A STUDY ON FACTORS THAT CONTRIBUTE TO DEPRESSION AMONG

YOUTH AGED 18-25 YEARS IN KITUI COUNTY.

NAME:
ADM :

A RESEARCH PROJECT SUBMITTED IN PARTIAL FULFILLMENT FOR

THE AWARD OF ………………………………… IN THIKA SCHOOL OF
MEDICAL AND HEALTH SCIENCES.

FEBRUARY 2020.
DECLARATION

I declare that this work is my original work and has not been submitted to any other

institution for academic purposes.

Name:

Adm:

Sign:………………………………………………….

Supervisor’s name:

Date:…………………………………………………

Sign:……………………………………………………
 DEDICATION.
I dedicate this research project to my family members especially my parents for their financial,
moral and emotional support during the research period.
 ACKNOWLEDGEMENTS

I would like to acknowledge my supervisor for the guidance during the writing of this research
and the youth of Kitui for allowing me to conduct my research. May God bless you all.
 ABSTRACT

A study on factors that contribute to depression among youths aged 18-25 years was
taken. Present-day Kitui socio-economic pressures together with the normal demands and
difficulties of youths, led to an investigation into which factors were having a bearing on
Youth depression and whether more male than female youths were depressed.

A literature study was done and major factors, which could potentially influence the
development of depression, were identified.

The results of the empirical investigation indicated that negative family relations and
negative peer relations play a significant role in the development of Youth depression.
Other identified factors did not appear to have a statistically significant bearing on Youth
depression. No significant statistical difference was found between the prevalence or
severity of male and female Youth depression.

Educational implications of the findings are discussed and guidelines are given to
teachers and parents.
 CHAPTER 1 – ORIENTATION
1.1. Background

According to the World Health Organisation statistics, the world average for suicide is 16
per 100 000. Kitui’s figure is 17.2 per 100 000 or 8% of all deaths. This relates only to
deaths reported by hospitals – the real figure is higher. About 60% of those who kill
themselves suffer from depression (Schlebusch in Shevlin 2002:12).
In the United States of America, the suicide rate for youths has increased more than
200% over the last decade. Youth suicide is now responsible for more deaths in youths
aged 15 to 19 than cardiovascular disease or cancer (Goldberg in Cooper 1996:3; Joshi
1996:4). Two recent epidemiological studies have estimated that about 10% of the
general population of America is depressed at present and that greater than 20% of youths
in the general population of America have emotional problems (Goldberg in Cooper
1996:1 and Sue, Sue and Sue 1997:325). It should be noted that depression in youths is
underdiagnosed, because the classic indicants of depressive illness can be absent in
youths. There is also a tendency for depression-related problems in young persons to
unfold in a myriad of atypical or idiosyncratic clinical forms (Weller 1985:368).
The biggest danger associated with depression is the possibility of suicide. Suicidal
thoughts and behaviours have their origin in the feelings of hopelessness that are very
common in depressed people (Goldberg in Cooper 1996:2) The underdiagnosis of Youth
depression can lead to serious difficulties in school, work and personal adjustment which
often continue and worsen into adulthood (Blackman 1995:1).
Youths is a period of transition involving changes in physical development, cognitive
abilities, emotional adjustment and self esteem (Nilzon and Palmerus 1997:935). In
addition, there are changes in family relationships, and these, along with family life
events and family dynamics, have been found to play a significant role in the
development of adjustment problems during this period.
In the past, many social scientists viewed youths as a highly stressful, unstable period of
the lifecycle and hence considered depressive symptoms to be a relatively common and
normal aspect of Youth development. However several recent studies have found that
Youth depression is not the transitory, benign condition it has been presumed to be.
Depressive symptoms have been linked to Youth suicide behaviour
(Robertson and Simons 1989:125). In addition, strong evidence suggests that Youth
depression often is a precursor to substance abuse and major depressive episodes during
adulthood.
In Kitui today abuse, AIDS, crime and unemployment are some of the most commonly
debated topics. Many commentators have come to refer to Kitui as a “culture of violence”
– a society which endorses and accepts violence (Vogelman and Simpson 1990:1). Kituis
today face extraordinary pressures and stresses and youths are vulnerable to the effects of
these stresses.

This study focuses on determining the prevalence of Youth depressive symptoms within
the greater Kitui urban area. The study focuses on the factors and stressful events, which
appear to influence the development of depressive symptoms in Kitui youths. It
determines whether there is a significant difference in the prevalence of depression
amongst males and females. With greater knowledge of the epidemiology of Youth
depression within this sample, one is able to begin to determine the relative influence of
familial, peer, genetic, gender and other life factors on Youth depression. The ultimate
aim is therefore to gain a better understanding of the prevalence of Youth depression and
the factors that are influencing the development of Youth depression, within the Kitui
context.

1.2. Statement of the Problem

This section deals with becoming aware of the problem. A preliminary literature study is
done to explore the problem and finally a problem statement is formulated.

1.2.1. Awareness of the problem

Effective prevention and treatment of Youth depression requires the identification of

those environmental factors that predispose a young person to depression. If adults can
learn to recognise the kinds of psychological, behavioural and social events that are risk
factors, they can begin constructive interventions and stimulate healthy emotional
development with youths.
 5

Many social scientists believe that the characteristics of youths have evolved. Some label
the youth of today Generation X (Codrington 1998:1). Whether we agree with this label
or not, there is substantial evidence that today’s generation of young people do have
certain defining characteristics that differentiate them from their parents when they were
youths. It is wholly relevant to bear these characteristics in mind, as they are the essence
of understanding today’s youth. Effective intervention rests on having a clear
understanding of what is deemed most important in the lives of today’s youths.

The bulk of evidence supporting family factors as antecedents to depression should

encourage further new and creative approaches to involving families in treatment of
Youth depression. The worldwide rise in Youth suicide rates in both developing and
developed countries serves as a vivid reminder that modern society often does not
provide a nurturing, supportive, and healthy environment in which children can grow and
develop. It is therefore vital that more creative and appropriate ways are found to include
families in the treatment of Youth depression.

1.2.2. Exploring the problem

Youths is a time of acute stress and parents would seem to be a natural source of support
and understanding during this period. Peers might serve this function to some extent, but
it seems likely that certain types of doubts and anxieties cannot be shared with friends,
given the volatile nature of peer associations during this period of social sorting and
identity formation (Robertson and Simons 1989:128). Thus the quality of the relationship
between an Youth and his or her parents might be considered a rough index of whether
the youth has access to an important source of social support.
Weakened family structures and social relations have resulted in this generation of youths
spending every other weekend at their other parent’s home and has seen a profusion of
different family relationships, such as “dad’s girlfriend” or “mom’s previous ex-
husband”. This has not only caused young people to be sceptical of relationships but has
negatively impacted on the social support available to youths (Codrington 1998:4).

Kitui teenagers today are subject to more stress than were teenagers in previous
generations. The stress is of three types. First teenagers are confronted with many more
freedoms today than were available to past generations. Second, they are experiencing
more losses, to their basic sense of security and expectations for the future that earlier
generations did not encounter. And third, they must cope with the frustrations of trying to
prepare for their life’s work in school settings that hinder rather than facilitate this goal
(Codrington 1998:9).
In Kitui, this generation of youths will struggle to find employment and if they are lucky
enough to find a job they will earn less (in real terms) than the generation before them.
The current economic prospects for Kitui look bleak to say the least. Add to this the
AIDS epidemic and the ever increasing crime rate and the future is not a bright place.

The drawbacks of the treatments available to depressed youths are discussed below:

Insight Oriented Therapy – This is usually a lengthy, expensive process, since therapy
sessions are scheduled weekly for periods of time, which can extend for years. With this
approach, parents often complain they are “out of the loop” and have no idea what is
going on with their Youth’s therapy, since the bulk of the work takes place between the
child and his therapist. Youths may find the hard work of therapy tedious and not
particularly enjoyable. Certainly if this approach is to be successful, it requires that the
young person make a commitment to a lot of hard – sometimes painful –work for a fairly
long period of time. While there are some very bright, verbal young people who can
follow through on such a commitment, many youths find the experience uncomfortable,
incomprehensible, and therefore of little help (Ingersoll 1996:83).

