Personality, Help-Seeking Attitudes, and Depression in Adolescents Tessa DeRosa A thesis submitted in confonnity with the requirements for the degree of Doctor of Philosophy Department of Human Development and Applied Psychology Ontario Institute for the Studies in Education University of Toronto O Copyright by Tessa DeRosa 2000
156
Embed
Depression in Adolescents · Perfectionism Self-Presentation Scale, the Adolescent Depressive Experiences Questionnaire. the Self Concealment Scale, ... Depression in Adolescents
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Personality, Help-Seeking Attitudes, and Depression in Adolescents
Tessa DeRosa
A thesis submitted in confonnity with the requirements for the degree of Doctor of Philosophy
Department of Human Development and Applied Psychology Ontario Institute for the Studies in Education
University of Toronto
O Copyright by Tessa DeRosa 2000
National Library 1*1 of Canada Bibliothéque nationale du Canada
Acquisitions and Acquisitions et Bibliographic Services services bibliographiques
395 Wellington Street 395. nre Wdlingtori Ottawa ON KI A ON4 OttawaON K l A W Canada Carda
The author has granted a non- exclusive licence allowing the National Library of Canada to reproduce, loan, distribute or sel1 copies of this thesis in rnicroform, paper or electronic formats.
The author retains ownership of the copyright in this thesis. Neither the thesis nor substantial extracts fiom it may be printed or otherwise reproduced without the author7s permission.
L'auteur a accordé une licence non exclusive permettant à la Bibliothèque nationale du Canada de reproduire, prêter, distribuer ou vendre des copies de cette thèse sous la forme de microfiche/nlm, de reproduction sur papier ou sur format électronique.
L'auteur conserve la propriété du droit d'auteur qui protège cette thèse. Ni la thèse ni des extraits substantiels de celle-ci ne doivent être imprimés ou autrement reproduits sans son autorisation.
Personality, Help-Seeking Attitudes, and Depression in Adolescents Tessa DeRosa, Doctor of Philosophy, 2000
Department of Human Development and Applied Psychology University of Toronto
Abstract
Although there has been increased attention on individual differences among
adolescents in their levels of adjustment, several factors still have not received extensive
investigation. The current research investigated whether personality variables such as
perfectionism and self-criticism are associated with depression and negative attitudes
towards help-seeking in a sarnple of adolescents. A total of 1 32 Cath01 ic high school
students (5 1 males, 8 1 females) completed the Child-Adolescent Perfectionism Scale, the
Perfectionism Self-Presentation Scale, the Adolescent Depressive Experiences
Questionnaire. the Self Concealment Scale, the Center for Epidemiologic Studies
Depression Scale, and the Help-Seeking Scale. Descriptive analyses of the data indicated
that the sample as a whole was characterized by high levels of depressive symptoms,
consistent with past research on adolescent samples. Correlation analyses showed that
higher levels of depressive symptoms were associated with socially prescribed
perfectionism, dimensions of perfectionism self-presentation, self-criticism, dependency,
and sel f-concealment. Correlational analyses showed that negative help-seeking attitudes
were not correlated significantly with depression, but negativc help-seeking attitudes
were associated with a dimension of perfectionism self-presentation and lower levels of
dependency. Hierarchical regression analyses showed that perfectionism did not account
for a significant degree of unique variance in depression scores once self-criticism and
dependency had been entered into the equation. However, a dimension of perfectionism
self-presentation (Le., an unwillingness to disclose imperfection to others) did predict
significant variance in negative help-seeking attitudes, over and above self-criticism and
interpersonal dimensions of perfectionism as well as trait dimensions and self-
presentational dimensions of perfectionism in adolescents as they relate to depression and
attitudes towards help-seeking. The results are discussed in terms of their clinical
implications and possible delivery options of mental health services for those at risk.
Dedication
In loving memory of my grandfather Louis Leon Smith.
Acknowledgements
The collaborative efforts of a project of this magnitude cannot be understated.
This has been a long journey and like many joumeys your ability to persevere is a
function of what you take with you and what you pick up dong the way. I am deeply
indebted to Dr. Gordon Flett's tireless efforts and encouragement. His contribution to my
academic development is testimony to his considerable cornpetence not only as a scholar.
but also as an educator. 1 would also like to thank Dr. Solveiga Miezitis for her wisdom,
support and encouraging words.
1 was blessed at the outset with a truly supportive family, which has shouldered
the tremendous financial burden of schooiing a foreign student. But, more importantly
they have given me the opportunity to allow my personal and intellectual interests to
mature. My grandmother has been the pillar upon which 1 have leaned for much of my
life. Through her vision. my education has become a reality. 1 would like to thank my
mother for her support and friendship. She has always found a way to help me, at any
cost. 1 would also like to thank my father for his encouragement and support. 1 would like
to thank Sandra Foster for the many years she h a , and continues to be by my side. 1
would also like to thank Tom Martin for his statistical guidance and expertise. I am also
indebted to Averil Massie, who provided an invaluable critique of my thesis. In addition,
I would Iike to thank Jeanie Stewart, IT analyst, for her patience and assistance in the
organizational structure of my thesis. Finally, 1 would like to thank rny husband Bobby
for his companionship, love and support which has enabled me to becorne the person that
I am today. He is truly a blessing in my life. 1 would also like to thank the staff and
students at the Toronto Catholic high schools who took the time to participate in my
Dedication .......................................................................................................................... iv ............................................................................................................. Acknowledgements v
......................................................................................................................... Introduction 1 ................................................................................................................ Literature Review 3
............................................................................................................... Comorbidity ... 13 Sex Differences and Depression ................................................................................. 14 Classification of Depression .......................................................................................... 21
Sex Differences and Help-Seeking Behaviour ......................................................... 31 ............................................................... Adolescence and Help-Seeking Behaviour 32
Perfectionism ................................................................................................................. 37 ........................................................................... Trait Dimensions of Perfectionism 38
Dimensions of Perfectionism Self-Presentation ...................................................... 39 ............................................................................... Perfectionism and Depression 4 3
Perfectionism and Depression in Adults ............................................................... 43 .......................................................... Perfectionism and Depression in Adolescents 50
Perfectionism and Help-Seeking Behaviour ........................... .. ....................... 5 5 .......................................................................................................... Sel f-Concealment 56
Summary of Goals and Main Hypotheses ...................... .. ............................................. 59 iMethod .............................................................................................................................. 64
.................................................................................. Self Concealment Scale (SCS) 68 The Cen ter for Epidemiologic S tudies Depression Scale (CES-D) .......................... 69
............................................................................. Sel f-Conceal ment 82 v i
.................................................................................... Correlations with Help-Seeking 82 Correlations with Depression ...................................................................................... 83
...................................................................................................... Multiple Regression 83 Personality Predictors of Help-Seeking ....................................................................... 84 Personality Predictors of Depression ............................................................................ 86 Personality Predictors of Self-Concealment ................................................................. 87
This 22-item instrument was designed to measure children's and adolescents'
wil lingness to seek help for psychological problems from adutts in the school setting.
Items include "Teachers andor counsellors can help when you're upset about a personal
probiem" and "There should be an adult at school who talks to kids about personal
problems and family problems" (see Appendix J). Items are rated on 4-point scaie that
ranges from "strongl y agree" to "strongly disagree." In a recent study with 1 8 1 students
ages 15- 16, the mean score was 35.3 (SD = 9.6) for males and 60.2 (SD = 9.3) for
fernales. Correlation coefficients for the help-seeking score and the following variables
are listed below (al1 were significant at the .O1 level): Hopelessness (Kazdin scale) (-.37);
Total Behaviour Problem Score on the YSR (Achen bach) (-.38); Depression (Kovacs
CDI) (-.45); Satisfaction with SociaI Support (Samson) (-22); Social Competence on the
YSR ( - 2 1 ). In a multiple regression analysis, the strongest independent predictor of
negative heIp-seeking attitudes was depression scores (Garland, 1995).
Results
The extant research design permits assessrnent of the contribution of personality
factors to depression and response styles, specifically help-seeking and self-concealment.
The analyses of these relations included correlations, analysis of variance (ANOVA),
multivariate analysis of variance (MANOVA). and hierarchical multiple regression. Al1
data was anaiysed separately for males and females given the issue of gender differences
in adolescent depression.
Upon exploration of the variables, it was discovered that the Center for
Epidemiologic Studies Depression Scale (CES-D) was not normally distributed. There
was significant positive skew (t(13 1 ) = 3.96, p < -05). To transform the data to normality.
a log transformation of depression was taken and the resulting variable was not skewed
(A( 13 1 ) = 1 -05, P > -05). While the mean and standard deviaticn of the untransformed
variable is reported, subsequent statistical analyses involving the CES-D scale were done
with the transfomed variable. Also, it should be noted that the residuals from the
regression analysis of the transfomed data will be discussed later in the multiple
regression section.
Descriptive Analvses
The means and standard deviations for al1 the measures, as well as interna1
consistency values (Cronbach, 195 1 ) are displayed in Table 1 : Help-seeking (a = -8 1 ),
Dependency (a = .72), Self-criticism (a = .64), Efficacy (a = .46), Self-concealment (a =
.84), Depression (a = .86), The need to appear perfect (a = .80), The need to avoid
appearing imperfect (a = .8 1 ), The need to avoid disclosure of imperfection (a = .72),
7 1
Self-oriented perfectionism (a = 32). and Socially prescribed perfectionism (a = -87).
Although the alphas for some measures were considerably lower than those obtained in
other research (e-g., Blatt et al.. 1992c), this is likely due to the use of the 20-item version
of the scale rather than the full 66-item version. Given the relatively low alphas obtained
for self-criticism and efficacy, the results involving these measures should be interpreted
with a degree of caution.
Table 1
Reliabilities using the Total Sample
Total Smple
M SD ALPHA
~elp-Seekinga 6 1.52 7.54 0.8 1
~ e ~ e n d e n c ~ ~ 27.32 5.26 0.72
self-criticismb 22.52 4.83 0.64
Efficacyb 14.64 2.47 0.46
self-Concealment' 27.10 8.40 0.84
Appeard 39.9 1 9.87 0.80
Avoidd 41.15 9.94 0.8 1
on-~isclosure~ 22.55 6.90 0.72
Sei? 35.90 7.64 0.82
Social' 29.92 8.14 0.87
~epression' 17.69 9.56 0.86
Note.
" Adolescent version of the Help-Seeking Scale Adolescent Depressive Experiences Questionnaire ' Sel f-Concealment Scale "erfectionistic Self-Presentation Scale ' Multidimensional Perfectionism Scale ' The Center for Epidemiologic Studies Depression Scale
As for the means obtained in this study, statistical tests were not computed to
determine whether these means differed significantly from the means from other samples,
and this decision was based on the lack of established norrns for some of the key
measures. However, it appeared in general that the means were quite comparable to those
obtained from other samples, with the exception of the scores obtained for the measure of
help-seeking attitudes. An overall mean of 6 1.52 was obtained in the current study, while
Garland et al. (1994) reponed a mean of 66.50 for their subsample of older adolescents.
This outcome suggests that help-seeking attitudes were more negative in the current
sampie.
The means obtained for the perfectionism measures were in keeping with the
means obtained with previous samples. Regarding the Child-Adolescent Perfectionism
Scale. Hewitt et al. (1997) reported means of 34.03 for self-oriented perfectionism and
27.20 for socially prescribed perfectionism when the scale was adrninistered to their
sample of inpatient adolescents. The respective means for self-oriented and socially
prescribed perfectionism in the current study were 35.90 and 29.92. Thus, levels of
socially prescribed perfectionism were slightly higher in the current sample. As for the
Perfect ionism Sei f-Presentation Scale, there are no publications in the literature that
describe previous research with this measure in an adolescent sarnple. However, the
means shown in Table 1 are consistent with the values reported in other research (see
Habke et al., 1999; Hewitt et al., 1995). For instance, Hewitt et al. ( 1995) reported
respective PSPS means of 41.38,44.68, and 22.98 for the subscale measures of the need
to appear perfect, the need to avoid appearing imperfect, and the need to avoid disclosing
imperfections when these measures were assessed in their study of appearance-related
concerns in university women. The respective means for these three subscales in the
current study were 39.9 1,4 1.15, and 22.55. These values are very similar to the means
reported by Habke et al. ( 1999).
