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Your use of the JSTOR archive indicates your acceptance of the Terms & Conditions of Use, available at https://about.jstor.org/terms is collaborating with JSTOR to digitize, preserve and extend access to Journal of Health and Human Services Administration This content downloaded from 154.59.124.208 on Mon, 10 May 2021 17:40:30 UTC All use subject to https://about.jstor.org/terms COMMON RISK FACTORS ASSOCIATED WITH ADOLESCENT AND YOUNG ADULT DEPRESSION SWENDA MOREH HENRY O'LAWRENCE California State University, Long Beach, CA ABSTRACT Depression is one of the leading causes of disability for all ages and genders in the United States. Historically, depression had been viewed as a condition that only affected older adults; however, in recent years health professionals have recognized depression as a serious condition also affecting adolescence and young adults. The purpose of this study was to identify whether gender was a risk factor of depression within the adolescent and young adult population as literature shows that depression can impact growth and development, school performance, peer or family relationship and at times can be fatal. Data from the 2005-2006 National Health and Nutrition Examination Survey was studied to gain understanding into the predictive relationship between adolescent depression and gender. The hypothesis that gender is a predictive factor for depression in this population was supported. INTRODUCTION Everyone experiences unhappiness at some point throughout his or her life. Most often these feelings are a result of change due to various events such as growing older, illness, the loss of a family member, or the breakup of a relationship. The painful thoughts and feelings that accompany these events are usually appropriate, needed, and temporary, and can even present an opportunity for This content downloaded from 154.59.124.208 on Mon, 10 May 2021 17:40:30 UTC All use subject to https://about.jstor.org/terms 284 JHHSA FALL 2016 personal growth. However, when these feelings continue and impair everyday life, it may be an indication of depression. Severity, extent, and the manifestation of symptoms are the factors that distinguish normal sadness from depression (Torpy, 2006yf . Depression is a common psychological disorder that can alter a person's mood, physical functions and social interactions with several subtypes. Approximately 121 million citizens worldwide of all genders, ages, and backgrounds are affected with symptoms of depression (McMillian, 2011yf 3 H R S O H Z L W K G H S U H V V L Y H L O O Q H V V H V G R Q R t all experience the same symptoms but when untreated these problems can become chronic or recurrent and interfere with an individuals' everyday life. Depression is a medical illness that causes a persistent feeling of sadness and loss of interest. In fact, in the year 2012, WHO classified depression as the leading cause of disability for all ages and genders, which demonstrates the importance of understanding, diagnosing, and treatment of this illness (World Health Organization, 2012yf . Historically, depression has been viewed as a condition that only affected older adults; however, in recent years health professionals have recognized depression as a serious condition also affecting adolescence and young adults. It is estimated that about 10 to 15 percent of adolescence and young adults are depressed at any given time. Research suggests that one of every five young people will experience an episode of major depression during high school with the average age of onset being 14 years and one out of every four college students or adults (Heller, 2012yf . Five percent of those 9 to 17 years of age meet the criteria for major depressive disorder and 3 percent of adolescents have dysthymic disorder with the incidence of depressive disorders markedly increases after puberty (Bhatia & Bhatia, 2007yf . This content downloaded from 154.59.124.208 on Mon, 10 May 2021 17:40:30 UTC All use subject to https://about.jstor.org/terms JHHSA FALL 2016 285 Depression is one of the leading causes of morbidity and mortality in the world today and places a significant economic burden on society. It is among the most treatable mental disorders, yet it remains a chronic illness with 85yb of people who experience a single episode of depression experiencing another episode within 15 years (Gladstone, Beardslee & Erin, 2012yf . Most importantly, depression is known to increase the risk of suicide in adolescents. According to Halpem (2004yf V L Q F H W K H \ H D U V X L F L G H L V W K H W K L U G O H D G L Q g cause of death for adolescents accounting for approximately 2,000 lives or 12yb R I W K H D Q Q X D O G H D W K V L n this age group annually. Furthermore, the number of adolescent deaths from suicide in the United States has drastically increased