Behaviour Therapy – There is evidence to show that behavioural methods can be very
helpful for specific behaviour problems associated with depression, such as social
withdrawal, school refusal and poor school performance. However the scope of
behaviour therapy is limited: behavioural techniques alone cannot offer a comprehensive
treatment programme for depression (Sue, Sue and Sue 1997:350). Behavioural
techniques such as modelling, rehearsal, self-monitoring and rearranging consequences
are important components of other forms of treatment, especially cognitive therapy .

Cognitive-Behavioural Therapy – Researchers who have studied the thought patterns

and beliefs of depressed individuals tell us that negative bias and cognitive distortions
accompany depressive illness in both adults and children. Cognitive therapy techniques
are designed to help depressed youths identify and alter these maladaptive ways of
thinking, include cognitive restructuring, attribution training, self-control training and
adjunctive techniques such as social skills training (Beck 1991 368-75). The brevity of
the treatment as well as the structured, directive approach is likely to appeal to youths
(Sue, Sue and Sue 1997:351 and Ingersoll 1996:89).

Interpersonal Therapy – Interpersonal therapy is a short-term treatment for depression

that targets the client’s interpersonal relationships and that uses strategies found in
psychodynamic, cognitive-behavioural and other forms of therapy (Sue, Sue and Sue
1997:350). Treatment is aimed at correcting these disturbances by improving
communication among all family members, teaching problem solving skills, and helping
parents re-establish their positions as authority figures in the household. In restoring
equilibrium to the dysfunctional family it is assumed that the depressed Youth will
gradually improve as family functioning improves (Ingersoll 1996:89).

Antidepressant medication – Antidepressant medications are described as “mood

regulators” since they seem to restore normal functioning by correcting malfunctions in
the chemical messenger systems of the brain. Different antidepressants apparently work
in different ways to correct neurochemical problems.
Appropriate and successful treatment of Youth depression rests on:
• the early and accurate diagnosis of depressive symptoms;
• an understanding of the specific aetiology of the Youth’s depression;
• a broader understanding of the epidemiology of Youth depression within the Youth’s
specific context;
• an up-to-date understanding of the world for the Youth in the new millennium.

1.2.3. Problem Statement

Our knowledge of the epidemiology of Youth depression in Kitui is extremely limited.

Without this knowledge how can we be alert to the psychosocial risk factors and the early
warning signs of Youth depression?

Does insufficient understanding of the complex nature of current Youth biopsychosocial

development and the changing social world faced by youths negatively impact on their
mental health care? Surely the mental health care of youths is best achieved when
parents, teachers and therapists build socially supportive relationships with them, that
may moderate adverse influences that youths experience in their environment. To build
socially supportive relationships one needs understanding.

It appears that there is a valid need for epidemiological studies on Youth depression, its
risk factors and methods of treatment and prevention. There is a need for adults living
and working with youths to be educated with regard to Youth biopsychosocial
development, to have greater awareness of Youth depression and to be trained to identify
early signs and symptoms of physical, emotional and social distress in youths.

1.3. Objectives of the Research

This section concerning the Objectives of the research deals with general as well as
specific Objectives for the research undertaken.

1.3.1. General Objectives

The general aim of the research is to:

• Determine the prevalence of Youth depression symptoms among males and females.
• Determine the influence of familial, peer, gender, genetics and Kitui factors on the
development of Youth depressive symptoms with a sample of High school youths in
the greater Kitui urban area.

1.3.2. Specific Objectives

The specific aim of the study was to use the Goldberg Depression Scale
(QUESTIONAIRES) and the Youth Life Perspective Questionnaire
(QUESTIONAIRES), which investigated the bio-
 13

psychosocial factors, which influence the Kitui Youth today. As many factors, as
possible, which could influence the emotional development of an Youth were included in
this Youth Life Perspective Questionnaire. The study thus provided data on the
correlations between certain biopsychosocial factors and Youth depressive symptoms.

1.4. Research Methods

The study was comprised of two methods: namely the literature study and the empirical
investigation. The literature study provided information with regard to depression in
general, Youth depression in particular and the biopsychosocial factors, which could
influence the development of depressive symptoms in youths.

The empirical investigation of the study attempted to determine the epidemiology of

Youth depressive symptoms and the factors, which appeared to influence the
development of Youth depressive symptoms. This was done by means of questionnaires,
which the youths completed. A pilot study was conducted with a small sample of High
school youths and feedback from the youths involved, denoted any confusion in the
application or wording of the questionnaires. Based on this feedback, further refinement
to the questionnaires took place. Thereafter a sample of High school youths in the greater
Kitui urban area was selected for the research study.

1.5. Demarcation of the study

One of the problems with trying to research the epidemiology of Youth depression is that
depression is a medical condition, which requires a clinical diagnosis. Therefore this
study – being largely empirical – and relying on questionnaires, specified that the factors
influencing depressive symptoms and not clinical depression were researched.

Further, this study focused on a sample of youths from Secondary Schools in the greater
Kitui urban area. The results of the sample attempted to reflect the
 14

generalised urban population of Kitui youths. The Kitui area was chosen for practical
purposes, but it could be considered to be representative of any urban area of Kitui.

1.6. Explanation of concepts

This section will define a number of concepts that are relevant to this research.

1.6.1. Youths

For the purpose of this study, youths is defined as the period from puberty (12 or 13
years) into the early twenties. During this period, which Erikson called Identity versus
Role Diffusion, the child has to integrate all of the tasks from the previous four stages
into a coherent identity, and prepare to face the world as an independent adult. In addition
to dealing with the changes in his or her body brought on by the onset of puberty, the
Youth must compare and integrate how others see him or her and how he or she sees
himself/herself. The Youth must also adjust to his or her budding sexuality (Erikson
1968:21).

Throughout all of this, the Youth must also decide whether he or she will act on his or her
emerging sexual abilities and, if so, how he or she will establish the relationship(s) in
which he or she will do this. During this phase, the Youth must also connect the roles and
skills he or she has learned with what he or she wants to be as an adult. Integrating these
skills and desires with practical realities takes place through career planning (Erikson
1968:25).

1.6.2 Depression

Depression is defined as a psychological state of despondency, dejection, low spirit,

sadness, inactivity, and difficulty in thinking, concentrating and in seeing a situation in
perspective. Prolonged depression is a common ultimate cause of suicide and a common
 15

emotional experience among youths (Van Den Aardweg and Van Den Aardweg
1993:82).

1.6.3 Depressive symptoms

Depressive symptoms refers to the changes in the body and the mind which are the signs
of the mental state of depression.

1.6.4 Epidemiology of Youth depression

Epidemiology of Youth depression refers to the study of the causes, spread and
control of the mental state of depression.

1.6.5 Genetic Predisposition

This definition refers to the inherited characteristics, which could influence the
development of depression.

1.6.6 Peer Relationships

Peer relationships are defined as relationships with people of approximately the same
age and status as oneself.

1.6.7 Family Relationships

Family relationships are defined as relationships between a group consisting of parents

and their children.

1.6.8 Gender characteristics

Refers to the social and cultural differences and expectations that are associated with the
state of being male or female.
 16

1.6.9 Biopsychosocial factors

Refers to the biological; psychological and social factors, which can combine to cause
depression. Bio-psychosocial models of depression suggest that there are multiple causes
of depression and a number of factors may operate singularly or interact in causing
depression in youths (Goldberg in Cooper 1996:6).

1.7 Limitation of the study

In adolescence, depression can be mistaken for adolescent angst or for hormone-related
moodiness although it is a disorder associated with serious consequences. Youth do not
always readily report on emotional or behavioral manifestations of psychiatric disorders.
They might deny the existence of these symptoms or behaviors or simply have difficulty
articulating their thoughts and feelings.
1.7.1 Delimitation of the study
The use of open-ended or indirect questions is recommended in questionnaires, as the
information collected is likely to be more comprehensive and reliable. Direct or closed-
ended questions tend to elicit more limited and potentially biased responses from children
and teens, due to their leading nature and the tendency of youth to be suggestible.
 CHAPTER 2 – LITERATURE REVIEW

2.1. Introduction

Depression affects at least 10% of the population directly at some stage or other in their
lives (Goldberg 1996:1). A number of recent epidemiological studies have reported that
up to 2.5% of children and 8.3% of youths in the United States of America suffer from
depression (Birmaher; Ryan and Williamson 1996:1427-39).

