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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
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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
study and this study reflects their contribution.
Table of Contents
. . Abstract ............................................................................................................................... 11
Dedication .......................................................................................................................... iv ............................................................................................................. Acknowledgements v
......................................................................................................................... Introduction 1 ................................................................................................................ Literature Review 3
..................................................................................................................... Introduction 3 Depression ....................................................................................................................... 3
............................................................................................................... Comorbidity ... 13 Sex Differences and Depression ................................................................................. 14 Classification of Depression .......................................................................................... 21
......................................................................................... Depressive Disorders 2 1 Depressive mood ................................................................................................. 22 Depressive syndromes ......................................................................................... 23 Major depressive disorder .................................................................................... 24
Dysthymia ............................................................................................................. 25 ............................................................................................... Help-Seeking Behaviour 26
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
Participants .................................................................................................................... 64 ....................................................................................................................... Procedure 64
Measures ............ ... ......................................................................................................... 65 The Child-Adolescent Perfectionism Scale (CAPS) ............................................ 65
.......................................................... Perfectionism Self-Presentation Scaie (PSPS) 66 The Adolescent Depressive Experiences Questionnaire (DEQ-A) ........................... 67
.................................................................................. Self Concealment Scale (SCS) 68 The Cen ter for Epidemiologic S tudies Depression Scale (CES-D) .......................... 69
................................................................................................... Help-Seeking Scale 70 Results ............................................................................................................................... 71
..................................................................................................... Descriptive Analyses 71 MANOVA of Scales by Gender .................................................................................... 74 Correlational Analyses .................................................................................................. 76 Correlations Correlations Correlations Correlations Correlations
with with with with with
............................................................. Self-Oriented Perfectionism 76 Socially Prescribed Perfectionism ................................................... 79 Dependency ...................................................................................... 80 Self-Criticism ................................................................................. 81
............................................................................. 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
Discussion ...................... ... ........................................................................................... 89 .......................................................................................... Depression in Adolescents 8 9
Personality and Depression ........................................................................................... 92 Correlates of Help-Seeking Attitudes ........................................................................... 95
.................................................................................................. Psychometric Results 102 Limitations .............................. ... .......................................................................... 103 Future Directions ......................................................................................................... 107
................................................................................................................. Implications 109 Summary ......................................................................................................................... 1 1 1 References ........................ ... ...................................................................................... 113 Appendices ...................................................................................................................... 133
List of Tables
Table 1 .................................................................................. Reliabilities using the Total Sarnple 72
Table 2 Analyses of Variance and Mean Scores for Males and Females ................................... 75
Table 3 ................................................................ Correlational Analyses using the Total Sample 77
Table 4 Correlational Analyses for Males .................................. .. ............................................ 78
Table 5 Correlational Analyses for Females .................................................................................. 79
Table 6 ........... Results of Hierarchical Regression Analyses for the Prediction of Help-Seeking 85
Table 7 Results of Hierarchical Regression Analyses for the Prediction of Depression ............... 87
Table 8 .... Resul ts of Hierarchical Regression Analyses for the Prediction of Self-Concealment 88
viii
List of A~pendices
Appendix A Description Ietter of the study .............,......-.~.......-...................................................... . . . . 133
Appendix B Paren t/Guardian consent forrns .. .... .. .. .... . ...........-.-..-. .. .-.-.... ........ . . . . . . . . . . . 1 34
Appendix C S tudent consent forms ................-.--.---.- -..-----..----................. . . . . . ............ 1 35
Appendix D Introduction to the study ....................................................................................... 136
Appendix E Children and Adolescent Perfectionism Scale (CAPS) ........................... . .-................ 137
Appendix F Perfectionism SeIf-Presentation Scale (PSPS) .............................................................. 139
Appendix (3- The Adolescent Depressive Experiences Questionnaire (DEQ-A) ............................. .... 141
Appendix H The Center for Epidemiologic Studies Depression Scale (CES-D) ................................ 143
Appendix 1 Self-Concealment Scale ( S C S ) ............... .. ................. ............. . ................. . ............. 144
Appendix J Heip-Seeking ScaIe .................... - .-.......... - - - - - ........................................ - ...................... 145
Introduction
A growing number of investigations point to the potential rate of personality
factors in maladjustment. This study examines the relationship between personality as it
relates to depression and help-seeking khaviour. Specifically, this research attempts to
determine if personality variables such as perfectionism are related to depression and
attitudes toward help-seeking. Before describing the study in detail, it is essential to
examine relevant literature involving the variables in this study.
The past decade has witnessed a rapid expansion of clinical and theoretical
interest in personality and depression. This interest is important because it may help to
identify persons at-risk as well as identify variables related to the triggering of
depression. Additionaily, it may uncover the necessary treatment interventions needed for
this particular population (Hewitt & Flett, 1993a). A central goal of the current research
is to examine the extent to which personality factors such as perfectionism, self-criticism,
and dependency are linked with depression in adolescents. If it can be established that
these factors play a role, then appropriate interventions can be designed.
Many people experience psychological problems, but few seek heip through
counselling. Numerous factors are associated with negative help-seeking tendencies,
including the experience of depression. Currently, little is known about the role of
personality and self-concealment and negative help-seeking attitudes, especially in
adolescents.
As indicated above, the current research will examine personaiity and help-
seeking in adolescents with a particular focus on perfectionism. The main hypothesis of
this study is that two forms of perfectionism (i.e., socially prescribed perfectionism and
perfectionism self-presentation) will be associated with negative help-seeking attitudes.
1
Socially prescribed perfectionism is identified with a perception of helplessness
asociated with the notion that other people have unrealistic perfectionistic standards for
the self and it is impossible to attain these socially presctibed standards of perfection.
Perfectionism self-presentation is defined as the social facets of perfectionism and
involves the need to appear perfect and avoid displaying faults to others. The general
premise is that these elements of perfectionism, based on previous theories, will be
associated with negative attitudes as the act of seeking help represents an open admission
of faiiure.
The organization of the introduction section is as follows. First, background
literature in each area is described. The introduction focuses on depression in children
and adoIescents highlighting and providing background on the nature of depression and
the subsequent classification and characterization of depressive disorders in the field of
psychology. This section was written to provide knowledge on the standards for the
categorization of depressive disorders and to illustrate the complexity of depression
especially in adolescents. The second section reviews sex differences and help-seeking
behaviour in adolescents. Third, perfectionism is explored in considerable detail with a
focus on the different personality factors. The fourth section focuses on the psychological
construct. self-concealment. The fifth section details the goals of the present study and a
summary of the main hypotheses. Details of the positive and negative findings of this
study and its limitations are also discussed. Finally, implications for advancements and
suggestions for future research are explored.
Literature Review
In spite of the increased attention k ing given to the research of chiidhood and
adolescent depression, Our understanding has been hampered, in part, by the small gains
in methodology and conceptualization of adolescent depression. Research has failed to
keep up with the burgeoning adult Iiterature. Further, the extent to which there is
universality of the adult findings to adolescents is not full y understood. However, the
increasing literature devoted to depression in adolescence does suggest that adolescents
are substantiall y more depressed than children and that they may in fact be more
depressed than adults (Angold, 1988; Shoenbach, Garrison, & Kaplan, 1984). Hence,
from a treatment perspective, given the increase in the rate of adolescent suicide (Wright-
Strawderrnan & Watson, 1992) and the evidence, which points to the fact that greater
depression increases the Iikelihood of having further episodes, it is cntically important
that more research attention be given to the study of depression in this age group
( Allgood-Merten, Lewinsohn, & Hops, 1990).
Over the last 20 years, depression in children and adolescents has becorne an area
of extensive research, particularIy in the disciplines of psychiatry, psychology, and
related fields (Reynolds & Johnston, 1994). Further, the research in these fields confirm
that childhood affective disorder is a documented clinical occurrence (Miezitis, 1992).
Interestingly enough, the majority of research on depression in children and adolescents
was not conducted until the mid- 1970s. The reason for the delay in our focus on
3
depression in young people may be due in part to the existence of several widespread
myths about the perception of this disorder. The first myth suggests that perhaps
depression is entirely nonexistent, that it is very uncommon if not impossible in children
and adolescents. A second explanation is that it is a passing and fleeting phase. The third
myth suggests that developmentally normal persons tend to have a propensity towards
this disorder. Finally, if it does exist, it cm take the form of "masked depression" in that
the dysphonc mood may be concealed as "depression equivalents" such as somatic
complaints, behaviour and conduct problems, school difficulties, or "adolescent turmoil"
instead of being directly expressed (Haggerty, Sherrod, Garmezy, & Rutter, 1994).
According to Carlson (198 l ) , it is true that the symptoms of adolescent depression are
quite difficult to discem from "adolescent tumoil". As a result, children and adolescent
depression have been frequently underdiagnosed and untreated. Unfonunately, as a result
of the misdiagnosis, a majority of psychiatrically il1 adolescents become psychiatrically
i l 1 adults. However, current findings with adults indicate that depression is a widespread
reaction that occurs in a large segment of this population at various times in their lives. It
is speculated that this response pattern can begin as early as childhood (Miezitis. 1992).
The perception of self as described in terms of one's self-concept in relation to
one's intellecnial functioning and the evaluation of the self in different areas of
functioning, as well as, self-esteem as it applies to one's emotional state and self-worth is
considered to be a central construct in the understanding of depression by several
theorists (Miezitis, 1992).
Several groups of investigators from a variety of theoretical traditions have
similarly outlined two personality configurations that presumably develop based on the
quality of interpersonal relationships and appear as distinct preernptory concems that
increase a person's risk for chronic depression (Blatt & Maraudas, 1992). The two
personality configurations referred to as dependency and self-criticism which Blatt and
Zuroff (1 992) discuss, differ in the degree of emotionai distress that they display in
response to the nature of life events and life experiences that precipitate their depressive
episodes. Among dependent individuals, incidents of rebuff and rejection in important
relationships are Iikely to trigger feelings of depression. The dependent personality style
is distinguished by a desperate need to maintain positive interpersonal relations (Luthar &
Blatt, 1995). Self-critical individuaIs, in contrast, derive their feelings of self-worth
mainly from successes in persona1 accomplishments. Depression is initiated by some
disruption in their self-schema or identity. They tend to be particularly insecure about life
events representing personal failures (Blatt et al., 1992d). These individuals constantly
strive for extreme goals and perfection, are often very cornpetitive, work hard, maintain
excessive self-standards, and often attain a great deal; but with little acknowledgement or
satisfaction. They repeatedly engage in stringent self-evaluation, they are highly critical
of others as this is related to their intense competitiveness. Also, by overcompensating,
their intent is to receive praise and approval from others (Blatt, 1974). The dependent
individual, however, has a constant need to keep in close physical contact with need-
gratifying others, has a constant need to feel safe, protected, cared for, and loved.