Unfortunately, Fichrnan et al. (1994) did not report the means for each of their
subscale measures of dependency, self-criticism, and efficacy so it was not possible to
conduct meaningful comparisons. The level of self-concealment reported in the present
study was slightly higher (M = 27.10) than the mean reported of 25.02 obtained for
Larson et al., (1990) university student sample.
Finaily, and perhaps most irnportantly, the CES-D mean of 17.69 in the current
study is noteworthy in that the mean score for the current sample exceeds the
recommended cut-off of 16 that has been used in the past to establish the existence of a
case of at least rnild depression. The current result is in keeping with reports that levels of
depressive symptoms are substantidly elevated in adolescent samples. This issue will be
addressed at length in the subsequent discussion section.
MANOVA of Scales bv Gender
A multivariate analysis of variance (MANOVA) using Hotelling's Trace statistic
was performed to see if gender differences existed on al1 measures. The results were
significant (F( 1 1,120) = 2.02, p < -05). Univariate results showed (refer to Table 2) that
there were statistically significant differences for Help-Seeking (F(1,130) = 6.15, <
-05); the need to appear perfect (F( 1,130) = 4.86, p < -05) and the need to avoid
disclosure of imperfection (F( 1,130) = 10.52, p < .O 1 ). As predicted, females reported
that they were more likely to engage in heIp-seeking behaviour = 62.82, SD = 6.48)
than males (M = 59.57, SD = 8.58). The need to appear perfect was higher in maIes &f =
31.19, SD = 8.98) than in females (M = 38.38, SD = 10.19). The need to avoid disclosure
of imperfection was also higher in males (M = 21.85, SD = 7.16) than in females (M =
21-01, SD = 6.3 1).
Table 2
Analyses of Variance and Mean Scores for Males and Females
,Males Females
M SD M SD F-value
Help-Seeking'
13ependencyb
self-criticismb
~ f f i c a c ~ ~
seIf-Concealmentc
~ p p e a r ~
~ v o i d ~
c on-~isclosure~ SelF
Social"
~ e ~ r e s s i o n '
Note.
" Adolescent version of the Help-Seeking Scale b Adolescent Depressive Experiences Questionnaire ' Self-Concealment Scale
Perfectionistic Self-Presentation Scale " Multidimensional Perfectionism Scale f The Center for Epidemiologic Studies Depression Scale
Correlational Analvses
Next, the interrelations arnong the variables utilized in this study were examined.
Pearson correlations were computed to determine the extent to which perfectionism,
dependency, self-criticism, self-concealment, and depression were associated. These
correlations were also examined separately by sex. The correlations that emerged are
discussed below. A test looking at the largest difference in correlations for males and
females was also conducted; significant results were not found, therefore no further tests
were performed.
Correlations with Self-Oriented Perfectionism
Pearson product-moment correlations were computed among the numerous
measures. These results are shown in Table 3 for the total sample. It can be seen that self-
oriented perfectionisrn was significantly correlated with the following variables: self-
oriented perfectionism was associated with higher levels of efficacy (r(I30) = .25, g <
.O 1 ), self- concealrnent (~(130) = - 1 9 , ~ < .Os), the need to appear perfect (r(130) = .6C,
< .O I ), the need to avoid appearing imperfect (r( 130) = .46, p < .O 1 ), and the need to
avoid disclosure of imperfection (r(l30) = -38, p < -01).
Note. - " Adolescent version of the Help-Seeking Scalc b Adolescent Dcprcssive Experiences Questionnaire ' Sel f-Concealment Scale
Pcrfcctionistic Self-Presentation Scale ' Multidimcnsional Perfcctionism Scalc f The Center for EpidemioIogic Studies Depression Scalc
Tables 4 and 5 present the analyses conducted separately for mates and fernales. It
can be seen that particularly for males, self-oriented perfectionism was correlated
significantl y with efficacy b(5 1 ) = -34, E < .05), the need to appear perfect ( r (5 1 ) = .6 1.2
< .O 1 ). and the need to avoid disclosure of imperfection (r(5 1 ) = -4 1, p < .O 1).
Table 4
Correlational Analyses for Males
Variables 1 2 3 4 5 6 7 8 9 10 1 1
1 Help-Sceking" -- 2 ~ e ~ e n d e n c ~ ~ 0.24 - 3 self-~riticism~ -0.14 0.29* -- 3 t3fficacyb 0.00 O. 1 1 -0.28* -- 5 Self-Concealmentc -0.07 0.34* 0.38** -0.08 --
6 ~ ~ p u ~ 0.08 0.19 0-1 1 0.22 0.40** -- 7 ~ v o i d ~ -0.05 0.31* 0.24 0.10 0.54** O-51** -- 8 ~on-~ i sc losu rc~ -0.3 I* -0.01 0.16 0.13 0.53** 0.37** 0.45** --
' Adolescent version of the Help-Seeking Scale Adolcsccnt Depressive Experiences Questionnaire ' Sclf-Concealment Scale d Pcrfcctionistic Self-Presentation Scalc " Multidirncnsiond Perfectionism Scale ' ~ h c Center for Epidemiologic Studies Depression Scale
With females it was shown that self-oriented perfectionism was correlated with
dependency (r(77) = - 2 9 , ~ < .Ol), and with al1 three major components of perfectionism
self-presentation: the need to appear perfect (r(77) = .60, p < .01), the need to avoid
appearing impei-fect (1(77) = - 5 8 , ~ < .O 1 ), and the need to avoid disclosure of
imperfection ( ~ ( 7 7 ) = -34, p c .O 1 ).
Table 5
Correlational Analyses for Fernales
- -- - - -- - -
Variables 1 2 3 4 5 6 7 8 9 10 1 1
I Help-Seeking" -- 2 ~ c ~ e n d c n c ~ ~ 0.38** --
3 ~ e l f-criticismb -0.1 1 O Z * -- 3 ~ f f i c a c ~ ~ O. 17 O. 19 -0.27* -- 5 Self-Concealmentc -0.05 0.30** 0.49** O. 19 --
6 Appeatd -0.03 0.29**0.23* 0.07 0.26* -- 7 ~ v o i d ~ 0-09 0.50** 0.41 ** O. 15 0.47** 0.70** --
8 ~ o n - ~ i s c l o s u r e ~ -0.33** 0.14 0.38** -0.02 0.48** 0.41 ** 0.51** -- 9 Self 0.17 0.29** 0.15 0.21 0.20 0.60** 0.58** 0.34** -- 1 O Social' -0.07 0.22 0.22* 0.33** 0.37** 0.37** 0.45** 0.46** 0.62** -- 1 1 ~e~rcss ion ' -0.04 0.27* 0.46** -0.07 0.43** 0.1 1 0.22* 0.3 1 ** 0.16 0.32** --
Note.
" Adolescent version of the HeIp-Seeking Scalc Adolcsccnt Deprcssive Experiences Questionnaire ' Sclf-Concealment Scale
Pcrfectionistic Self-Prcsentation Scale ' Mul tidimcnsional Perfectionism Scale f The Ccnter for Epidemiologic Studies Depression Scalc
Correlations with Sociallv Prescribed Perfectionism
As expected, socially prescribed perfectionism in the total sampie was positively
correlated with self-criticism (~(130) = -34, p < .O1 ), self-concealment (~(130) = .38, Q <
.O 1 ). the need to appear perfect (r( 130) = .34, Q c .O t ), the need to avoid appearing
imperfect (r( 130) = -40, < .01), the need to avoid disclosure of imperfection (r(130) =
-42, p < .O 1 ), and depression (r( 130) = .30, p < .O 1 ). Even though these individuais
reported higher levels of depression, they also reported feelings of efficacy (r(130) = .25,
2 < .O 1). This was true for female socially prescribed perfectionists as well (see below).
This anomalistic finding suggests that despite feelings of depression, these individuals
still have feelings of power and effectiveness to bring about change.
Funher correlational analyses were performed to assess the correlates of socially
prescribed perfectionism among males. Specifically, high levels of this variable were
related to greater self-criticism (r(5 1 ) = -59, E < .O 1), self-concealment (r(5 1) = -39, <
.O 1 ), and the three elements of perfectionism self-presentation: the need to appear perfect
( ~ ( 5 1 ) = 2 8 . E < .05), the need to avoid appearing imperfect (r(5 1) = -29, < .05), and the
need to avoid disclosure of imperfection (r(5 1 ) = -4 1, p < .O 1 ).
Analyses conducted for females yielded similar results. Social1 y prescribed
perfectionism was associated with higher levels of self-criticism (r(77) = -22, p < .05),
self-concealment (~(77) = .37, Q < .O 1); and with the three dimensions of perfectionism
self-presentation that is, the need to appear perfect (r(77) = -37, < .O 1 ), the need to
avoid appeanng imperfect (r(77) = .45. p < -01); and the need to avoid disclosure of
imperfection (~(77) = -46, p c .01). Socially prescribed perfectionism was also linked
with higher levels of efficacy (~(77) = -33, < -01) and greater depression (r(77) = -32, p
< .O 1 ).
Correlations with Dependencv
Dependency in the total sample was correlated with help-seeking (r(130) = .32, p
c .O 1 ), self-concealment (r(130) = -30, p < .01), the need to appear perfect (r(130) = -23, p
< .O l ) , the need to avoid appearing imperfect (r(l30) = .42, p < .01) and with depression
(r( 130) = -28, Q < .01).
For males, dependency was also associated with greater self-concealment (r(5 1) =
.34, E < .05), the need to avoid appearing imperfect (r(5 1 ) = -3 1, < .05), and depression
(xi5 1 ) = .29, Q < .OS). For, males this variable was not correlated with help-seeking-
For females, however, dependency was related to help-seeking ('r(77) = -38, p c
-01 ). It was also related to self-concealment (r(77) = .30, < .01), as well as to the two
eIements of perfectionism self-presentation: the need to appear perfect (r(77) = -29, p <
-0 1 ), and the need to avoid appearing imperfect (r(77) = S O , e c .O 1 ) as well as with
depression (r(77) = .27, p < -05).
Correlations with Self-Criticism
Regarding the total sample, high self-criticism was associated with lower efficacy
(x( 1 30) = - 2 8 , < -0 1 ), higher self-concea'ment (r( 130) = - 4 5 , ~ < .O 1 ), the need to
appear perfect (r( 1 30) = - 1 7, e < .05), the need to avoid appearing imperfect (r( I 30) =
-35, E < -0 1 ), the need to avoid disclosure of imperfection (r(l3O) = -26, g < -0 I ) and with
depression (r( 130) = -49, g < .0 1 ).
Males high on self-criticism indicated greater self-concealment (r(5 I ) = -38, <
-0 1 ), and depression (r(5 I ) = -55, p < .O 1 ). Additionally, a significant inverse relationship
with efficacy (r(5 I ) = -28, p < .05), was also revealed.
The data involving females also yielded an inverse relationship between efficacy
and self-criticism (r(77) = -.27, p < .05) and a positive relationship between self-
concealment (~(77) = - 4 9 , ~ < .01), the need to appear perfect (r(77) = -23, c .OS), the
need to avoid appearing imperfect (r(77) = .4I, E c .OI), the need to avoid disclosure of
imperfection (r(77) = -38, g < .01), and depression (r(77) = -46, p < .01).
Correlations with Self-Concealment
High levels of self-concealment were correlated with a strong need to present to
others an image of perfection (r( 130) = -32, p < .O 1 ). It was aiso correlated with those
wanting to avoid presenting as imperfect (r(I30) = -50, < .01), and the disclosing of
imperfections (r( 130) = .50, p < .O 1 ).
For males, similar results were found; higher levels of self-concealment were
correlated with the need to appear perfect (r(5 1 ) = -40' I> < .01), and the need to avoid
disclosure of imperfection (r(5 1) = -53, p < .O 1 ).
Analyses conducted for females also yielded similar results. Self-concealment
was correlated positively with the need to appear perfect (r(77) = - 2 6 , ~ < .OS), the need
to avoid the appearance of imperfection (r(77) = -47, pl < .OI), and the need to avoid
disdosure of imperfection (r(77) = -48, p < .O1 ). Overail, self-concealment was not
correlated with help-seeking.
