The role of depression literacy and stigma in how parents perceive and respond to adolescent depressive symptoms: Lessons for childhood mental health

What is meant by ‘depression literacy’ and ‘depression stigma’? Why are these important concepts in adolescent mental health?

Adolescence is a peak period for the development of depressive disorders. Parental responses do not ‘cause’ adolescent depression, but unhelpful parent-child communication patterns can intensify negative emotions in young people. Depressive behaviours in adolescents can elicit negative reactions from parents, and negative parental responses can exacerbate the child’s negative mood. In addition to identifying how parents respond to adolescent depressive behaviours, it is also important to examine why parents respond in particular ways.

Parental mental health problems (e.g. depression) are one factor that may impact their parenting style; however, parents’ attitudes and beliefs around depression are also likely to influence how they respond to their child. Specifically, accurate parental knowledge about the causes, symptoms and treatment of adolescent depression (called ‘depression literacy’) and their level of ‘depression stigma’ (including prejudicial attitudes and discrimination) are likely to influence how they respond to their child’s depressive symptoms.

The current study

In a recent Australian study of 440 parents of adolescents aged 13-17 years, some of the important questions that researchers aimed to investigate were:

• Do parents of adolescents with depression respond differently to low mood in their child compared to parents of non-depressed adolescents?
• Do parents who experience depressive symptoms themselves respond more negatively to symptoms of low mood in adolescents? 
• Can parental knowledge about adolescent depression (‘depression literacy’) impact on how a parent responds to depression in their adolescent child?
• Can parental depression stigma impact on how parents respond to depression in their adolescent child? 

Of the 440 parents that were surveyed, 185 reported elevated depressive symptoms in their adolescent child using the Short Mood and Feelings Questionnaire (SMFQ). They also answered questions about their reactions, attitudes and understanding of adolescent depressive symptoms using a questionnaire called the Parental Reactions, Attitudes and Understanding of Depression (PRAUD).

What patterns were found in how parents responded to depressive symptoms in their adolescent child?

The results of the study suggested four patterns of parental responses to depressive symptoms in their adolescent child:

• Overprotection (e.g. not pushing adolescents to do things when they are depressed; feeling compelled to prevent their child from feeling sad)
• Criticism (e.g. beliefs that adolescent depression is controllable, a passing phase or a sign of weakness; telling their child what to do to feel better)
• Personal distress (e.g. feelings of guilt and self-blame for their child’s low mood; difficultly being around their child when they feel sad)
• Support (e.g. encouraging emotional expression; listening).

What factors were associated with negative parental responses towards adolescent depressive symptoms?

• Parents of depressed adolescents and parents who reported experiencing higher depressive symptoms themselves tended to report more negative parental responses to adolescent depression (overprotective, critical and distressed responses) and less supportive responses.
• Parents with greater stigma towards adolescent depression (negative opinions, judgements or stereotypes about teenagers who experience depression) reported more negative parental responses.
• Parents with poorer depression literacy (poorer understanding of adolescent depression) reported more negative parental responses.

What implications may the study have for approaches to adolescent mental health?

Understanding the factors that contribute to problematic parent-child interactions are important, especially when these can be modified. There was evidence of more negative parental attitudes and responses among depressed parents and parents of young people with depression, and this was especially pronounced when parents held stigmatising beliefs or a had poor understanding of adolescent depression. This highlights the importance of considering and addressing parental mental health issues, parental depression literacy, and parental depression stigma when attempting to prevent, assess and manage depressive symptoms in adolescents.

Improving parental depression literacy and reducing depression stigma during treatment for adolescent depression may help to facilitate parental support and responsiveness, and in some circumstances, may help buffer against the negative impact of parental depression.

What implications may the study have for approaches to childhood mental health?

As the Australian authors Tully et al. (2019, p. 1) highlight, “half of all lifetime mental health disorders emerge in childhood, so intervening in the childhood years is critical to prevent chronic trajectories of mental health disorders.” Despite growth in the availability of evidence-based interventions, the prevalence of children’s mental health disorders has not reduced, with one of the underlying reasons proposed being low child mental health literacy – “[the] knowledge and beliefs about mental health disorders that aid their recognition, prevention and management” (Tully et al., p. 1).

While the current study by Johnco and Rapee (2018) highlights the importance of considering parental mental health, parental depression literacy, and parental depression stigma in the understanding and treatment of adolescent depression, it is important to recognise that further research is needed to investigate the potential impact of these factors on mental health in younger age groups (i.e. children aged 0–12 years). The topic of mental health literacy has received much attention in Australia with regards to the adolescent and adult populations but has been under-researched and under-recognised in the area of childhood mental health (Tully et al., 2019). Tully and colleagues (2019) have advocated for a much-needed national child mental health literacy initiative to address this critical gap, and to help improve key factors such as knowledge, stigma, help-seeking, and prevalence.

References

Johnco, C. & Rapee, R. M. (2018). Depression literacy and stigma influence how parents perceive and respond to adolescent depressive symptoms. Journal of Affective Disorders, 241, 599-607. doi: 10.1016/j.jad.2018.08.062

Tully, L.A., Hawes, D.J., Doyle, F.L., Sawyer, M. G. & Dadds, M.R. (2019). A national child mental health literacy initiative is needed to reduce childhood mental health disorders.  Australian and New Zealand Journal of Psychiatry.  https://doi.org/10.1177/0004867418821440