during the past few decades. While the rates of completed suicide are low (1.5 per 100,000 among 10- to 14-year-olds and 8.2 per 100,000 among 15- to 19- year-oldsyf W K H U H D U H P D Q \ P R U H D W W H P S W D Q G V X L F L G D l ideations (Gould et al, 2003yf / H D U Q L Q J W K H U L V N I D F W R U V I R r depression and it's correlation and warning signs to suicide will go a long way toward prevention of both. STATEMENT OF THE PROBLEM Nevertheless, depression in adolescents and young adults are more often overlooked, misdiagnosed, or undetected in comparison to older adults, possibly due to the eminence of irritability and mood fluctuations within this age group. Various risk factors such as gender, psychosocial and family environment, or genetics disposition could increase the likelihood of adolescent or young adulthood depression (A.D.A.M Health Solutions, 2012yf 6 L Q F H G H S U H V V L R Q L V X Q G H U G L D J Q R V H G L W L V L P S R U W D Q t for professionals and parents to pay attention to any signs of depression amongst adolescent and young adults. Understanding high risk factors and targeting those This content downloaded from 154.59.124.208 on Mon, 10 May 2021 17:40:30 UTC All use subject to https://about.jstor.org/terms 286 JHHSA FALL 2016 individuals for prevention, intervention, and lifestyle changes could be the difference between life and death for some (Pereira, 2010yf . Purpose of the Study Depression is a complex condition that has no single cause; however, a combination of genetics, biologic, and environmental risk factors may increase the probability of acquiring the condition. Therefore, the purpose of this study was to examine gender and whether or not it is a determinant of depression in adolescents and young adults. Significance of the Study Adolescents and young adults struggling with depression often go unidentified, untreated, or mistreated; however, depression can impacts growth and development, school performance, peer or family relationships and at times can be fatal. Suicide is the most devastating outcome of depressive symptoms during adolescence and due to the alarming statistics the importance of understanding the signs and symptoms of depression and focusing on prevention efforts has become crucial (Bulhões et al., 2013yf 7 K H U H I R U H L W L V K R S H I X O W K D W W K L V V W X G \ Z L O O K H O p highlight whether gender is associated with depression in adolescence and young adults. LITERATURE REVIEW Adolescence is defined as the transitional stage of physical and mental development that occurs between childhood and adulthood. Adolescence is roughly considered to be the period between 13 and 18 years of age in which the youth experiences biological, social, and psychological changes. Whereas, young adulthood is roughly considered as the time from the end of adolescence at age 18 to age 21 in which an individual emerges into This content downloaded from 154.59.124.208 on Mon, 10 May 2021 17:40:30 UTC All use subject to https://about.jstor.org/terms JHHSA FALL 2016 287 young adult responsibilities. Many adolescents and young adults develop depression during these years as they try to make sense of the numerous changes that are occurring in their lives. According to the National Institute of Mental Health, (2010yf L Q R U \b of American adolescents or young adults are currently affected by symptoms of depression. Depression in adolescents and young adults is often difficult to identify and diagnose, as it is common for this age group to alter their moods or emotions. (Bhardwaj & Goodyer, 2009yf , W L V T X L W H W \ S L F D O I R U D W H H Q D J H U R U \ R X Q g adult to feel sad or overwhelmed by school, peers, or changes in their physical development. Although most teenagers or young adults may have some or all of these symptoms at some time or another, continued symptoms over long extended periods can be reason to believe they are suffering from depression. Common Forms of Depression Depression comes in many shapes and forms. In some, depression can persist at a low level for months and even years. In others, the symptoms are so severe that it can lead to suicide. Depression can be triggered or provoked by many factors including personal/ interpersonal events or hormonal changes (i.e. pubertyyf $ W D Q \ J L Y H Q W L P H X S W o 15 percent of adolescents and young adults have some symptoms of depression. Five percent of those, 9 to 17 years of age, meet the criteria for major depressive disorder and three percent of adolescents have dysthymic disorders, which are the two most common forms of depression in adolescents (Bhatia & Bhatia, 2007yf $ O W K R X J K E R W K I R U P s of depression have similar characteristics; the severity, frequency and duration of symptoms will vary depending on the individual and his or her particular illness. Healthcare professionals