A recently published longitudinal prospective study found that early-onset depression

often persists, recurs and continues into adulthood and indicates that depression in youth
may also predict more severe illness in adult life (Weissman and Wickmaratne 2000:5).
Depression in children and youths is associated with an increased risk of suicidal
behaviours. In 1997, suicide was the third leading cause of death in 10-24 year olds
(Birmaher; Ryan and Williamson 1996:1427-39).

Kitui has no official suicide figures, but according to Lifeline (a 24-hour telephone
counselling service), in the first nine months of 1999, they received 1364 suicide calls,
and 2590 in 1998. The Depression and Anxiety Support Group, which runs a nationwide
telephonic counselling service, received 667 calls during the first three months of 2001,
of which 448 were from depressed people (Shevlin 2001:2). Seventy percent of people
who attempt suicide have major depression, which is a treatable condition (Jones
2000:47).

2.2. Definitions of depression

Depression occurs on at least three different levels: as a symptom, as a syndrome and as a

disorder. Everyone shows symptoms of depression at one time or another, usually,
although not necessarily, in response to situational stresses or traumas. This type of
reaction can be called a depressed mood. Someone in a depressed mood is likely to report
feeling "down" and sad. The individual is likely to have crying spells, to lack energy and
to have insomnia, but these are temporary symptoms that do not interfere with
functioning for prolonged periods (Epanchin and Paul 1994:195).

Depression as a syndrome occurs when these feelings and behaviour are not fleeting and
when they occur along with other symptoms such as decline in motivation, decrease in
energy level, and feelings of self-deprecation (Cooper 1996:1 and Epanchin and Paul
1994:193). Depression may occur as a primary problem or secondary to other disorders,
such as drug or alcohol problems. Depression as a disorder connotes a characteristic
clinical picture that has an expected course of onset, response to treatment, and expected
outcome, much like other illnesses. It is considered a fully developed psychiatric problem
(Epanchin and Paul 1994:195).

The criteria for a diagnosis of major depression are listed in the Diagnostic and Statistical
Manual of Mental Disorders, Fourth Edition, Text Revision (DSM IV TR) (American
Psychiatric Association 2000:369). See table below:
DSM-IV TR Criteria for Major Depression
A. Five or more of the following symptoms, present during the same two-week period,
represent a change from previous functioning, and include either (1) or (2) below
1. Depressed mood
2. Diminished pleasure
3. Significant weight loss
4. Insomnia or Hypersomnia
5. Psychomotor agitation or retardation
6. Fatigue or loss of energy
7. Feel worthless or guilty
 8. Diminished ability to concentrate, indecisive
9. Recurrent thoughts of death or suicide
B. Symptoms do not meet criteria for Mixed Episode
C. Significant distress or impairment
D. Not due to substance or medical condition
E. Not better accounted for by bereavement after loss of a loved one
Some youths have a chronic but less severe form of depression, called dysthymic
disorder, which is diagnosed when depressed mood persists for at least two years and is
accompanied by at least two other symptoms of depression. Many youths with dysthymia
later develop major depressive episodes (American Psychiatric Association 2000:376).

2.3. Types of depression

There are different types of depression, which can be distinguished by looking at the
signs and symptoms of the illness, the individual’s personality features and his or her life
experiences. Various brain wave recordings and hormonal tests also help to identify the
particular type of depression the individual has. The different types of depression have
different causes and in most instances depression results from a combination of factors
coming together at one point in time to produce the mood change (Sue, Sue and Sue
1997:329).

1. Reactive depression
Reactive depression is a response to an unhappy event in the individual’s life for which
they are usually unprepared. Death of a close relative or friend, family strife or the
unexpected loss of employment, are some of the events that can evoke an extreme state of
unhappiness (Aware Organisation 2000:2). Here the mind’s state of sadness is an
appropriate response to an unwelcome event. Typically the person with reactive
depression will feel low, anxious, often angry and irritable and will tend to be
preoccupied with the upsetting event. While everybody is vulnerable to this form of
depression and will succumb if the stress is great enough, some people, because of
previous experiences, are more prone to a reactive depression (MacLaren 1999:24).

2. Neurotic depression
Some individuals have a low vulnerability to stress, in that aspects of their personality
leave them ill prepared to deal with the everyday problems of life. These individuals are
unable to manage the everyday problems of life in an emotionally efficient manner and
consequently experience repeated episodes of reactive depression. Personality traits,
which typically pose a psychological handicap in this respect, are extremes of
perfectionism, timidity, unassertiveness, dependency and narcissism. Perfectionism leads
to disappointments; unassertiveness brings frustration and avoiding situations because of
anxiety results in a sense of failure. Inevitably, repeated exposure to these experiences
leads to neurotic depression (Aware Organisation 2000:3 and MacLaren 1999:25).

3. Endogenous Depression and Bipolar Depression

These types of depression are caused mainly by genetic factors. Whereas 1% of the
population will develop bipolar depression at some stage in their life, some 15% of the
immediate relatives of a patient with bipolar depression will develop a similar illness.
Genetic research has shown that the risk increases the closer one is related to the person
with the illness. An identical twin has a seventy per cent chance of developing a similar
mood disorder (Bartlett 2001:3 and MacLaren 1999:26). A variety of different adoption
studies have come to the same conclusion and clearly indicate that the major causative
factors in these forms of depression are biological ones. However this is by no means the
full explanation. Frequently such bouts of depression will only occur when precipitated
by some stressful factor or major change in the person’s life.

4. Secondary Depression
Secondary depression can be described as mood changes, which are due to some
underlying medical or other psychiatric disorder. Probably the most familiar one in this
category is a depression following a bout of flu. Depression can occur with many other
viral infections, anaemia, vitamin deficiencies, thyroid and other hormonal disturbances.
Certain treatments such as steroids and some blood pressure tablets can also induce mood
changes. Alcohol and drugs can have a profound influence on mood and for some
patients it is a major contributing factor to their depression. (Cooper 1996:6).

2.4. Youth depression

The DSM-1V criteria for major depression are the same for youths and adults.
Depression presents in youths with essentially the same symptoms as in adults;
however, some clinical shrewdness may be required to translate the teenagers' symptoms
into adult terms. Pervasive sadness in youths may be exemplified by wearing black
clothes, writing poetry with morbid themes or a preoccupation with music that has
nihilistic themes. Sleep disturbance may manifest as all-night television watching,
difficulty in getting up for school, or sleeping during the day. Lack of motivation and
lowered energy level is reflected by missed classes. A drop in grade averages can be
equated with loss of concentration and slowed thinking. Boredom may be a symptom for
feeling depressed. Loss of appetite may lead to anorexia or bulimia (Epanchin and Paul
1987:195).

The available data suggests that many youths are depressed. They report feelings of
wanting to leave home, of not being understood, of being alienated and rejected and of
restlessness. Withdrawal from family and other social activities, indifference to personal
appearance, and other symptoms typical of adult depression are common. Depression is
also manifested by negativistic, antisocial, irritable behaviour, especially among male
youths. Determining whether these symptoms indicate a serious depression can be
especially difficult for the diagnostician because "normal youths" is also a time of
moodiness and, occasionally, social withdrawal (Epanchin and Paul 1987:197).
Youth depression may also present primarily as a behaviour or conduct disorder,
substance or alcohol abuse or as family turmoil and rebellion with no obvious symptoms
reminiscent of depression (Blackman 1995:2).
• It is often not possible to identify a single cause of Youth depression. This can be
distressing for youths who want to understand the reasons why they are ill, and
frustrating for therapists who want to help. There are biological, psychosocial and
social causes of depression. Research shows that: (Edelbrock 1997:3).
• Genes or early life experiences may make some youths more vulnerable to
depression.
• Stressful life events may trigger an episode of depression.

• Some physical illnesses, drug treatments and recreational drugs can trigger depression
 The diathesis-stress model of depression states that: (Edelbrock 1997:4).
• Genetic factors influence personality, emotional tone and sociability
• Environmental factors like disrupted or inadequate parenting, emotional
unavailability, insensitivity and marital conflict act on top of this predisposition,
resulting in extreme depression in some people.