Relationships are valued primarily for the care, cornfort. and satisfaction they can provide
because they do not possess a fixed and consolidated intemal mental mode1 of
pleasurable and gratifying experiences or of the attributes of others who can provide
happiness and contentment. These individuals rely intensely on others to provide and
maintain a sense of well-king, and consequently, they attempt to minimize overt
conflicts, avoid expressing anger, conform, and constantly placate others for fear of
abandonment and loss of love that the interpersonal relationship can provide. Clearly,
maintaining a good relationship with others is paramount. as separation from others and
desertion is a source of intense fear and anxiety (Blatt et al., 19924).
A wide range of empirical and clinical research reveaied that an unsettled
relationship between parent and child may cause the child to develop a broad range of
disorders such as a distorted working mode1 (Main, Kaplan, & Calcium, 1985) or
cognitive representations (Blatt, 1974) of self and others. It is felt that many of these
misrepresentations may predispose one to a higher risk of depression. The lack of
consistent care, discipline, or parental support in addition to the use of excessive parental
influence, control, disapproval and rejection are associated with depression (e.g.,
McCranie & Bass, 1984; Lekowitz & Tesiny, 1984; Zemore & Rinholm, 1989; Miezitis,
1992). These inconsistencies in the early caring parental relationship cm create a
damaged and distorted mental representations or interna1 working models of tnisted
relationships, such that an individual may experience a number of things: the need for
constant encouragement and reassurance; separation anxiety; or the continuous
expectation of rejection and criticism, avoiding and resisting interpersonal involvement
(Blatt & Homann, 1992). The experience of parental scorn, neglect. disapproval, extreme
authority and criticism are internalized and this exemplifies the child's foundation of the
self and of others in caring relationships. These exemplifications' can cause some
individuals to have an impaired cognitive schema. This has k e n referred to as the
"depressive triad" indicating how the individual feels about themselves, their
environment, and the future (Beck, 1967). The general finding of the disruption between
these two types of caring relations demonstrate that the first is around the issue of
consonance and consistency of care. The second is around issues of excessive control,
force, and independence between parent and child, and how they correspond to the two
types of depression which is also based on issues of interpersonal associatedness such as
dependency and the second is on issues of self-importance and self-worth (i.e., self-
criticism: Bowlby, 1973, 1980; Btatt 1974, 199 1 ; Blatt, Quinlan, Chevron, McDonald, &
Zuroff, 1982; Arieti & Bemporad 1978, 1980; Beck, 1983)-
The recent work of Luthar and Blatt ( 1995) exarnined whether a sample of inner-
city adolescents with different dysphoric tendencies varied in the types of life experiences
to which they were most vulnerable. The expectation in this study, based on previous
research, was that inner-city adolescents high in self-criticism would exhibit high levels
of depression and anxiety due to academic difficulties and interpersonal problems. By
contrat . among those with dependent personality types high levels of distress would only
be associated with difficulties in interpersonal relationships.
The results of this study concur with other investigations in several respects. As
expected, levels of self-criticism revealed nonspecificity of effects, so that adolescents
high in sel f-criticism revealed greater depression related not on1 y to educational
accomplishments, but to close interpersonai relations as well. Greater levels of depression
was seen among those high in self-criticism in response to increasingly negative ratings
by teachers and peers, as opposed to those adolescents whose scores indicated low levels
of self-criticism. Conversely, results involving grades indicated that adolescents lower in
self-criticism as compared to those higher in self-criticism exhibited less, rather than
more variation in depression. In fact, they seemed to be relatively unaffected by their
poor academic achievement (Luthar et al., 1995).
Consistent with other findings, levels of dependency revealed a specificity of
effects. Although interaction terms involving high dependency and school grades were
not statistically significant as compared to children low in dependency, highly dependent
youngsters did, however, show higher levels of depression when they felt that others held
a negative opinion of them. These significant associations were seen only in the context
of negative teacher ratings; with peer ratings, a nonsignificant association was found
(Luthar et al., 1995).
The work of Luthar and Blatt ( 1993) has further established that certain aspects of
social and emotional functioning are uniquely associated with dependency as compared
to self-criticism. With respect to directionality, the pattern of results was consistent with
previous findings. Dependent teenagers showed greater increases in excessive and
chronic worry as well as an acute awareness of cues from others. Among dependent
individuals, a sense of self is derived from the intensity and characteristics of their
relationships. They are overly concerned about offending others and experience great fear
and apprehension about the possibilities of social rejection. These individuals are sharply
attuned to the behaviour of those around them. In contrast, self-criticism was more
strongly associated with depression and with chronic fears of k ing criticized and the loss
of approval of significant others (Luthar et al.. 1993).
The variables social control and the ability to express one's thoughts and feelings
were not equally related to the two types of depressive tendencies. However,
physiological anxiety and locus of control were found to be equally related to both
dependency and self-criticism, a cornplaint considered typical of dependent individuals.
Self-critical individuals may dso experience physiological difficulties such as
sieeplessness, extreme fatigue and exhaustion. Support for self-critical individuals
characteristicaIIy experiencing considerable guilt and self-blarne has been seen in
previous research, it was assumed that in addition these individuals would experience a
strong sense of attribution in response to negative life events as well. However, Luthar et
ai., 1993) found that self-criticism was highly correlated with an extemal locus of control.
Further, the extent of this association between dependency and externality did not differ
significantly, suggesting that, individuals high on both dependency and self-criticism
experience feelings of insecurity and defenselessness to extemal forces.
Within another body of literature, it has k e n shown that the children of mothers
who have a history of unipolar depression reported significantly lower perceived self-
esteem and a more depressogenic attributional style than children of medically il1 or well
mothers (Goodman, Adamson, Riniti, & Cole, 1994). The goal of Garber and Robinson's
( 1997) study was to replicate and extend this research by testing whether children of
parents with a history of mood disorders differ from children of parents who have never
experienced mental health problems. Results of their study were consistent with previous
findings in several respects. As expected, the children of mothers with a history of
depressive syndrome reported experiencing a wide range of psychopathology. These
individuals reported feelings of unimportance, lower perceived scholastic
accomplishments and abilities, a more intemal attribution of causality for negative life
events, greater seIf-loathing, and more recurrent negative thoughts than offspring of
mothers who had no history of mood disorders. It is possible that the observed
differences between the high- and low-risk children's cognitive differences could have
been due, in part, to their current level of depression. Further anaiyses were conducted to
circumvent this issue. Results indicated that even when depression was controlled for,
high-risk children still reported feelings of worthlessness, academic and behaviourai
inhibitions, and increased self-rejection. This specificity of differences between the high-
risk and Iow-risk children was basically unchanged even when data was reanalyzed
controlling for children with a history of a mood disorder. Essentiaily, the recurrent
negative thoughts reported by high-risk children were not primarily a result of their
existent disposition or a permanent effect left from a previous depressive episode. This
suggests that children of mothers with a history of mood disorders who repcrted greater
self-criticism and feelings of inferiority may indicate a cognitive vulnerability to
depression (Garber et al., 1997).
Particularly in this study, cognitive vulnerability was associated with children of
mothers with a more chronic history of depression. Data analysis revealed that even after
control ling for their current level of depressive symptoms, children who had a longer
exposure to depressed mothers -- that is mothers who reported long bouts of depression
lasting four years o r longer -- were more likely to report having a negative attributional
style, greater self-criticism, poor self-image, Iower academic readiness and greater
hopelessness than children of mothers less chronically depressed o r well mothers. The
recurrent negative thoughts that characterized some children of chronicall y depressed
mothers emphasize the dissirnilarity of such chiidren. Potentially, therefore, these
findings might heIp to account for the development of and transmission of increased
negative cognitive style arnong children of chronically depressed mothers. A number of
broad explanations for this have k e n advanced. The first suggests that perhaps children
deveIop a negative self-perception and a negative cognition of the causality of events in
response to their daily interactions with their depressed mothers. Consistent with
expectations and prior research, it has k e n revealed that the relationship between the
depressed mother and child are characterised by conflict, feelings of unimportance,
disapproval, and excessive authority. Once estabhshed, this negative form of interaction
between mother and child is perpetuating and these individuals are more likely to develop
a negative cognitive style (Garber et al., 1997).
Second, it aiso is possible that there may be a heredity component involved;
chronicall y depressed mothers rnay have a greater genetic and biological vulnerability
that is inherited by their children (Garber et al., 1997).
Third, there is the likelihood that the hardships of life may result in mothers
experiencing depression and children developing a negative self and social perception.
Clearly, future research needs to explore the importance of hereditary. intrapersonal and
interpersonal factors in the developrnent of negative cognitions and depression (Garber et
al., 1997).
As noted earlier, many researchers suggest that there is a link between depressive
concerns and dysfunctional early family relationships (Arieti & Bemporad, 1980;
Bowlby, 1980). The work of Frank, Poorman, Van Egeren, and Field (1997) has extended
the empirical work on adolescent-parent relationships. Their findings are consistent with
a cognitively mediated model of depression that is cyclic in nature. This model links
adolescents' difficulties with their parents to their self-representation, sel f-schema and to
their depressed moods. As children, self-critical and interpersonally consumed
individuals learn to accommodate and adjust to varying parenting styles by adopting
contrasting but similarly unstable means of maintaining closeness to and distance from
their parents. Essentidly, self-critical individuals rely on withdrawal. and avoidant
behaviours to pa rd themselves against parents who are demanding and controlling,
while dependent children are more likely to be accommodating, unassuming, and quick to
avoid any dissension (Blatt et al., 19924). The findings in this context highlight the
unique role of self-representation, which includes a constant battle to maintain a positive
and competent self-image and the fear of estrangement, k ing disapproved by others and
the withdrawal of love.
Adolescents high in self-criticism reported high levels of counterdependency and
alienation from their parents, whereas those describing themselves as highly dependent
and intensely close to their parents reported more interpersonal concems. Additionally,
adolescents indicating separation difficulties with their parents reported more of both
types of concerns, while individuals reporting more depressive concems revealed greater
ievels of depression (Frank et al., 1997). A parent-child reiationship that darnages the
dependant's ability to regulate proximity needs with separation and autonomy needs
predetermines an internalized depressive self-schema (Blatt et al., 1992a).
Generally, adolescents' depressive concems explained most of the variance in
adolescent depression, which was initially accounted for by perceived difficulties with
parents. The one exception was a statistically significant, albeit weak, relationship
between lack of parental involvement and rejection in relation to mother and adolescents'
syrnptoms of depression. The authors suggest that the impact of parental behaviour
occurs as an integral effect that involves not only the sex of the child but also the sex of
the parent. Given the primary feelings of interpersonal alienation, separateness, and
seclusion associated with adolescent depression and the uniqueness of the mzternal
relationship in providing their offspring with a caring and dependable relationship, the
above results are not surprising.
