Depression and school functioning in non-referred adolescents: A pilot study

Depression and School Functioning inNon-Referred Adolescents: A Pilot Study

Gabriele Masi, MDBarbara Sbrana, PhDPaola Poli, PhDFrancesco Tomaiuolo, PhDLetizia Favilla, MDMara Marcheschi, MD

University of PisaIRCCS Stella Maris, Pisa

ABSTRACT: Self-image and self-perceived competencies have been considered to berelated to depression in childhood and adolescence. Data from literature points toschool functioning as one of the most important factors in self-esteem and self-worthduring adolescence. Academic self image, defined as the way adolescents representthemselves as students, directly affects the global self-image; for this reason it hasimportant psychopathological implications. The major aim of this preliminary report isto specifically analyze the relationship between academic self-image (assessed with aspecific questionnaire), and self-reported depressive symptoms (assessed with the Chil-dren's Depression Inventory) in a school sample 150 adolescents. Our data indicatethat the emotional beliefs about schooling and learning were significantly related todepressive symptomatology. Females scored higher in CDI and school anxiety. A realschool failure did not affect the academic self image. These data seem to suggest thatdifferent components of the academic self-image can be differently associated with de-pressive feelings.

KEY WORDS: Depression; Self-Image; School Functioning; Adolescence.

In normal development a major task of children and adolescents isthe construction of a sense of self-competence, that contributes to apositive self-image (Harter 1985).1 Self-image and self-perceived com-petencies have been considered to be related to depression in child-hood and adolescence;2 negative self image is reported to be present in79% of the depressed adolescents.3 In literature, a global self-image

Address correspondence to Gabriele Masi, MD, Division of Child Neurology and Psy-chiatry, University of Pisa, Via dei Giacinti 2, 56018 Calambrone (Pi) Italy; e-mail:masi@ inpe.unipi.it.

Child Psychiatry and Human Development, Vol. 30(3), Spring 2000© 2000 Human Sciences Press, Inc. 161

Child Psychiatry and Human Development

has been distinguished from specific self-images. The former refers toan unidimensional view of self-concept, the general view one has ofoneself, a product of a combination of judgements and beliefs aboutthe self.4 The latter refer to self-images differentiated across differentdomains.1 Physical appearance, peer acceptance, academic compe-tence, athletic competence, etc., can differently contribute to globalself-image during adolescence. The knowledge of specific self-imagescan increase our understanding of the links between global self-imageand depression.5

Weisz and associates6 correlated Children's Depression Inventory(CDI)7 scores to self-perception profile (that is the perceived individ-ual level of ability) and contingency scale (the degree to which theperceived ability is attributed by the subject to the behavior of rele-vant others) across five specific domains: academic, social, behavioral,athletic, physical appearance. A general, non-clinical sample of chil-dren (age range 8-12 years) participated in the study. A strong rela-tionship between measures of perceived competence and CDI scoreemerged. According to these data, a major role was played by chil-dren's perceived academic competence and contingency, which ac-counted for 35% of the variance in CDI scores. Similar data are re-ported in Cole and coworkers' study,8 according to which children'sself-perceptions in different domains, including self-reported aca-demic competence, are significantly correlated with CDI score. Theresult of these studies indicated that children's beliefs about their ac-ademic self-image strongly predicted a depressive state.

Academic self image can be defined as the perception one may haveof himself as a student.9 It includes students' understanding of theirlearning profiles, their self-awareness about learning strategies andthe role of cognitive effort, and their beliefs about academic compe-tence. Developmental and gender differences have been reported inthe perception of academic abilities in normal students. Younger chil-dren (first or second grade) are usually excessively confident abouttheir skill levels.10 After the third grade this excessive confidence be-gin to wane, and many students tend to underestimate their schoolcompetencies.11 Gender differences can emerge during this period: ac-cording to several studies boys tend to maintain greater confidenceabout academic performances than do girls.12,13 The consequences ofnegative academic beliefs on girls' motivation has been specificallyexplored.14 Different studies have revealed consistent deficits in aca-demic self image in adolescents with learning disabilities, comparedwith normal achieving students.8,15,16 A less positive academic self may

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G. Masi, B. Sbrana, P. Poli, F. Tomaiuolo, Favilla, and M. Marcheschi

affect the conceptualization that adolescents have of their own intel-ligence, lower their self-esteem, and increase the risk for psycho-pathology, such as depression, anxiety or conduct disorders.17 Accord-ing to Cole and coworkers a strong negative relation exists betweenthe underestimation of academic competence and self-reported symp-toms of depression and anxiety.13

Academic self has been usually considered as a global entity,6,8 butit has also been subdivided in academic versus non-academic do-mains.18 The different components of academic beliefs, cognitive aswell as emotional components, seem particularly relevant from a psy-chopathological point of view.19 Academic self-image can be affected bythe way one portrays his/her cognitive functioning and competence,but also by the perceived strength of emotional attitude in a learningsituation. An analysis of these different components, often neglectedin the literature, with their psychopathological implications, can yieldfurther insights for diagnosis and treatment.

