Stressful events and depression among Chinese adolescents: The mitigating role of protective factors

Abstract

This study examines the role of salient external factors (family, peer and school caring relations) and internal factors (goals and aspirations, problem solving and self-efficacy, empathy, and self-awareness) in protecting adolescents experiencing interpersonal problems and academic pressure from depression. A total of 1,297 eighth and ninth grade students in Shandong province of Eastern China completed self-report measures. Results of hierarchical regression analyses indicated that interpersonal problems and academic pressure predicted depression positively. Peer caring relationships, home caring relationships, goals and aspirations, problem solving and self-efficacy, and self-awareness predicted depression negatively, but empathy did so positively. The interactions of home caring relationships with interpersonal problems, peer caring relationships with academic pressure, and self-awareness with academic pressure were negatively associated with depression. The relationships between interpersonal problems and depression, and academic pressure and depression, were less apparent for adolescents who had higher levels of peer caring relationships, home caring relationships, and self-awareness. The results suggest that school psychologists and counselors should note and build upon positive strengths while providing intervention services for adolescents experiencing depression related to interpersonal problems and academic pressure.

Keywords

Academic pressure Chinese adolescents depression interpersonal problems protective factors resilience stressful events

Mental health research has consistently shown that the incidence and prevalence of depression increase dramatically during adolescence (e.g. Lakdawalla, Hankin, & Mermelstein, 2007; Liu, 1997). In Western countries, 10% to 40% of adolescents suffer from depression (Compas, Ey, & Grant, 1993; Petersen et al., 1993). In China, the incidence rates range from 17.9% to 42.3% (e.g. Feng & Zhang, 2005; Su, Xi, & Kang, 2012).

Research suggests that the experience of depression during adolescence can be triggered by stressful life events such as puberty, school change, serious illness, or injury (Graber & Sontag, 2009). There are variations in the types and frequencies of these age-related negative life events in different cultural contexts. For example, among children and adolescents in Southern Africa, the most frequent stressor is the birth or adoption of new siblings (Djarova, Dube, Tivchev, & Chivengo, 2007). For Norwegian adolescents, the most prevalent negative life event occurs when someone close to them experienced serious illness or injury (Lien, Haavet, Thoresen, Heyerdahl, & Bjertness, 2007). In China, interpersonal problems and academic pressure are two negative life events to which adolescents are frequently exposed (e.g. Liu, 1997).

Interpersonal and academic life events and adolescent depression

Peer relationships, family relationships, and teacher-student relationships constitute important social contexts for adolescents. Literature has demonstrated that the qualities of such relationships are closely associated with adolescent depression (e.g. Hankin, Mermelstein, & Roesch, 2007; Li & Prevatt, 2008). Considering interpersonal harmony is greatly valued within both traditional and contemporary collectivistic Chinese societies (Liu & Chen, 2003), it is reasonable to assume that stressful events in interpersonal relations and interactions such as peer rejection, conflict with parents, and problems with teachers may cause even greater internalizing problems (such as depression) among Chinese adolescents.

A salient feature of the context in which Chinese adolescents live is the exam-oriented nature of the Chinese school system. Traditionally, academic achievement has been greatly valued in Chinese culture and is still the most important pursuit for adolescents in contemporary China (Fuligni & Zhang, 2004). For example, before every school year in China, two days of city-wide senior high school entrance examinations are held for all junior high school graduates, who must compete for the limited spaces available in the higher status local senior high schools. Whether students can be admitted to one of these key senior high schools depends on whether their scores reach a certain standard. Therefore, it is not difficult to imagine that learning constitutes one of the most frequently referenced criteria by Chinese teachers in their evaluation of students (Ni, Jones, & Bruning, 2012). Largely because of limited opportunities to receive high quality high school education and subsequent higher education, adolescents are constantly pressured by their parents and teachers to perform optimally in school. Studies indicated that academic pressure is a crucial source of stress for Chinese adolescents and constitutes an important risk factor for depression within this population (e.g. Chen et al., 2012). Therefore, in the present study we expected that academic pressure would be positively associated with depression among Chinese junior high school students.

