On May 14, 1996, a 15-year-old middle school student shot his
bus driver in the leg, forced all the students off the bus and
led police on a high speed chase through a residential neighborhood
in Salt Lake City. The chase ended when the boy shot himself
right before crashing the school bus into the family room of
a house. The boy, dressed in a cowboy hat and poncho, was holding
the obituaries of two recently deceased classmates (Horiuchi,
et al., 1996).
One month earlier across town, Caz and Joey, bright, popular
high school students were lab partners in honors physics class.
One morning, after a fight the night before with his father,
Caz was found dead, hanging from a pipe in the basement. Two
weeks later, Joey ran his car into a cement barrier wall at
70 miles an hour, killing himself instantly.
Depression During a Unique Period of Development
depression effects one in fifty school children. Countless others
are effected by milder cases of depression which may also effect
school performance (Lamarine, 1995). The peak age of depression
correlates with the peak years of low self-esteem. Feldman &
Elliot (1990) write that the prime period for low self-esteem
is early and middle adolescence with a peak period between the
ages of thirteen and fourteen.
The suicide rate in teenagers has quadrupled in the last quarter
century making it the 3rd leading cause of adolescent death
in the nation. In Utah, it is the number one cause of death
in for individuals 15 - 44 years old (Wagner, 1996). A high
school with a population of 2,000 students can expect 50 attempted
suicides per year (Kahn,1995). And yet depression and other
affective disorders continue to be an area primarily ignored
by the public schools.
One of the factors that makes depression so difficult to diagnose
in adolescents is the common behavior changes that are normally
associated with the hormonal changes of this period (Lamarine,
1995). It has only been in recent years that the medical community
has acknowledged childhood depression and viewed it as a condition
which requires intervention.
History of Adolescent Depression
Historically, children were not considered candidates for depression
(Whitley,1996). Mostly because of Freudian notions about the
unconscious, depression had been viewed as a condition which
only effected adults. Today, childhood depression is widely
recognized and health professionals see depression as a serious
condition effecting both adolescents and young children (Whitley,
1996; Lamarine, 1995).
Views on adolescent depression have changed significantly even
since the 1970's where childhood depression was thought to be
masked by other conditions (Kahn, 1995). The debate continues,
even today, as to whether other childhood and adolescent behaviors
are simply "masks" for childhood depression.
Fritz (1995), writes that depression may often be seen in physical
ailments such as digestive problem, sleep disorders or persistent
boredom. Lamarine (1995), considers that in children, 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 (Burford, 1995).
Other writers prefer to move past the philosophy of masked depression
and view adolescent depressive symptoms as similar to those
of adults (Kahn, 1995; Sanford, 1996; Fritz, 1995; Rao, 1994).
Along with a reconsideration of depression in children, mania
and bipolar disorder (manic-depression) are being added to the
acceptable list of childhood and adolescent conditions. The
symptoms of mania in children or adolescents consist of euphoria
along with extreme anger and rage. Mania or manic-depression
may also be misdiagnosed and treated as a masking condition
such as and ADHD (Whitley, 1996).
Symptoms of Depression and Low Self-esteem
to some research (Fritz, 1995) about 5% of adolescents suffer
from depression symptoms such as persistent sadness, falling
academic performance and a lack of interest in previously enjoyable
tasks. In order to be considered major depression, symptoms
such as suicidal thoughts, lack of appetite and loss of interest
in social activities must continue for a period of at least
two weeks (Arbetter, 1993).
