative contribution, since there are no other studies to consider these same variables. However, there are some limitations that should be referred and taken into account when interpreting its results. The sample, though not balanced in gender, is representative of what is found in Portuguese schools, where most students are females. However, it’s concentrated in specific geographical areas of the country. Another limitation relates to the difficulty in controlling variables that can influence responses of subjects and consequently the results, namely, social desirability, fatigue or lack of motivation. These variables may have influenced subjects’ responses, as it was asked of them to fill out an extensive battery of questionnaires, part of the research project in which this study was integrated. Also the fact that is was applied in a group setting may have been counterproductive, because it naturally causes greater inhibition or distraction. Finally, being a study of transversal nature, we cannot arrive at conclusions regarding the causal relationship between these variables.

It would be important, in the future, to replicate this study in clinical samples and wider community samples, more representative of the population. Furthermore, longitudinal studies would allow to verify variations of Depressive Symptomatology over time, and experimental studies would facilitate the understanding of the causal relationships between these variables.

Acknowledgements

would like to express our gratitude to all the participants, to FCT that funded the study by ERDF – European Regional Development Fund through the COMPETE Program (operational program for competitiveness) and by National Funds through the FCT – Fundação para a Ciência e a Tecnologia (Portuguese Foundation for Science and Technology) within the project “Prevention of depression in Portuguese adolescents: efficacy study of an intervention with adolescents and parents” (PTDC/MHC-PCL/4824/2012) and to the Realan Foundation (USA) that currently funds the project.

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