The major aim of this preliminary report is to specifically analyzethe relationship between academic self-image and self-reported de-pressive symptoms in a school sample of adolescents. In the currentstudy different components of academic self-image are considered,cognitive as well as emotional. We hypothesize that different compo-nents of the academic self-image can be differently associated withdepressive feelings. These data are also discussed considering actualschool functioning, assessed by the presence of a school failure, anddifferences between gender.

Method

Sample

A total of 150 students (77 females and 73 males), attending the first twoyears of different types of high school, were recruited from Pisa (Italy) andsurrounding areas. The age range of the subjects was 14-18 (mean age 15.6years, SD = 0.8). The age range of the males was 14-18 years (mean age 15.7,SD 0.9). The age range of the females was 14-17 (mean age 15.5, SD 0.8).

In order to verify if actual school functioning could affect the findings, theparticipants were divided in two groups according to the presence or absenceof a significant school failure. In the Italian school system when a severeschool difficulty exists, and many subjects are failed, the faculty can requestthat the student repeat the grade. In this study we considered school failureonly when the student repeated a grade in one of the two preceding academicyears. According to this criterion participants were divided in a Failure group

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(17 subjects, 8 females and 9 males, mean age 17, SD 0.5), and a non-Failuregroup (131 subjects, 68 females and 63 males, mean age 15.4, SD 0.7). Twosubjects who scored more than 3 standard deviations above the mean of theChildren's Depression Inventory were excluded from the sample.

All the students and their families accepted to participate in this study. Theresearch was approved by the Human Subjects Committee of our Hospital.

Instruments

Children Depression Inventory (CDI).7 This 27-item self-report question-naire is designed to survey cognitive, affective, and behavioral symptoms ofdepression in children and adolescents. The instrument quantifies a range ofdepressive symptoms; several items are specifically concerned with the func-tional consequences of depression in contexts that are relevant to children.On each item of the CDI the subject is instructed to choose, from three state-ments, the one that best describes his/her feelings in the past two weeks. Ascore of 0,1 or 2 is given to each item. Total score on the CDI ranges from 0 to54. Reliability and validity of this scale have been documented in severalstudies.20,21 A cut-off of 19 identified as depressed the upper 10% of the popula-tion of regular classroom students."

Questionnaire on Ability to Study (QAS).22 This self-report questionnaire,standardized on Italian junior and high school students, is designed to surveystudents' beliefs about studying, cognitive style, learning strategies, relation-ship with teachers and peers, emotional components in learning processesand school attendance (anxiety, confidence). The questionnaire consists of 163items. On each item the subjects is instructed to choose which of three an-swers, rated on a scale from 0 to 2 (Much, Slightly, Few), best describes astatement regarding school functioning (for example: I am not able to under-stand some of the mistakes I make. I am aware of my limitations and skills.When school work gets too difficult, I reduce my effort. During the lessons Iask questions. I believe I am not liked by to my schoolmates). Items aregrouped in 21 areas that tap beliefs about emotional and cognitive function-ing in scholastic activity: motivation, self-organization of school work, capac-ity of using aids (pictures, videos, audiocassettes), active processing of school-work, flexibility in study skills, participation skills during the lesson,systematic/intuitive cognitive style, global/analytic cognitive style, impulsive/reflective cognitive style, verbal/visual cognitive style, personal and creativeapproach to study, concentration, ability to select significant components ofschoolwork, self-evaluation, strategic approach to a task, metacognitiveawareness, relationship with schoolmates, relationship with teachers, schoolanxiety, attitude toward schooling, and attributional style. Psychometricproperties of the questionnaire and normative data are described in Cornoldiand associates.22

Data Collection

The instruments were collectively administered in the classrooms duringone 90-minute session to small groups of no more than 30 students (whichincluded a break between the CDI and the QAS). Two or three experimenterswere present during the group administration to ensure that students under-

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stood the questionnaire format and that they worked independently. All sub-jects participated anonymously.