Research has also found a correlation between major depression
in adolescence and the likelihood of depression in young adulthood
(Rao, 1994). Not only were most depressed adolescents depressed
adults, but serious social adjustment problems plagued these
individuals as they moved into adulthood. And there is evidence
that depression in adolescents is likely to repeat itself within
a year or two. In fact, two-thirds of depressed teens will be
depressed again during their teenage years (Sanford, 1996; Fritz,
One of the chief differences between adult and adolescent depression
is that depression in adolescents usually involves more social
and interpersonal difficulties which directly leads to self-esteem
problems. Adolescents are also more likely to idealize suicide
as a solution to feelings of helplessness. Adolescents may also
socially isolate themselves when depressed out of feelings of
guilt. Dramatic behaviors such as aggression and an obsession
or fascination with death often accompany their depression (Lamarine,
Adolescent problems that correlate with low self-esteem include
depression, unsafe sex. criminal activity, and drug abuse. (New
model 1995). Educators and schools can be ideal scouts for depression
in adolescents. Since depression often results in lower academic
performance, behavior problems, and poor socialization, schools
are often the best place to observe all these symptoms (Lamarine,
Causes and Correlations of Depression
Causes of depression number almost as high as symptoms of depression.
There appears to be a genetic factor to depression. Families
with a history of depression often exhibit the symptoms during
adolescence (Fritz, 1995). And depressed children frequently
come from parent who have been depressed. Besides genetic predispositions
to depression, social skills deficits may also contribute. These
social skills deficits are harder to determine as it is difficult
to find whether the inability to form good social skills causes,
or results from the depression (Lamarine, 1995). Sexual orientation
adjustment problems have also been linked to depression, especially
in communities with strong social pressures. A study in currently
underway with the Utah Department of Health to study the link
between homosexuality and adolescent suicide (Wagner, 1996).
Coincidently, the peak age of depression and low self-esteem
coincides with the transition from elementary to junior high
school. This age may have an inability to deal with the new
social demands as well as academic demands of a new school (Feldman
& Elliot, 1990; Eccles, et. al., 1993).
There appears a relationship between latch-key kids and depression.
Unsupervised adolescents are more prone to substance abuse,
risk-taking,depression, and low self esteem (Richardson, et.
al., 1993). One of the factors that correlates with recurring
depression is a negative relationship between adolescents and
their fathers along with an inability of the mothers to monitor
behavior (Sanford, 1996).
There is an negative correlation between depression and athletic
participation. Although adolescents that participate in athletics
do not show a decrease in drug use, they do exhibit significantly
less depression and suicidal tendencies (Oler, 1994).
Depressed adolescents with a history of sexual abuse have a
higher incidence of posttraumatic stress disorder, but no increase
in the severity of depression symptoms nor tendency for suicide
(Brand, et. al., 1996).
Another factor associated with adolescent depression and negative
behaviors is difficulty in establishing autonomy in the adolescent's
relationship with parents.
Adolescent depression is seen in higher frequency in families
where the children have difficulty establishing their own identity
because of negative communication patterns and other dysfunctional
family attributes (Allen, et. al., 1994).
One topic that permeates the research on depression is the concept
of self- esteem. There has been a long standing correlation
between low self-esteem and depression. The views on self-esteem
are changing more rapidly than even the views on depression.
The traditional thinking with self-esteem was if one could improve
the way an individual perceived him or herself, then the secondary
behaviors that accompany low self-esteem would disappear (New
model, 1995). This traditional philosophy is taking a new direction.
Relationship of Depression to Self-esteem
There is a strong correlation between a person's emotional reactions
and their involvement in social relationships. Therefore, to
increase one's self-esteem, one needs to improve one's standing
in interpersonal relationships rather than trying to fix some
perception about themselves. Research has shown that it doesn't
have to be the actual rejection of a person by a social situation,
it can simply be the imagined or anticipated rejection. (At
New research indicates that the behaviors are not the result
of low self-esteem, but rather the result of social rejection
which leads to low self-esteem. In other words, self-esteem
does not cause a person to behave a particular way, it is the
result of poor social relationships (New model, 1995; Rao, 1994).
and self-esteem may be viewed as a vicious cycle. The inability
to relate positively in social situations may lead to low self-esteem
which leads to depression. The depression then leads to further
inability to relate with others or be fully accepted in social
groups which then adds to the feelings of low self-esteem (Davila,
et. al., 1995).
This research opens a new area of study into the relationship
between depressed people and their environment. Following Bronfenbrenner's
(1986) notion of the mesosystem model of interactions, the relationships
between an individual and the various environments of influence,
must be considered just as important as the individual's self.