must distinguish between the two This content downloaded from 154.59.124.208 on Mon, 10 May 2021 17:40:30 UTC All use subject to https://about.jstor.org/terms 288 JHHSA FALL 2016 clinical forms of depression in order to diagnose and treat appropriately. Major depression (clinical depressionyf 0 D M R U G H S U H V V L Y e disorder is characterized by a combination of severe symptoms such as lack of interest in activities, strong feelings of worthlessness or guilt, and thoughts of suicide, that may disable or prevent a person from executing daily activities(A.D.A.M Health Solutions, 2012yf 6 \ P S W R P V R f depression must persist for over two weeks in order to be considered a major depressive episode. "Depression is one of the most prevalent mental disorders among adolescents and young adults, with approximately 20yb H [ S H U L H Q F L Q J D n episode of major depressive disorder during adolescents." (Cates, Feldman & Passero, 2007yf 6 R P H L Q G L Y L G X D O V K D Y e isolated episodes that are separated by many years without any depressive symptoms, whereas others have clusters of episodes, and still others have increasingly frequent episodes as they grow older. After the first episode of this disorder, there is a 60yb F K D Q F H R I K D Y L Q J D V H F R Q G H S L V R G H . After the second episode, there is a 70yb F K D Q F H R I K D Y L Q J a third, and after the third episode, there is a 90yb F K D Q F H R f having a fourth (Long, 201 1yf . Dysthymia (chronic/ mild depressionyf 7 K H * U H H N Z R U d dysthymia means "bad state of mind" or "ill humor." As one of the two chief forms of clinical depression, dysthymia disorder is characterized as a long-term (two years or greateryf I R U P R I G H S U H V V L R Q $ Q L Q G L Y L G X D l suffering from dysthymic disorder has fewer or less severe symptoms than major depressive disorder but experiences depressive symptoms more consistently and for longer periods of time. Although the symptoms are chronic, those who suffer from dysthymia are usually able to perform daily functions adequately but might consistently appear This content downloaded from 154.59.124.208 on Mon, 10 May 2021 17:40:30 UTC All use subject to https://about.jstor.org/terms JHHSA FALL 2016 289 unhappy or unmotivated (Harvard Health Publications, 2005yf . Symptoms of Depression Recognizing the symptoms of depression is often the biggest hurdle to the diagnosis and treatment of any form of depression. Unfortunately, many people who experience symptoms never do get diagnosed or treated for their illness, which in many cases has led to suicidal thoughts or life-ending events. According to Cates, Feldman & Passero (2007yf V \ P S W R P V W K D W D U H J H Q H U D O O y associated with major depressive disorder and dysthmia disorder include but are not limited to the following: loss of interest in activities, insomnia or excessive sleeping, poor appetite, impaired concentration, irritability/restlessness, persistent sadness or hopelessness, significant weight loss or gain, withdrawal from friends and family, fatigue or decreased energy, tearfulness or frequent crying, persistent aches or pains, feeling of worthlessness and guilt, or thoughts of death or suicide. Common Risk Factors Associated with Depression Gender. Epidemiological findings suggest that increases in depressive disorders are greater for girls than for boys during adolescence and young adulthood (Lewinsohn, Rohde & Seeley, 1998yf * H Q H U D O O \ W K H L Q F L G H Q F H R f depressive disorders noticeably increases as adolescence reach puberty. Puberty refers to the process in which a boy or girls sexual and physical characteristics mature. It is initiated by hormone signals from the brain, which stimulate the growth, function and transformation of variance body parts including the reproductive organs. By 14 years of age, depressive disorders are more than twice as common in girls as in boys possibly because of differences in coping styles during puberty (Bhatia & Bhatia, 2007yf . This content downloaded from 154.59.124.208 on Mon, 10 May 2021 17:40:30 UTC All use subject to https://about.jstor.org/terms 290 JHHSA FALL 2016 Girls are more likely than boys to begin going through puberty before or during the transition to secondary school making it a more stressful transitional period. At puberty, girls' attitudes regarding their physical appearance often become more negative, as it is difficult to adjust to a new body image. Body image is closely linked to self- esteem in women and body dissatisfaction is a risk factor for depression. Girls who enter puberty prior to their peers must also face additional stress of coping with the reaction of other to her development. They often tum to older woman for support and guidance which may isolate her from her own peers who are not experiencing the same social, psychological, and physical