External and internal protective factors

Despite exposure to risk factors, many children and adolescents display positive adaptation, experience normal developmental trajectories, and become healthy adults (Garmezy, 1983). Central to this phenomenon is the concept of resilience. According to Hjemdal, Friborg, Stiles, Rosenvinge, and Martinussen (2006), resilience is defined as the protective factors, processes, and mechanisms that contribute to a good outcome despite experiences with stressors shown to carry significant risks for developing psychopathology. Protective factors are believed to reduce the negative effects of risk factors or act as buffers against the distress associated with adversity (Cummins, 2010).

Studies have demonstrated that a supportive relationship between adolescents and their families, teachers, and peers is an important protective factor when adolescents are exposed to dangerous conditions (Hamre & Pianta, 2001; Jackson & Warren, 2000). Besides contextual factors, studies also have revealed that certain individual factors, such as goals and aspirations (Dickson & MacLeod, 2004), problem solving (Frye & Goodman, 2000), and self-efficacy (Ehrenberg, Cox, & Koopman, 1991) negatively predict adolescent depression. However, noteworthy findings show empathy may be positively associated with adolescent depression (O’Connor, Berry, Lewis, Mulherin, & Crisostomo, 2007), and that a positive relationship exists between self-awareness and depression (Chen, Mechanic, & Hansell, 1998). This suggests empathy and self-awareness, unlike the other individual factors mentioned above, may be risk factors for adolescent depression. These findings were mainly obtained by studying adolescents from Western cultures; thus, in this study we replicated the findings by sampling adolescents within a Chinese context.

Although it is important to know the risk and protective factors that are associated with adolescent depression, a central and more challenging issue in research on resilience and depression involves the processes or mechanisms that may underlie the evidence of good adaptation in the presence of risk and adversity. Understanding these processes has significant implications for school practice and intervention (Compas & Reeslund, 2009). A substantial body of research has indicated that in addition to directly affecting risk, protective factors interact with risk or vulnerabilities, thereby moderating the relationships between these stressors and depression (Grant et al., 2006).

Purpose

Although resilience and its protective functioning have been studied extensively in recent years, research in this area has almost exclusively been conducted in Western countries. Research on adolescent resilience in the Chinese cultural context has been scarce. The purpose of this study was to examine the role of resilience in protecting adolescents experiencing interpersonal problems and academic pressure from depression. The research questions were: (1) Do interpersonal problems and academic pressure predict depression? (2) Do positive assets predict depression? (3) Does resilience moderate the relations between stressful events and depression?

Method

Sample

A total of 1,297 students in the eighth (M_age = 13.9 years) and ninth (M_age = 14.8 years) grades of three junior high schools in China participated in the study. Approximately half of the sample lived in an urban area and attended two schools in Shandong Province in Eastern China. The other half of the sample attended one school in the rural area of Shandong Province. The total sample from both locations was fairly evenly divided between males (52.7%) and females (47.3%). All students lived with their families while attending school.

Measures

Stressful life events

Interpersonal problems were measured with five items from the Adolescent Self-Rating Life Events Checklist (ASLEC; Liu et al., 1997). The items reflect the severity of interpersonal stress from school, family, and peers. This scale involves respondents reporting which, if any, of the negative life events described in the items they had experienced. For those items that have been experienced, respondents indicate the perceived stressfulness of the event by using a Likert scale ranging from 1 (not at all) to 5 (extremely severe). Cronbach’s α for this scale in the current sample is 0.67.

Academic Pressure was measured using four additional items from the ASLEC (Liu et al., 1997). The items reflect the severity of academic stress from school and family. In the current sample, Cronbach’s α is 0.64.

External protective factors and internal assets

Three external protective factors and four internal assets were measured using subscales from the Chinese version (Li, Zhang, & Zhang, 2008) of the Resilience Assessment Module from the California Healthy Kids Survey (RAMCHKS; California Department of Education, 2003). The participants indicated their responses using a Likert scale ranging from 1 (not at all true) to 4 (very much true).

School caring relationships were measured with three items, which reflect adolescents’ supportive connections to teachers. This scale produces a Cronbach’s α of 0.70 within the current sample. Peer caring relationships were measured with three items, reflecting adolescents’ supportive connections to peers. In the current sample, Cronbach’s α is 0.80. Home caring relationships and meaningful participation were measured with five items, reflecting adolescents’ supportive connections to parents or other adults in the family, and the involvement in family activities. Cronbach’s α for this scale in the current sample is 0.71.