When depressed youths are asked about their childhood experiences, they are more likely
to report neglect, abuse, rejection and parental conflict. Depressed youths often have
depressed or stressed parents. Can the stress of coping with a depressed Youth lead to
parental rejection or is it the poor parenting that leads to the child’s depression? The
answer may be different in different cases. A depressed Youth may be hard to raise.
Some parents have more coping skills than others do. An Youth may learn to give up
because parents have not modelled good ways of coping with stressful situations. A
parental pattern of irritability and withdrawal lead to low self-esteem in youths and this
predisposes youths to depression (Watkins 2000:2).

2.5. Youth depressive symptoms

Youths exhibit various expressions of stress depending on their age. Young children tend to
exhibit their stress by their active behaviour: hitting, throwing things, anger, and frustration.
Mixed with this may be some emotional behaviour: withdrawal, non-participation in groups,
separation anxiety, unexplained episodes of crying, and sadness (Epanchin and Paul
1987:196-7). For youths it is estimated that 10-15% exhibit some sort of psychological
upheaval and may demonstrate it in one of 2 ways: external behaviour vs. internal behaviour
(Weller and Weller 1984:39).
Youths who demonstrate depression through external behaviour are more likely to have
problems with aggression, sex and acting-out behaviour. Boys are more likely to be referred
for psychological counselling because of this acting-out conduct. They are also more
involved with alcohol and drug abuse and antisocial problems. Youths who demonstrate
depression through internal behaviour are more likely to exhibit problems with obsession,
phobias and somatic complaints. Here girls exhibit more phobias and depression (Epanchin
and Paul 1987:196-7).
Symptoms of depression in youths can include any of the following:
• Depressed or irritable mood.
• Temper, agitation.
• Loss of interest and reduced pleasure in activities.
• Change in appetite, usually a loss in appetite.
• Persistent difficulty falling asleep or staying asleep (insomnia).
• Sleeping difficulty.
• Excessive daytime sleepiness or general fatigue.
• Difficulty concentrating and memory loss.
• Preoccupation with self.
• Feelings of worthlessness or sadness.
• Excessive or inappropriate guilt feelings.
• Acting out behaviour.
• Thoughts about suicide or abnormal thoughts about death.
• Plans to commit suicide or actual suicide attempt.
• Excessively irresponsible behaviour pattern (Frazier 2000:4).

Symptoms often persist for weeks or months. A physical examination rules out medical
causes for the symptoms. A psychological evaluation confirms a diagnosis of depression.
2.6. Diagnosis of depression in youths

Diagnosis of depression in youths can be difficult. Youths are expected to be moody and
unpredictable to some extent, due to the dramatic physiological changes they are
undergoing. Further, youths – particularly troubled youths – often withdraw from parents
and caregivers, who might be able to see behind their troubled masks. It is difficult to
know where teenage behaviour ends and clinical depression starts but there are some
definitive signs that something is awry, which should not be ignored.

Signs to be taken seriously include:

• extreme behaviour and mood changes including a persistent depression (not just a bad
day);
• loss of interest in previous interests;
• risk-taking behaviour such as drug or alcohol abuse;
• social withdrawal;
• a break in a key relationship, which could be a best friend or even parent who was,
and is no longer, close to the teenager (Schlebusch and Bosch 2000:3).

A proper diagnosis of depression must be made to rule out other explanations for the
Youth’s behaviour – such as school phobia, attention deficit hyperactivity disorder and
generalised anxiety disorder. A thorough family history should be taken and a physical
examination should be conducted, with blood and urine samples to detect if there are any
medical constraints on treatment choices (Schlebusch and Bosch 2000:4)

2.7. Common factors influencing Youth depression.

This literature study focuses on familial; peer; genetic and gender factors, which
influence the development of Youth depression. It then focuses on the Youth living
within the present Kitui context and factors, which could contribute, to the development
of depression within this context.
2.7.2. Peer factors influencing Youth depression
Peer pressure can be positive. It keeps youths participating in religious activities and
playing on sports teams, even when they are not leaders. The peer group is often a source
of affection, sympathy and understanding, a place for experimentation and a supportive
During youths, peers play a large part in a young person's life and typically replace the
family as the centre of an Youth's social and leisure activities. Ross (1999a:1) goes so far
as to say that at youths, a child’s physiological, emotional and hormonal processes come
together for the purpose of achieving one thing – independence from his family.

Because many children are from single-parent homes or homes in which both parents
work, the amount of time youths spend in the company of peers is greater than ever.
Studies have revealed several negative impacts are associated with peer rejection.
Rejected children in Asher’s (1994:1462) research reported more loneliness, aggression
and higher levels of depression.

Youths who lack friendships or have difficulty with peer relationships miss out on their
many benefits. Friends provide companionship and support each other in times of stress,
such as during parental divorce or when they are having trouble at school. Because peer
relationships benefit youths immensely, practitioners and researchers.
Parents have the unique opportunity of enhancing their Youth’s self-esteem, maintaining
their position as being the primary influence upon their youths and lessening peer
influence. Garber; Little; Hilsman and Weaver (1998:448) describe the influences upon a
child's self-esteem as taking the shape of a pyramid with four levels. In this paradigm, a
parent's unconditional love for his or her child forms the foundation of the pyramid. The
second level is composed of the child's daily accomplishments. Level three involves the
feedback which parents give to their children and finally, the fourth level, or top of the
pyramid, is what the child's peers think about him or her. The theory is that the broader
the foundation of the pyramid, the smaller the top of the pyramid is proportionally (Ross
1999a: 4).

Ross (1999b:6) suggests that one way of showing unconditional love to your Youth is by
not getting sucked into the content of what she says, but instead, listening to her feelings,
and developing a non-judgemental attitude, thereby keeping the lines of communication
open.
2.7.4. Gender factors influencing Youth depression
During youths there is a dramatic change in the ratio of females to males who suffer from
depression, with females taking an early and enormous lead. In fact, by the age of 18,
females have almost twice the reported depressive rate of males (Regier, Narrow and
Rae 1993: 90). According to Koenig (in Alexander 1999:1), the surging rates of female
Youth depression continue to affect women throughout their lifespan. It is suggested that
if girls do not receive the necessary treatment in youths, it is likely that their depressive
symptoms could continue into adulthood. Their depressive episodes often go unnoticed
by adults, because depressive symptoms are often perceived as normal hormonal, Youth
moodiness (Alexander 1999:1-2).

If adults are to notice and hopefully treat female Youth depression, it is necessary to
know which factors contribute to the decline in her mental well being in the first place.
Which factors explain the vast gap between female and male Youth depression?

There are suggestions that the hormonal changes, which accompany puberty, are
responsible for higher rates of depression in Youth girls (Sue, Sue and Sue 1997: 344).
Other researchers speculate that males and females have different response styles. Males
distract themselves from a depressed mood, whereas females ruminate and therefore
amplify the depressed mood (Ingersoll 1995: 20-21).

According to research (Rimm 1999:12), almost all-female youths are pressured to value
modesty, poise, beauty, femininity and future marriageability. Youths become
increasingly aware of their roles as women and learn to identify societal, parental and
peer messages, in order to conform to their gender roles. When girls do not conform to a
feminine sex role, they risk rejection or isolation from their peers.

Finally, it is important to note that although women are more likely than men to be seen
in treatment and to be diagnosed as depressed, this may not mean in fact that more
women are depressed, for several reasons. First, women may simply be more likely than
men to seek treatment when depressed: this tendency would make the reported depression
rate for women higher, even if the actual male and female rates were equal (Sue, Sue and
Sue 1997:342-3). Second, women may be more willing to report their depression to other
people. That is, gender differences may occur in self-report behaviours rather than in
actual depression rates. Third, diagnosticians or the diagnostic system may be biased
towards finding depression among women. And fourth, depression in men may take other
forms and thus be given other diagnoses, such as substance dependency (Sue, Sue and
Sue 1997:343).

