Self-evaluation as an active ingredient in the experience and treatment of adolescent depression; an integrated scoping review with expert advisory input

Abstract

Background Negative self-perceptions is one of the most common symptoms of depression in young people, and has been found to be strongly associated with severity of depression symptoms. Psychological treatments for adolescent depression are only moderately effective. Understanding the role and importance of these self-perceptions may help to inform and improve treatments. The aim of this review was to examine self-evaluation as a characteristic of adolescent depression, and as an active ingredient in treatment for adolescent depression. Methods We conducted a scoping review which included quantitative and qualitative studies of any design that reported on self-evaluation as a characteristic of, or focus of treatment for, adolescent depression. Participants were required to be 11–24 years and experiencing elevated symptoms of depression or a diagnosis. We also met with 14 expert advisory groups of young people with lived experience, clinicians, and researchers, for their input. Findings from 46 peer-reviewed research studies are presented alongside views of 64 expert advisors, to identify what is known and what is missing in the literature. Results Three overarching topics were identified following the review and reflections from advisors: 1) What does it look like? 2) Where does it come from? and 3) How can we change it? The literature identified that young people view themselves more negatively and less positively when depressed, however expert advisors explained that view of self is complex and varies for each individual. Literature identified preliminary evidence of a bidirectional relationship between self-evaluation and depression, however, advisors raised questions regarding the influences and mechanisms involved, such as being influenced by the social environment, and by the cognitive capacity of the individual. Finally, there was a consensus from the literature and expert advisors that self-evaluation can improve across treatment. However, research literature was limited, with only 11 identified studies covering a diverse range of interventions and self-evaluation measures. Various barriers and facilitators to working on self-evaluation in treatment were highlighted by advisors, as well as suggestions for treatment approaches. Conclusions Findings indicate the importance of self-evaluation in adolescent depression, but highlight the need for more research on which treatments and treatment components are most effective in changing self-evaluation.

The Influencing Factors of Self-evaluation in Adolescents: A Structural Equation Modeling

“…Poor self-evaluation in adolescents can have signi cant long-term implications for mental health disorders, including further episodes of depression as an adult and an increased risk of suicidal ideation [54,55]. Negative self-evaluation, including worthlessness, are one of the most common mental health disorders in adolescent.…”

The Influencing Factors of Self-evaluation in Adolescents: A Structural Equation Modeling

“…Poor in adolescents can have signi cant long-term implications for mental health disorders, including further episodes of depression as an adult and an increased risk of suicidal ideation [54,55]. Negative self-evaluation, including worthlessness, are one of the most common mental…”

Adolescent Depression from a Developmental Perspective: The Importance of Recognizing Developmental Distress in Depressed Adolescents

“…Adolescent depression is a particularly important mental health disorder, and its recognition and treatment have important short and long-term mental health implications. Adolescence is a critical time for mental well-being, as almost 75% of adult mental illnesses have origins during childhood and youth [ 1 , 2 , 3 , 12 , 13 ]. Adolescent depression is common, and almost 70% of adolescents who have a depressive disorder will have a recurrence within five years, with a four-fold risk of experiencing depression in adulthood [ 4 , 14 , 15 ].…”

“…The treatment outcomes for adolescent depression are only moderately effective and so remain confusing and stubbornly disappointing [ 12 , 16 , 22 , 23 ]. Accurately identifying appropriate treatments for depressed adolescents is particularly challenging and important.…”

“…It is argued here that the high level of adolescent undifferentiated emotional distress in depressed adolescents could be regarded as a form of developmental distress resulting in dysphoria. Although there may be differing approaches to understanding adolescent depression, there is strong evidence that depressed adolescents are struggling with negative self-perception [ 12 , 45 , 47 ]. Self-perception is important in depressed adolescents when considering the high self-reported rates of internal insecurity, poor coping perceptions, poor self-efficacy, low self-worth, poor self-esteem, and disturbed self-image [ 13 , 45 , 46 , 47 , 48 , 49 ].Adding further weight to self-perceptions importance is the strong correlation between the severity of self-image disturbance and the severity of adolescent depression [ 50 , 51 , 52 ].…”