changes (Stice, Hayward, Cameron, Killen & Taylor, 2000yf . Hormonal changes that accompany women's developmental and reproductive processes may also play a role in depression. For some girls, the simple changeability of estrogen levels during puberty in adolescent years and possible pregnancy in young adulthood is sufficient to lead to depression (Studd & Panay, 2004yf + R U P R Q e fluctuations related to the menstrual cycles can also profoundly influence mood changes for many women. The symptoms associated with the menstrual cycle such as bloating, irritability, and fatigue might make some women feel distressed and lead to depression. For most adolescence, this transitional period is uncomfortable and often embarrassing. As they learn about their sexuality and experience the physical changes occurring to their bodies' adolescent girls avoid discussing their feelings with others, which results in separation or division from their everyday lives (Keenan & Hipwell, 2005yf . On the other hand, for adolescent boys the development experienced during puberty such as the deepening of the voice, development of facial hair, and refinement of muscles is welcomed by society. Adolescent boys embrace their self-image unlike girls and create a This content downloaded from 154.59.124.208 on Mon, 10 May 2021 17:40:30 UTC All use subject to https://about.jstor.org/terms JHHSA FALL 2016 291 social network that supports the changes they are experiencing which often continues on into young adulthood. However, this is not always the case for all, as some do not develop as quickly as their peers or have distorted body image which may be linked with elevated risk of depression (Blashill & Wilhelm, 2013yf ( Y H Q W K R X J h depression rates for adolescent girls are twice as high as those in adolescent boys, many boys are still affected by the condition. Unfortunately, depression in men can often be overlooked as many find it difficult to talk about their feelings or fear a falling of masculinity (Branney & White, 2008yf . Moreover, in Western societies, the mass media is typically regarded as the single strongest transmitter of unrealistic beauty ideals, and often held responsible for the high proportion of body dissatisfaction of young adolescents (Hargreaves & Tiggemann, 2003yf 7 K H P H G L a plays an enormous role in defining modern day beauty and manhood; however, for young adults and adolescents these messages can often convolute their understanding of reality. Due to the influence of the media, adolescence has been targeted as the most likely time for the emergence of body dissatisfaction. Body dissatisfaction, in the form of wishing to be thinner has now been demonstrated in girls as young as six years of age and is generally found to be greater for girls than boys. (Clark & Tiggemann, 2006yf $ s one enters into adolescent years and begins experiencing changes with their bodies may lead to less satisfaction with body image and physical appearance leading to depression. Family history of depression and traumatic childhood events. Children are a product of their environment. Many children are at high-risk for depression due to familial predisposition and exposure to adversity throughout their childhood. Those who are brought up in loving, caring, and supportive environments are more likely to behave that way This content downloaded from 154.59.124.208 on Mon, 10 May 2021 17:40:30 UTC All use subject to https://about.jstor.org/terms 292 JHHSA FALL 2016 as adults. Just as children who were brought up in abusive, un-stable, or negative environments tend to have behavioral or substance abuse problems. Approximately 15 million children in the United States grow up in a household where a parent has experienced one or more episodes of a major depressive disorder. (Parent, Forehand & Compas, 2013yf 5 H V H D U F h has proven that children of depressed parents are at greater risk to experience depression and have emotional and behavioral problems during their adolescent and young adult years (Diego, Sanders & Field, 2001yf 7 K R X J K S D U H Q W s often feel that their child's behavior is the source of their distress, in fact the child is actually often reacting to the patient's depression. Depressed parents experience difficulties in their parenting role and struggle to remain responsive to their children (O'Conner, 2006yf 3 D U H Q W V Z K o are depressed are often overwhelmed with their own lives and do not have the patience to help their children develop structure in theirs. Children without structured lives and responsibilities often feel lost or useless. They are unable to establish or accomplish goals and are unsure of the future. Depressed parents often expect their child to do well but never spend the time to develop a bond and partake in the establishment of a stable and structure environment to allow their child to prosper. Lack