Chapter IIntroductionDepression is among that of the most recognized disorders, which as a result, has been termed the ”common cold” of psychopathology (Gotlib and Hammen, 2002). This disorder is known to be common in adolescents, since the adolescence stage is an important risk period for the development of illnesses (Rice et al., 2017) because this period of maturity is considered the transitional stage wherein physical and psychological changes commonly occur (Hockenberry, Wilson 2015). Depression among adolescents has the capability to lead to distress among the young adult and their family or career (Jones et al., 2012). In the language of clinical psychology, depression is a syndrome (Pinsky, 2015). It is an aggregation of emotional, physical, and behavioral symptoms which are usually depicted by sadness, low self-esteem, loss of pleasure, and difficulty functioning (Pinsky, 2015). It may also predict future risks for suicide, self-harm and poor physical health, and may pave a way to the beginning of long-term mental health complications (Thapar, Collishaw, Pine 2012). In ordinary day-to-day conversation, people often remark that they are depressed whenever they are feeling unhappy, down, or hopeless (Pinsky, 2015). Almost everyone has experienced these emotions, and many of which, in due course, suffer adversity that enables them to be anxious or depressed sporadically. These feelings are only one part of everyday life for most people (Pinsky, 2015). According to the World Health Organization (WHO), depression places as an exceptionally prominent source of disability, and will be the second most important disorder by 2020 in terms of burden of disease (Murray and Lopez, 1996) if the condition is not controlled at once. Depression is an important global public-health issue. It has become more common than bipolar disorder and schizophrenia (Rice et al., 2017). In the Philippines alone, it is estimated that 3.29 million people are diagnosed with depression (Mateo, 2017). These facts are particularly true for young adults because depression rises substantially with the transition from childhood through adolescence and then remains at high prevalence levels throughout much of adulthood (Lakdawalla, Hankin, Mermelstein 2007). The increasing prevalence of depression and the illnesses and risks associated with this, leads to the question of how these disorders compare in terms of their effect on overall individual health (Moussavi et al., 2007).Regrettably, adolescent depressive disorder remains to be unrecognized and untreated regardless of evidence that duration of untreated depressive illness is a key factor in predicting recurrence in adult life (Rice et al., 2017). This is possibly because of the prominence of irritability, mood reactivity, and fluctuating symptoms in adolescents (Thapar, Collishaw, Pine 2012). Depression can also be missed if the primary presenting problems are unexplained physical symptoms, eating disorders, anxiety, refusal to attend school, decline in academic performance, substance misuse, or behavioral problems (Thapar, Collishaw, Pine 2012). Hence, early treatment and prevention of adolescent depression is, therefore, a major public health concern (Rice et al., 2017) that requires immediate attention.Problem StatementAdolescent depressive disorder remains to be unrecognizable. Many are unaware of its causes and tend to neglect signs that have the ability to telltale that of the underlying illness, hence being unable to prevent or treat the problem extensively.ObjectivesThe main objective of this study will be to determine the causes of depression among college adolescents so that people may become aware of its behavioral symptoms and proper treatment and prevention of the illness can be resolved. Specifically, this study will deliver the following:Assess the status of the diagnosed adolescent using the case study method Determine the cause of depression by way of interview and gathered medical recordsAnalyze and correlate each cause of depression with the prevailing illnessTheoretical FrameworkBeck’s Cognitive Theory of DepressionIn Beck’s cognitive theory of depression (Beck, 1987), poor adjustment of self-schemata which include dysfunctional attitudes, insufficiency, failure, and worthlessness, amount to the cognitive vulnerability observed among most adolescents (Pinsky, 2015).These schemata consist of stored quantities of knowledge that have influence on adolescent tasks such as encoding, comprehension, and retrieval of information (Lakdawalla, Hankin, Mermelstein 2007), which are vital abilities involved in a day-to-day basis. These schemata also have the capability to affect psychosocial abilities such as being able to blend with their peers. In line with vulnerability–stress models of depression (e.g., Hopelessness Theory), these dysfunctional attitudes are expected to occur following the incidence of a negative life event (e.g., bullying), which would consequently give rise to specific negative cognitions (e.g., negative thoughts about the self, world, and future), and eventually lead to a high chance of developing depressive symptoms (Lakdawalla, Hankin, Mermelstein 2007). Adolescents’ cognitive development results in the feeling that they are constantly on stage (Hockenberry, Wilson 2015) making them cognizant to their own mistakes and failures, allowing them to be vulnerable to these dysfunctional attitudes. Cohen’s Social Support theorySocial support is said to be the “support accessible to an individual through social ties to other individuals, groups, and the larger community” (Charney, D., et. al, 2007). The National Cancer Institute’s Dictionary of Cancer Terms defines social support as “a network of family, friends, neighbors, and community members