Goals and aspirations were measured with three items, which reflect adolescents’ goals and plans for the future. Cronbach’s α for this scale in the current sample is 0.68. Problem solving and self-efficacy was measured with six items, reflecting adolescents’ strategies to overcome problems, and beliefs in their abilities to succeed in specific situations. Cronbach’s α for this scale in the current sample is 0.72. Empathy was measured using three items, reflecting adolescents’ capacities to recognize others’ feelings. Cronbach’s α for this scale in the current sample is 0.70. Finally, three items measured self-awareness, which reflect adolescents’ knowing and understanding one’s self. Cronbach’s α for this scale in the current sample is 0.66.

Depression

Depression was measured using the Chinese version (Wang, Wang, & Ma, 1999) of the Center for Epidemiologic Studies Depression Scale (CES-D; Radloff, 1977), a 20-item self-report scale designed to measure depressive symptomatology in the general population. The items reflect major dimensions of depression: Depression mood, feelings of guilt and worthlessness, feelings of helplessness and hopelessness, psychomotor retardation, loss of appetite, and sleep disturbance. Participants are asked to rate each item on a scale from 0 (rarely or none of the time) to 3 (most or all of the time) on the basis of how often they have felt that way during the past week. Cronbach’s α for the measure in the current sample is 0.87.

Procedure

Students were approached in their own classrooms by psychology graduate students and were told the purpose of the study, students were also given a non-consent form that their parents could sign if they did not wish for their child to take part in the study. No student returned the form, so none were excluded from the study. Students completed the survey in a single class period during the regular school day.

Analysis plan

Bivariate Pearson correlations were conducted to examine the associations between each measure of stressful life events, external protective factors, internal assets, and depression. This procedure was followed by a three-step hierarchical regression analysis. The main effects of negative life events (e.g. interpersonal problems, academic pressure) were entered at Step 1. The main effects of resilience factors (e.g. school caring relationships, peer caring relationships, home caring relationships and meaningful participation, goals and aspirations, problem solving and self-efficacy, empathy, and self-awareness) were entered at Step 2. Two-way interactions between each of the negative life events and each of the resilience factors were entered at Step 3. Interaction terms were composed of the product of the two predictors (e.g. interpersonal problems × self-awareness) that were standardized to avoid problems of multicollinearity.

Results

The means, standard deviations, and intercorrelations of the major variables are presented in Table 1. As expected, interpersonal problems and academic pressures were significantly and positively related to depression. While most resilience factors exhibited significant negative associations with depression, empathy was an exception.
Table 1.
Correlations, means, and standard deviations of study variables.

Variable 1 2 3 4 5 6 7 8 9 10

1. D –

2. IP 0.485 –

3. AP 0.405 0.473 –

4. SCR −0.183 −0.130 −0.118 –

5. PCR −0.215 −0.153 −0.103 0.280 –

6. HCRMP −0.251 −0.151 −0.162 0.276 0.316 –

7. GA −0.231 −0.117** −0.058* 0.257 0.253 0.323 –

8. PSS −0.268 −0.165 −0.163 0.265 0.351 0.447 0.413 –

9. EM −0.032 −0.004 −0.027 0.210 0.295 0.260 0.289 0.398 –

10. SA −0.242 −0.107 −0.095 0.194 0.262 0.345 0.441 0.478 0.331 –

M 0.70 1.12 1.80 3.14 3.35 2.97 3.48 3.07 3.24 3.37

SD 0.50 0.88 1.08 0.75 0.70 0.68 0.63 0.57 0.66 0.61

Note. Means and standard deviations are based on the item-mean level for each scale.

AP = Academic Pressure; D = Depression; EM = Empathy; GA = Goals and Aspirations; HCRMP = Home Caring Relationships and Meaningful Participation; IP = Interpersonal Problems; PCR = Peer Caring Relationships; PSS = Problem Solving and Self-Efficacy; SA = Self-Awareness; SCR = School Caring Relationships.