of support, disengagement, and minimal communication create negativity and an adverse relationship between parents and their children (O'Conner, 2006yf . Furthermore, according to O'Conner (2006yf , depressed parents have been found to be more tolerant, inconsistent and more likely to avoid confrontation, which impairs there parenting responsibilities. They engage in negative habits such as tobacco-use or alcohol-use and have a difficult time maintaining stable friendships or relationships. Furthermore, compared to non-depressed individuals, depressed individuals raise more negative This content downloaded from 154.59.124.208 on Mon, 10 May 2021 17:40:30 UTC All use subject to https://about.jstor.org/terms JHHSA FALL 2016 293 topics in conversation and are more likely to provoke negative emotions in others. Depressed parents spend their days with negative thoughts or emotions which are regularly passed on to their children. These interactions and outlooks during childhood are the foundation for adult life. Children begin to feel and portray the same characteristics as their parents, which increase their likelihood to experience depression as well (Davila, Stroud & Starr, 2010yf . Even the best of parents are unable to completely shield their children from events as they happen. There are many factors that may increase the chance of depression including traumatic events during childhood such as the loss of a loved one, exposure to violence, physical/sexual/emotion abuse, divorce, and many more. Children who experience traumatic events such as these tend to show signs and symptoms of depression during their adolescent and young adult age (Goodyer, Herbert & Tamplin, 1997yf & K L O G U H Q D E V R U E D Q G S U R F H V V H Y H Q W V M X V W D s adults do, though they may not be able to express their feelings as easy. The healing process after a traumatic event takes time; however, children are often powerless when they experience these events at a young age and begin to re-live them when they reach an older age increasing their vulnerability to develop depression. With high percentages of marriages ending in divorce in the United States, this has become one of the most common traumatic events children are experiencing. After nearly 30 years of research, there is a consensus in literature regarding the impact of parental divorce on depression in adolescence. From a child's perspective a single event is not what leads to divorce but rather a series of negative events or stressors such persistent family conflict, economic hardship, or family disorganization. These episodes often instill adverse feelings towards on parent and create an unstructured and chaotic environment This content downloaded from 154.59.124.208 on Mon, 10 May 2021 17:40:30 UTC All use subject to https://about.jstor.org/terms 294 IHHSA FALL 2016 for the child. Children often feel responsible for the yelling or arguments their parents have about them, which lead to feelings of hopelessness or depression (Aseltine, 1996yf . Substance abuse. According to Williams (201 1yf V X E V W D Q F e abuse by adolescents remains a major public health problem in the United States. Teenagers and young adults who suffer from depression are at greater probability of self-medicating by initiating substance use including: cigarette smoking, utilization of alcohol, and utilization of illicit drugs such as marijuana. The National Survey on Drug Use and Health, in an annual survey of approximately 45,000 participants aged 12 years or older, revealed that young adults often begin smoking cigarettes or engage in marijuana use within a year of their depression diagnosis and "that too often people tum to cigarettes or other substances to try to deal with their depression." (Substance Abuse and Mental Health Services Administration, 2007yf . Furthermore, according to Goldstein (2009yf V X E V W D Q F H X V e is twice as common among adolescents with depression (29.2yb \f compared with those without depression (14.5yb \f. For adolescents, the simultaneous presence of depression and substance use can create a health-related disadvantage that persists into young adulthood and that last through their lifetime. Chronic illness. A chronic illness or medical condition is a health problem that lasts for a prolonged period of time, is often incurable, and requires frequent medical interventions. (Compas & Jaser, 2012yf 7 K H V H F R Q G L W L R Q s can vary in severity from asthma, to diabetes, to cancer; however, any of these conditions can present children and their families with significant challenges and stressors. About 2 million adolescents (6yb R I S H U V R Q V D J H G 8 yearsyf L Q W K H 8 Q L W H G 6 W D W H V K D Y H D F K U R Q L F K H D O W K F R Q G L W L R n that results in limitation of daily activities or disability This content downloaded from 154.59.124.208 on Mon, 