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Depression and its sociodemographic, clinical correlates amongst adolescents seeking treatment
*Corresponding author: Radhakrishnan Govindan, Department of Nursing, National Institute of Mental Health and Neuro Sciences (INI), Bengaluru, Karnataka, India. dr.rk76@hotmail.com
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Received: ,
Accepted: ,
How to cite this article: Bhimanagar S, Govindan R, Ramu R, Kommu JV. Depression and its sociodemographic, clinical correlates amongst adolescents seeking treatment. Karnataka Paediatr J. 2025;40:219-25. doi: 10.25259/KPJ_31_2025
Abstract
Objectives:
Depression is a universal public health concern, and it stands as one of the illnesses having the highest burden for persons with mental illness, families and society. It has been observed that there is a rise in depressive disorders during the post-pubertal phase corresponding to the adolescent age group, which can be accounted for by various biopsychosocial risk factors.
Material and Methods:
The study aimed to find the relationship between depression among adolescents and their sociodemographic, clinical variables. A descriptive correlational research design was adopted for this study. Fifty adolescents who met the inclusion criteria were recruited using the convenience sampling technique. Data were collected with a sociodemographic questionnaire, clinical correlates questionnaire and Kutcher Adolescent Depression Scale-11 questionnaire. Statistical Package for Social Science 28 was used for the data analysis. Mann–Whitney test, Kruskal–Wallis test and Wilcoxon test were used to find an association between adolescent depression and its sociodemographic factors and clinical factors.
Results:
Analysis revealed clinically and statistically significant (P < 0.05) associations between adolescent depression and their sociodemographic factors, such as nuclear family, education of parents and clinical factors such as family history of psychiatric illness.
Conclusion:
Depression amongst adolescents is a major mental health problem that significantly disturbs adolescents in reaching developmental and emotional milestones. This study observed that socio-demographic factors, such as a nuclear family, have a significant relationship with adolescent depression whereas adolescents whose parents are post-graduates have less severe depression scores. This study’s findings corroborated with research evidence that indicates a correlation between social and clinical factors among adolescents with depression. Clinically, the findings highlight the need for early screening for depression in adolescents, especially those from nuclear families or with family psychiatric history. Policymakers should strengthen school-based mental health programs. Future research should use larger, multi-centre samples to validate these associations.
Keywords
Adolescents
Demographic and clinical correlates
Depression
INTRODUCTION
Mental health among adolescents is a significant factor in their overall development. Depression is manifested by an alteration in mood that is expressed by feelings of sadness, despair and pessimism. There is a loss of interest in usual activities and somatic symptoms may be evident. Changes in appetite and sleep patterns are common. Furthermore, data from community surveys identified that depression co-occurring with other disorders is recurrent in adolescents, with anxiety often included. Co-occurring estimates of depression with anxiety disorders ranged from 15% to 75%. There is a rise in depressive disorders during the post-pubertal phase corresponding to the adolescent age group, which can be accounted for by various biopsychosocial risk factors.[1-3] This mental derangement in youth appears to be the result of complicated interactions between biological risk and environmental factors. Despite its serious consequences, adolescent depression often remains concealed with insufficient treatment. Hence, proper identification of adolescent depression, its correlates and risk factors, can lead to early intervention and optimal treatment, thus constituting a potentially significant preventive strategy is possible. However, the disorder is frequently underdiagnosed in this population. Further, the clinicians are posed with challenges because of its unique presentation with prominent irritability and varying psychopathology.[3,4]
According to the national mental health survey report, in India, at least half of those with a mental disorder reported disability in all three domains, such as professional, social and family life. It is found that greater disability was reported among persons with Bipolar Affective Disorders. Subsequently, the study, which was conducted in North India, revealed its results where, 40% of the school-going adolescents suffered from depressive disorders, out of which 7.6% had major depressive disorders and 32.5% had other depressive disorders.[5] At the same time, the National Mental Health Survey of India, 2016-rationale, design and methods revealed that the weighted estimates for lifetime prevalence and current prevalence of depressive disorder among adolescents and adults (18+ years) were 5.3 and 2.7, respectively.[6] Further, the various researchers identified in recent years that the human age at onset and occurrence of depression is decreasing, and it is now increasingly being identified in older children and adolescents. Consequently, depressive symptoms in children can lead to social and educational disability, such as recurrent suicidal thoughts, poor academic ability and social isolation in adolescents. Early diagnosis of depression in children and adolescents can help early and appropriate secondary preventive interventions to reduce morbidity and long-term complications. Knowledge of the prevalence of adolescent depression can inform policymakers about the severity of the problem and direct them in resource allocation for early intervention programs.[7] A very scanty number of studies were found by the researchers in the area of Karnataka. Along with the above background and considering the importance of early identification of the correlates of depression among adolescents for early intervention, this study was designed and executed by the researchers.