Statistics

Correlation between Children's Depression Inventory score and the re-ported answers at the 21 areas of the Questionnaire on the Ability to Studywere analyzed with Pearson Correlation. Bonferroni correction was used todecrease the experiment-wise error rate, setting alpha at 0.002. In order toverify possible gender and school functioning effects on CDI and QAS scores,a two-factor between-subjects ANOVA was carried out (p<.05), with CDI andQAS as dependent variables and gender and school functioning as indepen-dent variables.

Results

The CDI mean score for the whole sample was 11.2 (range 0-54;SD = 7.4). The distribution was not normal (Skewness = 1.8; Kur-tosis = 7.0). In order to obtain a more acceptable normal distributiononly the subjects who scored less than 3 standard deviations abovethe mean were considered. With this procedure, two outliers were ex-cluded from the sample and the mean CDI score became 10.7 (SD =6.3) (range was 0-33). The distribution was normal (Skewness = 0.7;Kurtosis = 0.4).

To assess the correlation between CDI score and the reported an-swers at the 21 areas of the QAS, Pearson values were calculated forthe whole of the group of subjects. Data are reported in Table 1. As-terisks indicate significant correlation that survived Bonferroni ad-justment (alpha at .002). The pattern of correlation shows that emo-tional beliefs about schooling and learning are more significantlycorrelated to CDI scores than cognitive beliefs.

In order to verify if CDI and QAS scores could be affected by genderand actual school functioning, a between-factor ANOVA (males versusfemales, and Failure group versus non-Failure group) was applied.Differences on CDI scores between males and females (F(l,148) = 8.6,p = .004) and between Failure and non-Failure groups (F(l,148) = 5.5,p = .02) were significant. The interaction between the two factors wasnot significant. Children's Depression Inventory score was signifi-cantly greater in females than in males (12.9 ± 6.1 versus 8.6 ± .7)and in Failure than in non-Failure group (7.5 ± 4.9 versus11.2 ± 6.3).

The only item of QAS that differed according to gender and/orschool functioning was school anxiety. School anxiety differed be-

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Discussion

Data from literature points to school functioning as one of the mostimportant factors in self-esteem and self-worth during adolescence.23

Academic self-image, defined as the way adolescents represent them-selves as students, directly affects the global self-image; for this rea-son it has important psychopathological implications." The relation-ship among school performances, self-image and mood are complex.Negative affects can influence behavior in learning situations, pro-ducing tendency to give up, low attention in performances, anxiety,

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tween gender (F(l,147)= 15.9, p<.001) but not between Failure/non-Failure groups. School anxiety score was higher in females than inmales (29.7 ± 5.1 versus 25.8 ± 5.5). A trend to significancewas found for Impulsive-Reflective cognitive style (p = .06), that washigher in females (14.4 ±2.1 versus 13.2 ± 2.1), but non-affected byschool functioning. The other differences were non-significant.

Table 1Correlations Between CDI and QAS for the Whole Sample (148 subjects)

Items

MotivationSelf organisation of school workCapacity of using aidsActive processing of school workFlexibility in study skillsParticipation skills during the lessonSystematic-intuitive cognitives styleGlobal-analytic cognitive styleImpulsive-reflective cognitive styleVerbal-visual cognitive stylePersonal approach to studyConcentrationSelection of significant aspectsSelf evaluationStrategic approach to a taskMetacognitive awarenessRelationship with schoolmatesRelationship with teachersSchool anxietyAttitude toward schoolingAttributional style

r

-.114- .177- .123- .059

.200- .090

.185

.010

.147- . 0 0 8-.086- .270*- .090- .304*- .075- . 0 1 0- .255*- .345*

.510*-.291*- . 1 2 4

*= significant after Bonferroni adjustment correction, <.002.


stress in achievement situations, lowering school performances.24 Onthe other hand school difficulties and frustrations can trigger sad af-fects and depression. Learning disorders have been frequently associ-ated with depressive symptomatology, which is many times higher inlearning disabled subjects than in normal controls;25,26 depressive feel-ings are strongly connected with cognitive and metacognitive func-tioning.27,28 However, negative self-perceptions can be found in nor-mally achieving students.29