Separation difficulties with parents led to depression only via their relationship to
negative cognitive self-schema. Frank et al. ( 1997) suggests that at this point, it may be
beneficial to identify the subtle, theoretical characterization of adolescents' separation
conflicts. In essence, self-criticism seemed to be heightened by parents who attempted to
discourage the adolescent's effort at assertion and autonomy. Relationship concerns,
however, were central for those adolescents admitting that they had persona1 fears of
estrangement and that they yearned for a less separate relationship with their parents. The
authors note that although the size of these relations was quite small, the overall results
are largely supportive of prior descriptions of cornpositional differences in the degree of
separation difficulties experienced by self-critical individuals as compared to adolescents
wi th interpersonal concerns (Blatt et al., l992d).
Comorbiditv
Over the past decade, a striking feature of depressive phenornena in children and
adolescents is the relatively high degree of comorbidity to which these experiences are
associated with other conditions, emotions, syndromes, and disorders (Haggerty et al.,
1 994). Research now indicates that a vast majority of other ps ychiatric disorders are more
likely to be found among youngsters with depressive disorders. With regard to
depression, Compas, Grant, and Ey (1994) believe that it is safe to Say that comorbidity is
the ruIe rather than the exception during childhood and adolescence. This phenomenon
has been implicated in anxiety disorders (Alessi, Robbins, & Dilsaver, 1987), conduct
problems (Alessi & Magen, l988), attention-deficit disorder (Anderson, Williams,
McGee. & Silva, 1987), eating disorders (Rastarn, 1992; Smith & Steiner, l992), and
substance-abuse disorders (Bukstein, Glancy, & Kaminer, 1992), among other disorders.
Current perceptions of depression in children and adolescents suggests that depression in
these individuals, as in adults, is quite a common psychological problem that is usuaily
linked to other forms of psychopathology (Reynolds et al., 1994). While it is uncornmon
for parents :O report that their children are depressed, they will frequently describe
behaviours such as those mentioned above. This misunderstanding results in infrequent
referrals for care and treatment.
Sex Differences and De~ression
The possibility of gender differences has important implications for the current
research. Clearly, it is necessary to examine whether males and females differ in levels of
depression and related phenornena, and it is also necessary to separately examine
correlational results for males versus females. Previous research on gender differences is
discussed beiow.
Most of the literature on adolescent depression proposes that adolescents are
considerably more depressed than children (Angold, 1988) and that they may be
substantially more depressed than adults (Shoenbach et al ., 1984). Sex differences also
have been observed in adolescent samples (Nolen-Hoeksema, 1990).
Nolen-Hoeksema ( 1987) found that among adults, females were twice as likely as
males to show depression. These sex differences were observed in both major depressive
disorders and in Iess serious levels of depression. Interestingly, Pearce ( 1978) found that
among prepubescent children there was a slight tendency for males to display more
depression than femdes. It seems that this shift in the sex differences takes place some
time in mid- to late adolescence. This is a general assumption and the precise timing
remains unctear (Nolen-Hoeksema, I W O ) .
It has been suggested that two resources are significant in the management and
modification of change when dealing with depression: social support and interna1 coping
resources. Social support is a concept that has gained a great deal of attention in the
examination of stressful life events and its impact on mental health among adults. Whik
there is growing evidence that parental support is critical for adolescent mental health,
less is known about the influences of peers.
Intemal coping resources are usually referred to as coping styles (e.g., Nolen-
Hoeksema, 1987) and have been linked to both the appearance and amelioration of
depression in adults. Clearly, Nolen-Hoeksema's theory is appropriate for the study of
depression in adolescence. Not only is coping style linked to the socialization process of
males and females, it is also believed to change during adolescence. This change is
known as gender intensification. According to the gender intensification theory, the
propensity for the acceptance of feminine and masculine gender rotes during adolescence
may, in girls, increase the reliance on relationships with others for self-esteem as well as
characteristics of dependence and unassertiveness. In boys, it may decrease reliance on
relationships with others for self-esteem resulting in a higher level of self-assurance and
assertiveness. These differences in the way girIs and boys identify with their environment
may influence the development of gender differences in depression (Nolen-Hoeksema &
Girgus, 1994). Although, Nolen-Hoeksema ( 1987, 1990) suggests gender differences in
depression, it is important to note that rumination as discussed below is not assessed in
the current research. However, this literature illustrates the need to consider possible
gender differences and ruminative responses in depressive phenomena.
The duration of a depressed mood is directly related to how individuals react to it.
Ruminating and agonizing will augment and perpetuate the mood, while self-imposed
distractions will relieve the depressed mood. The Iatter response is referred to as
nonsymptom-focusing behaviour. (Nolen-Hoeksema, Morrow, & Fredrickson, 1993).
Men are more prone to distracting behaviours that are incompatible with their present
mood state. Distracting responses take the individual's mind off his or her symptoms of
depression and allow the individual to focus on more enjoyable and pleasing activities
(Nolen-Hoeksema, 1987, 199 1 ). Clearf y, some distracting responses may be intrinsically
counterproductive because they c m lead to fatal or life-threatening consequences,
Examples include engaging in violent behaviour or the use of narcotics. Even though
these actions may in fact divert the individual's attention from his or her unhappy feelings
and allow the individual some relief from the depressed mood, the relief is short-lived
because their negative actions will ultimately lead to more depression. However, not al1
distracting responses are intrinsically hazardous to the individual (Nolen-Hoeksema,
1987, 1991).
In contrast, women are more likely to ruminate, augmenting their depressed mood
by deliberating at Iength about it and its possible causes. Ruminative responses are
thoughts and behaviours that direct the depressed individual's attention to his o r her
symptoms (Nolen-Hoeksema, 1987, 199 1 ). These behaviours and thoughts tend to be
self-focused and deliberative. Ruminating individuals tend to be very distressed about the
reasons and significance of their depression. Though they are very concerned, they d o not
take any action to alter their condition, and they spend a great deal of time thinking about
how unhappy and sad they feel.
Current literature on adolescent coping styles suggests that sex-typed adult coping
patterns may begin in adolescence (Siddique & D'Arcy, 1984). In a study conducted b y
Nolen-Hoeksema, Girgus, and Seligman ( 199 1 ), they found that boys consistently
recounted more depressive symptoms than girls did. Additionally, they fourid that boys
and girls were equally likely to report sad moods, feelings of worthlessness, and
physiological complaints, but boys were more likely than girls to report behaviour
disturbances symptoms and Ioss of pleasure in previously valued activities.
An exphnation for these results is that boys were more prone to select internai,
fixed and global explanations for negative occurrences than girls were. According to this
principle. individuals seem to have fixed styles of justifying good and bad events which
are Iabelled "explanatory style" (Abramson, Seligman, Teasdale, 1978). When
considering the explanatory style theory, it seems that individuals who have such a style
are inciined to expect negative events and they d o not expect positive events to recur.
Also. these individuals tend not to take credit for those positive events that may occur.
Abramson and her colleagues ( 1978) maintain that the hopelessness and dismal
expectations as weIl as feelings of worthlessness which are a consequence of the
maladaptive explanatory style, put the individual at risk for the impulsive, influential, a n d
self-esteem deficits of depression. Studies have revealed that generaily adolescent girls
tend to feel an increasing pressure from others to comply with the prescribed ferninine
sex role and they report an increasing concem about the resulting social consequences of
challenging their sex role (Nolen-Hoeksema et al., 1991). For example, Rosen and
Aneshensel ( 1976) questioned 3,049 seventh- through twelfth-grade children about the
consequences of challenging their sex role. Girls, more than the boys, reported that they
would be disliked by a member of the opposite sex if they were aggressive, aspired to
their own interests or defeated a boy in a competition. Additionally, girls reported that
they atternpted to hide their ability and forcefulness more and behaved in defenceiess and
submissive ways. They also revealed worrying about the reactions of others to their
appearance and behaviour.
Nolen-Hoeksema and her colleagues ( 199 1 ) have proposed that perhaps the
increasing pressure for females to behave nonassertively and to conceal their ability may
cause at least some females to experience feeIings of helplessness about their ability to
bring about desired results. As a result they may develop a maladaptive explanatory style,
making them more susceptible to depression. Further study in this area is needed, as there
are few relevant and supportive studies that exist.
When coping styles were examined, fernales coped with depressive symptoms by
discussing their problems with a friend or by seeking professional help. However, male
depressives coped by neglecting the problem, using narcotics, or drinking alcohol
(Vredenburg, Krames, & Flett, 1986).
Further, Vredenburg et al. revealed that persons of the opposite sex more
frequently rejected depressed individuals than nondepressed individuais. This strong
negative reaction was consistently seen in ratings of interest in future contact, self-
rejection, and perceived impairment of individual functioning. Additionally, regardless of
sex, a greater number of feminine traits were attributed to depressives than
nondepressives. Extensively, the findings suggest that males are more likely to encounter
negative social experiences for revealing emotive aspects of depression and for seeking
help. It is conceivable that the prevalence of depression in women is higher because men
are more likely to experience greater social rejection and retribution for disclosing
feelings of depression and therefore seek alternative ways to deal with it.
Work conducted by Hammen and Padesky ( 1977) established that sex differences
do not exist with respect to the intensity of depressive symptoms. These findings are
consistent with results from past investigations (Bedrosian, 198 1; Teri, 1982). They
revealed, however, that different patterns for male and female adolescents in their
expression of depression do exist. Specifically, males showed symptomatology
characterized by oversensitivity, work inhibition, social isolation and disturbed sleep
patterns. Females, on the other hand, presented symptoms characterized by body image
distonion, eating problems, weight loss, feelings of sadness, and dissatisfaction.
Baron and Joly (1988) specifically looked at the patterns of depressive responses
of adolescents on the Beck Depression Inventory (BDI; Beck, Ward. Mendelson, Mock,
& Erbaugh, 196 1). Although the results revealed that there were no sex differences in the
severity of depressive symptoms --- which is consistent with findings from previous
investigations looking at both clinical (e-g., Strober, Green, & Carlson, 198 1 ) and
nonclinical adolescent samples (e.g., Kaplan, Nussbaum, Skomorowsky, Shenker, &
Ramsey, 1980; Siegel & Griffin, 1984) --- they did, however, ciearly reveal that different
patterns for male and female adolescents in their expression of depression were
widespread. Male adolescents tended to show a symptomatology characterized by
oversensitiveness, reduced productivity, decreased interest in pleasurable activities, and
sleeping problems, while females' contributing symptoms were characterized by concerns
with body image, feelings of unattractiveness, eating problems, weight loss, irritable
moods. and lack of satisfaction. There seems to be an important relationship between
physical self-concept and depression for femde adolescents. That is, femde extemal
focus is characterized by bodily concems while male extemal focus is characterized by
proficiency concerns such as an inability to perform satisfactorily at work. Overall, what
this shows is that gender differences in mean levels of depression must be examined, and
related personality factors and separate correlations must be done for males and females.