that is available in times of need to give psychological, physical, and financial help” (www.cancer.gov). Social support theory can be described into hypotheses explaining that life events increase the risk of major depression and that people differ in the extent to which life events increase risk for depression. Events are stressful to the extent that people perceive these events as threats and may depend based from people’s coping strategies. Theoretical models and perspective on social support also hypothesizes that support may decrease the effects of stressful life events on someone’s health (e.g, giving advice) (Cohen and Lakey, 2000). Different studies proved that low social support has been associated with physiological and neuroendocrine effects such as elevated heart rate, increased blood pressure, exaggerated cardiovascular and neuroendocrine responses to laboratory stressors and increase in the level of stress (Charney, D., et. al, 2007).A large number of different questionnaire measures social support, that can be classified into three types namely perceived support, enacted support, and social integration (Barrera, 1986). Measures of perceived support is obtained through asking the respondents to make subjective judgments about the extent to which their family and friends would provided effective support and other social provisions such as attachment (Cutrona & Russell, 1987) Enacted support measures on the other hand, is obtained through asking the respondents to report (a) whether or not friends and family have provided specific supportive actions (e.g., advice, reassurance, help with a task, loans) or (b) the frequency of their provision of supportive actions. For social integration, the respondents are asked to indicate their number of social ties, such as marital status, number of living siblings, and number of living children (Brissette et al., 2000).Ainsworth and Bolwby’s Attachment theory Attachment, according to Bolwby is a “long lasting psychological connection” with a significant person that causes pleasure and may soothe stress. Attachment theory states that “a strong emotional and physical attachment to atleast one primary caregiver is critical to personal development” (www.psychologistworld.com). It emphasizes the importance of a secure relationship in the development of someone’s well-being (www.learning-theories.com). His theory was tested using the strange situation in which children’s responses to their mother’s presence and absence compared to that of a stranger, were recorded. It was also influenced by a study conducted by Harlow and Zimmerman in 1959 that led to the conclusion that claims “attachment to be an intrinsic need for an emotional bond with one’s mother” (David, L., 2016). Over the years, attachment theory, which was originally made to describe and prove “infant-parent emotional bonding”, has been used and applied in the study of adolescent and romantic relationships, and later on in the study of psychological processes (Mikulincer and Shaver, 2012). In a study entitled “An attachment perspective on psychopathology”, results were used to help explain why experiences of separation, isolation, rejection, abuse and other negative life events are often a cause of mental disorders like depression.Scope and Limitation This study dealt mainly on determining the causes of depression among college adolescents. It seeks to gain knowledge and spread awareness regarding depression and its predisposing signs. The researchers focused on an adolescent diagnosed with depression, currently a patient at the UST Graduate School Psycho-trauma Clinic, as the subject and respondent of the study. In addition, the researchers chose the case study research technique and used methods/instruments such as interviews and medical records. The aspects looked into were the nature of the illness, the history of the patient, the past and current environmental situation of the patient, and the behavioral symptoms associated, which were then carefully analyzed and correlated in order to determine the possible causes of the disease. Although the research has reached its aims, there are unavoidable limitations. One of these limitations is the lack of data, possibly because the patient was unwilling to provide us with answers to a few questions. It is not the objective of the study to compare the findings of our respondent with that of other diagnosed patients. It will not also be within the scope of the study to determine the effects of depression.Significance of the StudyThis study will provide awareness and provisions suitable to combat depression. The results of this study will be important to the following:The nursing students of a comprehensive universityThe college adolescents with the medical illnessThe college adolescents at risk for the medical illnessThe parents of adolescents The professors and peersChapter IIRELATED STUDIESDepressionIt is undeniable that people of all ages starting from school age to adulthood experience a heavy feeling among themselves. They may feel uneasy, bothered and confused on how to cope with their personal issues. Studies show that these feelings are an accumulation of one or more negative events that lead to a collectively known term called, Depression (Kelvin, R., 2016). The moment wherein we experience these dark moments are called, depressive episodes. In the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders, these depressive episodes are ”a period of two weeks or longer during which where there is either depressed mood or loss of interest or pleasure, and at least four other symptoms that reflect a change in functioning, such as problems with sleep, eating, energy, concentration and self image.” Depression among people revolve around the