MATERIAL AND METHODS
Study design and setting
The study aimed to find the relationship between depression among adolescents and sociodemographic, clinical variables. A descriptive correlational research design was adopted for this study. Fifty adolescents who met the inclusion and exclusion criteria were recruited using the convenience sampling technique. The study was conducted in the Department of Child and Adolescent Psychiatry (CAP) Center of a tertiary care mental health centre in Bengaluru.
Study participants and sampling
Adolescents attending CAP Out Patient Department (OPD) and adolescents admitted to CAP ward were included in this study; convenience sampling was used for recruiting the study subjects. Adolescents aged between 10 and 19 years, both genders, visiting CAP department both inpatient and outpatient, with their parents and someone who knows Kannada, Hindi and English were included in this study. Adolescents with Intellectual and developmental disabilities were excluded from the study. The final sample size included in the analysis was n = 50.
Data collection tools and techniques
The researcher developed the tool to collect essential information on the sociodemographic and clinical profiles of the adolescents. The following research tools were used to collect the data:
Sociodemographic data sheet: Which includes the variable items such as age, gender, educational status, income, religion, family type, occupation, place of residence and use of substances
Clinical variables – such as level of depression, duration of depression, response to pharmacological and non-pharmacological treatment, co-morbid disease conditions, psychiatric disorders in the family, Body Mass Index (BMI)[8]
Assessment of the current level of functioning using the Children’s Global Assessment Scale (CGAS).[9]
Kutcher Adolescent Depression Scale-11 (KADS-11), its items are worded using standard and colloquial terminology and responses are scored on a simple 4-point scale to assess depression. The total score of the KADS is formed from the simple sum of the items’ scores. All scores were assessed relative to an individual patient’s baseline score (higher scores indicating worsening depression, lower scores suggesting possible improvement).[10]
Ethical approval and informed consent
The study was started after obtaining Ethical clearance from the Institute Ethics Committee (No.NIMH/DO/BEH.Sc.Div/2022-23, dated 15 July 2022). Permission was obtained from appropriate authorities for using copyrighted standardised tools for the current study, as well as for translating them into Kannada and Hindi languages. Written informed consent was taken from the caregivers and informed assent from adolescents who participated in the study. Caregivers and adolescents were assured of the confidentiality of the data and were informed about the study. Caregivers and adolescents were given the option of dropping out of the study.
Data collection procedure
Before the data collection, permission was obtained from the head of the department of CAP and the head of the department of nursing. The data were collected from October 2022 to December 2022. Adolescents who met the inclusion criteria were identified and included in the study with a convenience sampling technique, and the purpose and objectives of the study were explained to adolescents and caregivers. After obtaining informed consent and assent, a sociodemographic questionnaire and clinical correlates questionnaire were administered initially, then the BMI data were calculated after obtaining the height and weight of the adolescents, and then the CGAS scoring was obtained. Followed by the depression scale, was administered to the subjects. The total duration of the interview varied from 20 min to 30 min, and the language of communication was English, Kannada and Hindi based on the adolescents’ and caregiver’s convenience of communication.
Data analysis
Systematically collected raw data were categorised, coded, computed and analysed. Using descriptive and inferential statistics’ data were analysed under the guidance of a Statistician. Statistical Package for Social Science version 28 was used for analysis. Mann–Whitney test, Kruskal–Wallis test and Wilcoxon test were used to find an association between adolescent depression and their sociodemographic factors and clinical factors.