The rnost frequently used taxonomy system for the clinicai characterization of
depressive disorders in North Arnerican is the Diagnostic and Statistical Manual of
Mental Disorders (DSM), which, with the publication of the 3rd edition and its
subsequent revision (DSM-III and DSM-III-R; Amencan Psychiatric Association, 1980,
1987), estabtished the standard for the categorization of depressive disorders in children
and adolescents. DSM is currently in its 4th edition (DSM-N; American Psychiatric
Association 1994).
Research has spawned a number of viewpoints and systems for the classification
and identification of depressive phenomena in children and adolescents. The three levels
of categorization are depressive mood, depressive syndromes, and depressive disorders-
Whiie there is considerable overlap among the three concepts, they each reflect different
underlying assumptions about the evaluation and classification of depressive phenomena
(Haggerty et al., 1994). The purpose of this section is to provide background on the
nature of depression in adolescents.
Depressive Disorders
This discussion of depressive disorders will highIight the three major types:
depressive mood, depressive syndromes, and major depressive disorders as identified by
DSM-W. The discussion will outline the relationship between symptom and syndrome in
the delineation of these disorders.
De~ressive mood. We have al1 experienced periods of sadness or unhappy moods
at some point in our lives. Depressed mood is a universal human experience. Varying life
experiences are known to bring about these depressed periods; these phases of depressed
mood rnay be a result of such negative environmental incidents as the break up of a long-
time relationship or k ing unsuccessful at an important task. These feelings of sadness
rnay iast momentarily or they may remain for an extended period of time. Further, these
feelings rnay occur in response to one particular problem or they rnay be a consequence
of many different problems (Petersen? Compas, Brooks-Gunn, Stemmler, Ey, & Grant,
1993).
Work in the field of depressed mood has particularly focused on depression as a
symptom. In this sense, the term depression refers to the presence of a sad mood,
unhappiness, or blue feelings, which rnay last for an unspecified length of time (Petersen
et al.. 1993). At this level, no assumptions are made about any existing or nonexisting
additional symptoms. The process by which depressed mood is described and validated
are through adolescents' self-reports on their emotions and feelings obtained through
measures specifically designed to assess mood levels or through responses made on items
found in checklists of depressive symptoms (Petersen et al., 1993). Sad or depressed
mood is usually experienced with various negative emotions, such as feelings of guilt and
self-reproach, feu, anger, contempt, and self-loathing (Cantwell & Baker, 199 1 ) and is
relativeiy common during the stage of adolescence when al1 or some of these other
negative emotions rnay be present (Saylor, Finch, Spirito, & Bennett, 1984).
Depressed mood is also likely to regularly cooccur with other problems. In
particuiar. the depressed mood has k e n associated with such emotions as anxiety and
social withdrawal. While it is true that anxiety and depressed rnood frequently cooccur,
anxiety may or may not be associated with positive moods. Conversely, when one is
experiencing depressed mood it is not possible for the individual to experience happiness
or self-pleasure; these two emotions do not occur at the same time. Similady, when one is
feeling happiness, depressed mood does not consii tute a part of this emotion (Watson &
Clark, 1984; Watson & Kendall, 1989). Parental referral, indicating the presence of
depressed mood, has k e n the most signifiant factor in differentiating clinically referred
and nonreferred youth (Achenbach, 199 1 b, 199 Id).
Depressive svndromes. The prevailing viewpoint in Our understanding of
depression in children and adolescents suggests that depression in young people is a
fairly common mental health problem that typically displays itself along with a wide
range of other forms of psychopathology (Reynolds et al.. 1994). At this level, the terni
depression is used to refer to a syndrome that refers to a group of behaviours and
eniotions that have been found to regularly occur together in a determined pattern that are
not associated with chance. However. it cannot be inferred that a particular modei exists
for the nature or cause of these identified symptoms (Petersen et al., 1993). The
depressive syndrome has generally been recognized as consisting of not only complaints
that include both anxiety and depression, but also complaints about feelings of loneliness
and isolation: crying speils; feelings of guilt about displaying unacceptable behaviours;
feelings of a strong need to be perfect; feelings of rejection; fears of persecution and
mistreatment from others; feelings of unimportance, agitation, fear, shame, and self-
loathing (Achenbach, 199 la, 199 1 b, 199 1 c). Our understanding of these groups of
symptoms has been greatly enhanced by two foms of assessment methodologies:
adolescent self-reports and reports from parents and teachers.
Maior demessive disorder. Grounds for a depressive disorder diagnosis include
signs of a depressive disorder episode. The depressive disorder has generally been
recognized as consisting of changes in mood plus changes in at least five of nine primary
symptom clusters within a 2-week period that distinguishes a change from one's former
functioning. These five symptoms must consist of either ( I ) a depressed or irritable mood
evident for most of the day or (2) loss of interest in usual activities and a loss of pleasure
that is normally derived from performing these activities. These symptoms are essential if
the diagnosis is to be considered. The following qualifying symptoms are necessary to
characterize the existence of a depressive disorder: changes in appetite and in weight,
changes in the individual's sleep pattern, psychomotor agitation or psychomotor
retardation. fatigue or loss of energy, feelings of worthlessness or feelings of guilt,
decreased ability to think or concentrate, and recurrent thoughts of death or suicide
(Petersen et al., 1993).
Once it has been established that there is evidence for a depressive disorder, it is
essential to further mle out ( 1 ) any accompanying natural factors that may have provoked
or caused the disorder, (2) the presentation of the syndrome as a product of an
environmental factor such as the grief reaction resulting after a significant loss, (3) the
preexistence of delusions or hallucinations in the absence of mood symptoms, and (4) the
manifestation of underlying thought disorders (Poznanski & Mokros, 1994).
Once the occurrence of a major depressive episode has been established the next
step is to define the occurrence of the major depressive disorder as a single episode. This
is true if the individual's history does not reveal any indication of a prior happening. If
there is evidence of more than one episode then it is defined as recurrent (Poznanski et
al., 1994).
Dvsthvmia
While major depressive episodes characterize episodic mood disturbances,
Dysthyrnia describes a slightly milder chronic course. A dysthymic disorder is diagnosed
when an individuai has had a period of depressed or irritable mood, which is prominent
and present rnost days for a duration of at least 1-year. in addition, dysthymic disorder
requires at least two of six qualifying symptoms, which must occur in conjunction with
the essential symptom. These syn-iptoms include changes in appeti te, sleep disturbance,
reduced energy, low self-esteem, diminished ability to concentrate, and feelings of
hopelessness (Petersen et al., 1993). Further: ( 1 ) A decrease in the symptom presentation
cannot have continued for more than 2 months during the episode and there (2) cannot be
any evidence of major depression during the episode, (3) there cannot be any evidence of
a history of manic or hypomanic disorder, (4) or any indication of an underlying thought
disorder, and (5) no evidence of an organic basis for the episode can be established
(Poznanski et al., 1994).
Although the distinction between dysthymia and major depression is clearly
ambiguous in children and adolescents, Kovacs, Feinberg, Crouse-Novack, Paulauskas,
& Finkelstein (1984), has established that a distinction can indeed be made, and that it is
not unusual for children to be diagnosed with double depressions in which the occurrence
of an episode of major depression concomitantly occurs with preexistîng dysthyrnia.
Help-Seekinp Behaviour
Most individuals suffering from distress and persona1 problems do not seek help.
A large number of reasons have been noted in the clinical and theoretical Iiterature for
this reluctance. Initially, individuals may be hesitant to ask for support because their
problems are difficult to acknowledge or their existence is denied (Amato & Bradshaw,
1985). Acosta ( 1980) believes that extemal constraints may aIso p h y a role in an
individual's unwillingness to seek help. The perception of restraints such as financial
concerns. transportation, and not being able to afford the time have also been found to
prevent help-seeking. in addition, if the actual help source is perceived as being inept,
incapable of helping, or inaccessible. help-seeking is unlikely to occur (Saunders,
Resnick, Hoberman, & Blum, 1994).
Additionally, factors which are more psychological in nature have also been
suggested. Some have argued, based on the reasoning of an equity theory, that an
assumption of obligation with respect to the helper may be aversive enough in various
circumstances to delay or inhibit help-seeking (Greenberg, 1980). Other studies have also
shown that help-seeking is affected by feelings of obligation. Greenberg and Frisch
( 1972) found that feelings of indebtedness intensify as the amount of help rendered
increases. Further to this, experiments have indicated that when an individual feels that
the help received cannot be reciprocated, then help-seeking is less likely to occur (Moms
& Rosen, 1973). Also, it has also been found that individuals who regarded the cause of
the probkm to be a result of their own actions were more likely to report fear of help-
seeking. This overall framework is consistent with research that suggest sceking
professional help is a threat to self-esteem, which indicates that problems that cannot be
attributed to external factors are more likely to make the recipient appear and feel
helpless, powerless, and incornpetent (Schonert-Reichl & Muller, 1996). Other findings,
which confirm this position, suggest that individuals with more personal problems were
also more prone to be apprehensive. Consistent with this, problems that are more intimate
tend to be more centrai to an individual's self-perception, and consequently, more likely
to be ego-threatening (Amato et al., 1985). Fisher, Nadler, and Whitcher-Alagna (1982)
advanced a slightly different theoretical overview, contending that help-seeking is
ultimately threatening to the recipient's self-esteem. Consistent with this threat to self-
esteem rnodel is the fact that people have k e n found to be reluctant to seek help or
utilize heaith services based on privacy concems, distress about self-reliance, and
personal inadequacy (Newacheck, 1989). Thus, it appears that this reluctance to seek help
exemplifies rneaningful psychological obstacles, which stands between the perception of
a disturbing problem and the motive behind searching for help which might improve the
situation. It seems that the attitudes surrounding an individual's reason for k ing reluctant
to seek help are related to the overall nature of the situation, the perceived severity of the
problem, and the personality and attitude of the individual. In this context, the
characteristics and intensity of these reluctance motives influence the decision as well as
one's attitude toward or actual use of the help source (Amato et al., 1985). Brown (1982),
in his study of the social and psychological correlates of help-seeking among urban
adults, found that individuals who did not obtain help for emotional problems reported a
greater reluctance to discuss problems with others while those individuals who did obtain
help reported little difficulty discussing their problems.
Robbins and Greenley ( 1 983) propose a similar theoretical framework. They
suggest that the attribution and definition of problems are more likely to influence help-
seeking decisions. Specifically, the more the individual concludes that the problems they
are experiencing are crippling, bothersome, or threatening to his or her emotional
stabitity, the greater the proclivity towards seeking professional assistance. Also, if the
individual believes the taxonomy of their problems is a resuIt of interna1 factors as
opposed to the environment or other external factors, and if they assume that their
problems will be long-term as opposed to self-restricting and limiting, then the individual
is more inclined to self-refer. The greater the tendency to interpret one's problems as the
result of personal failure or inadequacy as opposed to king extemally attributed. the
greater the tendency of professional help-seeking. Problems feared to be of long duration
are more iike1y to influence one to search for help. Conversely, if problems are thought to
be short-lived and likely to go away by themselves, then the individuai is less likely to
search for help.
