Children’s and adolescents’ conceptualisations of depression

Abstract

While there is extensive research on adult conceptualisations of mental illness, as well as on children’s understanding of physical health and illness, research on children’s conceptualisations of mental illness is limited. The primary aim of this thesis is to provide a detailed account of children’s and adolescents’ conceptualisations of depression. In the first study, individual semi-structured interviews with primary school pupils (N=105) from two age groups (mean ages: 8.9 and 11.8 years) were conducted, with the use of depression and control vignettes, to elicit children’s depression concepts, help-seeking intentions and desired social distance. Children’s depression conceptualisations were organised according to the common-sense model of illness representations (CSM). Quantitative content analysis was performed to allow for descriptive analysis; in turn, inferential statistics were used to examine age, gender and self-reported direct and indirect experience differences. Children differentiated between depression and control vignettes, however did not spontaneously label depression or recognised the mental health nature of difficulties. Children provided a wide variety of possible causes that reflected common risk factors for depression, primarily referring to interpersonal factors. Children considered negative consequences of untreated depression, and identified that depressed characters need help. They suggested numerous sources of help, which were mainly informal. Children considered depression to be curable and would seek help primarily from parents if depressed. Older children showed more sophisticated conceptualisations of depression. No substantial gender or experience differences were found. Subsequently, a single session school-based mental health literacy intervention on adolescent depression, adapted from an intervention created by NHS mental health professionals, was developed, using the mental health literacy and CSM frameworks. The second study consists of a pilot evaluation of the intervention, using a controlled before and after design, to examine the effect of the intervention on young people’s depression literacy, help-seeking and help-providing intentions as well as social distance. Young people’s depression literacy was measured by the Adolescent Concepts of Depression Questionnaire (ACDQ), developed for the purposes of this study. Exploratory factor analysis was conducted to indicate the factor structure of the ACDQ, which was in turn used to examine participants’ baseline depression literacy and the effect of age, gender, current depressive symptomatology and direct/ indirect experience with depression and other mental illness (Study 2a). In turn, the effectiveness of the intervention is presented (Study 2b). 339 adolescents (mean age: 13.4 years, 168 female) were allocated to either the intervention (N=171) or a control group (N=168), and completed the ACDQ one week before and following the intervention. Mixed results were found for gender, depressive symptoms and experience differences. Mixed ANOVA was conducted between time and group; the results show that the intervention was effective in informing young people’s depression literacy (ACDQ total score), and specifically in young people’s knowledge of treatment options for depression (treatment subscale), perceived curability of depression (curability subscale), symptom recognition, help-seeking and help-providing intentions. No significant improvements were found for social distance, perceived helpfulness of sources of help, and two of the ACDQ subscales. The contribution of this thesis lies upon the detailed examination of children and adolescent depression conceptualisations, adding to the limited evidence base, especially in children’s mental health literacy. The pilot evaluation of the intervention is promising, and upon re-evaluation could be standardised and implemented in Scottish schools. Implications for clinical practice and mental health literacy are also discussed.