Correlations with Heh-Seeking
As expected, a negative correlation was found for the need to avoid disclosure of
perfection and help-seeking (r( 130) = -.36, Q < .O 1 ). Help-seeking attitudes reported by
males was associated negatively with the disclosure of imperfections (r(5 1) = -.3 1, p <
.05). They reported having a negative attitude towards help-seeking. Similarly, females
high on this dimension indicated a negative help-seeking orientation (r(77) = -.33, e <
.O 1 ). Clearly, if one were reluctant to reveal imperfections, then seeking help would not
be viewed as a viable option.
Correlations with Depression
It was also revealed in the total sample that depression was experienced by those
possessing a strong need to avoid appearing imperfect (r(130) = 20, c .05), and a
strong need to avoid disclosing imperfections (r(130) = 2 2 , < -05). Further, an
association was found among depression and self-concealment (r(I30) = - 4 0 , ~ < -01).
While higher depression in males was associated with greater self-concealment
(5(5 1 ) = .36, Q < .O 1), depression in females was not only associated with greater self-
concealment (r(77) = .42, e < -01). it was also associated with the need to avoid
appearing imperfect (r(77) = .22, p < -05). as well as the need to avoid disclosure of
imperfection (~(77) = -3 1, E < -01). Overall, it should be noted that there was a lack of
correlation with depression and help-seeking.
Multi~le Repression
A hierarchical regression procedure (Cohen, 1968) was used to test the
incremental contribution of the perfectionism dimension after removing variance
attributable to dependency and self-criticism. A separate regression analysis was
conducted for each of the outcome variables. Self-criticism and dependency were the first
independent variables entered into the regression equations. These two independent
variables were followed by the five main effects (self-oriented perfectionism, the need to
avoid non-disclosure of imperfection, socially prescribed perfectionism, the need to
appear perfect, and the need to avoid appearing imperfect). With each model, a final
bIock tested whether the mode1 was equivalent for males and females. As noted earlier, a
particular goal of this study was to test the incremental predictive utility of perfectionism
over and above measures of self-criticism and dependency in terrns of their relative
ability to predict variance of these outcomes.
The equivalence of the regression model for males and fernales, which can be
called homogeneity of regression models, was tested by adding sex as the main effect and
creating interaction tems as the cross products of sex by each of the other predictors.
These interaction tems were entered as one block after al1 main effects were entered. The
Fchuige test of the entire block is then a test of whether or not the model varies depending -
on sex. For al1 regression models tested, it was not possible to reject the nul1 hypothesis
that the models are equivalent across gender. The eh,, tests are as follows: Help-
and for Self-concealment (Fchmg, (7,116) = 0.70, > -70). As a result, al1 analyses were
performed without the sex main effect or the sex by other predictors.
Personalitv Predictors of Heb-Seekinp
For the model predicting help-seeking as the dependent measure, dependency and
self-criticism accounted for a significant proportion of the variance. about 14%, (Frhuige
(2,129) = 10.55, E < .001). IndiviciualIy, dependency explained unique variation in help-
seeking (F(1,124) = 14.10, p < .001). Greater dependency was associated with increased
help-seeking. Results are shown in Table 6.
Table 6
Results of Hierarchical Regression Analyses for he Prediction of Help-Seekinp;
Predictors R2change Fchange Sig - Fchange Std. B t Sio - t
Block One DEQ O. 13 10.55 0.001 *** Dcpcndency" 0.33 3.87 0.001*** Self-Criticism" -0.06 -0.75 0.46
B lock Two Perfectionism 0.16 5.78 0.00 1 *** car^ -0.09 -0.82 0.42 ~ v o i d ~ 0.05 0.44 0.66 Non ~ i s c l o s u r e ~ -0.42 -4.5 1 0.001*** Self 0.29 2.73 0.01 ** Socialc -0.08 -0.85 0.40
Block Two Perfectionism 0.03 1.19 0.3 18 car^ -0.09 -0.79 0.43 ~ v o i d ~ -0.10 -0.91 0.37 Non ~ i s c l o s u r e ~ 0.1 1 1.20 0.23 Sclf 0.06 0.59 0.56 SociaI' O. 12 1.27 0.21
Std. B = Standardized Rcgression Coefficient Sig t = AI1 single predictor values reported as rneasured with al1 predictors in the model
Personalitv Predictors of Self-Concealment
The final analysis looked specifically at self-concealrnent as the outcome
measure. The results, as seen in Table 8, revealed that the dependency and self-criticism
block was significant. (Fchmgc (2,129) = 19.97, p < -001 ), accounting for 24% of the
variance. Examination of the predictors within the block found that greater self-criticism
was associated with higher levels of seIf-concealment (F(1,124) = 7.62, p < -05). The
perfectionism block was significant, &,,, (5,124) = 8.13, p < .001), accounting for an
additional 19% of the variance. Greater non-disclosure was associated with self-
concealment, (F(1,124) =14.59, E < -001).
Table 8
Results of Hierarchical Re~ession Analvses for the Prediction of Self-Concealment
Predictors R2 change F change Sig Fchanae Std. B t Sig t
Block One DEQ 0.24 19.97 0.00 1 *** Dcpendency" O. 14 1.80 0.07 Sclf-Criticisrn" 0.22 2.76 0.01**
Block Two Perfectionkm 0.19 8.13 0.001 *** ~ ~ ~ e a r ~ 0.01 -0.08 0.94 ~ v o i d ~ 0.20 1.90 0.06 Non ~ isc losure~ 0.32 3.82 0.001*** Sclt" -0.10 -1.08 0.28 Socialc 0.1t 1.33 0.19
Analysis of such information would be of great benefit to the understanding of the
characteristics, construction and execution of outreach efforts targeted to reach those
adokscents most in need who are unidentified and underserved (Schoner-Reich1 et al.,
1996).
Aside from an individual's help-seeking behaviour. another variable that deserves
exploration is the importance of cultural identity and relations and farnily values. Cultural
identification and social network characteristics are likely to play an important role in
influencing a child's perception of the mental health care system and his or her help-
seeking activities. Also, the extent to which an individual identifies with ethnic and
cultural beliefs and values, which are incompatible with help-seeking --- for example,
exposing problems that will embarrass the family- the stigmatization that goes with
having persona1 problems or seeking help --- may delay or deter service utilization
(Gariand et al., 1994). Further, having an orientation towards medical intervention such
as embracing the efficacy of physicians and medical personnel rather than destiny,
religion, or claims of psychotherapeutic methods for curing the individual are also
thought to be related to help-seeking behaviour. In addition, the importance of cultural
context. their birth place, ethnic diversity of their host country, the process of social
adaptation. and cultural identity have also been suggested as influences on help-seeking
attitudes and behaviour. As noted earlier, there are those who suggest that research on
service utilization of mental health systems should include more detailed investigations
of the impact of acceptance and awareness as this may be related to one's prior
experience. Evaluating extemai influences such as accessibility and attractiveness of
services is vital, considering that an adolescent's eagerness to seek help is likely to be
greatly associated with the actual or perceived utility and value of formal mental health
services (Garland et al., 1994).
Garland et al. believe that one of the central goals of this area of research is to
identify variables and disentangle a wide range of factors that facilitate, inhibit or pose a
barrier to help-seeking artitudes and behaviours. Specifically, it is important to foster a
greater understanding of the pathways of support and assistance for adolescents. We need
to determine why some young people who have a clinically identified need are so
reluctant to seek or obtain medical help. Can it be explained simply as refusai to admit to
the existence of persona1 problems? Or is it a perceived lack of service availability?
Underutilization and non-attendance may also be founded on previous negative
experiences with prior help-seeking attempts. Also, is a failure to seek help due to a
fatalistic view in which the child sees little or no hope or change likely to influence help-
seeking? It i s a de fini te challenge for professionals to cncourage help-seeking behaviour
while still recognizing the need for autonomy in this population. More information is
required to map the force and direction of casual factors. Clearly, better attempts at
understanding young people's reluctance and barriers as well as motivation for seeking
help and service selection will help to improve and allow the most accessibility for early
intervention and delivery of appropriate services.
Despite the limitations outlined above, the data d o enhance the understanding of
personality factors, depression and help-seeking attitudes. As mentioned previously, the
distinction between self-concedment and self-disclosure has been explored, and some
believe that the two are separate, yet related concepts (Larson e t al., 1990). As such, there
is a clear need to look at non-disclosure in counselIing sessions. It is also important to
specifically examine personality variables and the counselling medium and low levels of
disclosure. As well, this applies to self-concealment in that future research could examine
the effects of concealment as a client variable on the counseling process o r outcome. In
addition, research could explore the issue of early termination from therapy specifically
for low versus high self-concealers. If heightened fears of psychotherapy ensue, as the
reality of seeking treatment becomes imminent, anxiety around treatrnent may culminate
during the initial stages, resulting in decreased motivation to continue with the counseling
process. Similarly, clients entering therapy for an acute problem may abandon treatment
prematurely as they begin to experience relief and feel better. As a result, their motivation
to remain and continue with treatment is likefy to decline. Hence, clients who begin to
feel better, but remain apprehensive and fearful of psychotherapy would likely have a
higher dropout rate compared to clients who experience acute distress or who undermine
their fears. Approaching new clients entenng therapy and assessing their distress levels
and anxiety around treatment could verify this. Another potential area of exploration is to
investigate the extent to v~hich counsellors can reduce premature termination by
goveming the counsellors' Iistening intentions, specifically this would include the
counsellors' ability to Iisten to clients' anxieties while discussing treatment gains and
advancing a continued commitment to treatment (Cepeda-Benito et al., 1 998).
Causal statements cannot fK made based on the analysis used in the current study
and therefore one would need to conduct longitudinal prospective studies. Other
measures such as clinical, peer, school or parentai ratings, and behavioural measures will
help to verify the validity and generalizability of research findings in this area.
Nevertheless. longitudinal studies are needed to further examine the extent of personality
factors on depression and help-seeking behaviours as well as parental influences. Studies
assessing parenting in early childhood are essential in further understanding the subtypes
of depression and other clinical symptoms. Longitudinal studies, albeit a few, have found
that adult depressive tendencies were more strongly associated with parenting attributes
particularly for girls. This was not true for boys. Parenting seems to be an important
factor in the development of depressive tendencies as well as other psychopathologies
(Blatt et al., I992d; Missildine, 1963). This suggests that future studies need to examine
the links arnong biologicai, external forces, and interpersonal factors in the development
of depression.
Also, it may be beneficial not only to utilize interview measures but also utilize
them in the context of other variables such as stress and coping ability (Srebnik, et al.,
1996).
It is important to explore the relationship between perfectionism, depression, and
self-concealment and the treatment process. The development of a better understanding
of the role of these factors in the treatment process is in the best interest of not only the
client but the counsellor as well. There is increasing evidence that the counselling process
has the potential to be an effective means of helping to lessen the psychological and
emotional distress associated with psychiatric probiems (Kushner & Sher. 1991).
Therefore. in this context. it becomes clear that it is important to better understand and
learn more about the causal factors that influence an individual's view of therapy. This
knowiedge would help those in the helping profession to develop prevention programs
that increase the appeal of psychotherapy. creating a proactive use of service at the onset
rather than during the advance stages of psychological distress. Increased screening
efforts to recognize and identify adolescents with intemalized symptoms are needed.
These individuals, aithough troubled, often exhibit socially desirable behaviours and may
appear to be well-adjusted (Garland et al., 1994). Other interventions to improve help-
seeking rnight involve the role of helping to remove shame and dispel unfavourable
attitudes toward treatment.
Although research has focused on perfectionism and self-concealment as a
multifaceted phenomenon, limited research exists on the effects of perfectionism and
self-concealment as a client variable on the treatment process and outcome and further
work is needed (Hewitt et al., 1990; Kelly et al., 1995). Also, the role of depression needs
to be explored. Research has indicated that adolescents are taking extreme rneasures
when they experience difficulty coping with psychiatric and psychologicai problems.