Academic self-image is a multidimensional concept that can be dis-entangled in different ways. Current research has stressed the self-efficacy component of academic self-concept, that is the perceivedability to perform. This ability can be affected by the representationthe subject has on his/her own cognitive functioning and competence,but also by the perceived strength of emotional attitude in learningsituation. We hypothesized that these different components of aca-demic self-perception may contribute differently to depressive feel-ings. Our data seem to confirm this hypothesis. Item concerningemotional beliefs about learning and schooling correlated with CDIscores. Self-reported depressive feelings correlated with reported highscholastic anxiety, the feeling of not being able to concentrate onstudying, low self-evaluation, poor relationships with school-fellowsand teachers, negative general attitude toward school. In other wordsself-attributions about emotional strength in achievement situationsare significantly related with self reported negative affect. Self-attri-butions about cognitive ability, namely the capacity of actively elabo-rate learning material, the cognitive style, the learning strategies, themetacognitive behavior, do not show a similar significant relation.These findings can be considered in the light of recent competency-based models of depression in children.8 These findings might providea better definition of the academic component of the depression; emo-tional aspects of academic self image are probably related with theway the adolescent represent his/her capacity of coping with externalreality. This can enable us to focus supporting psychological interven-tions on more specific targets.

We have also determined if there is a relationship between the real,and not just perceived, level of school performance, and depressivefeelings, in order to define if depressive feelings are the consequencesof a scholastic underachievement or not. The literature reports thatself-image is not necessarily affected by the severity of underachieve-ment.29 According to our data scores on the CDI were higher in thesubjects with school failure. On the contrary, any item of QAS wasaffected by school performances. If this split between depressive feel-

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ings and beliefs about emotional and cognitive aspects of schoolingand learning in the Failure group is antecedent to the school failure(and possibly related to psychological or social and environmental fac-tors), or, on the contrary, it is secondary to the school failure, it needsfurther research.

Analyses of gender indicate that females scored higher in CDI,school anxiety and impulsive cognitive style, but also in participationduring lesson and strategic approach to tasks. Correlation betweenCDI scores and QAS scores is more pronounced in females, especiallyin the non-Failure group. The finding of higher CDI scores in femalestudents is consistent with the greater risk of depression, that is cur-rently reported in females after entering adolescence.30,31 Previousstudies have shown that adolescent girls score higher in self-reportmeasures for anxiety.13 Data from literature indicate that associationbetween depression and anxiety is very frequent during adolescence,32-35

and symptoms of anxiety often precede symptoms of depression.36

Furthermore, our previous data showed a significant positive correla-tion between impulsive cognitive style and CDI scores.28 These find-ings may support the existence of a cluster depression-anxiety-impul-sive cognitive style, that is more frequent in females. Well-designeddevelopmental studies are needed to define possible pathogenic path-ways between these different psychopathological aspects, for examplein terms of which disorder best predicts the others. These pathogenicpathways may be different in males and in females. For example, infemales a crucial role may be played by depression and/or anxiety,while impulsivity may be secondary; on the contrary, in males impul-sivity (cognitive as well as behavioral) may be primitive, and anxietyand depression (or demoralization) may be secondarily related. Thesestudies may offer new opportunities for timely diagnoses and specificpreventive interventions.

This preliminary study must be considered in the light of some im-portant methodological limitations. Some of these limitations are re-lated to the epidemiological sample, such as the absence of a morecomprehensive evaluation of psychopathology, besides that of depres-sion. Other emotional, temperamental and behavioral aspects, suchas anxiety, behavioral inhibition, externalized disorders, and socio-environmental variables, could be related to beliefs about schooling.Further studies about these topics could allow for an early identifica-tion of adolescents with school failure that are more vulnerable orresilient to psychopathology. Another avenue for further researchmay be to replicate these findings in a clinical sample of depressed

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children and adolescents, diagnosed with more formal diagnostic in-struments (both self- and other- report), such as clinical interviews.

Summary

Mood disturbances in adolescence are heavily influenced by theself-image, that is "the value one places on the self as a person." Inliterature, a global self-image has been distinguished from specificself-images, that is self-images differentiated across different do-mains, such as physical appearance, peer acceptance, academic com-petence, athletic competence, etc. A major role can be attributedto subject's perceived academic competence; children's beliefs abouttheir academic self-image, defined as the way they represent them-selves as students, can predict a depressive state. The aim of thispaper is to specifically analyse the relationship between the differentcomponents of academic self-image (cognitive as well emotional) andself-reported depressive symptoms in a non-clinical sample of adoles-cents. Our data indicate that the pattern of correlation between emo-tional beliefs about schooling and learning are significantly related todepressive symptomatology (Children's Depressory Inventory scores),but this correlation is not evident for the cognitive beliefs. This pat-tern of correlation is affected by actual school functioning, becausecorrelation between CDI and beliefs is much more significant in sub-jects without school failure. The hypothesis that different componentsof the academic self-image can be differently associated with depres-sive feelings was confirmed.

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Depression and school functioning in non-referred adolescents: A pilot study

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