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Article Excerpt
Gender-specific attributes and socialization influence the development of depression in adolescents, but little research has addressed adolescents' views on this topic. We interviewed 22 adolescents regarding their views on the impact of sex and gender role influence in depression. Male and female participants: (a) described societal expectations and cultural messages, including high and conflicting expectations for girls, and consistent messages of being "macho" and unemotional for boys, as related to adolescent depression; (b) perceived physical changes during puberty as contributors to depression for girls, but not for boys; and (c) associated loneliness and rejection with depression for both boys and girls. We discuss implications for treatment that include directly addressing gender roles with depressed adolescents.
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Depression among adolescents is a costly phenomenon with wide-ranging health sequelae, including increased likelihood of difficulties related to academic and occupational performance, interpersonal relationships, tobacco and substance abuse, and suicide attempts (Birmaher et al., 1996; Lewinsohn, Clarke, Seeley, & Rohde, 1994; Luber et al., 2000; Petersen et al., 1993; Pincus & Pettit, 2001; Schradley, Gotlib, & Hayward, 1999). Depression during adolescence also predicts future illness (Lewinsohn, Rohde, Seeley, Klein, & Gotlib, 2000; Mufson & Moreau, 1997; Weissman et al., 1999). Environmental influences related to the development of depression include stressful life events (Rudolph, 2002), family problems (Sheeber, Hops, Alpert, Davis, & Andrews, 1997), and peer problems (Kaslow, Brown, & Mee, 1994).
A number of treatments for depression in adolescents have demonstrated empirical support. Cognitive behavioral therapies, interpersonal psychotherapy, and antidepressant medications have been found to be very effective treatments with adult populations, and studies in recent years have tested these treatments on adolescents. Antidepressant medications have demonstrated effectiveness in use with adolescents, especially selective serotonin reuptake inhibitors (SSRIs). Psychotherapy is recommended prior to or in conjunction with antidepressant medication, and adolescents on antidepressant medication need to be monitored closely for increased suicide risk (Whittington et al., 2004). Both CBT and Interpersonal Psychotherapy--Adolescent (IPT-A) have been demonstrated to decrease depressive symptoms (for reviews see: Michael & Crowley, 2002; Mellin & Beamish, 2002; Millin, Walker, & Chow, 2003) Although these treatments have been demonstrated as efficacious, there is no single treatment that has been found to work with all adolescents at all times (Michael & Crowley, 2002). Continuing theory building and research is therefore needed to expand on the empirically supported treatment base.
An area within these domains that has been suggested as important in adolescent treatment is attention to gender role (Hazler & Mellin, 2004). As early as 1990, the American Psychological Association's National Task Force on Women and Depression (McGrath, Keita, Strickland, & Russo, 1990) recommended that therapies address sociocultural factors that impact women's depression. More recently, others have called for attention to the particular needs of men with depression (Mahalik & Cournoyer, 2000). Although a large body of research has been developed on gender differences in depression, specific treatments that address these gender differences are still in early stages.
Outcome and efficacy research regarding gender and depression treatment in adolescents has generally been limited to exploring the outcome of specific treatments by sex. For instance, in their meta-analytic review, Michael and Crowley (2002) found that treatments obtained higher mean effect sizes when the sample was more than 60% females, leading to the possibility that treatments may be less effective for males. Many researchers have identified the importance of taking gender into account when structuring treatment (Culbertson, 1997; Hazler & Mellin, 2004; Marcotte, Fortin, Potvin, & Papillon, 2002; Reed, 1994), and a number of theories and some empirical evidence exists to explain the possible impact of gender role expectations on depression (see review below). However, it appears that a gap in the literature exists for obtaining adolescents' views directly.
The purpose of this study was to explore adolescents' perspectives on the impact of sex and gender role on depression and its symptoms. We refer to sex as one's biological sex (male/female), while gender role is considered socially constructed expectations based on sex (such as expectations for females' passivity). Eliciting this information directly from adolescents in an open format is an important early step in theory development and testing in order to design effective gender-specific treatments. Recent studies have highlighted the need for more qualitative research to learn about adolescents' perspectives on depression without the constraints of quantitative methodology (Hazler & Mellin, 2004; Hetherington & Stoppard, 2002; Nelson & Quintana, 2005; Wisdom & Green, 2004). Furthermore, qualitative inquiry provides a rich format from which to build theory and treatment models that adolescents feel are relevant to their lives.
Gender Roles and Depression
Gender role socialization has emerged as a proposed component in girls' depression, and evidence supports this influence on boys as well. The gender intensification hypothesis (Hill & Lynch, 1983) postulates that many girls experience pressure to conform their behavior to gender expectations as they reach puberty and begin to change physically (Culbertson, 1997; Moreau, 1996). This pressure, when combined with contextual factors and personal characteristics, has been linked empirically to the emergence of girls' depression in adolescence (Barrett & White, 2002; Obeidallah, McHale, & Silbereisen, 1996; Sands, 1998). Barrett and White (2002) outlined the difficult task for adolescent girls of deciding how to interpret society's mixed messages regarding gender. Girls are neither expected nor encouraged to adopt instrumental characteristics that are typically associated with masculine gender role and lower levels of depression, and girls who defy gender roles are more often rejected by peers and have a higher risk for experiencing significant psychological difficulties (Nolen-Hoeksema & Girgus, 1994).
There has been little attention to the impact of gender role socialization on depression in boys. General findings about depression in boys indicate that boys' depression is related to greater substance use and externalizing disorders (Kovacs, Obrosky, & Sherril, 2003). Greater externalizing may be gender role related. For instance, young adolescents tend to believe that it is appropriate for girls to ruminate (i.e., worry) when distressed, whereas boys should distract themselves instead (Broderick & Korteland, 2002). For boys, the social prescription to avoid femininity may suppress emotional awareness and expression and may contribute to depression or the masking of depression. O'Neil (1990) outlined a theory of gender role conflict for men that identifies masculinity mandates of success, restriction of emotionality, restriction of affection with men, and work/family conflict as primary concerns. Mahalik and Cournoyer (2000) also found correlations between components of gender role conflict and depression in college-age men. Given the empirical and theoretical perspectives emerging on gender socialization's impact on depression, further research is warranted to determine adolescents' awareness and understanding of gender roles and depression.
The need to develop more efficacious treatment strategies for long-term depression, the gender differences in rates of depression, and the emerging significance of gender role socialization as...
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