2.7.5. Kitui factors that influence Youth depression

The psychological consequences of poverty, deprivation and crime are endless. These
include the mental and physical developmental impact of poor nutrition on children
and the anxiety, depression and stress-related conditions caused by poor living
conditions, violent crime and occupational circumstances. Gradients in physical and
mental ill health by socio-economic status are well-recognised (Desjarlais, Eisenberg,
Good and Kleinman 1995:22).
2.7.5.2. Crime and Violence
Statistics seem to support the view that Kitui is an extremely violent country. The
experience of being violently victimised in Kitui has become a statistically normal feature
of everyday life in the urban and rural setting. Kitui Police Service figures indicate that in
1996 there were a total of 25 782 reported murders, 28 516 attempted murders and 12
860 car hijackings. In terms of sexual violence, there were a total of 50 481 rapes. Kitui
children are not exempt from violence. In 1996, 20 333 crimes of a sexual nature were
reported to the Child Protection Units, while there were 8 626 reported assaults of
children (Hamber and Lewis 1997:2-6)

The consequences of the high levels of violent victimisation permeate increasingly

widely into Kitui society, and few, if any, Kituis can remain unaffected. Vast
numbers of Kituis are likely to struggle to relate to other individuals due to shattered
trust, and feelings of grief and loss; to have difficulty in the workplace due to
intrusive trauma symptoms; and to be left with an overwhelming sense of anxiety,
anger and vulnerability. This must leave many Kituis, including youths, with raised
levels of fear, suspicion and aggression - all of which negatively affect their daily
functioning (Hamber and Lewis 1997: 2-6).
 CHAPTER THREE
THE METHODOLOGY

3.1. Introduction

This chapter looks at the research design used in measuring the symptoms of Youth
depression and its relationship to other variables such as family relations, peer relations,
gender, genetics and variables particularly relevant to Kitui, like crime, the threat of HIV
and future job prospects. These variables were identified in the literature study.
Certain hypotheses with reference to these variables and Youth depression are
formulated. A brief description of the procedures used to test these hypotheses is given.
This includes the selection of the sample, a description of the measuring instruments
used, the procedure used in formulating and administering the questionnaires and finally
the methods used in analysing the data.
3.2. Hypotheses
The following hypotheses, based on the literature study were formulated.

3.2.1. Hypothesis 1
A similar number of Kitui youths have major symptoms of depression as compared to other
youths.
3.2.2. Hypothesis 2
Significantly more Youth girls than boys will be found to be suffering from depression.
3.2.3. Hypothesis 3
Youth girls will have more severe symptoms of depression than Youth boys.
3.2.4. Hypothesis 4
Negative perceptions of family relationships and peer relations will be significant
predictors of Youth depression.
3.2.5. Hypothesis 5
A negative perception of Kitui life circumstances will have a significant positive
correlation to symptoms of Youth depression.
3.3. Selection of the sample

The sample consisted of 385 High school youths, 114 boys and 271 girls. The average
age of the youths was 17 years and 4 months. High school youths were chosen as it was
preferable to have as high level of education as possible. It was considered too much of
an interruption to use college youths.
 51

was duly granted and the research went ahead. Permission to conduct research was also
granted from all the Heads of the identified schools.
The youths were selected from an elite private school, a co–educational government
school in a middle socio-economic environment, a government school in a low socio-
economic environment and a government school in a very low socio-economic
environment. The sample could be said to be representative of the Youth population in
the greater Kitui area.
The private school identified insisted that parental permission was obtained before their
High school pupils could be part of the sample. However, pupils were told that
completing the questionnaire was voluntary and would be totally anonymous.
3.4.1. The development of a measuring instrument to measure an Youth’s
perspective of important aspects of his or her life
3.4.1.1. Introduction
It was stated in chapter 2 that certain models of Youth depression measure family
relations, peer relations, negative gender socialisation or genetic predisposition as a prime
variable. However, few studies have attempted to investigate and compare the links
between Youth depression and the above variables as well as factors particularly relevant
to Kitui, like crime, perspective of the future and the threat of contracting HIV. As a
result, no questionnaire existed for Kitui youths that measured all of these variables.
It was therefore decided that a questionnaire would be developed that would measure the
Youth’s perception of life – including his or her perception of his or her family and peer
relations, genetic predisposition to depression, negative gender socialisation and attitude
to living in Kitui today.
3.4.1.3. The structure of the Youth Life Perspective Questionnaire
(i) Initial Considerations
In constructing the measuring instrument, which attempts to assess youths’ perspectives
of their relationships, gender and genetic influences on their mental health and their
perspective on Kitui, certain considerations, were taken into account.
Firstly, the instrument should not be too time-consuming. The instrument would be used
in conjunction with the depression questionnaire and should therefore not be too long.
Secondly, the instrument should be flexible in that it should be possible to use in an
individual or group test situation – once again the time factor is of importance.
Thirdly, the instrument should be of such a nature that any school guidance counsellor;
psychometrist or psychologist should be able to administer without having any specific
training in the test. Therefore the administering and the interpretation of the instrument
should not be too complicated.
For the above reasons, it would seem that an interview or any other descriptive method
would not be practical as it would be too time consuming, not conducive to a group
testing situation and standardisation and objectivity would be very difficult to achieve.
experiencing depressive feelings and/or difficulties in their daily functioning as a result of
anxiety or worry.
 CHAPTER 4
RESULTS OF THE STUDY

4.1. Introduction
A number of causative factors of Youth depression were identified in the literature study
(see pages 18 to 47). Although many of these factors had formed part of previous
research on Youth depression, it was decided that a new instrument would be developed
in order to include some of the possible causative factors of depression among Kitui
youths today.

In order to assess the significance of these factors, interviews and questionnaires were
administered to 385 youths. Each Youth’s age and gender was also obtained. A sample of
142 (out of the original 385) was then specifically selected for further analysis, because
their scores on the Youth depression questionnaire were higher than 22. The cut-off score
for major symptoms of depression is 22, according to the validation study conducted by
Holm, Holm and Bech (2001:263-266). For this specific sample, the questionaires were
analysed according to each of the five factors and this factor analysis was correlated with
their scores.
 0 to 9 10 to 17 18 to 21 22 to 35 36 to 53 54 -

No Possible mild Borderline Mild to Moderate to Severe

depression depressive depressive moderate severe depressive
likely symptoms symptoms depressive depressive symptoms
symptoms symptoms

4.2. Results of Goldberg Depression Scale (questionnaires)

4.2.1. Government School in Kitui – 99 High school girls

No Non-significant Borderline Mild/Moderate Moderate/Severe Severe

Depression Depression Depression Depression Depression Depression
17 41 10 20 8 3
Thirty-one High school girls from a Girls School in Kitui scored above 22 on the
questionnaires. These girls were therefore selected for factor analysis using their scores.
4.2.2. Combined School in Kitui – 33 High school’s 19 girls and 14 boys

No Non-significant Borderline Mild/Moderate Moderate/Severe Severe

Depression Depression Depression Depression Depression Depression
3 7 7 9 6 1
Sixteen High school girls and boys from a Combined School in Kitui scored above 22 on
the questionaires and were therefore selected for factor analysis using their scores.

4.2.3. Private Boys’ College in Kitui – 31 High school boys

 67

No Non-significant Borderline Mild/Moderate Moderate/Severe Severe

Depression Depression Depression Depression Depression Depression
3 7 7 8 6 0

Fourteen High school boys from a private Boys College scored above 22 on
questionnaires. These fourteen boys were therefore selected for factor analysis using their
scores.

4.2.4. Private Girls’ College in Kitui – 73 High school girls

No Non-significant Borderline Mild/Moderate Moderate/Severe Severe

Depression Depression Depression Depression Depression Depression
11 28 6 18 8 2

Twenty eight High school girls from a private Girls College scored above 22 on the
questionnaires and therefore formed part of the sample chosen for factor analysis using
their scores.

4.2.5. Government School in Kitui - Boys – 69 High school Boys

No Non-significant Borderline Mild/Moderate Moderate/Severe Severe
Depression Depression Depression Depression Depression Depression
15 23 13 13 4 1

Eighteen High school boys from a government school in Kitui scored above 22 on the

questionnaires, were selected for factor analysis using their QUESTIONAIRES scores.

4.2.6. Government School in Kitui - Girls – 80 High school Girls

No Non-significant Borderline Mild/Moderate Moderate/Severe Severe
Depression Depression Depression Depression Depression Depression
15 21 9 26 8 1
4.3. Results of the Youth Life Perspective Questionnaire for youths who scored
above 22 on the Scale

See Appendix C (page 105) for the detailed results of the Youth Life Perspective
Questionnaire.