RESULTS
Sociodemographic variables of the adolescents
The majority of the subjects were found in the age group of 16 (minimum 14, max 17), the majority were female n = 37 (74%), completed high school n = 27 (54%), majority were Hindu religion n = 36 (72%), from nuclear families 43 (86%). All of them were students 50 (100%), and majority of the subjects were from urban background n = 37 (74%), did not have the habit of substance abuse n = 44 (88%). However, 50% of the adolescents had adverse childhood experiences n = 25 (50%), had low self-esteem n = 14 (28%), negative history of school environment n = 10 (20%) and n = 1 (2%) reported a lack of social support system [Table 1].
| S. No. | Variable | KADS score Median (Q1, Q3) | U-test | P-value |
|---|---|---|---|---|
| 1 | Gender | |||
| Male (n=13, 26%) | 26 (20.50, 28) | 218.5 | 0.626 | |
| Female (n=37, 74%) | 23 (19, 28) | |||
| 2 | Family type | |||
| Nuclear family (n=43, 86%) | 25 (20, 28) | 77.50 | 0.041* | |
| Joint family (n=07) (14%) | 18 (14, 25) | |||
| 3 | Place of residence | |||
| Rural (n=13, 26%) | 25 (19, 26) | 239.500 | 0.786 | |
| Urban (n=37, 74%) | 25 (19, 28) | |||
| 4 | History of substance use | |||
| Yes (n=6, 12%) | 22 (17, 26) | 111 | 0.530 | |
| No (n=44, 88%) | 25 (19, 28) | |||
| 5 | Education of adolescents | |||
| Higher primary high school (n=27, 56%) | 25 (19, 27) | 258.500 | 0.310 | |
| Pre-University (n=23, 44%) | 25 (20, 29) | |||
| 6 | Other factors | |||
| Negative history of school environment (n=10, 20%) | 27 (21, 29)# | 2.119# | 0.347 | |
| Adverse experience in childhood (n=25, 50%) | 25 (19, 27)# | |||
| Others such as low self-esteem, social support etc., (n=15, 28%) | 23 (18, 28)# |
Baseline profile of the parents of the adolescents
The sociodemographic profile of parents, such as gender, education, income, religion, occupation, place of residence, marital status, and other sociodemographic factors were identified. Any one parent who stayed most of the time with the subjects was included in the study. Of 50 parents, the majority parents, who were stayed along with the study subjects were female n = 30 (60%), majority of the parents were graduated n =19 (38%), majority parents received the income range of >40,000/month n = 36 (72%), majority of the parents n = 36 (72%) were Hindu. Regarding occupation of the parents, the majority were private job holders, n = 27 (54%). The residential status of the majority of parents was from urban n = 36 (72%) further majority of the parents reported that they got married and were living as a family n = 45 (90%). However, a few n = 05 parents reported that they were widows/separated from their husbands. The majority had parents and child interaction issues n = 36 (72%) [Tables 1-3].
| S. No. | Variable | KADS score Median (Q1, Q3) | U-test | P-value |
|---|---|---|---|---|
| 1 | Adherence to treatment | |||
| Yes (n=39, 78%) | 25 (20, 28) | 174 | 0.347 | |
| No (n=11, 22%) | 22 (18, 27) | |||
| 2 | Previous hospitalisation | |||
| Yes (n=20, 40%) | 24 (22, 28) | 267 | 0.512 | |
| No (n=30, 60%) | 25 (18, 28) | |||
| 3 | Family history of any psychiatric illness | |||
| Yes (n=13, 24%) | 28 (24, 29) | 121 | 0.008* | |
| No (n=37, 76%) | 23 (18, 26) | |||
| 4 | Co-morbid disease condition | |||
| If yes, specify the disease (n=1, 2%) | 28 (28, 28) | 11.50 | 0.366 | |
| No (n=49, 98%) | 25 (19, 28) | |||
| 5 | Duration of depression (Current episode) | |||
| <3 months (n=4, 8%) | 20.50#(17.25, 27.50) | 3.901# | 0.272 | |
| 4–11 months (n=8, 16%) | ||||
| 1-year (n=6, 12%) | 27#(19.25, 29) | |||
| More than 1-year (n=32, 64%) | 23#(19.25, 27) | |||
| 6 | Others | |||
| Side effects of medications (if any) –Weight gain, (n=12, 24%) | 21.50#(17.50, 26) | 2.606# | 0.272 | |
| Treatment resistant depression (n=5, 10%) | 20#(17.50, 28) | |||