The implications for practice are a better understanding of the reciprocal effect of
personality factors, the family and peer context and fonal service utilization to help with
semice planning. Better understanding of the obstacles to and advancement of certain
types of service areas will help to mark elements for service modification. Predictors and
the paths to particular kinds of services and support are likely to Vary depending on
si tuational determinants (Srebnik et al., 1996).
The implications for policy are a better understanding of the intncacies of the
health care system and the subsequent shortcomings and obstacles to adequate health care
for children and adolescents. Often, service utilization is simply based on available
service options. It can only be argued that given the limited resources available for
mental health services, it is clear that emotional and behaviourai disorders will certainly
outnumber actual services (Srebnik et al., 1996). Delivery of services for children and
adolescents at present depends on a number of factors including, the role of family, the
wider cornrnunity, quality of care. and the politicai environment. Service delivery is also
based on assessed and perceived service need as well as the development of effective
treatment inceptions (Srebnik et al., 1996).
Summary
In summary, a cross-sectional investigation was conducted to examine the extent
to which personality variables were associated with depression and negative help-seeking
attitudes in adolescents. The purpose of this investigation was to add to the existing
literature by exarnining some personality factors (e.g., trait perfectionism, perfectionism
sel f-presentation, and sel f-concealment) that have received relative1 y Iittle empirical
attention. In particular, the current investigation was designed to provide additional
information about personality correIates of negative help-seeking attitudes.
Overall, the results of the present study confirmed that adolescents tend to
experience elevated levels of depressive symptoms. in contrast to previous studies, no
gender difference was detected; females and males did not differ in their reported levels
of depression. Correhtiond results established that several personality factors are
associated with depression in adolescents. These factors include socially prescribed
perfectionism, perfectionism self-presentation, self-criticism, dependency, and setf-
concealment, with self-criticism being the factor with the strongest link with depression.
Analyses w ith the help-seeking measure found that higher levels of dependenc y were
associated with more positive attitudes toward seeking professional help, while more
negative attitudes were associated with an unwillingness to disclose imperfections to
others. Self-criticism was not associated with negative help-seeking attitudes. In contrast
to past research, depression was not associated with help-seeking attitudes. FinalIy,
regession analyses showed that perfectionism dimensions did not predict unique
variance in symptoms of depression, over and above measures of self-criticism and
dependency. However one element of perfectionism self-presentation (Le., an
1 1 1
unwillingness to disclose imperfections) was able to predict unique variance in self-
concealment and negative help-seeking attitudes.
The results were discussed within the context of the limitations of the current
researc h, and directions for future research were outlined. Clearl y, findings such as these
have important implications for the potential role cf perfectionism, self-criticism,
dependency, and self-concealment in personal and social adjustment, and related issues
of personai importance to depressed adolescents. A key challenge for the future will be to
find ways to encourage depressed adolescents to seek help, even though they may have a
personality style that inhibits them from seeking help from adults and mental healfh
services.
References
Abramson, L.Y., Seligman, M.E.P., Teasdale, J. (1978). Learned helplessness in humans: Critique and reformulation. Journal of Abnomal Psychology, 87,49-74.
Achenbach, T.M. ( 199 1 a). Integrative guide for the 199 1 CBCU4-18, YSR, and TRF Profiles. Burlington: University of Vermont, Department of Psychiatry.
Achenbach, T.M. ( 199 1 b). Manual for the Child Behavior Checklist and 1991 Profile. BurIington: University of Vermont, Department of Psychiatry.
Achen bach, T.M. ( 199 1 c). Manual for the Teacher's Report F o m and 199 1 Profile. Burlington: University of Vermont, Department of Psychiatry.
Achenbach, T.M. ( 199 1 d). Manual for the Youth Self-Report and 1991 Profile. Burlington: University of Vermont, Department of Psychiatry.
Acosta, F.X. ( 1980). Self-described reasons for premature termination of psychotherapy by Mexican American, Black American, and Anglo-American patients. Psychological Reports, 47,435-443.
AIessi, N.E., & Magen, J. (1988). Comorbidity of other psychiatrie disturbances in depressed ps ychiatricall y hospitalized children. American Journal of Psychiatry, 145, 1582-584.
AIessi. N E , Robbins, D.R., & Dilsaver, S.C. (1987). Panic and depressive disorders among psychiatrkally hospitalized adolescents. Psychiatry Research, 20,275- 283.
Allgood-Merten, B., Lewinsohn, P.M., & Hops, H. (1990). Sex differences and adolescent depression. Journal of Abnormal Psychology, 99,55-63.
Amato, P.R., & Bradshaw, R. (1985). An exploratory study of people's reasons for delaying o r avoiding help-seeking. Aicstralian Psychologist, 20, 2 1-3 1.
Ambrosini, P.J., & Puig-Antich, J. (1985). Major depression in children and adolescents. In D. Shaffer, A.A. Ehrhardt, & L.L. Greenhill (Eds.), The clinical guide to child psyclziatry (pp. 182- 19 I ). New York: Free Press.
American Psychiatrie Association. ( 1980). Diagnostic and statistical manual of mental disorders (3rd Ed.). Washington, DC: Author.
American Ps yc hiatric Association. ( 1 987). Diagnostic and statistical manual of mental disorders (3rd Ed., rev.). Washington, DC: Author.
American Psychiatnc Association. ( 1994). Diagnostic and statistical manual of mental disorders (4th Ed.). Washington, DC: Author.
Anderson, J-C., Williams, S., McGee, R., & Silva, P.A. (1987). DSM-III disorders in preadolescent children. Archives of General Psychiatry, 44,69-76.
Angold, A. (1 988). Childhood and adolescent depression: 1. epidemiological and aetiological aspects. British Journal of Psychiatry, 152,60 1-6 17.
Arieti, S., & Bemporad, J.R. ( 1978). Severe and mild depression: The therapeutic approach. New York: Basic Books.
Arieti, S., & Bemporad, J.R. (1980). The psychological organization of depression. American Journal of Psychiatry, 137, 1360- 1365.
Asarnow, J., Carlson, G.A., & Guthrie, D. (1987). Coping strategies, self-perceptions, hopelessness, and perceived farnily environments in depressed and suicida1 children. Journal of Consulting and Clinical Psychology, 55, 36 t -366.
Barker, L.A., & Adelman, H.S. (1994). Mental health and help-seeking m o n g ethnic minority adolescents. Journal of Adolescence. 17,25 1-263.
Baron, P., & Joly, E. (1988). Sex differences in the expression of depression in adolescents. Sex Roles, 18, 1-7.
Baumeister, R. ( 1990). Suicide as escape from self. Psychological Review, 97,90- 1 13.
Baumeister, R.F., Tice, D.M., & Hutton, D.G. (1989). Self-presentationai motives and personality differences in self-esteem. Journal of Personality, 57,547-579.
Baydar, N., Brooks-Gunn, J., & Warren, M.P. (in press). Determinants of depressive symptoms in adolescent girls: A four year longitudinal study. Developmental Psychology.
Beardlee, W.R., & Wheelock, 1. (1994). Children of parents with affective disorders: Empirical findings and clinical implications. In W.M. Reynolds & H.F. Johnston (Eds.), Handbook of depression in children and adolescents (pp. 463-480). New York: Plenum Press.
Beck, A.T. ( 1967). Depression: Clinical, experimental, and theoretical aspects. New York: Harper & Row.
Beck, A.T. (1983). Cognitive Therapy of depression: New perspectives. In P.J. Clayton, & J.E. Barrett (Eds.), Treament of depression: Old controversies and new approaches (pp. 265-290). New York: Raven Press.
Beck, A.T., Ward, C H . , Mendelson, M., Mock, J., & Erbaugh, J. (196 1 ). An inventory for measuring depression. Archives of General Psychiatry, 4, 56 1-57 1.
Bedrosian, R.C. (198 1). The application of cognitive therapy techniques with adolescents. In G- Emery, S.D- Hollon, & R-C. Bedrosian (Eds.), New directions in cognitive therapy: A casebook. New York: Guilford Press.
BIait, S.J. ( 1974). Levels of object representation in anachtic and introjective depression. Psychoanalytic Stu& of the Child, 24, 107- 1 57.
Blatt, S .J. ( 199 1 ). A cognitive morphology of psychopathoiogy. Journal of Nemous and Mental Disease, 1 79,449-458.
Blatt, S.J. ( 1995). The destructiveness of perfectionism: Implications for the treatment of depression. American Psychologist, 50 ( 1 2), 1003- 1020.
Blatt, S.J., D'Afflitti, J . P., & Quinlan, D.M. (1 976). Experiences of depression in normal young adul ts. Journal of Abnormal Psychology, 85, 383-389.
Blatt, S.J., & Homann, E. (I992a). Parent-child interaction in the etiology of dependent and self-critical depression. Clinical Psychology Review, 12,47-9 1.
Blatt, S .J. & Luthar, S.S. (1 995). Differential vulnerability of dependency and self- criticism arnong disadvantaged teenagers. Journal of Research on Adolescence, 5(4), 43 1 -449.
Blatt, S. J., & Maraudas, C. (1992b). Convergence of psychoanalytic and cognitive behavioral theories of depression. Psychoanalytic Psychology, 9, 1 57- 190.
BIatt, S.J., Quinlan, D.M., Chevron, E.S., McDonald, C., & Zuroff, D.C. (1 982). Dependency and self-criticism: Psychologicd dimensions of depression. Journal of Consiclring and Clinical Psychology, 50, 1 1 3- 124.
Bfatt, S.J., Schaffer, C.E., Bers, S.A., & Quinlan, D.M. (1992~). Psychometric properties of the depressive experiences questionnaire for adolescents. Journal of Personality Assessrnent, 59, 82-98.
Blatt, S.J., & Zuroff, D. (1992d). Interpersonai relatedness and self-definition: Two prototypes for depression. Clinical Psychology Review, 12, 527-562.
Boergers, J., Spirito, A., & Donaldson, D. (1998). Reasons for adolescent suicide attempts: Associations with psychological functioning. Journal of the Arnencan Academy of Child and Adolescent Psychiatry, 37, 1287- 1293.
Bornstein. R.F. ( 1998). hplicit and self-attributed dependency strivings: Differential relationships to laboratory and field measures of help-seeking. Journal of Persortality and Social Psychology, 75(3), 778-787.
Bornstein, R, F., Kmkonis, A.B., Manning, KA. , Masuosimone, C.C., & Rossner, S C . ( 1993). Interpersonal dependency and health service utilization in a college student sample. Journal of Social and Clinical Psychology, 12(3), 262-279.
Bowlby, J. ( 1973). Attachment and loss: Vol. 2: Separation, anrie& and anger. New York: Basic Books.
Bowlby, J. (1980) Attachment and loss: Vol. 3: Loss, sepnration, and depression. New York: Basic Books.
Brooks-Gunn, J., & Petersen, A.C. (1 99 1). Studying the emergence of depression and depressive symptoms during adolescence. Journal of Youth and Adolescence. 20(2), 1 15- 1 19.
Brown, G.W., & Harris, T. (1982). Disease, distress, and depression. Journal of AfJecrive Disorders, 4, 1-8.
Bukstein, O.G., Glancy, L.J., & Kaminer, Y. (1992). Patterns of affective comorbidity in a CI inical population of duai1 y diagnosed adolescent substance abusers. Journal of the American Academy of Child and Adolescent Psychiatry, 3 1, 1041 - 1045.
Burns, D.D. ( l98Oa). Feeling good: The mood therapy. New York: The New American Li brary Inc.
Burns, D.D. ( 1980b). The perfectionist's script for self-defeat. Psychology Today, pp. 34- 57.
Burns, D.D. ( 1983). The spouse who is a perfectionist. Medical Aspects of Human Se-rttality. 1 7. 2 19-230.
Burns, D.D., & Beck, A. T. ( 1978). Cognitive behavior modification of mood disorders. In J. P. Foreyt and D.P. Rathjen (Eds.), Cognitive behavior therapy: Research an application (pp. 109- 134). New York: Plenum.
Butler, L.F., & Miezitis, S. ( 1980). Releasing children from depression: A handbook for elenzentary teaciters and constiltants. Toronto: OISE Press.