4.4. Interpretation of the data

The questionnaires were administered to 385 youths. 63.12% of these youths obtained a
score of less than 22 on the Scale. Therefore their scores

were non-significant with regard to depression symptoms (In the chart below, they are
indicated in blue as “Not Depressed”. 36.88% of the youths obtained a score of 22 and
above, thus scoring in the mild, moderate or severe range of depression symptoms. Of
these, 24.42% scored in the mild to moderate range of depression symptoms and
12.47% of the youths obtained a score which fell within the moderate/severe to
severe range of depression symptoms. See Chart below.

TABLE 4.1 PREVALENCE OF DEPRESSION IN SAMPLE

Not Depressed
Depressive Symptoms Mild / Moderate
Moderate / Severe and Severe

63.12% 36.88% 24.42% 12.47%

TABLE 4.2 PREVALENCE OF DEPRESSION BY SCHOOL

Symptoms of Depression in Sample Schools

ofRespondent
s

50.0%
10.0%
40.0%

30.0%

20.0%
%

0.0%
Mild / Moderate /
Non-significant Borderline Severe
No Depression Depression Depression Moderate Severe Depression
Depression Depression
Govt School in Kitui 17.2% 41.4% 10.1% 20.2% 8.1% 3.0%
Comb. School in Kitui - Girls 21.4% 28.6% 14.3% 14.3% 21.4% 0.0%
Comb. School in Kitui - Boys 0.0% 15.8% 26.3% 36.8% 15.8% 5.3%
Private Boys College in Kitui 9.7% 22.6% 22.6% 25.8% 19.4% 0.0%
Private Girls College in Kitui 15.1% 38.4% 8.2% 24.7% 11.0% 2.7%
Govt School in Kitui - Boys 21.7% 33.3% 18.8% 18.8% 5.8% 1.4%
Govt School in Kitui - Girls 18.8% 26.3% 11.3% 32.5% 10.0% 1.3%

4.4.1. Gradient of symptoms of depression: by school

By analysing the symptoms of depression range, by school, it is possible to establish that
the pattern of depressive symptoms is similar in most schools. Only Kitui Girls Boys
show some deviation from this pattern.
The responses generally fell on either side of the Borderline Depression range, with a
peak in the non-significant category and, on the significant side of the scale, a large
number in Mild/Moderate and Moderate/Severe.
 71

Severe depressive symptoms appeared in, on average, 2.1% of the sample. In the case of
Kitui Girls and St Stithians Boys, non-significant depression was relatively lower than for
the other schools, with a correspondingly higher ratio of significant depression scores.
This suggests that the incidence of depression could be higher at either end of the socio-
economic spectrum, as these schools serve very poor and affluent sectors of society,
respectively. The researcher was anticipating that the rate of depression would be higher
in the lower socio-economic sector only, as many studies suggest that depressive
symptoms are more prevalent in lower than higher socio-economic status groups
(Stansfield 2001:1). This higher prevalence is normally explained by the stress hypothesis, where
stress is conceptualised as an imbalance between demands and resources and effective
coping with stresses depends on having both environmental and personal coping
resources (Stansfield 2001:1).

TABLE 4.3: Significant72 Depression Scores

Comparison by School
70.0%
60.0%
50.0%
40.0%
30.0%
20.0%
10.0%
0.0%
Govt School in Comb. School Comb. School Private Boys Private Girls Govt School in Govt School in
Kitui - Girls in Kitui = in Kitui = College in College in Kitui - Kitui - Average
Boys Girls Kitui Kitui Boys Girls
Severe Depression 3.0% 0.0% 5.3% 0.0% 2.7% 1.4% 1.3% 2.1%
Moderate / Severe Depression 8.1% 21.4% 15.8% 19.4% 11.0% 5.8% 10.0% 10.4%
Mild / Moderate Depression 20.2% 14.3% 36.8% 25.8% 24.7% 18.8% 32.5% 24.4%
4.4.2. Significant depression symptoms: schools compared

As indicated in the table above, the highest percentage of youths scoring in the Severe
Depressive Symptoms range was at the Combined School in Kitui - Girls (5.3%),
followed by the Girls school in Kitui (3.0%) and the private Girls College
(2.7%). It is interesting to note therefore that the gender factor was very evident in the
prevalence of severe depression. In Chapter 2 it was stated that literature points clearly to
the incidence of depression being significantly higher for girls than for boys during
youths (see pages 37 to 40). From this one might deduce that prevalence of severe
depression could also be higher among girls.

The highest percentage of youths scoring in the Moderate/Severe Depressive

Symptoms range was at Kitui Combined School – Boys (21.4%), followed by Kitui
Boys College (19.4%) and Kitui Combined School – Girls (15.8%). The highest
percentage of youths scoring in the Mild/Moderate range was at the Combined School in
Kitui– Girls (36.8%), followed by the government school – Girls (Kitui) (32.5%) and
Private Boys College (Kitui) (25.8%).
4.4.3. Correlation between factors and depression scores

.4.4. Possible causative factors

i) Gender Factors
It was anticipated that a negative perception of issues surrounding gender would prove
to be a causative factor of depressive symptoms for girls. However, the gender
questions gave rise to negative responses from both boys and girls. In further analysing
the potential reasons for this, the researcher realised that certain items that were
designed to measure a negative perception of gender were possibly culturally biased.

including youths, with raised levels of fear, suspicion and aggression - all of which
negatively affect their daily functioning (Hamber and Lewis 1997:2-6).
In terms of attitudes towards future prospects, Chapter 2 revealed that there is
contradictory research. Some research comments on the pessimism of this generation's
youths and connects this to the dramatic increase in teen suicides over the past two
decades and the increase in self-destructive behaviours (Codrington 1997:5). Other
research results indicate that students held a very positive outlook on their future. Students
discussed a variety of goals for their future and make it clear that they rely on one another
to make sense of their plans for the future (Jenkins 2000:2). The results of this research
sample reveal that there is some contradiction in attitudes towards future prospects within
Kitui.
The results of this study do not support the hypothesis that more girls than boys display
mild to severe symptoms of depression. A t-test revealed that there was no statistical
difference between the means of males and females with mild to severe symptoms of
depression.
Calculated t-value: 1.10
Critical t-value from the t-tables for a 1-tailed test:
- At a 95% confidence level 1.645
- At a 99% confidence level 2.326
As the calculated t-value is not greater than or equal to the critical t-value (at the 95%
confidence level), the null hypothesis cannot be rejected.
Further to the above, a t-test for all youths scoring above 9 was conducted as full
remission of depression is a score of 9 or lower (Holm, Holm and Bech 2001: 264).

Hypothesis 3
Youth girls will have more severe symptoms of depression than Youth boys.
The t-test for the difference in means indicates that there is no significant difference in
the intensity of depression between boys and girls. The t-value calculated by the software
is 1.966. The spread of the data can be evaluated by testing whether the medians of the
two distributions are equal. This non-parametric test does not show any significant
difference in medians (highlighted in green below), indicating no significant difference
between girls and boys with more than borderline depression. Therefore the study does
not support hypothesis 3 that Youth girls will have more severe symptoms of depression
than Youth boys.

Quantiles
Level Minimum 10% 25% Median 75% 90% Maximum
F 0 7 12 17 27 37 88
M 0 6 11 17 24 37 60

Median Test (Number of Points above Median)

Level Count Score Sum Score Mean (Mean-
Mean0)/Std0
F 271 134 0.494465 0.215
M 114 55 0.482456 -0.215
 82

Hypothesis 4

Negative perceptions of family relationships and peer relations will be significant

predictors of Youth depression.

Many studies have been conducted which have suggested that family cohesion is related
to several psychological outcomes, including depressive symptoms (Kashani; Beck;
Hoeper; Fallahi; Corcoran; McAllister; Rosenberg; and Reid 1987:586 and McGee;
Feehan; Williams; Partridge; and Silva 1990). Depressed youths have more negative
perceptions of their families than other youths do. The more depressed the young person,
the more negative are his perceptions of the way in which his family functions.
Specifically, depressed youths describe their parents as distant, unsupportive, and
emotionally unavailable (Ingersoll 1995:64-65)

Peer rejection is also linked to depressive symptoms, but it appears that when family
relations are supportive, a secure foundation is laid which protects the Youth from
developing mental health problems to some extent. Research shows that when an Youth
feels misunderstood by his parents, he is more likely to seek out the advice, lifestyle and
values of his peers (Ross 1999a:2). Peer relations appear to take on disproportionate
importance when family cohesion and supportive family relations are absent.