Since poor interpersonal problem solving skills lead to higher
levels of depression, which in turn leads to more interpersonal
difficulties, one may argue that teaching problem solving skills
is the intervention solution. However, there does not appear
to be a relationship between adolescent cognitive problem solving
abilities and interpersonal skills. Therefore, one could conclude
that it is not that adolescents do not know how to solve problems
but they lack the desire or willingness to use those interpersonal
skills (Davila, et. al, 1995).
Feldman and Elliot (1990) report that there is a direct relationship
between the perception of social success and self-esteem. This
success may include confidence in appearance, academic ability,
athletic ability, and social belonging. Self-esteem is then,
a barometer of how well one is doing socially. It monitors the
acceptance level of the people and groups in the surrounding
environment. Similar to Maslow's hierarchy of needs (Huffman,
et. al.,1994), this new theory supports the idea that people
seek a certain amount of social acceptance and belonging which
will take precedence over other factors such as self-actualization
(New Model, 1995; At last, 1995).
Other factors effect depression and other affective adolescent
problems. Parental influences on self-esteem are reported by
Feldman and Elliot (1990) who find that parents who model openness
and acceptance of new ideas can have a positive effect on their
child's self-esteem. Other parental factors include encouragement
for children to form their own view points, as well as a secure
family relationship to form a basis for exploration.
Transition from elementary to junior. high school or from junior
high to senior high increases feeling of low self-esteem. Students
who do not make such a change in school have a reduced incidence
of low self-esteem. Unfortunately, some students, particularly
females, do not recover from this low self image in later adolescence
(Feldman & Elliot, 1990).
Competition is a popular blame agent for low self-esteem. It
is easy for an adolescent to interpret a competitive loss with
failure, thereby damaging self-esteem. Not only does competition
damage self-esteem, it hinders interpersonal relationships.
Instead of being a demonstration of strength and confidence,
competition is a show of insecurity (Kohn, 1993). Competition
may be viewed as a disservice by educators who should be improving
the adolescent's ability to relate well with others. Instead,
this spirit of competition held in many school activities serves
to block healthy communication. Regarding competition in schools,
Kohn writes, "Kids face it all the time in an award assembly,
an event usually held in school auditoriums that instantly transforms
most people present into losers" (p.1).
Competition implies comparisons which should be eliminated from
parenting for the sake of self-esteem, according to Evitt (1990).
Rather than make comparisons between children, which makes the
child feel inferior, parents should acknowledge and encourage
the natural differences found in individuals.
Self-esteem has also been linked to problem solving skills.
Lochman, et. al., (1993), studied the relationship in aggressive
adolescent boys and their social problem solving skills. The
study was based on the idea that exhibited behaviors are the
result of a person's goals and their expectation that their
behavior will lead to that goal.
Goals set by socially unpopular adolescents tend to focus on
non-social goals involving peer relations. As might be expected,
aggressive adolescents value dominance and revenge over affiliation.
These adolescents had a higher incidence of depression, which
points to lack of self-esteem. Interestingly, while popular
students were very clear in their goals of affiliation, non-popular
students were unclear in their goals. While unpopular students
ranked dominance and revenge higher, they also indicated a significant
value for affiliation. This leads researchers to conclude that
aggressive, or unpopular children have greater internal conflict
than popular children.
This creates difficulty in social negotiations, leading to low
self-esteem, leading to depression. These researchers (Lochman,
et. al., 1993) suggest that intervention should include helping
problemed adolescents find more socially acceptable strategies
for problem solving which will enable them to reach their personal
Various therapies have been used with adolescent depression.
Psychoanalytical therapies target the unconscious conflicts
resulting in the depression. Behavior therapies design reinforcement
programs to change behavior patterns. Cognitive therapies look
to improve and examine metacognition and increase more positive
thought patterns (Lamarine, 1995).