Cantwell. D.P., & Baker, L. (1991). Manifestation of depressive affect in adolescence. Journal of Youth and Adolescence, 20(2), 1 2 1 - 1 3 3.
Carlson, G.A. (198 1). The phenomenology of adolescent depression. Adolescent Psychiatry, 9 , 4 1 1 -42 1.
Carlson, G.A., & Garber, J. (1986). Developmental issues in the classification of depression in children. In M. Rutter, C.E. Izard, & P.E. Read (Eds.), Depression in young people: Developmental and clinical perspectives (pp. 399-434). New York: Guilford Press.
Carlson, G.A., & Kashani, J.H. (1988). Manic symptoms in a nonreferred adolescent population. Journal of Affective Disorders, 1 5 ,2 19-226.
Caron, C., & Rutter, M. ( 199 1 ). Comorbidity in child psychopathology: Concepts, issues and research strategies. Journal of Child Psychology and Psychiatry, 32(7), 1063- 1080.
Cauce, A.M., Mason, C., Gonzales, N., Hiraga, Y., & Liu, G. (1994). Social support during adolescence: Methodological and theoretical considerations. In F. Nestmann, & K. Hurrelmann (Eds.), Social nemorks and social support in childhood and adolescence. New York: Walter de Gruyter.
Cepeda-Benito, A, & Short, P. (1998). Self-concealment, avoidance of psychological services, and perceived likelihood of seeking professional help. Journal of Coltnseling Psychology, 45, 58-64.
Cicchetti, D., & Toth, S.L. (1998). The development of depression in children and adolescents. American Psychologist, 53,22 1-24 1.
Cohen, J. (1968). Multiple regression as a general data-analytic system. Psychological Btilletin, 70,426-443.
Cohen, S., & Hoberman, H.M. (1983). Positive events and social support as buffers of life change stress. Journal of Applied Social Psychology, 13,99- 125.
Cohen, S.. & Wills, T.A. (1985). Stress, social support and the buffering hypothesis. Psychological Bulletin, 98, 3 1 0-357.
Compas, B .E. ( 1987). Stress and life events during childhood and adolescence. Clinical Psychology Review, 7,275-302.
Compas, B.E., Ey, S.. & Grant, K.E. (1993). Taxonomy, assessment, and diagnosis of depression during adolescence. Psychological Bulletin. 1 14(2), 323-344.
Compas, B.E., Grant, K.E., & Ey, S. (1994). Psychosocial stress and child and adolescent depression: Can we be more specific? In W.M. Reynolds & H.F. Johnston (Eds.), Handbook of depression in children and adolescents ( pp. 509-533). New York: Plenum Press.
Compas, B.E. & Hammen. CL. (1994). Child and adolescent depression: Covariation and comorbidity in development. In R.J. Haggerty, L.R. Sherrod, N. Garrnezy, & M. Rutter (Eds.), Stress, risk, and resilience in children and adolescents: Process, nzechanisms, and intemenrions (pp. 225-267). New York: Academic Press.
Compas, B.E., Malcarne, V.L., & Fondacaro. K.M. (1988). Coping with stressful events in older children and young adolescents. Journal of Consulting and Clinical Psychology, 56,405-4 1 1.
Compas, B.E., Orosan, P.G., & Grant, K.E. (1993). Adolescent stress and coping: Impiications for psychopathology during adolescence. Journal of Adolescence, 16, 33 1-349.
Coyne, J-C. ( 1994). Self-report distress: analog or ersatz depression? Psychological Brilletin, 1 16, 29-45.
Cronbach, L. ( 1 95 1 ). Coefficient alpha and the intemal structure of tests. Psychometrika, 16, 297-334.
Culp, A.M., Clyrnan, M.M., & Clup, R.E. ( 1995). Adolescent depressed mood, reports of suicide attempts, and asking for help. Adolescence, 30, 827-837.
Delisle, J.R. (1990). The gifted adolescent at risk: Strategies and resources for suicide prevention arnong gifted youth. Journal of Education of the Gijted, 13, 2 12-228.
Deykin, E.Y., Levy, J.C., & Wells, V. (1987). Adolescent depression, akohol and dmg use. American Journal of P~rblic Healrh, 77, 178- 182.
Downey, G., & Coyne, J.C. (1990). Chiidren of depressed parents: An integrative review. Psychological Bulletin, 108, 50-76.
Dubois, D.L., Felner, R.D., Sherman, M.D., & Buil, C.A. (1994). Socioenvironmental experiences, self-esteem, and emotionaVbehavioral problems in early adolescence. American Jorrrnal of Community Psychology, 22,357-397.
Dubow, E.F.. Lovko, K.R., Jr., & Kausch. D.F. ( 1990). Demographic differences in adolescent's health and concerns and perceptions of helping agents. Journal of Clinical Child Psychology, 1 9,44-54.
D'Zurilla, T.J., & Nezu, A.M. ( 1990). Development and preliminary evaluation of the Social Pro blem-Solving inventory (SPSI). Psychological Assessment, 2, 1 56- 1 63.
Earls, F., Reich, W., Jung, K.G., & Cloninger, C.R. (1988). Psychopathology in chiidren of alcoholic and antisocial parents. Alcoholism: Clinical and Experimental Research, 12,48 1-487.
Feldman, W., Hodgson, C., Corùer, S., Quinn, A. (1986). Heaith concerns and health- related behaviors of adolescents. Canadian Medical Association Journal, 1 34, 489-493.
Fichman, L., Koestner, R., & Zuroff, D.C. (1994). Depressive styles in adolescence: Assessment, relation to social functioning and developmental trends. Journal of Yorrth and Adolescence, 23(3), 3 15-329.
Fisher, J.D., Nadler, A., & Whitcher-Alagna, S. (1982). Recipient reactions to aid: A conceptual review. Psychological Bulletin, 9 1, 27-54.
Fleming, J.E. and Offord, D.R. ( 1990). Epidemiology of childhood depressive disorders: A critical review. Journal of the American Acaderny of Child and Adolescent Psvchia~ry, 29,57 1-580.
Flett, G.L., Blankstein, K.R., & Kleinfeldt, S. (1990). Depression and causal attributions for unexpected stressful events. Social Behavior and Personality, 19, 53-64.
Flett, G.L., & Hewitt, PL. (1990). CIinical depression and attributional complexity. British Journal of Clinical Psychology, 29, 339-340.
Flett, G.L., Hewitt, P.L., Blankstein, KR., & O'Brien, S. (1991a). Perfectionism and learned resourcefulness in depression and self-esteem. Personality and Individual DrTerences, 12,6 1-68.
Flett, G.L., Hewitt, P.L., Blankstein, K.R., & Pickering, D. (in press). Perfectionism and attributions for success versus failure. Australian Journal of Psychology.
FIett, G.L., Hewitt, P.L., Blankstein, K.R., & Van Brunschot, M. (199 1 b). Dimensions of perfectionism and problem-solving ability. Manuscript submitted for publication.
Flett. G.L., Hewitt, P.L., Boucher, D.J., Davidson, L.A., & Munro, Y. (1997). The Child- Adolescent Pe~ectionism Scale: Development, validation, and association with adjrrstment. Unpublished manuscript.
Flett, G.L., & Johnston, M.E. (1992). Depression. problem-solving ability, and probtem- solving appraisals. Journal of Cfinical Psychology, 48(6), 749-759.
Flett, G.L., Vredenburg, K., Krames, L. (1997). The continuity of depression in clinical and nonclinical samples. Psychologieal Bulletin, 12 1 (3), 395-4 1 6.
Frank, S. J., Poorman, M.O., Van Egeren, L.A., & Field, D.T. (1 997). Perceived relationships with parents among adolescent inpatients with depressive preoccupations and depressed mood. Journal of Clinical Child Psychology, 26(2), 205-2 15.
Freud. S. (1946). Mourning and melancholia. In Standard edition, Vol. 14 (pp. 243-258). London: Hogarth Press.
Frost, R.O., & Marten, P.A. ( l99Oa). Perfectionism and evaluative threat. Cognitive Therapy and Research, 14, 559-572.
Frost. R., Marten, P., Lahart, C., & Rosenblate, R. (1990b). The dimensions of perfectionism. Cognitive Therapy and Research, 14,449-468.
Frost, R.O., Trepanier, K.L., Brown, E.J., Heimberg, R.G., Juster, H.R., Makris, G.S., & Leung, A.W. (1997). Self-monitoring of mistakes among subjects high and low in perfectionistic concem over mistakes. Cognitive Therapy and Research, 2 1 (S), 209-222.
Frost, R.O., Turcotte, T.A., Heimberg, R.G., Mattia, J.I., Holt, C.S., & Hope, D.A. ( 1995). Reactions to mistakes among subjects high and low in perfectionistic concem over mistakes. Cognitive Therapy and Research, 1 9(2), 195-205.
Garber, J., & Robinson, N.S. (1997). Cognitive vulnerability in children at risk for depression. Cognitive and Emotion, 1 1 (5/6), 6 19-635.
Garland, A. ( 1995). Personal comrnrtnication wifh Professor Garland. Child and Family Researc h.
Garland, A.F., & Zigler, E.F. ( 1994). Psychological correlates of help-seeking attitudes among children and adolescents. Arnerican Journal of Orthopsychiatry, 64 (4), 586-593.
Garrison. C.. Shoenbach, V., & Kaplan, B. (1985). Depression symptoms in early adolescence. In A. Dead (Ed. ), Depression in rnultidisciplinary perspective (pp. 60-82). New York: Brunner/Mazel.
Gelfand, D.M., & Teti, D.M. (1990). The effects of maternal depression on children. Clinical Psychology Review, 10, 329-353.
Gjerde, P.F., Block, J., & Block, J.H. ( 199 1 )- The preschool family context of 18-year olds with depressive symptoms: A prospective study. Journal of Research on Adolescence, 1,63-9 1.
GIick. RA., & Roose, S.P. ( f 993). Rage, power, and aggression. New Haven: Yale University Press.
Goldsmith, S.J., Fyer, M., & Frances, A. (1990). Personality and suicide. In S.J. Blumenthal & D.J. Kupfer (Eds.), Suicide over the life cycle (pp. 155- 176). Washington, DC: American Psychiatrie Press.
Goodman, S.H., Adarnson, L.B., Riniti, J., & Cole, S. (1994). Mothers' expressed attitudes: Associations with maternal depression and children's self-esteem and psychopathology. Journal of the American Academy of Child and Adolescent Psychiatrÿ. 33, 1265- 1274.
Gotlib, I.H., Lewinsohn, P.M., & Seeley, J.R. ( 1995). Symptoms versus a diagnosis of depression: Differences in psychosocial functioning. Journal of Counselling and Clinical Psychology, 65,90- 100.
Greenberg, M.S. ( 1980). A theory of indebtedness. In K.J. Gergen, M.S. Greenberg, & R.H. Wills (Eds.). Social exchange: Advances in theory and research. New York: Wiley
Greenberg, M.S., & Frisch, D.M. ( 1972). Effect of intentionality of willingness to reciprocate a favor. Journal of Experimental Social Psychology, 8,99- 1 1 1.
Habke, A.M., Hewitt, P.L., & Flett, G.L. (1999). Perfectionism and sexual satisfaction in intimate relationships. Journal of Psychopathology and behavioral assessments, 2 1, 307-322.
Haggerty, R.J., Sherrod, L.R., Garmezy, N., & Rutter, M. (1994). Stress, risk, and resilience in children and adolescents: Processes, rnechanisms, and interventions. U S A : Cambridge University Press.
Hamachek, D.E. ( 1978). Psychodynamics of normal and neurotic perfectionism. Psychology, 15,27-33.
Harnmen, C., Marks, T., Mayol, A. & deMayo, R. ( 1985). Depressive self-schemas, life stress, and vulnerability to depression. Journal of A b n o m l Psychology, 94, 308- 3 19.
Harnrnen, C.L., & Padesky, C.A. (1977). Sex differences in the expression of depressive responses on the Beck Depression Inventory. Journal of Abnonnal Psychology, 86,609-6 14.
Hankin, B.L., Roberts, J., & Gotlib, I.H. (1997). Elevated self-standards and emotional distress during adolescence: Emotional specificity and gender differences. Cognitive Therapy and Research, 2 1 (6), 663-679.