Correlations

The possibility of collinearity between input variables was first checked. The elongation
of an ellipse indicates the degree of correlation observed. Only in the case of family
relations and genetics was a slight correlation observed, but not sufficient to suggest
collinearity.
This study’s research would appear to support the hypothesis that both negative
perceptions of family relationships and peer relations are significant predictors of Youth
depression.
Hypothesis 5
A negative perception of Kitui life circumstances will have a significant positive
correlation to symptoms of Youth depression.
Items measured how youths perceived Kitui life circumstances, with focus on:

• The threat of crime and violence

• The impact of the threat of crime on their enjoyment on life
• Future job prospects in Kitui
• Their hopefulness about the future in Kitui
Worry about finding a job, the threat of crime and the lack of hopefulness about the
future in Kitui were negative issues for most of the youths. The threat of contracting HIV
and the impact HIV was having on their lives was of much greater concern to the youths
in lower socio-economic schools.
The correlation matrix in Table 4.4 indicates that no significant correlation exists
between Kitui factors and depressive symptoms in this sample of youths.
It seems likely that Kitui life circumstances play a role in explaining the high overall
%age of youths who have major symptoms of depression. However, this study does not
support the hypothesis that a negative perception of Kitui life circumstances has a
significant positive correlation to symptoms of Youth depression.
 88

CHAPTER 5
SUMMARY AND RECOMMENDATION OF THE RESEARCH

5.1. Introduction
5.2. Summary of results

This section summarises the results from the literature study and the empirical
investigation.
5.2.1. Summary of results from the literature study

A number of theories that explain the causes of Youth depression were discussed in
Chapter 2. Although it can be seen that no single theory explains all the causes of Youth
depression, ample evidence exists to prove the pertinence of each theory.
5.2.2. Summary of results from the empirical study

It is clear that this research supports previous research, in that it concurs with the view
that family cohesion, family support and positive peer relations can protect the Youth
from developing symptoms of depression. Negative family relations and negative peer
relations had a higher correlation to Youth depression scores than any of the other
identified factors. This implies that family and peer relations should be the main areas of
focus for the educator.
“ What is the prevalence of Youth depression symptoms in the greater
Kitui area?”
The results of the empirical investigation confirmed that 38% (just over one third) of the
total number of youths had mild, moderate or severe indicators of depression symptoms.
This is a high percentage and exceeds percentages of Youth depression quoted in
American research studies (as seen in Chapter 1).
“What appears to be influencing the development of Youth depression
symptoms in the greater Kitui area?”
The results of the empirical investigation indicated that the two factors that were rated
most negatively by youths, who had significant depressive symptom scores, were
Family Relations and Peer Relations. The study reveals that significant depression scores
could be correlated with their negative perceptions of issues surrounding youths’ family
and peer relationships. Whilst the other identified factors played a role in influencing the
development of depression, their correlation to depression scores was not significant.
5.3. Educational implications

Exposure to negative family and peer relations as well as other factors place youth at a
higher risk of becoming depressed. An educational programme should therefore address
the following:
• Family relationships
• Parenting practices
• Peer relationships
• Decision-making skills
• Problem-solving skills
• Dealing with feelings in a healthy manner
5.3.1. The role of the educator
The implication of the importance of healthy family relationships in guarding against the
development Youth depression, is that it would be relevant for educators to educate and
support the family as a whole during the period of youths. This education should focus
attention on:
• Building mentally healthy families
• Promoting understanding in families of the causes and effects of stress and trauma on
youths
• Raising awareness of the emotional needs of youths.

Parents should be encouraged to attend workshops on how best to support their youths
and should be reminded of the value of the key ingredients regarding effective parenting,
which create a climate in which the Youth can thrive. Programmes, which inform parents
and youths together and are aimed at fostering family cohesion and understanding of
each other’s needs, would also be of benefit.
An emphasis should be placed on encouraging youths to build positive and healthy peer
relationships.
Underpinning the curriculum should be an emphasis on problem solving and decision
making. Learned helplessness and a lack of belief in the ability to control one’s
environment were areas of difficulty for both male and female youths. This implies that
educators need to make a definite shift away from traditional methods of teaching, which
encouraged passive rote learning of facts, which were force-fed to youths by teachers.
Constructing their own meaning of their learning in context, would allow youths to feel
that they have more control over their environments and would help to counteract the
learned helplessness which seemed very evident among the youths in this research
sample.
5.3.2. An educational approach to Kitui issues:
Negative employment prospects; HIV/AIDS; Crime and Violence
Educational life-skills programmes, should overall aim at building resilience in youths to
create positive mental health, but they should be tailor-made to meet the needs of the
youths within a particular school. This would be more beneficial than standardised
programmes for all youths.
As this research has shown, there are differences in the needs of youths in higher and
lower socio-economic areas. Youths in some of the higher socio-economic schools worry
about their future prospects within the country. These youths abuse alcohol and drugs as
their coping strategy. Therefore, programmes within these schools should emphasise the
development of alternative healthy coping strategies to deal with Youth stress – other
than turning to drugs and alcohol. Acquiring the ability to handle feelings of anxiety,
depression and rage removes the impetus to use alcohol and drugs as “self-medication”.
If these basic emotional skills were taught in schools as early as possible, addictive habits
should not become established (Goleman 1996:255).
Youths from lower socio-economic schools seemed to worry about contracting HIV and
the impact of HIV infection on their lives. These youths either live with the threat of HIV
or already have HIV in their homes. Therefore, programmes within lower socio-
economic areas should emphasise emotional intelligence in youths in dealing with the
HIV/AIDS crisis. For Youth males the emphasis should be on valuing and respecting
people of both genders. For Youth females, the emphasis should be on raising self-esteem
and teaching girls assertive skills and personal decision making, so that they learn to
empower themselves to be less submissive to males.
It is the role of the educator to assess the ever-changing needs of the youths in her or his
care. The curriculum must meet the needs of youths and learning should be relevant to
the context in which they live. Emphasis should be placed on helping youths to manage
their own expectations and prepare for the job market trends, which await them when
they leave school. Focus should be on the Youth acquiring relevant skills within an area
that holds interest for them. This implies that educators should not only focus attention on
market trends but also train youths in self-awareness, so that they can find a niche for
themselves within this market. Entrepreneurial projects should be encouraged at school.
5.5. Guidelines for improving Youth emotional well being
To improve Youth emotional well being there first needs to be acknowledgement of the
prevalence of Youth depression. There is at times a tendency for parents and educators to
view youths as a highly stressful, unstable period of the lifecycle and hence consider
depressive symptoms to be a relatively common and normal aspect of Youth
development. However several recent studies have found that Youth depression is not the
transitory, benign condition it has been presumed to be. Depressive symptoms have been
linked to Youth suicide behaviour. In addition, strong evidence suggests that Youth
depression often is a precursor to substance abuse and major depressive episodes during
adulthood (Robertson and Simons 1989:125).
Once there is an acknowledgement of the problem, motivation to improve the situation
should follow. Education of educators, parents and the youths with regard to the
symptoms of depression, should increase awareness and early diagnosis of depression.
Early diagnosis and early intervention helps to prevent an escalation of depression and
lessens the chances of concomitant problems like drug and alcohol abuse and other
negative behaviours developing.
It is particularly important that male youths are not ignored. The manifestation of
depression might be less overt in males than with females but this research has shown
that there is no statistical difference between the severity and prevalence of female and
male depression.
5.6. The role of the parents
Effective parenting of the Youth is vital to their emotional well being. The family is, of
all the social institutions in which the Youth can find himself, that which is likely to have
the most profound influence on his or her emotional well being. It is the role of the parent
to create a cohesive and supportive family.

