4 - (SYM 73) Adolescents' Beliefs About What Symptoms Constitute Depression: Are More Expansive Definitions Helpful or Harmful?

Purpose. What symptoms do adolescents think constitute depression? Little descriptive research has examined this question. What’s more, prior research on symptom beliefs is inconsistent regarding the consequences of these beliefs. In a mental health literacy framework, knowing more of depression’s symptoms (per formal psychiatric diagnostic criteria) is adaptive, as it helps people identify and seek help for depression. However, the common-sense model of self-regulation suggests that more expansive beliefs about what symptoms constitute an illness may be maladaptive, whereby viewing more symptoms as characterizing a disorder predicts greater functional impairment.

Methods. We conducted a pair of studies with diverse U.S. adolescents experiencing elevated depression symptoms (total N = 387), collecting data on symptom beliefs and outcomes via online questionnaires. Participants were 56% White non-Hispanic, 16% Hispanic, 12% Asian non-Hispanic, 7% Black non-Hispanic, and 8% other non-Hispanic; all were age 11-16; 54% were cisgender girls, 16% were cisgender boys, and 29% held a gender minority identity.

Results. Adolescents’ beliefs about what symptoms constitute depression varied widely; across both studies, adolescents reported 115 different symptom combinations, and only 42% endorsed all DSM-5 depression symptoms as characterizing the disorder. Adolescents who identified more symptoms as belonging to depression had more severe depression symptoms (p = .004), reported more hopelessness (p = .021), and were more pessimistic about the permanence of depression (p = .007); they were also more likely to rate medication as potentially helpful (p = .001).

Limitations. This study used a checklist approach to measure beliefs about what symptoms constitute depression, which limits direct comparison to research using other measurement approaches (e.g., vignette methods).

Conclusion. These findings simultaneously support and challenge elements of both the common-sense model and the mental health literacy framework. Future research should seek to explain why adolescents with more psychiatrically-accurate understandings of depression experience worse clinical outcomes.