Harter. S. (1989). Causes, correlates, and the functional rote of global self-worth: A life- span perspective. In J. Kolligian & R. Steinberb (Eds.), Perceptions of cornpetence and incompetence across the fife span. New Haven, CT: Yale University Press.
Hauser, S.T., & Smith, H.F. (1991). The development and experience of affect in adolescence. Journal of the American Psychoanalytic Association, 39, 1 3 1 - 165.
Helzer, J. ( 1 988). National Institute on Drug Abuse Research Monograph Series 81. Problems of Drug Dependence. NIDA. office of Science, Washington, DC.
Herman-Stahl, M.A., Stemmler, M., & Petersen, A. (1995). Approach and avoidant coping: Implications for adolescent mental health. Journal of Youth and Adolescence, 24,649-665.
Hewitt, P.L. ( 1989). Validation of a measure of perfectionism. Journal of Personalify and Assessment, 53, 133-144.
Hewitt, P.L., & Dyck, D.G. (1986). Perfectionism, stress, and vulnerability to depression. Cognitive Therapy and Research, 10, 1 37- 142.
Hewi tt, P.L., & Fiett, G.L. ( 1990). Perfectionism and depression: A multidimensional anal ysis. Joumal of Social Beha vior and Personality, 5,423-438.
Hewitt, P.L., & Flett, G.L. ( 199 1 a). Dimensions of perfectionism and unipolar depression. Journal of Abnonnal Psychology, 100,98- 10 1.
Hewitt, P.L., & Fiett, G.L. (1991 b). Perfectionism in the self and social contexts: Conceptualization, assessment, and association with psychopathology. Journal of Personality and Social Psychology, 60,456-470.
Hewitt, P.L., & Flett, G.L. (1993a). Dimensions of perfectionism, daily stress and depression: A test of the specific vulnerability hypothesis. Journal of Abnomal Psychology, 102,58-65.
Hewitt, P.L., & Flett, G.L. ( 1993b). Peflectionisric self-presentation and maladjustment. Paper presented at t!!e annual conference of the American Psychological Association, Toronto, Canada.
Hewitt, P.L., & Flett, G.L., & Ediger, E. (1995). Perfectionism traits and perfectionistic self-presentation in eating disorders attitudes, characteristics, and symptoms. International Journal of Eating Disorders, 18(4), 3 17-326.
Hewitt, P.L., & Flett, G.L., & Ediger, E. (1996). Perfectionism and depression: Longitudinal assessment of specific wlnerability hypothesis. Journal of Abnonna! Psychology, 105,276-280.
Hewitt, P.L., & Flett, G.L., & Endler, N.S. (!995). Perfectionism, coping, and depression symptomatology in a clinical sample. Clinical Psychology and Psychotherapy, 2, 47-58.
Hewitt, P.L., & Flett. G.L., & Fairlie, P. (1994). Self-presentational style and maladjusiment: Presenting the perfect self. Unpublished manuscript.
Hewitt, P.L., Flett, G.L., & Tumbull-Donovan, W. (1992). Perfectionism and suicide potential. British Joumal of Clinical Psychology, 3 1, 18 1 - 190.
Hewitt, P.L., & Genest, M. (1990). The ideal-self: Schematic processing of perfectionistic content in dysphoric university students. Journal of Personafity arzd Social Psychology, 59, 802-808.
Hewitt, P.L., Newton, J., Flett, G.L., & Callander, L. (1997). Perfection and suicide ideation in adolescent psychiatric patients. Jorrrnal of Abnormal Child Psyciiology, 25(2), 95- 1 0 1 .
Higgins, E.T. ( 1987). Self-discrepancy: A theory relating self and affect. Psychological Review, 94 ,3 19-340.
Holinger, P., & Offer, D. (198 1). Perspectives of suicide in adolescence. In R. Simmons (Ed.), Research in communiiy and mental health, Vol. 2 (pp. 139- 157). Greenwich, CT: JAI Press.
Kandel. D.B ., & Davies, M. ( 1982). Epidemiology of depression mood in adolescents. Archives General Psychiatry, 39, 1205-1212.
Kandel, D.B., Raveis, V.H., & Davies, M. ( 199 1). Suicida1 ideation in adolescence: Depression, substance use, and other risk factors. Journal of Youth and Adolescence, 20(2), 289-308.
Kanfer, F.H., & Hagerman, S. (198 1). The role of self-regdation. In L. Rehm (Ed.), Behavior rherapy for depression: Presenr starus and future directions (p p. 1 43 - 179). New York: Academic Press.
Kaplan, S.L., Nussbaum, M., Skomorowsky. P., Shenker, I.R., & Ramsey, P. (1980). Health habits and depression in adolescence. Journal of Yourh and Adolescence, 9, 299-304.
Kashani, J.H., Rosenberg, T.K., & Reid, J-C. (1989). Developmental perspectives in child and adolescent depressive symptoms in a cornrnunity sample. American Journal of Psychiatry, 146, 87 1-875.
Kelly, A.E., & Achter, J.A. ( 1995). Self-concealment and attitudes toward counseling in universi ty students. Jownal of Counseling Psychology, 42,40-46.
Kessler, R.C., Brown, R.L., & Broman, C.L. (198 1). Sex differences in psychiatric help- seeking: Evidence from four large-scale surveys. Journal of Heal~h and Social Behavior, 22,4944.
Klerrnan, G.L., & Weissman, M.M. (1989). Increasing rates of depression. American Medical Association Journal, 26 1 ( 1 S ) , 2229-2235.
Kobak, R.R.. Sudler, N., Garnble, W. (1991). Attachment and depressive symptom during adolescence: A developmental pathway analysis. Development and Psychopathology, 3,46 1 -474.
Koestner, R., Zuroff, D.C., & Powers, T.A. (1991). The family origins of adolescent self- cri ticism and its continuity into adulthood. Journal of Abnomal Psychology, I00,191-197.
Kovacs, M. (1980). Ratings scales to assess depression in school-aged children. Acta Paedopsychiatry, 46,305-3 15.
Kovacs, M., & Beck, A.T. (1977). An empirical- clinical approach toward a definition of childhood depression. In J.G. Schulterbandt & A. Askin (Eds.), Depression in childhood (pp. 1-27). New York: Raven Press.
Kovacs, M., Feinberg, T.L., Crouse-Novack, M.A., Paulauskas, S., & Finkelstein, R. ( 1984). Depressive disorders in childhood: 1. A longitudinal prospective study of characteristics and recovery. Archives of General P sychiatry, 4 I ,2 19-239.
Kranz, S.E., & Rude, S.S. (1984). Depressive attribution: Selection of different causes or assigrnent of dimensional rneanings? Jorirnal of Personality and Social Psychology, 47, 193-203.
Kuhl, J., Jarkon-Horlick, L., & Morrisey, R.F. (1997). Measuring barriers to help-seeking behavior in Adolescents. Journal of Youth and Adolescents, 26,637-650.
Kushner, M.G., & Sher, K.J. (199 1). The relation of treatment fearfulness and psychological service utilization: An overview. Professional Psychology: Research and Practice, 22(3), 196-203.
Larson, G.D., & Chastain, R.L. ( 1990). Self-Concealment: Conceptualization, measurement, and health implications. Journal of Social and Clinical Psychology, 9(4), 439-455.
Larson, R., Raffaelli, M., Richards, M.H., Ham, M., & Jewell, L. (1990). The ecology of depression in early adolescence. Journal of Abnormal Psychology, 99.92- 102.
Lekowitz, M. M., & Tesiny, E.P. (1984). Rejection and depression: Prospective and contemporaneous analyses. Developmental Psychology, 20,776-785.
Lewinsohn, P.M., & Rosenbaum, M. (1987). Recdl of parental behavior by acute depressi ves, remi tted depressives, and nondepressives. Journal of Personalih, and Social Psychology, 52,6 1 1-6 19.
Luthar, S.S., & Blatt, S.J. (1993). Dependent and self-critical depressive experiences arnong inner-city adolescents. Journal of Personalie, 61 (3), 365-386.
Luthar, S .S ., & Biatt, S.J. ( 1993). Dependent and seif-critical depressive experiences among inner-city adolescents. Journal of Personality, 6 1 (3), 365-386.
Luthar, S.S., & Blatt, S.J. ( 1995). Differential wlnerability of dependency and self- cri ticism arnong disadvantaged teenagers. Journal of Research on adolescence, 5(4), 43 1-449.
Mack, J. ( 1986). Adolescent suicide: An architectural model. In G. Klerrnan (Ed), Suicide and depression among adolescents and young adults (pp. 53-76). Washington, DC: American Psychiatric Press.
Mahler, M.S. ( 196 1 ). On sadness and grief in infancy and childhood. Psychoanalytic Study of the Child, 16, 332-35 1.
Main, M., Kaplan, N., & Calcium, J. (1985). Secunty in infants, childhood and adulthood: A move to the level of representation. In 1. Bretherton & E. Waters (Eds.), Growing points in attachment theor-y and research. Monographs of the Society for Research in Child Development, 50( 1 -2), 66- 104.
Maltsberger, J.T. ( 1 986). Suicide risk. New York: New York Universities Press.
McClelland, D.C., Koestner, R., & Weinberger, J. (1989). How do self-attributed and implicit motives differ? Psychological Review, 96, 609-702.
McCranie, E. W., & Bass, J.D. (1984). Childhood farnily antecedents of dependency and self-criticism: Implications for depression. Journal of Abnonnal Psychology, 93, 3-8.
Meissner, W. W. ( 1986). Psychotherapy and the paranoid process. Northvale, NJ: Jason Aaronson.
Miezitis, S. ( 1 992). Creating alternatives to depression in our schools: Assessment, intemention, prevention. Toronto: Hogrefe & Huber Publis hers.
Missildine, W.H. (1963). Perfectionism: If you must strive to "do better." Ln W.H. Missildine (Ed.), Your inner child of the pasi (pp. 75-90). New York: Pocket Books.
Morris, S C , DI, & Rosen, S. (1973). Effects of felt adequacy and opportunity to reciprocate on help seeking. Journal of Experimental Social Psychology, 9,265- 276.
Nadler, A., Fisher, J.D.. & DePauIo, B.M. (Eds.). (1983). New Directions in Helping: Vol. 3.Applied Perspectives on Help-seeking and Receiving. Academic Press, New York.
Nadler, A., Mayseless, O., Peri, N., & Chemerinski, A. (1985). Effects of opportunity to reciprocate self-esteem on help-seeking behavior. Journal of Personaliry, 53 23- 35.
Nelson-Le Gall. (198 1). Help seeking: An understudied problem-solving ski11 in children. Developmental Review, 1, 224-246.
Newacheck, P.W. (1989). Adolescents with special health needs: Prevalence, severity, and access to health services. Pediatrics, 84, 872-88 1.
Nolen-Hoeksema, S. ( 1 987). Sex di fferences in uni polar depression: Evidence and theory. îsychological Bulletin, 10 1,259-282.
Nolen-Hoeksema. S. ( 1990). Sex differences in depression. California: S tanford University Press
Nolen-Hoeksema, S. (1991). Responses to depression and their effects on the duration of depressive episodes. Journal of Abnormal Psychology, 100, 569-582.
Nolen-Hoeksema, S., & Girgus, J.S., ( 1994). The emergence of gender differences in depression during adolescence. Psychological Bulletin, 1 15(3), 424-443.
Nolen-Hoeksema, S., Girgus, J.S., & Seligman, M.E.P. (1991). Sex differences in depression and explanatory style in children. Journal of Youth and Adolescence, 20(2), 233-245.
Noien-Hoeksema, S., Girgus, J.S., & Seligman, M.E.P. (1992). Predictors and consequences of childhood depressive symptoms: A five-year longitudinal study. Journal of Abnormal Psychology, 10 1,405-422.
Nolen-Hoeksema, S., Morrow, J., & Fredrickson, B.L. (1993). Response styles and the duration of episodes of depressed rnood. Journal of Abnomal Psychology, 102, 20-28.
Offer, D., Howard, K.I., Schonert, KA., & Ostrov, E. (1991). To whom do adolescents tum for help? Differences between disturbed and nondisturbed adolescents. Journal of the American Acaderny of Child and Adolescent Psychiatry, 30(4), 623-630.