Unfortunately it is harder to medically treat adolescent depression
than adult depression because adolescents are less likely to
respond to the medication (Fritz, 1995). Therefore, alternative
treatments such as counseling have proven more successful. Physicians
will prescribe anti-depressant medication to a depressed adolescent,
but if that child appears suicidal, a psychological counselor
will also become involved (Burford, 1995).
Many schools have targeted depression by teaching students coping
strategies for stress. These programs are most effective with
those students that are at-risk for depression (Lamarine, 1995).
School administrators and teachers feel that although courses
may be offered for the adolescents themselves, the more successful
programs are those that are taught to parents for working with
adolescents in their own homes (Evitt, 1990). An important factor
in preventing depression is a positive relationship with parents.
This is especially important in early adolescence (Sanford,
Hindering solution strategies, is the stigma that remains attached
to mental health problems, especially for youth. This makes
it difficult for educators to consider emotional problems as
a cause for poor academic performance (Lamarine, 1995). It is
important however, to recognize the signs of adolescent depression
early, before the depression interferes with the child's interpersonal
relationships which will ultimately affect self-esteem.
According to Evitt (1990) self-esteem classes are one of the
most popular topics for parenting classes. Nationally, task
forces are calling for more parent workshops and classes on
how to improve the self-esteem of children. Based on the idea
that parents have a more powerful impact on children than the
schools, many of these programs are being offered at convenient
times for parents such as evenings or lunch hours.
Other intervention programs have attempted to increase self-esteem
through exercise. Depression has been reduced through the improvement
of body image that comes with exercise. Exercise can be particularly
beneficial if it is through a non-competitive sport such as
swimming (West, 1993).
Other programs are aimed at improving children's self esteem
through music coupled with exercise. These programs not only
target improvement of self-esteem, but also an improvement in
interpersonal relationships (Foreman, 1993). By increasing a
person's interpersonal social skills, self-esteem improves (At
last, 1995). According to Evitt (1990), some ways parents can
improve self-esteem in their adolescent include improving communication,
limit setting and setting expectations, and nurturing a sense
of responsibility. To insure a sense of security in the home,
parents should set clear expectations and limits. To improve
responsibility, parents should determine all the tasks a child
is capable of doing and then insist on them doing them.
Apparently if self-esteem remains low, adolescents will seek
out groups in order to find a collective self-esteem. Discrimination
between these groups increases personal self-esteem. The greater
the need for group or collective self-esteem, the greater the
discrimination. Long, et.al. (1995), found that people with
particularly low personal self-esteem rely on group or collective
self-esteem more than those with high personal self-esteem.
It was shown that persons with high personal self-esteem discriminated
not only between their group and others, but also within their
own group, as whole group competitions may rely on attributes
often out of the individual's control. Conversely, individuals
with low personal self-esteem discriminate very little within
their own group, as they depend on the collective self-esteem
of their group to compensate for their weakness. Perhaps then,
gang membership is a positive step toward reducing depression
in persons with low self-esteem. The only real difference between
belonging to a gang and belonging to an athletic team is the
To effectively target adolescent depression, schools need to
target self-esteem. The approach to improving self-esteem should
be different from the traditional view of individualized pep
talks. Self-esteem can only be improved when the environment
in which the person lives improves -- improvement, in terms
of interpersonal skills and social acceptance. Those adolescents
with particularly low self-esteem need to have the opportunity
for belonging. A collective self-esteem through group and team
membership can be especially helpful for persons whose family
environment lacks the acceptance and support necessary for healthy
The junior and senior high schools need to continue to examine
the isolation created by these large impersonal institutions.
We are subjecting all adolescents to these places at a time
when belonging, community, and interpersonal skills are so critical
and imperative. The damage that can be done at this age may
be long lasting and permanent, even deadly.