The results obtained from Robbins et al.'s (1983) study revealed that college
students who defined their personal or emotional problem as incapacitating, long-term,
and due to interna1 factors, were more likely to obtain professional help. In addition,
students who considered their problems to be frightening, interfering with their daily
activities. and emotionally threatening, were more likely to have sought professional
help. In contrast, those who perceived their problems to be less severe, restricting, or
threatening were Iess likely to obtain formal help. Further, it was also established that
students were twice as likely to seek help if they accepted persona1 responsibility for
causing their problems than if they believed their problems were caused by external
factors. A number of broad explanations for this difference have been advanced. The first
suggest that perhaps internals who believe that their own behaviour can bring about
valuable changes are more likely to view help-seeking as appropriate. A second
explanation has to do with one's level of education. Highly educated persons are inclined
to consider psychiatrists and psychologists more often than those with less education
(Robbins et al., 1983).
Bomstein, Krukonis, Manning, Mastrosimone, and Rossner (1993) put forth a
concept that, in the present context, implies a positive relationship between interpersonal
dependency and health service utilization. Specificafiy, the authors investigated the
relationship of college undergraduates' level of dependency to their decision to seek
professional help. The difference with this study is that the methodological problems that
have characterized previous studies in this area have been addressed: The participants'
level of interpersonal dependency was measured beforehand, and repeated measures of
utilization of professional services were then collected over a three-month period,
Further, monthly self-reports of health status from each participant were collected. The
authors hypothesized that dependent participants would demonstrate an overutilization of
professional services such as a greater number of visits to the college health center, to
private physicians and to hospitals than nondependent participants, after controlling for
health status.
In the research, the dependent person is described as a helpfd, insecure individual
who relies upon another for attention and affection, for protection, and emotional support,
electing to seek the opinions and direction of others rather than acting on their own ideas
and beliefs (Bornstein et al., 1993)
The resuhs of the study conducted by Bornstein et al. ( 1993) supported the
hypothesis that Ievel of interpersonal dependency predicts levels of untilization of
professional help in both men and women. The present study increases Our understanding
about mental health needs, professional help-seeking, and other elements associated with
the decision to seek help in dependent persondity types across a variety of settings such
as medical personnel, school- based sources and social support. The advantages of these
findings are twofold. First, the results suggest that dependent person's help-seeking
behaviour is manifested in many situations. Taken together, help-seeking behaviour is the
innermost feature of dependent personality types. Second, rather than fitting extant
findings, the results are not in line with previous research that suggests that dependency
is uniquely associated with negative personality traits. While the results did establish that
high levels of dependency correlated with increased use of health services, this frequency
actuaIly reveals an active rather than a passive individual taking action to ensure that their
health concems are taken care of. Given that increased dependency was associated with
high utilization of professional services in their sample of undergraduates, the current
resuIts suggest that in certain situations, interpersonai dependency can be a strength
rather than a handicap. To date, recent studies have begun to focus on the positive
qualities of dependency such as awareness of interna1 cues, cooperativeness, and a
readiness to corne to the aid of others.
These results have clear clinical implications in that it is important to understand
an individual's cause for seeking help before a medical or psychoIogical intervention
strategy is implemented. Indeed, an understanding of an individual's Ievel of dependency
may help rnedical, school personnel, psychologists, and other health care professionals to
recognise help-seeking behaviour that is based on general problems from help-seeking
that is fundarnentally based on an individual's need for guidance and nurturing. Although
this may not be feasible in every case, it does provide an overall frarnework. Other
findings revealed that women obtained significantiy higher interpersonal dependency
scores than did men. These results are consistent with the results of previous studies- One
reason for this may be that women are often more willing than men to acknowledge their
dependency needs even though their needs may be comparable (Bornstein et al., 1993).
Sex Differences and Hel~-Seekin~ Behaviour
Several speculations in the help-seeking literature are consistent wi th the findings
of Kessler. Brown, and Broman (198 1 ) who contend that women more readily than men,
tend to translate their psychological symptoms into conscious problem recognition. That
is. women seem to be more willing to translate emotionai anguish into a conscious
recognition that they have psychological problems. It is clear, however, that once
personal problems are identified, both men and women are equally likely to seek
professional help (Kessler et al., 198 1).
Some findings revealed that women generally hold a more positive attitude
toward help-seeking than do men (Paykel, 199 1 ). Others did not find a difference in help-
seeking orientation between the sexes. In a study conducted by Tijhuis, Peters, and Foets
( 1 WO), little difference in attitude and inclination toward help-seeking between the sexes
was found. Further research in this area is needed.
Developmental progressions have been conceptualized as a period in life
consisting of significant change. Adolescence is a period of social, emotional, and
psychological transition. For an adolescent not experiencing any significant hedth
problems this period of transition is typicaily stressful. For those adolescents who have or
have been diagnosed with a mental health problem, this penod of transition can be
particularly difficult. In a study conducted by Barker and Adelman (1994) they
considered the following questions: Where do young adolescent people go for help when
they experience difficulty coping with mental or psychological problems? What actually
influences their decisions to seek help? Robbins et al. (1983) suggest that generally, the
evidence indicates that adolescents tend to underutilize professional services based on
their related negative attitudes toward mental health professionals and preference for
informa1 sources of help such as family members and friends which tend to influence
their future help-seeking behaviour. Despite the obvious need for help, the utilization of
services may also be associated with the inability or unwillingness of adolescents to
identify themselves as experiencing a problem. Fears about autonomy, stigma and social
rejection may aiso be concems.
Seeking help, which is considered to be intemally caused is likely to suggest
greater personai inadequacy, hence posing a threat to self-esteem and increasing the costs
of help-seeking. This implies that people foreseeing embarrassrnent or reproach for
internally attributed problems, are particulariy guarded about the selection of an
appropriate help source.
Saunders et al. (1994) found that informai help-seeking behaviour was unrelated
to identifying a need for help, but was associated with obtaining help. Particularly,
adolescents who reported that they discussed their concems and problems with others
indicated that they would also be inclined to obtain formal help from a trained
professional. Adolescents who did not talk about their problems were less likely to seek
professionai help. However, despite this, both groups were equally likely to recognize the
need for help. One way to understand these results is to note that talking with others
encouraged the help-seeker to seek more formal and intensive medicd services by
establishing an environment where reassurance, support, and encouragement were
forthcoming.
Saunders et al. (1994) established in their study that adolescents were generally
more likely to turn to friends for specific problems such as depression and family issues.
However. they also reported that they would tum to family members for help.
Interestingly, it was further established that to whom adolescents tumed to help was not
associated with the Iikelihood of identifying the need for help, but was associated with
whether help was actually obtained. Adolescents who would go to a family member were
more likely to seek help which they believed was needed, whiie adolescents who would
not turn to a family member were the least likely to seek help. Other results found in their
study showed that those who experienced a relationship with their parents and who felt
loved and cared for by their parents and other adults were more inclined to seek help. It
seems that seeking informal support for problems is an important component of actually
obtaining forma1 help. However, there are other contributing factors that suggest that the
influence of social support is quite cornplex.
The ramifications of both intervention and prevention with respect to the help-
seeking behaviour of adolescents experiencing emotional problems are quite evident.
While only 50 percent of the adolescents who identified themselves as in need of help
actuaIIy obtained it; it is clear that educational and outreach programs designed to
facilitate the process and improve attitudes toward the use of medical services are clearly
needed. The strength behind these intervention establishments may be further facilitated
by the increased awareness of existing bamers that youth face when seeking treatment.
Prevention programs should focus not only on the advancement of resistance to the
progression of disorders or reducing behaviours that place adolescents at great risk for
such dysfunctions, but should also highlight the importance of self-awareness with regard
to clinical need and the relevance and benefit of help-seeking (Saunders et al., 1994).
Despite findings that show that adolescents experience great stress in their lives,
only recently have researchers begun to explore how adolescents cope (Srebnik, Cauce,
& Baydar, 1996; Hennan-Stahl, Stemmler, & Petersen, 1995). One area of investigation
that is receiving increased research attention is the investigation of the help-seeking
behaviours that adolescents utilize to cope with stress. anxiety and depression (Baker et
al., 1994; Dubow et al., 1990).
Compas, Malcarne, & Fondacaro (1988), has found that those who seek help and
advice from individuals in their social support network tend to be better adjusted, as this
serves as one type of problem-focused coping strategy. Certainly, a fundamental aspect
that may be important when distinguishing between those individuais who successfidly
traverse the course of childhood to adulthood versus those who do not, may be a result of
their ability to utilize varying sources of support from parental and peer relationships as
weII as school personnel, teachers, psychologists, psychiatrists and the like. The benefit
of such support has been shown to diminish the effects of stress and provide an
environment of understanding, support and concern (Cauce, Mason, Gonzales, Hiraga, &
Liu. f 994). Although earlier research has indicated that adults have more success deaiing
with stressful events when they are able to turn to farniiy and friends for advice and
guidance. scarce data exist regarding adolescents' use of support and their attitudes
towards help-seeking. As welt, tittle research has k e n conducted to understand the
underlying personality factors that may be linked to depression and seeking help during
adolescence.
Researchers have recently begun to document the help-seeking behaviours of
adolescents from individuals in their social networks (Nelson-Le Gall, 1981). While these
investigations have contributed significantly towards our understanding about the
properties and intent of adolescents' help-seeking behaviours, several issues need to be
addressed.
While previous research indicates a Iink between personality variables and social
support, relatively few studies have explored this correlation among adolescents. This
study will investigate the effects of personality variables such as perfectionism as they
are related to depression and attitudes toward help-seeking.
Research on self-worth and self-esteem in adolescents suggests that these factors
may determine the use of helping resources as well as in the preference for advice from
aduIts as opposed to their peers (DuBois, Felner, Sherman, & Bull, 1994; Wintre &
Crowley, 1993). A number of studies have suggested that an individual's sociai support
network may heighten self-esteem as well as defend against decreases in self-worth under
stressful conditions. A number of studies. regarding self-worth and social support have
indicated that children with enhanced self-worth were those who also reported having a
supportive network to turn to for help (Harter, 1989). Less obvious at this point, however,
is the association of self-worth to help-seeking. Nadler, Mayseless, Peri, & Chemerinski
( 1985) conducted a study of help-seeking behaviour involving an academic task and
found that individuals with high self-esteem were more reiuctant to seek help than those
individuals with low self-esteem. Other research conducted by Schonert-Reich1, Offer, &
Howard ( 1995), on adolescent help-seeking found that a positive self-concept was
correlated with seeking help and advice from parents, while a negative self-concept was
correlated with the utilization of support from mental health professionals.
