Adolescents’ Beliefs About What Symptoms Constitute Depression: Are More Expansive Definitions Helpful or Harmful?

Abstract

Abstract Purpose. What symptoms do people think constitute “depression”? In a mental health literacy framework, knowing more of depression’s nine core symptoms (per formal psychiatric diagnostic criteria) is thought to help 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 U.S. adolescents experiencing elevated depression symptoms (total N = 387), collecting data on symptom beliefs and outcomes via online questionnaires. 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). Conclusion. These findings simultaneously support and challenge elements of both the common-sense model and the mental health literacy framework. Future research on mental health literacy may examine why adolescents with more psychiatrically-accurate understandings of depression experience worse clinical outcomes. Likewise, future research on the common sense model should explore whether more expansive depression symptom beliefs may be adaptive as well as maladaptive.