F. Nunley is an educational psychologist, author, researcher
and speaker living in southern New Hampshire. Developer of the
Layered Curriculum® method of instruction, Dr. Nunley has
authored several books and articles on teaching in mixed-ability
classrooms and other problems facing today's teachers. Full
references and additional teaching and parental tips are available
Allen, J., Hauser, S., Eickholt, C., Bell, K. & O'Connor,
T. (1994). Autonomy and relatedness in family interactions as
predictors of expressions of negative adolescent affect. Journal
of Research on Aolescence, 4, 535-552.##
Arbetter, S. (1993). Way beyond the blues. Current Health, 20,
last -- a rejection detector! What to do when you find yourself
running low on self-esteem. (1995). Psychology Today, 28, 46-51.##
E., King, C., Olson, E., Ghaziuddin, N. & Naylor, M. (1996).
Depressed adolescents with a history of sexual abuse: diagnostic
comorbidity and suicidality.##
of the American Academy of Child and Adolescent Psychiatry,
U. (1986). Ecology of the family as a context for human development:
Research perspectives. Developmental Psychology, 22, 723-742.##
S. (1995). What's wrong with this 12-year-old boy? Patient Care,
J., Hammen, C., Burge, D., Paley, B., & Daley, S. (1995).
Poor interpersonal problem solving as a mechanism of stress
generation in depression among adolescent women. Journal of
Abnormal Psychology, 104, 592-601.##
Eccles, J., Midgley, C., Wigfield, A., Buchanan, C., Reuman,
D., Flanagan, C., & MacIver, D. (1993). Development during
adolescence. American Psychologist, 48, 90-101.##
M. (1990, February 19). The self-esteem team. San Jose Mercury
News, p. 1L.##
S. & Elliott, G. (1990). Adolescence: Path to a productive
life or a diminished future? Carnegie Quarterly, 35, 1-13.##
A. (1993). The M&M diet: Building self-esteem through music
and movement. American Fitness, 11, 46-48.##
Fritz, G. (1995). Child, adolescent depression distinct from
the adult version. The Brown University Child and Adolescent
Behavior Letter, 11, 1-3.##
V., Good, J., & Kapos, K. (1996, May 15). He was really
a good kid: Did deaths of two students push busjacker over the
edge? The Salt Lake Tribune, pp. A1, A5.##
Huffman, K., Vernoy, M. & Vernoy, J. (1994). Psychology
In Action (3rd ed.). New York: John Wiley & Sons. p.423.##
Kahn, J. (1995). Adolescent Depression: An overview. (Available
from the University of Utah Neuropsychiatric Institute, 501
Chipeta Way, Salt Lake City, Utah 84108).##
Kohn, A. (1993). Competition damages childrens' self-esteem.
The Brown University Child and Adolescent Behavior Letter,9,
R. (1995). Child and adolescent depression. Journal of School
Health, 65, 390-394.##
Lochman, J., Wayland, K., & White, K. (1993). Social Goals:
Relationship to adolescent adjustment and to social problem
solving. Journal of Abnormal Child Psychology, 21, 135-151.##
Long, K., Spears, R. & Manstead, A. (1994). The influence
of personal and collective self-esteem on strategies of social
differentiation. British Journal of Social Psychology, 33, 313-329.##
New model revises role of self-esteem. (1995, November). The
Addiction Letter, 11, 5.##
M. (1994). Depression, suicidal ideation, and substance use
among adolescents: Are athletes at less risk? The Journal of
American Medical Association, 272, 781-785.##
Rao, U. (1994). Adolescent depression may lead to depression
later in life. The Brown University Child and Adolescent Behavior
Letter, 10, 3.##
J., Radziszewska, B., Dent, C., & Flay, B. (1993). Relationship
between after-school care of adolescents and substance use,
risk taking, depressed mood, and academic achievement. Pediatrics,
Sanford, M. (1996). Which teens will still be depressed a year
later? The Brown University Child and Adolescent Behavior Letter,
N. (1996, May 8). Tracing history of suicides may aid prevention.
The Salt Lake Tribune. pp. A1, A4.##
M. (1993). Staying afloat: How sports like swimming influence
self-esteem. American Fitness, 11, 24-26.##
G. (1996, March). The seductive diagnosis. D Magazine, 84-99