A number of studies have suggested that self-consciousness may limit one's
ability to disclose persona1 problems in a help-seeking context. Self-consciousness is also
one mental factor that may impede or facilitate one's ability to seek help when dealing
with a crisis or a stressful event. Both those prone to socially prescribed perfectionism
and perfectionism sel f-presentation are more ii kel y to experience greater social reticence
as a fear of appearing inadequate and incompetent.
Existing beliefs and research indicate that adolescence is a highly disturbed and
tumultuous period in the life cycle which tends to be characterized by increased self-
consciousness (Saunders et al., 1994), with adolescent fernales indicating a higher level
of self-consciousness compared to their male counterparts. Currently, little data exist
investigating the relationship between self-consciousness and help-seeking behaviours
among adolescents.
Perfectionisrn
Perfectionism is a personality factor that is believed to be associated with
increased vulnerability to depression and reiated forms of dysfunction. It is a widely held
belief that the motivation for perfection is a significant influence on people's behaviour.
Typically. perfectionism is identified as the propensity to maintain and aspire to
extraordinarily high goals (Hewitt, 1989). Perfectionists frantically and obsessively strive
toward impossible goals and measure their own worth entirely in terms of productivity
and proficiency (Burns, 1980b). This type of perfectionist sets exceedingly high
standards. This is in sharp contrast to the normal pursuit of excellence where an
individual's worth is measured not by productivity, but by realistic, attainable steps
toward a desired goal.
To be perfect would require that the individud's actions be automatic and
mechanical in the absence of charm, without logic. and practically without any fulfilling
attributes (Pacht, 1984). Pacht has argued that perfection is not only an unacceptable
aspiration, but a crippling one as well. In reality the final goal of perfection is
nonexistent, but it is the striving toward this impossible goal that creates an environment
of discontent and turrnoil and is identified with a number of psychological and medical
complaints.
Most previous research is limited because perfectionism was considered to be a
unidimensional cognitive constmct (Burns, 1983). That is, perfectionism has been
conceptualized and evaluated as if it is a unidimensional personality trait with a belief
system based entirely on high personal standards. But current evidence suggests that the
perfectionism constmct should be viewed from a multidimensional perspective, which
has both personai and social aspects (Frost, Marten, Lahart. & Rosenblate, 1990b; Hewitt
et al., 1991 b).
Trait Dimensions of Perfectionism
The persona1 aspects of perfectionism have been identified as self-oriented
perfectionism (Hewitt & Flett, 1990, 199 1 b), which tdvpically has an intrapersonal
dimension. Self-oriented perfectionism is distinguished by a strong motivation to be
perfect, obsessive striving, a proclivity to engage in all-or-none thinking whereby only
total success or total failure exist as a final outcome, and generalization of idealistic self-
standards across behavioural domains. The self-oriented perfectionist establishes and
maintains unrealistic self-standards and focuses on his or her own imperfections and
failures. These characteristics reportedl y contribute to a depressive-prone personaiity by
heightening faiIure and influencing information processing associated with the inability
to achieve standads (e-g., Burns & Beck, 1978; Hewitt & Genest, 1990). Both cognitive
and self-control theorists (e.g., Beck, 1967; Kanfer & Hagerrnan, 198 1 ) believe that the
joint tendency to expect perfection from oneself and the motivation tc attain unrealistic
standards creates a susceptibility to depression by exposing failures, increasing self-
punitive behaviours and decreasing contentment and self-reinforcement (Hewitt et al.,
1993a).
While most believe that punitive self-standards are the foundational Iink between
self-oriented perfectionism and depression, socially prescribed perfectionism, it is held,
renders a person prone to depression because it involves the perceptions of one's inability
to fulfil the ideals and expectations of significant others. This theory assumes that others
have unrealistic principles and perfectionistic motives for personal behaviours and that
others will be pleased only when these standards are attained. This perfectionism
dimension involves numerous social interaction variables such as fear of negative social
evaluation, belief of external control of reinforcement, and a strong need for the approval
of others (Hewitt e t al., 199 1 b). Although it is believed that the standards in socially
prescribed perfectionism originate outside the self, it should be emphasized that
attributing control to external forces can result in depressive symptoms of self-blame
(Kranz & Rude, 1984). Interpersonal sensitivity in socially prescribed perfectionists, may
stem from a perceived inability to meet the imposed standards (Flett, Hewitt, Blankstein,
& Pickering, in press) and may be further intensified by the individual's need t o gain
approval from others and his or her sensitivity to criticism.
Other-oriented perfectionism (this dimension is not assessed in this study) is
identified with an unrealistic expectation of others. Other-oriented perfectionists are
prone to be extremely critical of others, dominating and unyielding. Consequently, this
dimension should be unrelated to depression because it involves an external focus on
other individuals' shortcomings rather than shortcomings of the self. However, it may
have secondary implications in that it can cause distress by creating difficult relationships
(Hewitt et al., 199 1 b).
Dimensions of Perfectionism Self-Presentation
In addition to the characteristic dimensions of perfectionism, Hewitt, Flett, and
Fairlie (1994) have also provided a framework for social facets of perfectionism, which
involve self-presentational styles that include a striving to create an image of flawlessness
to others. Research on the development of the Perfectionism Self-Presentation Scale
(PSPS; Hewitt et al., 1994) has shown that individual differences in perfectionism self-
presentarion can be measured and that the dimension encompasses three major
components: the need to appear perfect, the need to avoid appearing imperfect, and the
need to avoid disclosure of imperfection (Hewitt, Flett, & Ediger, 1995).
Al though researc h tends to indicate that the perfectionisrn sel f-presentation
dimensions are intercorrelated. there are some important conceptual and empirical
distinctions among the dimensions. One element of perfectionism self-presentation (i-e.,
the need to appear perfect) involves claiming a desired identity, while two elements of
perfectionism self-presentation (i-e., avoiding the appearance of imperfection and the
nondisclosure of imperfection) involve avoiding and undesired identity. A further
distinction involves the nondisclosure of imperfection dimension, which is more directly
associated with interpersonal communication than the other two perfectionistic
dimensions.
Work on the Perfectionism Self-Presentation Scale (PSPS) is stil1 in its
preliminary stages. However, initiai evidence supports the usefulness of this measure
when administered to a variety of sarnples. For instance, Hewitt et al., (1994)
administered the PSPS, the Multidimensional Perfectionism Scale and various measures
of self-esteem, depression, and anxiety to a sample of 169 undergraduates from York
University. Correlational analyses showed that the PSPS dimensions assessing the
avoidance of imperfection and the nondisclosure of imperfection were associated broadly
with the indices of depression, anxiety, and low self-esteem, and there were fewer
significant associations involving the need to appear perfect. In addition, regression
analyses were conducted to test whether the PSPS predicted unique variance in measures
of maladjustment, over and above the predictiveness of trait MPS dimensions. The
pattern of results indicated that the PSPS dimensions did indeed predict significant levels
of unique variance in distress scores, over and above the MPS. These data illustrate the
need to consider both trait dimensions and elements of PSP when seeking to predict
levels of psychological distress in university students.
The prirnary focus of Hewitt, Flett and Ediger's (1995) study was to assess the
relationship between personal, social, and self-presentational dimensions of perfectionisrn
and eating disorder behaviours in a sample of female coIlege students. A secondary
interest was to rneasure other characteristics associated with eating disordered behaviour,
namely body image avoidance, and global self-esteem. The results of the study indicated
that self-oriented perfectionism was related specifically to eirtreme loss of appetite and
aversion to food. Essentially, this dimension was concemed only with restricting food
intake and with being slender and lithe and did not seem to be involved in other aspects
of eating disordered behaviour. Social dimensions of perfectionism, however, were
related more to eating disorder behaviours as well as self-esteem issues.
Hewitt et al. (1995) also revealed that some perfectionistic striving seen in eating
disordered behaviour involved the strong need to accede to an archetype or mode1 of
perfection that was perceived as a demand by others. This suggests that the primary drive
behind this perception is that in order to be acceptable to others one must meet their
perceived perfectionistic requirements.
Another finding, aibeit unexpected. was a positive relationship between other-
oriented perfectionism and increased body image avoidance. One explanation for this
finding may be that, in a nonclinical sample, a preoccupation with body image avoidance
may be much the same as needing others to be perfect (Hewitt et al., 1995).
The findings of the study also suggest that two major components of the construct
perfectionism self-presentation: the need to appear perfect and the need to avoid
appearing imperfect were related to both anorexic and bulirnic tendencies and to a
preoccupation with public appraisal and responses to one's appearance. Taken together, it
seems that the social aspects of perfectionism are uniquely related to appearance and
global self-esteem. Overall, the findings speak to the relevance of identifying the
different dimensions of perfectionism as they relate to the various symptoms and
characteristics of eating disorders (Hewitt et al., 1995).
A recent study by Habke, Hewitt. & Flett (1999) examined the extent to which the
dimensions assessed by the perfectionism self-presentation scale are associated with
marital difficulties, especially in the form of sexual problems. A sampie of 74 married or
CO-habiting couples completed measures of trait perfectionism, perfectionism self-
presentation, depression, dyadic adjustment, and sexual satisfaction. Correlational
analyses confirmed the presence of a general association between perfectionism self-
presentation and problems in sexual satisfaction. Stronger findings where obtained for
women than men; perfectionism self-presentation in women was associated with self-
reports of low satisfaction with there partners.
However, research has not investigated perfectionism self-presentation in
adolescents. For instance, the association between perfectionism self-presentation and
psychological distress in adolescents has not been exarnined. Moreover, there are no data
available regarding adolescent's heip-seeking attitudes as they relate to the three
dimensions of perfectionism self-presentation. When exarnining the different dimensions
of perfectionism, the perfectionism self-presentation type variables would seem to be the
most relevant if the focus is on help-seeking attitudes. Clearly, when conducting a study
on help-seeking attitudes it would be very important CO have perfectionism self-
presentation dimensions included over and above socially prescribed perfectionism.
Perfectionism and Depression
Perfectionisrn and ûe~ression in Adults
The research literature on perfectionism has evolved significantly in the last 10
years. As previously stated, numerous empirical investigations using developed scales,
have provided convincing evidence that perfectionism is a multidimensional construct
that seems to play an important role in adaptive and maladaptive functioning, including a
broad range of disorders such as depression and suicide (Blatt, 1995). Based on the
findings that socially prescribed perfectionism is the belief that others have unrealistic
and exaggerated expectations that are difficult, if not impossible, to meet, and in order to
receive their approval and acceptance the individual must meet these standards (Frost et
al.. 1990b; Hewitt et al., 199 1 a, 199 1 b), it has been revealed that these unrealistic
standards are experienced as externali y imposed and uncontrollable. As a result, these
individuais often have feelings of failure, apprehension. anger, powerlessness, and
pessimism and these feelings are often associated with depression and suicida1 thoughts.