| Not applicable (n=33, 66%) | 25#(22, 28) |
| S. No. | Variable | KADS score Median (Q1, Q3) | U-test | P-value |
|---|---|---|---|---|
| 1 | Place of residence | |||
| Rural (n=13, 26%) | 25 (19, 26) | 239.50 | 0.786 | |
| Urban (n=37, 74%) | 25 (19, 28) | |||
| 2 | Gender of parents | |||
| Male (n=20, 40%) | 25 (18, 27) | 270 | 0.558 | |
| Female (n=30, 60%) | 24 (20, 28) | |||
| 3 | Marital status | |||
| Married (n=45, 90%) | 25 (19, 28) | 103 | 0.758 | |
| Divorced/separated (n=05, 10%) | 25 (20, 28) | |||
| 4 | Education of parents | |||
| Higher primary (n=7, 14%) | 23 (20, 25)# | 218.5# | 0.626 | |
| High school (n=7, 14%) | 25 (18, 28)# | |||
| Pre-university (n=8, 16%) | 23 (20.25, 28)# | |||
| Graduation (n=19, 38%) | 26 (25, 29)# | |||
| Post-graduation (n=9, 18%) | 18 (14, 22.50)# | |||
| 5 | Income of parents | |||
| 10,000–19,900 (n=7, 14%) | 23 (18, 30)# | 0.022# | 0.989 | |
| 20,000–39,900 (n=6, 12%) | 25 (22, 25.25)# | |||
| >40,000 (n=37, 74%) | 25 (19, 28)# | |||
| 6 | Occupation of parents | |||
| Daily wage labour (n=4, 8%) | 24 (20, 28)# | 2.983# | 0.394 | |
| Private job (n=27, 54%) | 26 (20, 28)# | |||
| Government job (n=13, 26%) | 22 (14, 26)# | |||
| Self-business (n=06, 12%) | 22.50 (18.50, 19.25)# |
#Kruskal Wallis test and H value, KADS: Kutcher adolescent depression scale, Significant at p<0.05 level
Clinical factors of adolescents’ depression
The analysis revealed that majority of the adolescents who were participated in the study had depression for, more than 1-year period n = 32 (64%), and about the severity of depression, majority had severe depression n = 42 (84%), majority 78%were adherence to treatment n = 39, further, majority were not hospitalised previously n = 30 (60%). About family history of psychiatric illness majority reported that they do not have a family history of psychiatric illness n = 38 (76%), further majority did not have any comorbidity n = 49 (98%), and the majority did not report any other clinical issues n = 30 (60%) [Table 2].
Relationship between adolescent’s depression and its correlates factors
The analysed data shows that statistically significant associations were found between subjects’ depression and their type of family and family history of psychiatric illness at P < 0.041 and at P < 0.008 level, respectively [Tables 1 and 2].
Other sociodemographic and clinical profiles did not have any relationship with the adolescent’s depressive status [Table 3]. Similarly, there is no statistically significant association found between adolescent depression and BMI [Table 4]. However, the researchers could find a significant relationship between adolescent depression and the Global Assessment Scale (CGAS) score at P < 0.05 level [Table 5].
| S. No. | BMI | KADS score Median (Q1, Q3) |
H (Kruskal Wallis test and H value) | P-value |
|---|---|---|---|---|
| 1 | Normal (n=39, 78%) | 25 (20, 28) | 0.414 | 0.813 |
| Overweight (n=8, 16%) | 22 (17.50, 28.25) | |||
| Obesity (n=3, 6%) | 27 (14, 28) |
BMI: Body mass index, KADS: Kutcher adolescent depression scale, Significant at p<0.05 level
| S. No. | CGAS scores | KADS score Median (Q1, Q3) | H (Kruskal Wallis-test value) | P-value |
|---|---|---|---|---|
| 1 | Very severely impaired and severe problems (n=10, 20%) | 29 (28, 30) | 27.08 | <0.001* |
| Serious problems (n=15, 30%) | 27 (25, 29) | |||
| Obvious problems (n=10, 20%) | 23 (21, 26) | |||
| Some noticeable problems (n=07, 14%) | 20 (19, 25) | |||
| Some problems (n=8, 16%) | 17 (14, 18) |
DISCUSSION
The study was conducted to assess the level of depression and to find the relationship between their depression and correlative factors such as their socio-demographic and clinical variables amongst adolescents seeking treatment at one of the tertiary care mental health centres.