Covey (1997 20-21), McKeown, Garrison and Jackson (1997:279) and Ge (1996:717-
731), all agree that a healthy family is neither necessarily average, nor merely lacking in
negative characteristics, rather it has described positive features. The hallmarks of
families that seem to flourish in an atmosphere of warmth and ease, even under stressful
life events appear to be, in summary, that these families:
• Believe in the inherent “goodness” of one another and do not assume bad intent of
other members.
• Set limits neutrally, without emotional rejection and judgement.
• Accept the inevitability of mistakes.
• Can show fear and uncertainty with expectation of reassurance and understanding
• Humour is present and there is joy and humour in family relationships.
• Have clear boundaries exist between family members i.e. the responsibilities of
adults are clear and separate from the responsibilities of the children. Children are
allowed to take responsibility and make decisions gradually.
• Give equal consideration to all family member's feelings and needs when decisions
are made.
• Allow all the family members the freedom to express themselves autonomously,
including different opinions or viewpoints.
• Are able to co-ordinate tasks, negotiate differences and reach closure effectively

• Accept different perspectives on reality and discuss philosophies and values

regarding life together.
5.7. Evaluation of the research
The principal aim of this study was to provide answers to the problems identified in
Chapter 1, namely, “ What is the prevalence of Youth depression symptoms in the greater
Kitui area?” and “What appears to be influencing the development of Youth depression
symptoms in the greater Kitui area?” It is indicated below that these questions were in
fact answered, and other significant aspects are noted. Finally, the problematic aspects of
the study are discussed.
5.7.1. Significance of the study
The study makes the following contributions to the field of educational psychology and
the study of youths:
• it summaries a number of theories on Youth depression and identifies aspects of
Youth depression that should be addressed by educators, parents and counsellors;
• risk factors that could lead to Youth depression are discussed and the aspects that
according to these factors need to be addressed in school programmes and by parents
are identified;
• the scale of Youth depression within the Kitui context and the need for awareness of
this within schools is identified;
• the need for effective, proactive addressing of Youth depression within schools in the
Kitui context is identified.
5.7.2. Limitations of the study
(i) The fact that within the overall sample, a small number of males
from a very high socio-economic school was used in the empirical
investigation, could have limited the validity of the results
(ii) Certain standard limitations are inherent in all self-report
questionnaires (Huysamen 1984:98) :
• It is very difficult to assess the level of honesty with which the youths
answered the questionnaires
• It is also difficult to assess whether all the youths interpreted all the
items correctly
• It is difficult to allow for all the different cultural norms when
developing the items for Questionnaires
• It is impossible to ensure that all input variables are totally
independent of one another when measuring human relationships.
• There may also have been individual youths with other problems, such
as anxiety or illness on the day of testing, which may have influenced
the results.
5.8. Recommendations for further research

• For practical reasons the investigation was conducted using only youths from
the greater Kitui area: Kitui; Sunward Park (Kitui); Kitui (Meadowlands) and Kitui.
A repetition of the investigation could be done using youths from a wider rural and
urban area to establish whether the same influential factors play a role in the
development of Youth depression.
• The sample could be said to be representative of the population of secondary youths
as it used a cross-section of cultures and socio-economic status, but a further
investigation should include more males in the sample.
• The investigation concerning the link between possible causative factors and
symptoms of Youth depression was conducted using only High school youths. This
research could be extended to include more subjects from earlier secondary school
grades, in order to use the results to develop programmes more timeously.
5.9. Conclusion
The research objective underpinning this study was to develop an understanding of the
factors which could be influencing the development of Youth depression in the Kitui
context.
This study provided the field of educational psychology with valuable research in the
field of Youth depression. An understanding was gained of the direction an educational
programme that serves as a basis for intervention in the field of Youth depression should
have.
This study highlighted some of the problems in the field of Youth depression and made
recommendations for further research.
 QUESTIONNAIRES
Youth Life Perspective Questionnaire

Please fill in the details below

Male / Female: ……………
Age: …………….
Are you presently taking any medication ? ……………..
Please list the medications ………………………………………………………………

Question Yes No
1. Is your family supportive of you?
2. Do you have friends your own age?
3. Are you a happy person?
4. Do you think you have to behave a certain way because you are
A girl/boy?
5. Do you think Kitui is a positive place to live?
6. Would you describe your relationship with your mother as good?
7. Do your friends influence you to do things you don’t want to do?
8. Do you feel ashamed or embarrassed about your body?
9. Do your friends value your opinions and respect you?
10. Does your mother cope well with day to day life?
11. Does your father cope well with day to day life?
12. Do you worry a lot about becoming a victim of crime?
13. Do you feel you can solve problems by yourself?
14. Does your family argue a lot?
15. Do you often feel lonely?
16. Does either of your parents seem sad, irritable or angry quite often?
17. Do you have to take care of others in your family?
18. Do you worry about getting infected with the HIV virus?
19. Are you allowed to make important decisions in your family?
20. Do you enjoy spending time with people your own age?
21. Has your mother ever been depressed for more than two weeks?
22. Has your father ever been depressed for more than two weeks?
 105

Youth Life Perspective Questionnaire - continued

Question Yes No
23. Do you think people want to hear your opinions?
24. Do you feel hopeful about your future in Kitui?
25. Do you and your friends drink alcohol often?
26. Do you feel accepted by your parents?
27. Do you cope well with day to day life?
28. Do you worry that your friends might be HIV positive?
29. Do you enjoy going home to your family?
30. Do people your own age enjoy spending time with you?
31. Is your mother a happy person?
32. Is your father a happy person?
33. Are your parents divorced?
34. Has the threat of crime caused you to stop trusting people?
35. Do you worry a lot about how you look?
36. Has anyone in your close family died in the last two years?
37. Are your opinions and beliefs respected in your family?
38. Have you been personally affected by crime?
39. Are you not allowed to do certain things because you are a boy/girl?
40. Do you worry a lot about your relationships with others?
41. Do you and your friends use illegal drugs?
42. Do you worry about finding a job when you leave school?
43. Do you feel it is your role to take care of others?
44. Has the threat of getting HIV affected your enjoyment of life?
45. Do you feel rejected by people your own age?
46. Do you feel dependent on others to sort out your difficulties in life?
47. Do you look forward to being an independent adult in Kitui?
48. Do you feel understood by people your own age?
49. Would you describe your relationship with your father as good?
50. Do your parents’ moods affect your moods?
 REFERENCES

Alexander, A. 1999. Sex differences in Youth depression: An overview of current

research.http://www.towson.edu/~vanfoss/sex_differences_in_Youth_de.htm Accessed
23 January 2002.
Asher, S.R, Hymel, S and Renshaw, P 1994. Loneliness in Children. Child Development.
Vol. 55: 1456 – 1464.
Association for the Development of Education in Africa Newsletter. 2000. HIV/AIDS in
Africa: Placing it High on the Agenda of ADEA. Vol. 12 No 2: 4-6.
Beaudoin in Codrington, G. 1998. Defining characteristics of Generation X.
http://www.jamescurran.co.uk. Accessed 2 February 2002.1998:10
Beck, A.T. 1991. Cognitive Therapy. American Psychologist. 46: 368-375.
Bednar, R.L., and Kaul, T.J. 1994. Experiential group research: Can the canon fire? In
A.E. Bergin and S.L. Garfield (Eds), Handbook of psychotherapy and behaviour change.
New York: Wiley.
Burke, L. 2000. The Consequence of Truth: Post traumatic Stress in the New Kitui.
Cooper, J.R. 1996. The Deep, Dark Tunnel of Depression. A Medical Reporter
interview with Ivan Goldberg, M.D.
http://medicalreporter.health.org/tmr0696/goldberg.html. Accessed 16 November 2002.
Dawes, A and Tredoux, C. 1990. Impact of Political Violence on Children of K.T.C. In
Centre for Intergroup Studies, The Influence of Violence on Children. Cape Town:CIS.
Desjarlais, R.; Eisenberg, L.; Good, B. and Kleinman, A. 1995. World Mental Health:
Problems and Priorities in Low-Income Countries. New York: Oxford University Press.
Dishion, T.J. 1999. When Interventions Harm: Peer Groups and Problem Behaviour.
American Psychological Association. Vol. 54. No 9: 755 – 764.

Edelbrock, C. 1997. Child and Youth Depression.

http://www.personal.psu.edu/faculty/c/s/cse1/Dep.htm. Accessed 24 January 2002.
Garber, J., Little, S., Hilsman, R. and Weaver, K.R. 1998. Family Predictors of Suicidal
Symptoms in Young Youths. Vol. 21, No 4, pp 445-457.
Hamber, B. and Lewis, S. 1997. An Overview of the Consequences of Violence and
Trauma in Kitui. The Centre for the Study of Violence and Reconciliation; Kitui. Kitui.