Al though sel f-oriented perfection ism interacts primaril y wi th achievement stressors to
predict depression, socially prescribed perfectionism interacts with both interpersonal and
achievement stress to predict depression (Hewitt & Flett, 1993b). Self-oriented and
socially prescribed perfectionism define the intrapersonal and interpersonal dimensions
of perfectionism (Flett, Hewitt, Blankstein, & O'Brien. 199 1 a), both of which are related
to mental stress and anxiety.
Hamachek ( 1978) suggested that neurotic perfectionism, one who is extremely
preoccupied with making mistakes and is fearfùl of negative judgements from othen,
may be the result of an unhappy childhood with rejecting or inconsistently accepting
parents whose admiration and praise was consistently dependent on the child's
performance. Parents with perfectionistic standards are extremely criticai, unyieiding, and
usually less understanding (Hamacheck, 1978). Perfectionistic parents are not only
indifferent about their own achievements, but also find it difficult to acknowledge and
recognize the efforts of their children. These parents rarely approve and appreciate their
children's accomplishments; they constantly push them to do better. As a result, the child
never feels fulfilled because his or her behaviour is never quite good enough to meet
parental standards and expectations (Missildine, 1963). Further, perfectionistic parents
tend to impan disapproval in more indirect ways by continually suggesting that they are
dissatisfied, but will be satisfied when the chi Id's performance irnproves. Consequentl y,
these children, similar to their parents. never recognize their own triumphs and come to
feel that they have never completely realised their parent's expectations (Missildine,
1963). Research indicates that perfectionistic parents use detachment and disapproval as
retribution, and their children come to react to mistakes with frustration, dread, and
apprehension. They view mistakes and failure as something that must be avoided. Once
established, this form of self-measure can become self-perpetuating and foster extreme
pressures for perfectionisrn (Burns 1 %Oa, 1 %Ob).
In summary, on the bais of these findings, perfectionistic individuals experience
depression that is primarily focused on issues of self-importance and self-disapproval;
they reprove, evaluate, and criticize themselves and have feelings of extreme regret,
humiliation, failure, and unimportance. They are highly motivated by the danger of
faiIing in order to meet severe and harshly voiced parental expectations and desires.
Research conducted by Blatt ( 1974) found that generally, children tend to believe that
their parent's praise was conditional upon meeting their strict and unreasonable standards,
and lived in fear of losing their parents' love and admiration. Consequently, their self-
crïticism appears to be a facsimile of their relationship with their parents, who intensely
watch their behaviour and strive to prevent their attempts at individuation and self-
growth. As a result, their profound self-loathing and need for perfection seem to emerge
from a relationship with parents who were invading, restricting and austere (McCranie et
al., 1984).
As compared to cl inical observations, recent longitudinal research i ndicates that
an individuai's recolIections about his or her parents, and correlational analyses or
Iongitudinal anecdotal reports and correlational findings reveal important causal links. It
seems that most of the formulations about the correlation of parental behaviour to the
development of perfectionism in children have been based on the former method which
limits the conclusions about a possible causal relationship between early childhood
experiences and the resulting development of perfectionism (Lewinsohn & Rosenbaum,
1987). Longitudinal studies demonstrate that parents that are controlling and rejecting
duri ng earl y childhood before the age of 8 is predictive of the child's level of self-
criticism in early adolescence (ages 12- 13) and of the level of depression when the child
reaches late adolescent and young adulthood (Koestner, Zuroff, & Powers, 1991 1. Also,
the level of self-criticism in early adolescence is predictive of lower education, lower
socio-economic occupational status, and a higher occurrence of maladjustment,
depression. discontent with farnily, penonal relationships and employment in later
adui thood (Zuroff, Koestner, & Powers, 1994). Consequently, perfectionistic individuals,
who are highly self-critical, intensely scrutinize and judge themselves in the same strict
punitive manner. as they believe that their parents have judged them. They constantly
strive to meet the harsh parental standards and also identify with them. They direct these
attitudes toward themselves so that whatever they achieve is never fully enjoyed or
acknowledged (Meissner, 1986).
On the basis of these developmental and clinical findings, certain perfectionism
dimensions may be associated with adaptive forms of coping, whereas other dimensions
may be associated with maladaptive forms of coping. Several studies have shown for
example, that self-oriented and other-oriented perfectionism were both related to a
positive problem-solving orientation. In contrat, socially prescribed perfectionism was
related to a negative problem-solving orientation. Specifically, Flett, Hewitt, Blankstein,
& Van Brunschot. (199 1 b) administered the Social Problem-Solving Inventory (D'Zurilla
& Nezu, 1990) and the Multidimensional Perfectionism Scale (MPS; Hewitt et al.,
199 1 b) to a sample of college students. Based on their findings, Flett et al. ( 199 1 b)
concluded that important causal links between socially prescribed perfectionism and a
negative problem-solving orientation may be due, in part, to feelings of unimportance and
learned helplessness that accompany the belief that others are setting and imposing very
high standards for them.
Similarly, in a related study, Flett et aI. (199 la) administered the MPS and the
Self-Control Schedule (SCS; Rosenbaum, 1980), a measure of learned resourcefulness or
coping ability, and measures of depression and self-esteem to another sample of students.
The research results showed that both self-oriented perfectionism and other-oriented
perfectionism were associated with greater forms of learned resourcefulness. This study
in particular showed no significant correlation between learned resourcefulness and
socially prescribed perfectionism, although learned resourcefulness was controlled by a
positive association between socially prescribed perfectionism and depression. Those
who reported experiencing the greatest depression were socially prescribed perfectionists
and those individuals with counteractive and low defenses.
Research findings, which examined the possibility of depression as a joint
function between levels of perfectionism and coping styles, indicated that self-oriented
perfectionism and emotion-oriented coping, combined to produce greater levels of
depressive symptomatology. That is, the association between emotion-oriented coping
and depression was greater for those individuals who tend to be perfectionistic and highly
self-critical in terms of their own goals and aspirations (Hewitt, Fiett, & Endler, 1995).
This finding was important for two reasons. First, it provided an expianation as to
why, in some studies, self-oriented perfectionism is associated as a main effect with
depression. (e.g., Hewitt et al., 1991b) and in other studies it is not (e.g., Fiett et al.,
199 1 a). It seems that self-oriented perfectionism and depression will be related to the
degree that perfectionists react to failure and stress by reflecting on their negative
ernotional States. Second, this finding is important because it further supports the need for
the examination of possible personality moderators and the association between coping
and depression. The interaction revealed in this study gives support to the outlook of self-
regdation models predicting the 1 ikelihood of more depression experienced by an
i ndividual c haracterized by simul taneousl y high personal standards and a maladaptive
fom of coping such as projection and wish fulfilment. The current findings add to a
growing number of studies that indicate the need for the opportunity to explore factors
that may be related to high levels of personal standards or feelings of imposed standards
to increase depression (Flett et al., 199 1 a, Hewitt & Dyck, 1986; Hewitt et al., 1993a;
Hewitt et al.. 1990).
In summary, research findings indicate that self-oriented perfectionism is relevant
to the study of coping for several reasons. As previously mentioned. self-oriented
perfectionism was identified with emotion-oriented coping. Second, sel f-oriented
perfectionism was a personality factor that has an intense investment in issues of self-
definition and self-worth, which is related to a certain amount of stress or failure because
these individuals have exceedingly high standards. Accordingly, self-oriented
perfectionism may be a stress-promoting factor that heightens the importance of effective
coping defences.
Past research has shown that socially prescribed perfectionists often have feelings
of failure, powerlessness, and pessimism and these feelings are often associated with
depression and suicida1 thoughts. As mentioned previousiy, research has also shown that
while sel f-oriented perfectionism interacis mainly with achievement stressors to predict
depression. socially prescribed perfectionism interacts with both interpersonal and
achievement stress to predict depression (Hewitt et al., 1993).
Consistent with past findings Fiett et al., ( 1991a) found that sociaily prescribed
perfectionism was the perfectionism dimension most strongly associated with depression
in college students. More precisely, students that had the belief that others upheld
perfectionistic expectations of them were strongly prone to increased severity of
depression. As expected, results were largely supportive of theoretical predictions with
self-esteem as the adjustment measure. It was found that higher levels of socially
prescri bed perfectionism were signi ficantl y associated with decreased sel f-esteem (Flett
et al.. 199 1 a).
The analyses aIso reveaied that the interaction of social1 y prescribed
perfectionism and self-control accounted for a significant amount of the variance in
depression and self-esteem scores, with greater socially prescribed perfectionism and
reduced self-control k ing more strongl y related to poorer adjustment. In addition,
consistent with expectations, it was found that the two main effects of self-control and
socially prescribed perfectionism interacted to account for a unique variance in
depression scores, such that socially prescribed perfectionistic individuals reported
significantly greater levels of depression but reported lower levels of learned
resourcefulness. These findings are interesting because of their implications. Once it is
perceived that externally imposed perfectionistic social standards exist, individuals who
possess and initiate effective instrumental coping strategies will respond in a relatively
adaptive rnanner to stressful life events. In contrast, individuals reporting significant
levels of depression are those who believe that external perfectionistic standards exist but
lack a basic adaptive response style, either in terms of responding to or controlling for
negative life events, behaviours or cognitions (Flett et al., 199 la).
The current study extends the literature by examining the link between
perfectionism self-presentation and depression, which has not been evident. The work of
Hewitt et ai. ( 1995) has established a link between a perfectionistic style of self-
presentation and low self-esteem. The authors (Hewitt et al., I993b) believe that the
endless need to appear accomplished is an attempt to offset their feelings of low self-
esteem. Others have suggested that low self-esteem involves self-presentation based
partially on a need to avoid attracting attention to oneself (Baumeister. Tice, & Hutton,
1989). Essentially, it seems that social aspects of perfectionism self-presentation are
uniquely associated with outward appearance and general self-esteem. As extreme
standards and self-appraisals are unrealistic, perceived failures and a poor self-concept
are common among these individuals (Hewitt et al.. I99l b). These individuals have a
marked aversion to public scrutiny. Their strong need to avoid exposure of their flaws
and inadequacies may characterize their efforts to escape from constant rerninders of
persona1 faiiures as well as to avoid private and public admission of their inability to
meet expectations of perfection (Hewitt et al., 1995). One of the primary goals of this
study is to test whether experiences of depression are evident among individuals high on
this dimension.