**
p < 0.01; p < 0.05.

Table 2 reports the unstandardized coefficients for the hierarchical regression analyses predicting depression. The hierarchical regression analyses for depression revealed a statistically significant increment in the variance explained (R²) at each step of the analyses: Step 1, ΔR²* = 0.275, p < 0.01; Step 2, ΔR² = 0.065, p < 0.01; Step 3, ΔR² = 0.012, p < 0.05. Interpersonal problems (p < 0.01) and academic pressure (p < 0.01) were positively associated with depression. In addition, peer caring relationships (p < 0.05), home caring relationships and meaningful participation (p < 0.05), goals and aspirations (p < 0.01), problem solving and self-efficacy (p < 0.01), and self-awareness (p < 0.01) were negatively associated with depression; however, empathy was positively associated with depression (p < 0.01). The two-way interactions of home caring relationships and meaningful participation with interpersonal problems (p < 0.05), peer caring relationships with academic pressure (p < 0.05), and self-awareness with academic pressure (p < 0.05) were negatively associated with depression.
Table 2.
Results of Hierarchical Regression Analysis of Depression.

Variable Depression

ΔR ² B (SE)

1. Negative Life Events 0.275

IP 3.319 (0.265)

AP 1.919 (0.262)

2. Resilience 0.065

PCR −0.646 (0.260)*

HCRMP −0.667 (0.270)*

GA −0.888 (0.267)

PSS −0.703 (0.294)

EM 0.943 (0.263)

SA −0.908 (0.275)

3. Negative Life Events × Resilience 0.012*

IP × HCRMP −0.641 (0.296)*

AP × PCR −0.510 (0.263)*

AP × SA −0.574 (0.291)*

Note. AP = Academic Pressure; EM = Empathy; GA = Goals and Aspirations; HCRMP = Home Caring Relationships and Meaningful Participation; IP = Interpersonal Problems; PCR = Peer Caring Relationships; PSS = Problem Solving and Self-Efficacy; SA = Self-Awareness.

**
p < 0.01; *p < 0.05.

To examine these interactions, we estimated the association between interpersonal problems and depression at high and low (1 SD above and 1 SD below the mean) levels of home caring relationships and meaningful participation (Aiken & West, 1991). Plotting the interaction revealed that the association of interpersonal problems with depression was less apparent when students had higher levels of home caring relationships and meaningful participation (see Figure 1; Supplemental Materials). We also estimated the association between academic pressure and depression at high and low levels of peer caring relationships. The association of academic pressure with depression was less apparent when students had higher levels of peer caring relationships (see Figure 2; Supplemental Materials). Finally, we estimated the association between academic pressure and depression at high and low levels of self-awareness. Plotting the interaction revealed that the association of academic pressure with depression was less apparent when students had higher levels of self-awareness (see Figure 3; Supplemental Materials).

Discussion

This study investigated associations between negative life events (i.e. interpersonal problems, academic pressure), resilience factors, and depression among adolescents in the Chinese cultural context. Similar to previous studies, individuals with more severe interpersonal problems (Chen et al., 2012) and academic pressure (Liu et al., 1997) were found to show higher levels of depression.

Peer caring relationships, home caring relationships and meaningful participation were all significant negative predictors of depression, such that adolescents possessing high levels of these variables reported low levels of depression. Results showing that close relationships with peers and parents reduce the likelihood of depression are consistent with the findings of previous studies conducted with adolescents in Western cultures (e.g. Jackson & Warren, 2000), and suggest that caring peer and parent-adolescent relationships are protective factors in regards to adolescent emotional well-being across different cultures.

A notable finding of the present study was that school caring relationships were not significant predictors of adolescent depression among Chinese adolescents. Conversely, studies conducted in Western cultures indicate that supportive relationships with teachers play a protective role in adolescent well-being and adaptation (Hamre & Pianta, 2001). This divergence may reflect a difference in the roles that teachers in Western and Chinese cultures play in the lives of students. Literature indicates that teachers in Western cultures play an important role in shaping children’s experiences in school. Beyond the traditional role of teaching academic skills, they are responsible for regulating activity level, communication, and contact with peers (Howes, Matheson, & Hamilton, 1994). Western teachers are also expected to provide behavioral support and teach coping skills to children (Doll, 1996). However, because of the exam-oriented nature of its schooling system and the fierce competitions among students and schools for academic achievement, performance evaluation for school teachers in China is predominantly based on the academic achievement of their students. The over-emphasis on academic achievement may result in teachers’ very limited emotional and behavioral support to students in Chinese schools.

