Kamal Gautam1, Brandon A Kohrt2, Syed Shabab Wahid3, Katherine Ottman2, Jyoti Bohara4, Vibha Neupane4, Helen L Fisher5,6, Christian Kieling7, Valeria Mondelli8,9. 1. Transcultural Psychosocial Organization Nepal (TPO Nepal), Baluwatar, Kathmandu, Nepal. kgautam@tponepal.org.np. 2. Division of Global Mental Health, George Washington University, Washington, DC, USA. 3. Department of International Health, Georgetown University, Washington, DC, USA. 4. Transcultural Psychosocial Organization Nepal (TPO Nepal), Baluwatar, Kathmandu, Nepal. 5. Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK. 6. ESRC Centre for Society and Mental Health, King's College London, London, UK. 7. Department of Psychiatry, Universidade Federal do Rio Grande do Sul and Child & Adolescent Psychiatry Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil. 8. Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK. 9. National Institute for Health Research Mental Health Biomedical Research Centre, South London and Maudsley NHS Foundation Trust and King's College London, London, UK.
Abstract
BACKGROUND: There is a lack of research on the adolescent experience of depression in low- and middle-income countries. Criteria derived from research conducted primarily among adult Western populations inform current diagnostic standards for depression. These clinical categories are often used without exploration of their relevance to adolescent experience. Also, reliance on these categories may overlook other symptoms of depression that manifest in non-western settings. Cross-cultural qualitative work with adults in non-Western settings has suggested some differences with experience of depression and symptoms that are most relevant to service users. Research into adolescent experiences of depression is warranted to inform the development of effective interventions. METHODS: Qualitative interviews were conducted in Nepal with adolescents with depressive symptoms (n = 9), healthy adolescents (n = 3), parents (n = 6), teachers (n = 10), social workers (n = 14), primary (n = 6) and mental (n = 6) healthcare providers, and policymakers (n = 6). Two focus groups were conducted with parents (n = 12) of depressed and non-depressed adolescents. Data were analyzed according to the framework approach methodology. RESULTS: Loneliness was the hallmark experience that stood out for all adolescents. This was connected with 5 other clusters of symptoms: low mood and anhedonia; disturbances in sleep and appetite, accompanied by fatigue; irritability and anger; negative self-appraisals including hopelessness and self-doubt; and suicidality. Adolescents distinguished depression from other forms of stress, locally referred to as tension, and described depression to involve having "deep tension." Perceived causes of depression included (1) Family issues: neglectful or absent parents, relationship problems, and family discord; (2) Peer relationships: romantic problems, bullying, and friendship problems; and (3) Social media: social comparison, popularity metrics, cyberbullying, and leaking of personal information. CONCLUSIONS: Consistent with other cross-cultural studies, loneliness was a core element of the adolescent experience of depression, despite its absence as a primary symptom in current psychiatric diagnostic classifications. It is important to note that among youth, symptoms were clustered together and interrelated (e.g., sleep and appetite changes were connected with fatigue). This calls for the need for more cross-cultural qualitative research on experience of depression among adolescents, and potential for modification of diagnostic criteria and prevention and treatments to focus on the experience of loneliness.
BACKGROUND: There is a lack of research on the adolescent experience of depression in low- and middle-income countries. Criteria derived from research conducted primarily among adult Western populations inform current diagnostic standards for depression. These clinical categories are often used without exploration of their relevance to adolescent experience. Also, reliance on these categories may overlook other symptoms of depression that manifest in non-western settings. Cross-cultural qualitative work with adults in non-Western settings has suggested some differences with experience of depression and symptoms that are most relevant to service users. Research into adolescent experiences of depression is warranted to inform the development of effective interventions. METHODS: Qualitative interviews were conducted in Nepal with adolescents with depressive symptoms (n = 9), healthy adolescents (n = 3), parents (n = 6), teachers (n = 10), social workers (n = 14), primary (n = 6) and mental (n = 6) healthcare providers, and policymakers (n = 6). Two focus groups were conducted with parents (n = 12) of depressed and non-depressed adolescents. Data were analyzed according to the framework approach methodology. RESULTS: Loneliness was the hallmark experience that stood out for all adolescents. This was connected with 5 other clusters of symptoms: low mood and anhedonia; disturbances in sleep and appetite, accompanied by fatigue; irritability and anger; negative self-appraisals including hopelessness and self-doubt; and suicidality. Adolescents distinguished depression from other forms of stress, locally referred to as tension, and described depression to involve having "deep tension." Perceived causes of depression included (1) Family issues: neglectful or absent parents, relationship problems, and family discord; (2) Peer relationships: romantic problems, bullying, and friendship problems; and (3) Social media: social comparison, popularity metrics, cyberbullying, and leaking of personal information. CONCLUSIONS: Consistent with other cross-cultural studies, loneliness was a core element of the adolescent experience of depression, despite its absence as a primary symptom in current psychiatric diagnostic classifications. It is important to note that among youth, symptoms were clustered together and interrelated (e.g., sleep and appetite changes were connected with fatigue). This calls for the need for more cross-cultural qualitative research on experience of depression among adolescents, and potential for modification of diagnostic criteria and prevention and treatments to focus on the experience of loneliness.
Authors: E E Haroz; M Ritchey; J K Bass; B A Kohrt; J Augustinavicius; L Michalopoulos; M D Burkey; P Bolton Journal: Soc Sci Med Date: 2016-12-22 Impact factor: 4.634
Authors: Syed Shabab Wahid; Gloria A Pedersen; Katherine Ottman; Abigail Burgess; Kamal Gautam; Thais Martini; Anna Viduani; Olufisayo Momodu; Crystal Lam; Helen L Fisher; Christian Kieling; Abiodun O Adewuya; Valeria Mondelli; Brandon A Kohrt Journal: BMJ Open Date: 2020-07-28 Impact factor: 2.692
Authors: Brandon A Kohrt; Daniel J Hruschka; Carol M Worthman; Richard D Kunz; Jennifer L Baldwin; Nawaraj Upadhaya; Nanda Raj Acharya; Suraj Koirala; Suraj B Thapa; Wietse A Tol; Mark J D Jordans; Navit Robkin; Vidya Dev Sharma; Mahendra K Nepal Journal: Br J Psychiatry Date: 2012-08-09 Impact factor: 9.319
Authors: Christian Kieling; Abiodun Adewuya; Helen L Fisher; Rakesh Karmacharya; Brandon A Kohrt; Johnna R Swartz; Valeria Mondelli Journal: Lancet Child Adolesc Health Date: 2019-04
Authors: Manaswi Sangraula; Brandon A Kohrt; Renasha Ghimire; Pragya Shrestha; Nagendra P Luitel; Edith Van't Hof; Katie Dawson; Mark J D Jordans Journal: Glob Ment Health (Camb) Date: 2021-02-19