Offer. D., & Schonert-Reichl, K.A. (1992). Debunking the myths of adolescence: Findings from recent research. Journal of the Arnerican Academy of Child and Adolescent Psychiatry , 3 1, 1 003- 1 0 1 4.
Onwuegbuzie, A.J., & Daley, C.E. ( 1999). Perfectionism and statistic anxiety. Personalis, and Individual Diferences, 26, 1089- 1 102.
Onwuegbuzie, A.J., DaRos, D., & Ryan, J. (1997). The cornponents of statistics anxiety: a phenomenological study. Focus on Leaming Problems in Marhematics, 19(4), 1 1-35.
Pacht, A.R. ( 1984). Reflections on perfectionism. American Psychol~gisr, 39,386-390.
Paykel, ES. ( 199 1 ). Depression in women. British Journal of Psychiatry, 158(suppl. 1 O), 22-29.
Pearce, J. ( 1978). The recognition of depressive disorder in children. Journal of Royal Social Medicine, 7 1,494-500.
Petersen, A C , Compas, B E , Brooks-Gunn, J., Stemmler, M., Ey, S., & Grant, K.E. ( 1 993). Depression in adolescence- American Psychologist, 48, 155- 168.
Peterson, AC., Kennedy, R E , & Sullivan, P. (1991). Coping with adolescence. In M.E. Colton & S. Gore (Eds.), Adolescent Stress: Causes and consequences (pp. 93- 1 10). New York: Aldine de Gniyter.
Peterson, A C , Sarigiani, P.A., & Kennedy, R.E. (1991). Adolescent depression: Why more girls? Journal of Youth and Adolescence, 20(2), 247-27 1.
Peterson, AC., SchuIenberg, J.E., Abrarnowitz, R.H., Offer, D., & Jarcho, H.D. (1984). A Self-image Questionnaire for Young Adolescents (SIQYA): Reliability and validity studies. Journal of Youth and Adolescence, 13, 93- 1 1 1.
Poznanski, E.O., & Mokros, H.B. ( 1994). Phenomenology and epidemiology of mood disorders in children and adolescents. In W.M. Reynolds & H.F. Johnston (Eds.), Handbook of depression in children and adolescents (pp. 19-39). New York: Plenum Press.
Preusser, K.J., Rice, KG., & Ashby, J.S. (1994). The role of self-esteem in mediating the perfectionism-depression connection. Journal of College Student Development, 35. 88-93.
Puig-Antich, J. (1986). Psychological markers: Effects of age and puberty. In M. Rutter, C.E. Izard & P.B. Read (Eds.), Depression in young people (pp. 34 1 -369). New York: Guilford Press.
Radloff, L. ( 1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1 , 385-40 1.
Rastarn, M. (1992). Anorexia nervosa in 5 1 Swedish adolescents: Premorbid problems and comorbidity . Journal of the American Academy of Child and Adolescents Psychiatry, 3 1, 8 19-829.
Reynolds, W.M. (1992). Depression in children and adolescents. in W.M. Reynolds (Ed.), lnternalizing disorders in children and adolescents (pp. 149-254). New York: John Wiley.
Reynolds, W.M. ( 1994). Depression in adolescents: Contemporary issues and perspectives. In T.H. Ollendick & R.J. Pnnz (Eds.), Advances in clinical child psyclrology, Vol. 16 (pp.261-3 16). New York: Plenum Press.
Reynolds, W.M.. & Johnston, H.F. (Eds.). (1994). Hondbook of depression in children and adolescents. New York: Plenum Press.
Robbins, J.M., & Greenley, J.R. (1983). Thinking about what's wrong: Attributions or severity, cause, and duration in the problem definition stage of psychiatrie help- seeking. Research in C o m m u n i ~ and Mental Health, 3 , 209-232.
Rosen, B.C., & Aneshensel, C.S. (1 976). The chameleon syndrome: A social psychological dimension of the female sex role. Journal of Marriage and Family. 38, 605-6 17.
Rosenbaum, M. ( 1980). A schedule for assessing self-control behaviors: Preiiminary findings. Behavior Therupy, 1 1, 109- 12 1.
Rubinstein, J.L., Heeren, T., Housrnan, D., Rubin, C., & Stechler, G. (1989). Suicidal behavior in "normal" adolescents: Risk and protective factors. American Journal of Orthopsychiatry, 59,59-7 1.
Rutter, M. (1986). The developmental psychopathology of depression: Issues and perspectives. In M. Rutter, C.E. izard, & P.B. Read (Eds.), Depression in young people: Developrnental and clinical perspectives (pp. 3-32). New York: Guilford Press.
Rutter, M., Izard, C.E., Read, B.R. (Eds.) ( 1987). Depression: Developrnental factors. New York: John Wiley & Sons.
Saddler, C.D.? & Sacks, L.A. ( 1993). Multidimensional perfectionisrn and academic procrastination: Relationships with depression in university students. Psychological Reports, 73,863-87 1.
Saunders, S.M., Resnick, MD., Hoberman, H.M., & Blum, R.W. (1994). Formal help- seeking behavior of adolescents identifying themselves as having mental heaith problems. Journal of the American Acaderny of Child and Adolescent Psychiatry, 33(5), 7 18-728.
Saylor, C. F., Finch, A.J., Spirito, A., & Bennett, B. (1984). School frorn the young adolescent's perspective: A descriptive report. Journal of Eady Adolescence, 4, 107- 1 30.
Schoenbach, V.. Garrison. C., & Kaplan, B. (1984). Epidemiology of adolescent depression. Pltblic Healrh Review, 12, 159- 189.
Schoenbach, V., Kaplan, B., Grimson, R., & Wagner, E. (1982). Use of a symptom scale to study the prevalence of a depressive syndrome in young adolescents. American Jorirnal of Epidemiology, 1 16, 79 1-800.
Schonert-Reich1, K.A., & Muller, J.R. ( 1996). Correlates of help-seeking in adolescence. Journal of Youth and Adolescence, 25(6), 705-73 1.
Schonert-Reichl, K.A., Offer, D., & Howard, K.I. (1995). Seeking help from informal and formal resources during adolescence: Sociodemographic and psychological correlates. In R.C, Marohn, & SC. Feinstein (Eds.), Adolescent Psychiatry, (Vol. 20). Hillsdaie, NJ: Analytic Press.
Sethi, S., & Nolen-Hoeksema, S. (1997). Gender differences in intemal and extemal focusing arnong adolescents. Sex Roles, 37,687-700.
Siddique. C M . , & D'Arcy, C. ( 1984). Adolescence, stress and psychological well-being. Journal of Youth and Adolescence, 13.459473.
Siegel, L.J., & Griffin, N.J. (1984). Correlates of depressive symptoms in adolescents. Journal of Youth and Adolescence, 1 3,475-487.
Smith. C., & Steiner, H. (1992). Psychopathology in anorexia nervosa and depression. Journal of the Arnerican Academv of Child and Adolescent Psychiatry, 3 1, 84 1 - 843.
Srebnik, D., Cauce, A.M., & Baydar, N. (1996). Help seeking pathways for children and adolescents. Journal of Emotionai and Behavioral Disorders, 4,2 10-220
Steer. R.A., Kurnar, G., & Beck, A.T. (1993). Self-reported suicida. ideation in adolescents psychiatrie inpatients. Journal of Consulting and Clinical Psychology, 61, 1096-1099.
Stehouwer, R.S., Bultsma, C.A., & Blackford, I.T. (1985). Developrnental differences in depression: Cognitive-perceptual distortion in adolescents versus adult female depressives. Adolescence, 20,29 1-299.
Strober, M., Green, J., & Carlson, G. (198 1). Utility of the Beck Depression lnventory with psychiatrically hospitaiized adolescents. Journal of Consulting and Clinical Psvchology, 49,482483.
Teri, L. ( 1982). Depression in adolescence: Its relationship to assertion and various aspects of seif-image. Journal of clinical cliild Psychology, 1 1, 101- 106.
Tijhuis' M.A.R., Peters, L., & Foets, M. (1990). An orientation toward help-seeking for emotional problems. Social Science and Medicine, 3 1(9), 989-995.
Vredenburg, K., Flett, G.L., & Krames, L. (1993). Analogue versus clinical depression: A critical reappraisai. Psychological Bulletin, 1 1 3(2), 327-344.
Vredenburg, K., Krames, L., & Flett, G.L. (1986). Sex differences in the clinical expression of depression. Sex Roles, 14, 3749.
Wagner, B .M., & Compas, B.E. ( 1990)- Gender, instrumentality, and expressivi ty: Moderates of the relation between stress and psychological symptoms d u h g adolescence. American Journal of Community Psychology, 18, 383-406.
Watson, D., & Clark, L. (1984). Negative affectivity: The disposition to experience aversive emotional states. Pqchological Brilletin, 96,465490.
Watson, D., & Kendall, P.C. (1989). Common and differentiating features of anxiety and depression: Current findings and future directions. in P.C. Kendall & D. Watson (Eds.), Anxieiy and depression: Distinctive and overlapping features (pp. 493- 508). San Diego, CA: Academic Press.
Webb. T E , & VanDevere, C.A. (1985). Sex differences and the epidemiology of depression: A developmental interaction effect. Sex Roles, 12, 9 1-95.
Weissrnan, M.M., & Kleman, G.L. (1977). Sex differences in epidemiology of depression. Archives General Psychiatrv, 34,98- 1 1 1.
Wintre, M.G., & Crowley, J.M. (1993). The adolescent self-concept: A functional determinant of consultant preference. Journal of Yortth and Adolescence, 22,369- 383.
Woznica, J.G., & Shapiro, J. (1990). An analysis of adolescent suicide attempts: The expandable child. Journal of Pediatric Psychology, 15, 789-796.
Wright-Strawderman, C., & Watson, B. L. (1992). The prevalence of depressive symptoms in children with learning disabilities. Journal of LRaming Disabilities, 4, 258-264.
Wylie, R.C. ( 1979). The self-concept. Lincoln: University of Nebraska Press.
Zemore, R., & Rinholm, J. (1989). Vulnerability to depression as a function of parental rejection and control. Carradian Journal of Belravioral Science, 2 1, 364-376.
Zuroff, D.C., Koestner, R., & Powers, T.A. (1994). Self-criticism at age 12: A longitudinal study of adjustment in later adoiescence and adulthood. Journal of Cognitive Therapy and Research, 1 8,367-385.
Zuroff, D.C., & Mongrain, M. (1987). Dependency and self-criticism: Vulnerability factors for depressive affective states. Journal of Abnomai Psychology, 96, 14- 22.
Zuroff, D.C., Moskowitz, D.S., Wieglus, M.S., Powers, T.A., & Franko, D.L. (1983). Construct validation of the dependency and self-criticism scales of the Depressive Experiences Questionnaire. Journal of Research in Personalitv, 17,226-24 1
Appendices
Amendix A Descti~tion Letter of the Studv
Dear ParentlGuardian:
We are conducting a research study to investigate personal and social characteristics of adolescents. This research will help us understand the behaviour patterns of adolescents when they encounter negative experiences in their Iives. The more teachers and parents know about these negative experiences the more positive support they cm offer.
We woüld like your adolescent to participate in this study. It will take approximately 30 minutes to complete and is entireiy voluntary. Your adolescent is free to refuse to participate in the study, to refuse to answer any specific question and/or withdraw from the study at any time. If you consent, your adolescent will be given a questionnaire containing a number of sentences in which he/she will be asked to indicate the degree to which the sentence reflects hisher feelings and experiences. There are no apparent risks üssociated with participating in the study and a trained researcher will be present to assist your adolescent if required.
Your adolescent's responses will be completely anonymous and wilI be kept strictly confidential. His or her name will not appear on any documents. Only research personnel will have access to the data. Overall results will focus on group trends rather than indi vidual responses.
Following the termination of the study, a summary of the research findings and a complete explanation of the purpose and results of the study will be available upon request.