10 May 2021 17:40:30 UTC All use subject to https://about.jstor.org/terms JHHSA FALL 2016 295 (Neinstein, 2001yf $ G R O H V F H Q W V R U \ R X Q J D G X O W V Z K R K D Y H a chronic disease more likely than not are depressed and it is not difficult to understand why. The risk of chronic illness and depression increase with the severity of the illness and the level of life disruption it causes. People with chronic illnesses and depression often overlook the symptoms of depression and assume it is normal to feel sad due to the incurable condition. The symptoms that are caused by these chronic illnesses such as side effects of medication or pain due to surgical intervention create stressors such as limited activities or changes in physical appearance. Coping with these lifestyle changes are difficult for anyone; however, the risk of depression increases during adolescents and young adulthood since it is considered to be the healthiest time of life. Many adolescents and young adults begin feeling anger followed by feelings of depression. They try to comprehend why they have this chronic illness; often times making it difficult to pursue enjoyable activities, undermines self-confidence, and a sense of hope for the future. METHODOLOGY This study uses secondary data from the 2005-2006 National Health and Nutrition Examination Survey (NHANESyf W R D Q D O \ ] H W K H U H O D W L R Q V K L S E H W Z H H Q W K H V H W Z o variables. The NHANES program is designed to assess the health and nutritional status of adults and children in the United States with depression as one of the health topics examined annually. The National Health and Nutrition Examination Survey (NHANESyf L V D P D M R U S U R J U D P R I W K H 1 D W L R Q D l Center for Health Statistics (NCHSyf X Q G H U W K H G L U H F W L R Q R f the Centers for Disease Control and Prevention (CDCyf D Q d has the responsibility for producing vital and health This content downloaded from 154.59.124.208 on Mon, 10 May 2021 17:40:30 UTC All use subject to https://about.jstor.org/terms 296 JHHSA FALL 2016 statistics for the Nation. The NHANES program began in early 1960s and has been conducted as a series of surveys focusing on different population groups or health topics. In 1999, the survey became a continuous program that has a changing focus on a variety of health and nutrition measurements to meet emerging needs (National Health and Nutrition Examination Survey, n.d.yf . The Data The survey examines a nationally representative sample of about 5,000 persons each year from the ages of 12- 100 years old. The questions are asked by computer- assisted personal interviews and approximately 5yb R I W K e interviews are recorded and reviewed for quality control purposes. For the purpose of this study, the target population was adolescents and young adults; therefore, data from the NHANES depression screener survey was extracted only for participants from the ages of 13-21 years old resulting in a sample population of 2,199 participants. Furthermore, as part of the NHANES annual examination these participants were provided with a Depression Screener and asked to answer a series of symptom questions that are used most often in primary care settings to identify signs of depression. Findings from the depression screener survey outlined below in combination with the demographic and socioeconomic questionnaires will be used to determine the prevalence of depression in adolescent and young adults by gender. As part of the depression screener, responders were asked to rate each question utilizing the following scoring system: "0"- not at all, "1"- several days, "2"- more than half the days, or "3" - nearly every day. The questions that were asked during the depression screener interview are listed below. Over the last 2 weeks, how often have you been bothered by the following problems: This content downloaded from 154.59.124.208 on Mon, 10 May 2021 17:40:30 UTC All use subject to https://about.jstor.org/terms JHHSA FALL 2016 297 1. Little interest or pleasure in doing things? 2. Feeling down, depressed, or hopeless? 3. Trouble falling or staying asleep, or sleeping too much? 4. Feeling tired or having little energy? 5. Poor appetite or overeating? 6. Feeling bad about yourself - or that you are a failure or have let yourself or your family down? 7. Trouble concentrating on things, such as reading the newspaper or watching TV? 8. Moving or speaking so slowly that other people could have noticed? Or the opposite - being so fidgety or restless that you have been moving around a lot more than usual? 