world especially in the United States. ”It is a common mental disorder affecting adolescents. For example in 2015, an estimated 3 million adolescents aged 12 to 17 in the United States had at least one major depressive episode caused by medical illness, bereavement or substance use disorders” says the National Institute of Mental Health. According to Birmaher, Ryan, et al., (1996), ”it is widely accepted that the depression is one of the most common psychological disorders in children and adolescents, often presenting as severe chronic and recurring condition with a high risk of self-harm and suicide.” To prove this, Han, B., Mojtabai, R., and Olfson, M. conducted a study to find the national trends during a 12-month prevalence of major depressive episodes in adolescents and young adults. They used a cross-sectional survey of the United States general population. The data was derived from the National Survey on Drug Use and Health to determine the amount of people who have experienced depressive methods from their own issues. The researchers found that out of the 172,495 adolescents and 178,755 young adults that responded to the study, 8.7% and 8.6% respectively met the criteria for major depressive episodes. This population included adolescents, non students, unemployed individuals, adolescents from households with no parents and adolescents with substance use disorders. Furthermore, this proves just a few of the causes amongst adolescents. They recommended that these people take part in mental health counseling or treatment but those who did participate did not improve significantly in a 2005 to 2014 study. Although there are large populations of depression nationwide, these symptoms are still unrecognizable with these common causes. II. RELATED LITERATURE Causes of Depression Among College Adolescents”College life is one of the most scintillating and memorable experience in an adolescent’s life” (Devi and Mohan, 2015). It is in this years that an adolescent enjoys the company of friends, and the various academic and co-curricular activities, which may or may not enrich, nurture and prepare the adolescent for adulthood, depending on how the college student would handle such experiences and activities. Over the years, there have been major theories of psychopathology that show strong connection between adverse life events and circumstances as the cause of major depression (Dobson, K., & Dozois, D); and may lead to serious impairment in the adolescent’s performance (Birmaher, Ryan, et al., 1996). Among all these theories, cognitive theories became prominent as a response to the failure of early behaviorists to take thoughts and feelings seriously (Dombeck, M. et al., 2007). Beck’s cognitive theory of depression is one of the most popular cognitive theories that integrate behavioral framework into mental events (Dombeck, M. et al., 2007).Academic Stress Academic stress, according to an assistant professor in India, is a mental suffering in regards to “some anticipated frustration associated with academic failure or even unawareness to the possibility of such failure.” Among the several causes of depression, Devi and Mohan in 2015 stated that 85.71% out of female students responded that the major reason for the cause of stress are academic problems. Essel and Owusu in 2017 also identified that academic factors were a source of stress to most students. According to them, there are “many things that take place in the day to day activities of the academic processes that make students stress up.” 1. Increase in Workload Student’s perception that they have to know, understand and master an extensive lesson or accomplish a requirement within a time frame, that for them feels not enough is a common cause of stress that may lead to depression (Misra, Mckean, West and Russo, 2000). They often compromise their time with their friends and families to meet up with the class workload and requirements. Because these tasks are too much for them, they end up messing everything up. They turn to get frustrated and are unable to focus and do the things they have to do (Essel, G., & Owusu, P., 2017). In Beck’s cognitive theory of depression, he proposes that cognitive distortions, a type of cognitive bias, may be developed by those with depression. The students’ cognitive thoughts were affecting them; the student’s current depressive states were found to be consistently related to their negative processing of personal information (Moilanen, 1993). 2. Lower Grades “It is the desire of every student to excel in their field studies as such high grades mean alot to students.” Stress happens when they set expectations for them to achieve, such as “get a high grade” but at the end they get a lower grade than they expected. “It weighs them down and kills the motivation they have” (Essel, G., & Owusu, P., 2017). Once this happens students start to think a lot about what they didn’t do, where they went wrong, thus causing them to blame themselves and eventually start to build negative self-schemata. Beck’s negative cognitive triad as explained in his cognitive theory of depression, shows that this negative self-schema originate from negative experiences. For example, college students receiving low scores are having negative thoughts about their future because they may not pass the class or may not graduate. Negative thoughts about the world, meaning they may think that no one will accept them because they do not intellectually meet the standards of the class. Negative thoughts about themselves on the other hand may develop based from their thinking that they do not deserve to be in college. These thoughts are classified into Beck’s negative cognitive triad about thoughts on future, world and self respectively (Brown, 1995).