Two of the four internal assets––goals and aspirations, problem solving and self-efficacy––negatively predicted depression among Chinese adolescents. The results generally coincide with results from previous studies conducted in Western cultures on these assets (Dickson & MacLeod, 2004; Ehrenberg, Cox, & Koopman, 1991; Frye & Goodman, 2000) and suggest that these internal assets serve a protective function for adolescents across different cultures. Empathy was positively associated with adolescent depression in this study, a result that is consistent with the findings of O’Connor et al. (2007). This result suggests that empathy is a risk factor for depression, such that adolescents who exhibit high levels of empathy are more likely to have depression.

Inconsistent with the finding of Chen et al. (1998) that adolescent self-awareness positively predicts depression, in this study adolescent self-awareness was negatively associated with depression. This discordance of results can be partially attributed to differences in the definition of self-awareness and the use of different measures in the two studies. In this study, self-awareness was defined as knowing and understanding one’s self (one’s thinking, moods, feelings, strengths, and challenges) (CDE, 2003). For example, one item assessed participants’ understanding of their own mood and feelings. Conversely, in the study by Chen et al. (1998), self-awareness referred only to self-focused attention and did not include any specific outcome variables such as negative feelings or physical states. For example, participants were asked to rate how much they pay attention to their feelings. Whereas in our study a high self-awareness score represents a clearer self-awareness, in the Chen et al. study (1998) it represents a higher degree of thinking about self concern.

The findings also illuminate an additional role that some resilience factors may play in the relationship between negative life events and depression. Peer caring relationships, home caring relationships and meaningful participation, and self-awareness may be important buffering factors which significantly moderate the association between negative life events (i.e. interpersonal problems, academic pressure) and depression among Chinese adolescents. Thus, the positive association of each negative life event with depression is less apparent when adolescents have more caring relationships from peers and home and higher levels of self-awareness. These results are consistent with extant literature using Western samples (e.g. Criss, Pettit, Bates, Dodge, & Lapp, 2002; Schwartz, Dodge, Pettit, & Bates, 2000).

Study limitations and future directions

There are several limitations of this study that must be considered. First, the results on Chinese adolescents may not be generalizable to individuals from other cultures or nationalities. To better understand relations between negative life events, resilience, and depression of adolescents, comparative, cross-cultural studies on this topic are needed. Second, we used adolescents’ self-reports of resilience factors, stressful events, and depression, which may lead to common method variance. Information from additional informants and alternative methods would be important for future research. Third, our cross-sectional data do not allow us to eliminate alternative explanations for our observed relationships or to draw definitive causal inferences. Longitudinal studies should be undertaken to establish a direct causal link between negative life events and resilience factors on depression.

Implications for practice

This study reveals possible directions for intervention efforts by providers of psychological services to adolescents in school aimed at reducing depression among adolescents. Interventions can be developed to reduce depression by mobilizing and nurturing individual’s strengths, increasing available external protective factors, and reducing stressors and environmental barriers. This is consistent with recommendations made by Wright and Lopez (2005) who urge that an assessment of an individual and his or her environment focus equal attention between assets available to the individual and deficits. Our findings suggest the possibility that increasing adolescents’ access to external protective factors (i.e. peer caring relationships, home caring relationships and meaningful participation) and internal assets (i.e. goals and aspirations, problem solving and self-efficacy, and self-awareness) might prevent or ameliorate increases in adolescent depression linked to interpersonal problems and academic pressure. Understanding more clearly the role resilience factors play in mental health outcomes would prove beneficial to school psychology practitioners and encourage the application of strength-based approaches to facilitate psychosocial adaptation among adolescents with negative life events. In addition, given that interpersonal problems and academic pressure account for much more variance in depression than resilience factors, reducing the occurrence of negative life events is still an important intervention method. Thus, this study highlights the necessity of a systemic intervention program that not only reduces negative life events, but also enhances protective factors.