9. Thoughts that you would be better off dead or of hurting yourself in some way? 10. How difficult have these problems made it for you to do your work, take care of things at home, or get along with people? (Not at all difficult, Somewhat difficult, Very difficult, Extremely difficultyf Statistical Analysis SPSS was used to analyze and determine correlation between gender and adolescent and young adult depression using the 2005-2006 NHANES data. The methodology used for this study was through secondary data analysis. Data was derived from multiple surveys; a combination of interview and physical examinations, conducted by NHANES. The measures used to analyze the data include descriptive statistics such as frequencies, percentages, and means. Dependent and Independent Variables The dependent variable in this study is depression. Data is based on the ten questions from the Depression This content downloaded from 154.59.124.208 on Mon, 10 May 2021 17:40:30 UTC All use subject to https://about.jstor.org/terms 298 JHHSA FALL 2016 Screener Questionnaire in NHANES assessing the signs and symptoms of depression.The independent variable in this study is gender (male/femaleyf . Research Hypothesis As mentioned above, rates of depression are greater for girls than for boys during adolescence and young adulthood, (Lewinsohn, Rohde & Seeley, 1998yf 7 K L V F R X O d be due to increased stressors throughout the stages of puberty, scrutiny and self-doubt due to changing body image, and different coping styles with these changes. Therefore, the researcher hypothesized based on the ten questions about is as follow: Hypothesis: Gender is a risk factor for adolescent depression with rates of depression greater for girls than boys. RESULT AND DISCUSSION The Statistical Package for Social Sciences (SPSSyf was utilized for this result. Of the 2,199 adolescent and young adults responders, males comprised of 1,068 participants (48.6yb \f and females comprised of 1,131 (51.4yb \f from the age of 13-21. Additionally, of the male and female responders at the time of the survey, 1,375 (62.5yb \f were enrolled in school, 317 (14.4yb \f were in between grades, 300 (13.6yb \f were not enrolled in school, and 207 (9.5yb \f did not respond to this question. Table 2 below showed the frequency of participant and Table 3 demonstrated current enrollment status among gender enrolled in school. This content downloaded from 154.59.124.208 on Mon, 10 May 2021 17:40:30 UTC All use subject to https://about.jstor.org/terms JHHSA FALL 2016 299 TABLE 2 Participants by Age Group and Gender Age Female 13 Years Old 144 (12.7yb \f 131 (12.3yb \f 14 Years Old 136 (12.0yb \f 126(11.8yb \f 15 Years Old 156(13.8yb \f 142 (13.3yb \f 16 Years Old 142(12.6yb \f 157(14.7yb \f 17 Years Old 143 (12.6yb \f 134 (12.5yb \f 18 Years Old 164(14.5yb \f 152 (14.2yb \f 19 Years Old 132(11.7yb \f 136(12.7yb \f 20 Years Old 56 (5.0yb \f 46 (4.3yb \f 21 Years Old 58(5.1yb \f 44(4.1yb \f This content downloaded from 154.59.124.208 on Mon, 10 May 2021 17:40:30 UTC All use subject to https://about.jstor.org/terms 300 JHHSA FALL 2016 TABLE 3 Participants by Current Enrollment Status in School and Gender School Enrollment Status In School 721 (63.8yb \f 654 (61.2yb \f Between Grades 150(13.2yb \f 167 (15.6yb \f Not in School 145 (12.8yb \f 155 (14.5yb \f Missing Response 115(10.2yb \f 92 (8.6yb \f Depression Scoring in Correlation to Gender Among the 2,199 participants who responded to the ten questions on the depression screener on whether they had signs/symptoms of depression on several days, more than half the days, or nearly every day within the last 2 weeks of when the survey was conducted; 1,572 questions were answered by both adolescent and young adult male and female participants as having experiences some thoughts of depression. Table 4 below is the mean differences of the responses to all the questions. This content downloaded from 154.59.124.208 on Mon, 10 May 2021 17:40:30 UTC All use subject to https://about.jstor.org/terms JHHSA FALL 2016 301 TABLE 4 Mean Responses for NHANES 2005-2006 Depression Screener Questions Mean Standard Deviation Feeling down, depressed, or hopeless .3 1 .625 Trouble sleeping or sleeping too much .54 .820 Feeling tired or having little energy .67 .782 Poor appetite or overeating .35 .706 Feeling bad about yourself .21 .528 Trouble concentrating on things .25 .568 Moving or speaking slowly or too fast .14 .47 1 Thought you would be better off dead .05 .308 Difficulty these problems have caused .28 .489 Ever been told you have asthma 1.85 .437 Both genders reported having signs and symptoms of depression; however, as a percentage of total females reported feeling depressed more often than males. About 16.52yb R I P D O H V L Q F R P S D U L V R Q W R \b of females reported that they had several days of depression, 3.29yb R f males in comparison to 3.46yb R I I H P D O H V U H S R U W H G W K D W W K H y felt depressed more than half the days, and 2.03yb R I P D O H s compared to 2.14yb R I I H P D O H V K D G V \ P S W R P V R I G H S U H V V L R n nearly every day over the 2 week period that was in question. The first hypothesis predicts that gender is a risk factor for adolescent depression with rates of depression This content downloaded from 154.59.124.208 on Mon, 10 May 2021 17:40:30 UTC All use subject to https://about.jstor.org/terms 302 JHHSA FALL 2016 greater for girls than boys. A Chi-Squared test was run to determine the relationship between the variables. It was determined that there was significant differences among girls and boys. The Pearson's chi-squared value of 515, df of 21, and />=.000 is statistically significant. The analysis supports Hypothesis 1 that depression is greater for girls than boys. Feeling little interest or pleasure in doing things, the Pearson chi-squared value 686, df of 4 and p=. 