This study is being conducted jointly by Dr. Solveiga Miezitis, Professor, Department of Applied Psychology, University of Toronto and Dr. Gordon Flett, Professor, Department of Psychology, York University and myseIf, a Ph.D. candidate at the University of Toronto. Should you require any further information, Dr. Flett can be contacted at (4 16) 736-2 100 Ext. 44575.
Thank you in advance for your willingness to consider our request. If you agree to allow your adolescent to participate, please sign the enclosed consent form and have your adolescent return it to hisher teacher.
S incerel y,
ParentKuardian Consent Forms
1 hereby gant permission for my adolescent, Y
(name of adolescent)
to participate in a study king conducted by Tessa DeRosa under the supervision of Dr. Solveiga Miezitis, Department of Applied Psychology, University of Toronto, and Dr. Gordon Flett, Department of Psychology, York University.
1 understand the purpose of this study is to examine how personality variables are related to individuai differences and attitudes towards seeking help. My adolescent's participation will involve hisher completion of self-report questionnaires.
1 understand that participation is entirely voluntary, that my adolescent's responses will be compIetely anonymous, and that the data collected will be kept strictly confidential. Only research personnel will have access to the data records. Analysis of the data will focus on group trends rather than individuai responses.
1 understand that a more complete explanation of the purposes and the results of the study wiII be given, if 1 request it, following the termination of the study, and that 1 will be able to obtain a summary of the research findings.
1 understand that my adolescent can refuse to participate in the snidy, refuse to answer any specific questions, andor withdraw from the study at any time.
Signature of Parent or Legal Guardian Date
Signature of Adolescent
Please pnnt surname of parentlguardian:
Student Consent Form
1 hereby agree to participate in a research study k i n g conducted by Tessa DeRosa under the supervision of Dr. Solveiga Miezitis, Department of Applied Psychology, University of Toronto, and Dr. Gordon Flett, Department of Psychology, York University.
1 understand the purpose of this study is to examine how persondity variables are related to individuai differences and attitudes towards seeking help. My participation will involve the completion of self-report questionnaires.
1 understand that my participation is entirely voluntary, that my responses will be completely anonymous, and that the data collected will be kept strictly confidentid. No one besides research personnel will have access to the data records. Anaiysis of the data will focus on group trends rather than individual responses.
1 understand that a more complete explanation of the purpose and the results of the study will be given, if I request it, following the completion of the study and that 1 will be able to obtain a summary of the research findings.
1 understand that I can refuse to participate in the study, refuse to answer any specific questions, and/or withdraw from the study at any time.
I am 18 years of age or older.
Signature
PIease print sumarne:
Date
Introduction to the Studv
Thank you for participating in this research study. This is not a test. There are no right o r wrong answers. D o not spend a great deal of time thinking about your answers to individual questions but d o take the time to carefully read the instructions for each part of the questionnaire.
Please d o not write your name on the document. Participation in this study is completely anonyrnous and voiuntary. Although it is hoped that you will answer al1 questions, you may refuse to answer any specific question a n d o r withdraw from the study at anytime. The data will be used to understand group trends and no individual student wiIl be identified.
Before beginning the questionnaire package, please complete the following:
Specify gender: MALE FEMALE (please circle one)
Specify age: years old
Current grade: grade
PIease begin ...
The Child and Adolescent Perfectionism Scale (CAPS)
This is a chance to find out about your self. It is not a test. There are no right answers and everyone will have different answers. Be sure that your answers show how you acnidly are. Please do not talk about your answers with anyone else. We will keep your answers private 2nd not show them to anyone.
When you are ready to begin. read each sentence and pick your answer by circling a number from "1" to "5". The five possible answers for each sentence are listed below:
1. False -- Not at al1 true of me 2. Mostly False 3. Neither True or False 4. Mostly True 5. Very True of me
For example. if you were given the sentence "1 like to read comic books", you would circle a "5" if this is very true of you. If you were given the sentence "1 like to keep my room neat and tidy", you would circle a "1" if this was false and not true of you. You are now ready to begin.
Please be sure to answer al1 of the sentences.
False
1 try to be perfect in everything 1 do. 1 2
1 want to be the best at everything i do. 1 2
My parents don't always expect me to be perfect in everything 1 do. 1 2
1 feel that I have to do my best al1 the time. 1 2
There are people in my Iife who expect me to be perfect. 1 2
1 always try for the top score on a test 1 2
It really bothers me if 1 don't do my best al1 the time. 1 2
My family expects me to be perfect. 1 2
True
4 5
4 5
9.
1 o.
I I .
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
1 don? al ways try to be the bat .
People expect more from me than 1 am able to give.
1 get mad at myself when 1 make a mistake.
Other people think 1 have failed if 1 do not do my very best al1 the time.
Other people always expect me to be perfect.
1 get upset if there is even one mistake in my work.
People around me expect me to be great at everything.
When 1 do something, it has to be perfect.
My teachers expect my work to be perfect.
1 do not have to be the best at everything 1 do.
1 am always expected to do better than others.
Even when 1 pas , 1 feel that 1 have failed if 1 didn't get one of the highest marks in the cIass.
1 feel that people ask too much of me.
22. 1 can't stand to be less than perfect. 1
138
Tnie
5
5
5
5
5
5
5
5
5
5
5
5
5
5
Amendix F Perfectionism Self-Presentation Scale (PSPS)
Listed below are a group of statements. Please rate your agreement with the statements using the following scale:
DIS AGREE NEUTRAL AGREE STRONGLY STRONGLY
1 . It is okay to show others that 1 am not perfect. f 2 3 4 5 6 7
2. 1 judge myself based on the mistakes I make in front of other people. 1 2 3 4 5 6 7
3. I will do almost anything to cover up a mistake. 1 2 3 4 5 6 7
4. Errors are much worse if they are made in public rather than in private. 1 2 3 4 5 6 7
5. 1 try always to present a picture of perfection. 1 2 3 4 5 6 7
6. It would be awful if 1 made a fool of myself in front of others. 1 2 3 4 5 6 7
7. If 1 seem perfect, others will see me more positively. 1 2 3 4 5 6 7
8. 1 brood over mistakes that 1 have made in front of others. 1 2 3 4 5 6 7
9. I never let others know how hard f work on things. 1 2 3 4 5 6 7
10. 1 would like to appear more competent than 1 really am. 1 2 3 4 5 6 7
1 1. It doesn't matter if there is a flaw in my looks. 1 2 3 4 5 6 7
DIS AGREE STRONGLY
AGREE STRONGLY
12.1 do not want people to see me do something unless 1 am very good at it. I 2
13.1 should always keep my problems to myself. i 2
14. 1 should soive my own problems rather than admit them to others. 1 2
15. 1 must appear to be in control of my actions at al1 times. 1 2
16. It is okay to admit mistakes to others. I 2
17. It is important to act perfectly in social situations. 1 2
18. 1 don? really care about king perfectly groomed.
19. Admitting failure to others is the worst possible thing. 1 2
20. 1 hate to make errors in public. 1 2
2 1 . 1 try to keep my faults to myself. 1 - 3
22.1 do not care about making mistakes in public. 1 2
23.1 need to be seen as perfectly capable in everything I do.
24. Failing at something is awful if other people know about it. 1 2
35. It is very important that 1 always appear to be "on top of things". 1 2
26. 1 rnust always appear to be perfect. 1 2
27.1 to look perfect to others. 1 2
The Adolescent De~ressive ExDeriences Ouestionnaire (DEQ-A)
Listed below are a group of statements. Please rate your agreement with the statements using the following scale:
DIS AGREE AGREE STRONGLY STRONGLY
1. 1 set my goals at a very high level.
2. Sometimes 1 feel very big, and other times 1 feel very small.
3. 1 often find that 1 fail short of what 1 expect of myself.
4. 1 feel 1 am always making full use of my abiiities.
5. It bothers me that relationships with people change.
6. There is a big difference between how 1 am and how 1 wish 1 were.
7. 1 enjoy competing with others.
8. Usually 1 am not satisfied with what 1 have.
9. 1 have difficulty breaking off a friendship that is making me unhappy.
10. Often, 1 feel 1 have disappointed others.
1 1. I very often go out of my way to please or help people 1 am close to.
1 2. 1 never reaily feel safe in a close relationship with a parent or a friend.
13. 1 generally watch carefully to see how other people are affected by what 1 say or do.
14. 1 worry a lot about upsetting or hurting someone who is close to me.
15.1 am a very independent person.
16. Anger frightens me.
17. If someone 1 cared about became angry with me, 1 would feel frightened that he or she might leave me.
18. What 1 do and Say has a very strong impact on those around me.
19. The people in my family are very close to each other.
10. 1 am very satisfied with myself and the things 1 have achieved.
DISAGREE STRONGLY
AGREE STRONGLY
AmendUr H The Center for E~idemioloeic Studies De~ression Scales (CES-Dl
Below is a list of the ways you might have felt or behaved. Please indicate by choosing the number which best describes how ofien you have felt this way dunng the past week.
O = Rarely or none of the time (Less than 1 day) 1 = Some or a little of the time ( 1-2 days) 2 = Occasionally or a moderate amount of time (3-4 days) 3 = Most o r al1 of the time (5-7days)
During the past week:
I was bothered by things that usually don t bother me. 1 did not feel like eating: rny appetite was poor. I felt that 1 could not shake off the blues even with help from my family or friends. 1 felt that 1 was just as good as other people. 1 had trouble keeping my mind on what was going on. 1 felt depressed. 1 felt that everything 1 did was an effort. 1 felt hopeful about the future. 1 thought my life had been a failure. 1 felt fearful. My sleep was restless. 1 was happy. 1 talked less than usual. 1 felt lonely. People were unfriendly. 1 enjoyed life. 1 had crying spells. 1 felt sad. 1 felt that people disliked me. 1 could not get "going."
Appendix 1 Self-Concealmen t Scale (SCS)
Listed below are a group of statements. Please rate your agreement with the statements using the following scale:
I have an important secret that I havent shared with anyone.
If I shared al1 my secrets with my friends, they'd like me less.
There are Iots of things about me that 1 keep to myself.
DIS AGREE STRONGLY
Some of my secrets have reaily tonnented me. 1
When something bad happens to me, 1 tend to keep it to myself. 1
I'm often afraid i'll reveal something I dont want to. 1
TelIing a secret often backfires and I wish I hadn't told it. 1
1 have a secret that is so private 1 would lie if anybody asked me about it. 1
My secrets are too embarrassing to share with others. 1
10.1 have negative thoughts about myseIf that 1 never share with anyone. 1
4 5
AGREE STRONGLY
Chose the answers that best describe how you feel.
S trongl y Agree
Adults are good at helping kids with personal or emotional problems.
The best way to d e d with personal problems is to keep them to yourself.
Just talking with someone about things that bother you c m be helpful.
School is not the right place to taik about persona1 or farnily problems.
1 would tell a friend to talk to a teacher or counsellor if he/she were very upset about a family problem.
If you are really sad, it is usuaily a good idea to keep these feelings to yourself.
1 would be willing to talk to someone who helps people with their problems, if 1 felt sad.
1 don't think teachers or counsellors know about how students feel.
If 1 were womed that a friend rnight hurt himself/herself, 1 would talk to another adult about it.
10. Talking with an adult about your problems might help you solve them.
1 1.1 can only talk to someone my own age about my problems.
Agree
2
2
2
2
Disagree
3
3
3
3
Strongl y Disagree
4
4
4
4
S trongl y Agree
12. 1 woutd talk to an adu!t at school about problems in my family. 1
13. Teachers and/or counsellors c m help when you're upset about a persona1 problem. 1
14. There should be an adult at school who talks to kids about personal problems and family problems. 1
15. 1 don't like to talk to any adults about my problems. 1
Agree
2
2
2
2
Disagree
3
3
3
3
146
S trongl y Disagree
4
4
4
4
Try to imagine that you had each of the follo~ing experiences, would you talk to an adult about these things?
Definitely Probably Probably Definitely Yes Not No
16. You felt extremely sad and couldn't concentrate on school.
17. You had a fight with a friend
18. You were scared of things other people aren't usually scared of.
19. You were very upset because your hest friend moved away.
20. You felt very lonely and wanted more friends.
2 1. You were very womed about a friend who was using drugs.
22. You were very sad because someone in your family was sick.