Variable	1	2	3	4	5	6	7	8	9	10
1. D	–
2. IP	0.485**	–
3. AP	0.405**	0.473**	–
4. SCR	−0.183**	−0.130**	−0.118**	–
5. PCR	−0.215**	−0.153**	−0.103**	0.280**	–
6. HCRMP	−0.251**	−0.151**	−0.162**	0.276**	0.316**	–
7. GA	−0.231**	−0.117**	−0.058*	0.257**	0.253**	0.323**	–
8. PSS	−0.268**	−0.165**	−0.163**	0.265**	0.351**	0.447**	0.413**	–
9. EM	−0.032	−0.004	−0.027	0.210**	0.295**	0.260**	0.289**	0.398**	–
10. SA	−0.242**	−0.107**	−0.095**	0.194**	0.262**	0.345**	0.441**	0.478**	0.331**	–
M	0.70	1.12	1.80	3.14	3.35	2.97	3.48	3.07	3.24	3.37
SD	0.50	0.88	1.08	0.75	0.70	0.68	0.63	0.57	0.66	0.61

Variable	Depression
1. Negative Life Events	0.275**
IP	3.319 (0.265)**
AP	1.919 (0.262)**
2. Resilience	0.065**
PCR	−0.646 (0.260)*
HCRMP	−0.667 (0.270)*
GA	−0.888 (0.267)**
PSS	−0.703 (0.294)**
EM	0.943 (0.263)**
SA	−0.908 (0.275)**
3. Negative Life Events × Resilience	0.012*
IP × HCRMP	−0.641 (0.296)*
AP × PCR	−0.510 (0.263)*
AP × SA	−0.574 (0.291)*

Footnotes

Funding

This study was supported by grants from National Natural Science Foundation of China (30970905, 31271105) to Wenxin Zhang.

Author biographies

Wenxin Zhang, PhD, is a Professor in the Department of Psychology at Shandong Normal University in Jinan, Shandong, China. Dr Zhang has published and presented on a variety of topics of child and adolescent development and school psychology, including aggression and peer victimization, peer relationships, family process, resilience, and gene-environment interactions. He has been leading a large-scale longitudinal project that aims to explore the developmental changes of aggression, prosocial behavior, and internalizing problems from middle childhood through adolescence. Zhang is a Mount Tai Scholar Professor in developmental psychology awarded by Shandong Provincial Government, and currently serves as a vice president of the Chinese Psychological Society.

Hailei Li, PhD, is a Lecturer in Educational Psychology in the Department of Psychology at Shandong Normal University in Jinan, Shandong, China. He has experience as a psychological consultant. Dr Li has published and presented on topics including youth resilience, school bullying, and adolescent depression.

Yanming Gong, PhD, is an Adjunct Professor of Applied Psychology in the Department of Psychology at Shandong Normal University in Jinan, Shandong, China. She has experience as an applied psychologist and has published and presented on resilience, entrepreneurship, and entrepreneur-training. Dr Gong is the co-PI of a research project that aims to identify and enhance the protective factors related to the maintenance of adolescent psychological well-being among adolescents experiencing adversity.

Michael Ungar, PhD, is a Professor of Social Work at Dalhousie University and Scientific Director of the Resilience Research Centre. He has published over 100 peer-reviewed articles and chapters and 11 books on the topic of resilience and its application to clinical and community work with children and families with complex needs (the social ecological approach to counseling). His latest work includes a clinical textbook Counseling in Challenging Contexts, an edited volume of international papers, The Social Ecology of Resilience: A Handbook of Theory and Practice, and a novel The Social Worker.

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Variable	Depression
Variable	ΔR ²	B (SE)
1. Negative Life Events	0.275**
IP	3.319 (0.265)**
AP	1.919 (0.262)**
2. Resilience	0.065**
PCR	−0.646 (0.260)*
HCRMP	−0.667 (0.270)*
GA	−0.888 (0.267)**
PSS	−0.703 (0.294)**
EM	0.943 (0.263)**
SA	−0.908 (0.275)**
3. Negative Life Events × Resilience	0.012*
IP × HCRMP	−0.641 (0.296)*
AP × PCR	−0.510 (0.263)*
AP × SA	−0.574 (0.291)*