812 is not statistically significant, for question about trouble falling or staying asleep, or sleeping too much, the Pearson chi-squared value of 686, df of 9 and p=. 189 is not statistically significant. Only the question about moving or speaking so slowly that other people could have noticed or the opposite - being so fidgety or restless that you have been moving around a lot more than usual proved to be significant. The Pearson chi-squared value of 515, df of 12 and p=. 000 is statistically significant. There are no major differences in response to other questions. There is increasing evidence that female adolescents and adults are more likely than their male peers to become depressed. Previous research identified the fact that by the age of 14 years old, depressive disorders are more than twice as common in girls as in boys (Bhatia & Bhatia, 2007yf ' X U L Q J W K H O L W H U D W X U H U H Y L H Z H G I R U W K L V V W X G \ , it was noted that the incidence of depressive disorders noticeably increases as adolescence reach puberty (Studd & Panay, 2004yf 3 K \ V L F D O W U D Q V I R U P D W L R Q V G X U L Q J D G R O H V F H Q W s such as hormonal variations or body image changes could contribute to adolescent girls' increased vulnerability to depression. Therefore, gender was explored in this research to examine whether the findings in previous research could be supported by this study. The study found a statically significant relationship between gender and adolescent depression. In this study, both genders reported having signs and symptoms of depression; however, females reported feeling depressed more often than males. These This content downloaded from 154.59.124.208 on Mon, 10 May 2021 17:40:30 UTC All use subject to https://about.jstor.org/terms JHHSA FALL 2016 303 results are comparable to findings in previous research; therefore, further research exploring the relationship between gender and depression is unnecessary. However, research regarding contributing factors that increase female susceptibility of depression would be warrantied. CONCLUSION AND RECOMMENDATION Extensive research has shown that depression is a complex condition that has no single cause; however, a combination of genetics, biologic, and environmental risk factors may increase the probability of acquiring the condition. Furthermore, depression is no longer a condition that is limited to adults but one that is acknowledged to be affecting approximately 10 to 15 percent of adolescents and young adults at any given time (Heller, 2012yf $ O W K R X J h there are common misconceptions about adolescent depression, if depression is unnoticed and untreated, it has been known to increase the risk of suicide. Understanding the signs, symptoms, and common risk factors of depression can assist parents and healthcare providers find the resources to treat the disorder. The purpose of the current study was to investigate whether gender was a predictor of depression in adolescents and young adults. Gender was found to have a significant relationship with adolescent depression with rates of depression greater for adolescent girls than boys. Understanding the increased rate of depression in adolescents and the higher likelihood for adolescent girls to become depressed makes it a significant health care problem that is worthy of the efforts required to investigate causes, diagnosis, and opportunities for prevention and intervention. For parents and healthcare professionals, it is important to note that, depression is often overlooked, misdiagnosed, or undetected in adolescents. It is suggested that in the field of adolescent depression, further studies are This content downloaded from 154.59.124.208 on Mon, 10 May 2021 17:40:30 UTC All use subject to https://about.jstor.org/terms 304 JHHSA FALL 2016 to be conducted to assist primary care clinicians in identifying and initiating management of depressed adolescents while researching contributing factors that increase female adolescent predisposition to having depression. REFERENCES A.D.A.M Health Solutions. (2012, Februaryyf $ G R O H V F H Q t depression in-depth report. 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