In this study, we found a statistically significant relationship between adolescent depression with the type of family, family history of psychiatric illness and children’s global assessment scale score. The result of the present study is consistent with Shelke et al. study.[11] They conducted a study among adolescent students of rural Maharashtra to find out the level of depression and its association with sociodemographic factors, wherein they found a significant statistical association among the students’ depressive status and family type who belong to a nuclear family and a joint family.[11] Although statistical significance was observed for family type and adolescent’s current level of functioning, the practical implications are noteworthy adolescents from nuclear and joint families may benefit from structured family therapy interventions to improve coping and communication based on the family’s existing knowledge and understanding. Factors such as urban–rural access to care, parental mental health and social media exposure could have influenced depression levels and were not controlled. Future studies should include these variables as covariates. However, in various other studies, they have found a significant relationship between BMI and Depression. During low mood and depression, generally neurotransmitters would secret insufficiently. Hence, when individuals are depressed, low energy and motivation may result in decreased activities of daily living and exercise, which can be associated with weight gain.[12-14]
The current study revealed that the majority of subjects were in the age group of 15 years, 74% lived in an urban area and data showed a statistically significant relationship between adolescent depression and family history of psychiatric illness. Mohammadi et al., in 2019 conducted a study on “the prevalence, comorbidity and sociodemographic factors of depressive disorder among Iranian children and adolescents.[15] Wherein, the majority of the subjects (35%) were between 10 and 14 years of age and 83.6% lived in an urban area, the prevalence rates of depression for those children and adolescents living in rural and urban areas were 1.6% and 1.9%, respectively.[15] Similarly, the findings of the present study are consistent with Girma et al.’s. study who have identified that Sex, urban residence, low social support, being in a higher-grade level and adverse childhood experiences were found to be associated with depression among adolescents in Jimma town, Southwest Ethiopia.[16]
Further, the current study revealed a statistically significant relationship between adolescent depression and family history of psychiatric illness. This is consistent with Halonen et al.’s study, on familial risk factors in relation to recurrent depression among adolescent psychiatric inpatients and their findings.[17] The present findings are consistent with regional studies from South India showing higher depression rates in nuclear families and urban adolescents. However, compared with northern states such as Bihar or Maharashtra, the prevalence in the NIMHANS sample appears lower, possibly due to better mental health literacy and early intervention facilities in Karnataka.
Implication
Clinically, the findings highlight the need for early screening for depression in adolescents, especially those from nuclear families or with family psychiatric history. Policymakers should strengthen school-based mental health programs. Future research should use larger, multi-centre samples to validate these associations.
Limitation of the study
This study also has some limitations. The study was conducted in a specific area in a single department of the Child and Adolescent Mental Health Center. The small sample size (n = 50) limits statistical power and generalisability. The results should be interpreted cautiously.
Recommendations for future studies
A larger sample size over a larger geographical area would aid in generalising the findings.
Comparative studies can be done on other age groups to find out the level of depression and its relationship. The current study assessed adolescent depression and its associated factors; a feature study can be done on the preventive strategies for adolescent depression.
CONCLUSION
Depression amongst adolescents is a major mental health problem that significantly disturbs adolescents in reaching developmental and emotional milestones. This study observed there are research shreds of evidence that indicate a significant correlation between social and clinical factors amongst adolescents with depression. This study’s findings corroborated with research evidence that indicates a correlation between social and clinical factors among adolescents with depression. Clinically, the findings highlight the need for early screening for depression in adolescents, especially those from nuclear families or with family psychiatric history. Policymakers should strengthen school-based mental health programs. Future research should use larger, multi-centre samples to validate these associations.
Acknowledgement:
The researchers are thankful to all the adolescents who participated in this study, their parents, and the institution that approved the data collection, and Dr. PV, Assistant Professor (Department of Biostatistics), for the statistical analysis of the data.
Ethical approval:
The research/study was approved by the Institutional Review Board at National Institute of Mental Health and Neurosciences (INI), number (No.NIMH/DO/BEH. Sc.Div/2022-23), dated 15 July 2022.
Declaration of patient consent:
The authors certify that they have obtained all appropriate patient consent.
Conflicts of interest:
There are no conflicts of interest.
Use of artificial intelligence (AI)-assisted technology for manuscript preparation:
The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript, and no images were manipulated using AI.
Financial support and sponsorship: Nil.
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