Perfectionism and De~ression in Adolescents
There is growing literature on suicide and suicide atternpts in adolescents
(Holinger & Offer, 198 1). Some authors believe that suicide among adolescents has
increased to epidemic proportions (Woznica et al., 1990). It has been suggested that
suicide among adolescents has tripled in recent years. This increase in suicide has given
rise to the need to further understand the nature and manifestations of the risk factors
involved (Hewitt et al., 1997). While there have been rnany trait related investigations of
adolescent suicide, there has been far less theoretical focus on intrapersonal and cognitive
factors. Goldsmith et al., (1990) have identified adolescence as an especially important
period of development for understanding perfectionistic behaviour and increased suicidal
behaviour.
A number of studies have provided evidence that two dimensions of
perfectionism are closely related to youth suicide. These dimensions involve self-
imposed expectations of perfection (Delisle, 1990) and socially imposed expectations
which involve the perception that others are impressing perfection on oneself
(Baumeister, 1990).
The work of Hewitt et al. (1997) has established that there is an association
between levek of perfectionism dimensions and suicide ideation in an adolescent
psychiatrie sample. A positive relationship between socially prescribed perfectionism and
higher ievels of suicide ideation in adolescents was established. Indeed, sociaily
prescribed perfectionism may be especially relevant in adolescent suicide ideation, in that
it may be a function of the preoçcupation many adolescents have with an increased
identification with peers and acceptance, as well as fears of public failure (Hewitt et al.,
1 997).
Taken together, these findings have obvious clinical implications. For example,
the importance of assessing perfectionistic behaviour has been emphasized when
considering suicide risk, given the current thinking that suggest social dimensions of
perfectionism may be the most important to assess (Maltsberger, 1986). Second, Hewitt
et al. (1993a) have argueci that perfectionists are more inclined to interpret events as
failures. Consequently, it is important to assess how individuals perceive and ascribe
existent stressors and life events. Third. the authors have begun developing a treatment
approach for the various aspects and consequences of perfectionism, and this treatment
may be significant in reducing suicide threats by adolescents (Hewitt et al., 1997).
The work of sorne researchers has attempted to develop distinguishing
characteristics between depression and anxiety based on their fundamental cognitive
structures. Consistent with this notion, self-discrepancy ttieory has proven to be an
essential theoretical framework (Higgins. 1987).
Research in the development of the self-discrepancy theory has established that
specific types of self-standards are invariably associated with obvious foms of emotional
distress, particularly depression and anxiety. The theory encompasses three integral parts
of the self that effect a person's emotional experience: the actual self (the belief system
one holds of the attributes he or she actually believes to currently possess), the ideal self
(the belief system one holds of the attributes that he or she would ideally like to possess),
and the ought self (the belief system one holds of the attributes that he or she ought to
process: Hankin et al., 1997). Wylie (1979) explains that the ideal and ought selves are
thought of as self-guides, whereas the actual self represents our understanding of the
terrn, sel f-concept.
Essentially, the self-discrepancy model posits that an individual's vulnerability
and increased negative emotion such as feelings of depression and anxiety result as
discrepancies emerge between the actual self and the self-guides (i.e., the ideal and ought
selves). Increased negative emotions emerge when a greater discrepancy between the
actual self and self-guides exist (Hankin et al., 1997).
The same theoretical frarnework as proposed by the self-discrepancy theory has
been put forth by Hewitt e t al. ( 199 1 a, 199 1 b). Their mode1 of perfectionism also
suggests a relationship between a person's vulnerability to experience negative emotions
and particular types of high standards. The sirnilarity continues in that self-oriented
perfectionism appears to be related to ideal self-guides, as this dimension involves the
setting and maintaining of high standards for the self. Hence, those who demand
perfection may experience more events as stressful, because of an uncompromising
standard for success that permits only absolute success o r complete failure as outcornes
(Han kin et al.. 1997). Likewise, socialIy prescribed perfectionism appears to have the
same properties as the ought self. as this construct involves how they perceive themselves
from the standpoint of others. Both actual self and ought self discrepancies and socially
prescribed perfectionism entai1 a form of social failure were one has not met the
standards and expectations of others, and this results in high Ievels of stress (Hankin et
al.. 1997).
Taken together, given the overall similarity between the two constructs of
perfectionism and self-discrepancy theory, one might correctly predict that self-oriented
perfectionism would be associated with higher levels of depressive symptoms, while
socially prescribed perfectionism would reveal a higher evidence of anxious syrnptoms
(Hankin et al., 1997).
The findings of Hankin et al. ( 1997) support this general hypothesis that extreme
self-standards are uniquely associated with particular kinds of emotional distress during
adolescence. Specifically, ideal standards were related to depressive moods and
symptoms, and not to overall negative emotional States. Further, actual self and ought self
discrepancies were significant predictors of anxious symptoms, as opposed to general
dysphoric ernotion, whereas socially prescribed perfectionism seemed to be associated
with various types of maladjustment (Hewitt et al., 199 la) rather than to any specific type
of distress. However, self-oriented perfectionism and depression were not linked in this
sample. These results were not consistent with previous findings with adult samples
(Hewitt et al., 199 la, i 99 1 b) where self-oriented perfectionism was correlated positively
with depressive symptoms. As noted above, the Hankin et al. (1997) study suggests that
socially prescribed perfectionism is a better predictor of depression in adolescents than is
self-oriented perfectionism. This conclusion is also supported by the results of a recent
study conducted by Boergers, Spirito, & Donaldson (1998) who investigated suicidal
tendencies in a sample of 120 adolescent suicide attempters. The participants in this
research completed a battery of measures that included the Child-Adolescent
Perfectionism Scale, and scales assessing hopelessness, depression, motivation for self-
harm, and family functioning. Correlational analyses showed that socially prescribed
perfectionism but not self-oriented perfectionism was associated with suicidal tendencies.
Moreover, a discriminant function analysis found that depression and socially prescribed
perfectionism were robust predictors that were associated with the adolescents' stated
desire to die. These data combine with the findings reported by Hankin et al. ( 1997) to
suggest that socially prescribed perfectionism is a more relevant predictor than self-
oriented perfectionism.
Perfectionism and Helo-Seekine Behaviour
Although help-seeking attitudes for mental distress has not yet been studied in
adolescents, there are two studies (Onwuegbuzie & Daley, 1999; Frost Trepanier, Brown,
Heimberg, Juster, Makris, & Leung, 1997) that indirectly suggest that perfectionism
should have a negative orientation towards help-seeking. Specifically, Onwuegbuzie et
ai. ( 1999) found that socially prescribed perfectionism was associated with a fear of
asking for help. They investigated perfectionism and statistic anxiety in graduate
students. Results revealed that socially prescribed perfectionism was correlated with
higher statistic anxiety and a greater feu of asking for help. What this suggests, is that
similar tendencies may be associated with this construct and fear of asking for help in a
therapeutic context. Essentiall y, although in a very di fferent context, one could
hypothesize that this dimension would be related to a negative help-seeking attitude,
given that it was associated with fear of asking for help in a graduate-level research - methodology course.
To date, there has been little research on perfectionism and trait self-concealment
using the self-conceaiment scale. However, Frost et al. (1997) in a daily monitoring study
found that perfectionists who had a high concern over mistakes reported a greater desire
to keep their mistakes a secret from other people. Suggesting that if you look at trait
measures the more defensive forms of perfectionisrn, like socially prescribed
perfectionism or perfectionism self-presentation, they would be associated with trait
levels of self-concealment.
Self-Concealment
In this study, to investigate the impact of self-concealment and help seeking in
adolescents, students were asked both to indicate their willingness to seek help for
psychological problems and whether they had self-concealed It was hypothesized that
socially prescribed perfectionism and perfectionism self-presentation would be associated
with high self-concealment and negative attitudes toward help-seeking.
Larson and Chastain ( 1 990) suggest that sel f-concealment is a widespread inner
personal experience. Self-concealment is defined as a predisposition to actively hide
distressing and potentially painful intimate information. Work in this specific area has
caused the need to distinguish between self-disclosure and self-concealment. Borrowing
from Larson et al. self-disclosure is described as the act of revealing personal information
to others and self-concealment, as outlined above, is described as the act of concealing
personal information from others. Differentiating between these two concepts is thought
to be an important conceptual and research issue. Some researchers argue that self-
concealment and self-disclosure are two distinct. yet related constructs. One possible
relationship is that they share an inverse association. Essentially, high self-concealing
individuals do not disclose and Iow-disclosing individuals do not self-conceal.
Nonetheless, it is hoped that the self-concealment Iiterature will help to further extend the
lines within the sel f-disclosure research tradition.
Most people have negative thoughts and self-information that they have not
shared with others. This intimate and private information can include highly sensitive and
traumatic experiences or simple everyday embarrassments. These factors may shape and
influence an individual's propensity to share these secrets, which may be told to a select
few or to no one at d l . Clinical observation, practice, and research indicate that some
individuals are more inciined to self-conceal than others, and the inability or reluctance to
discuss major concems with others is attributed to circumstance or individual differences
(Larson et al., 1990). By not confiding and discussing personal problems, especially those
threatening to self-esteem, high self-concealing individuals are denied the health benefits
of a social support network. The psychological and physical health significance of self-
concealment has been further underscored by recent evidence that not expressing and
revealing traumatic events leads to long-terrn negative effects. For instance, one example,
is that self-concealment has been found to be positively correlated with symptoms of
depression (Kelly and Achter, 1995).
Kelly et al. found that high levels of self-concealment was associated with less
favorable attitudes towards psychotherapy but that both favorable attitudes toward
psychotherapy and high levels of self-concealment were a greater predictor of perceived
likelihood of seeking help. Also, high self-concealers were more IikeIy to have sought
counselling as compared to low self-concealers. These authors further hypothesized that
seIf-concealers' negative attitudes toward psychotherapy could be attributed to their
intense fear of having to reveal their most private thoughts, emotions, and behaviours to a
therapist. They speculated that despite high self-concealers' apprehension towards
psychotherapy, they were more Iikely to actively seek professional help due to their
limited access to a socid support network. The authors also hypothesized that self-
concealment would better predict intentions to seek professional help than would
depression. Conversely, some chaiienged this proposal with findings showing that high
self-concealers were three times more likely than low self-concealers to report needing,
but not seeking professional help. Further, it was found that self-concealment actually
attenuated the advantageous effect of low social support on perceived likelihood of
service utilization. AIso, it was reveaied that self-concealment was not a better predictor
of the intentions of seeking help than was depression. In fact, data suggested that types of
distress experienced was a better predictor of the intentions to seek-help depending on the
nature of problems help was sought for (Cepeda-Benito & Short, 1998; Cohen & Wills,
1985, Cohen & Hoberman, 1983).
In this context, understanding this construct is highiy relevant for counselIors,
because the core of psychotherapy often involves the client's revelation of their most
traumatic and private experiences. Chicians have long beheld this construct as
extrerneiy important in the etiology and treatrnent of mental disorders.
Adolescents who sought help from professionals reported having lower feelings
of self-worth while those adolescents who did not seek help from professionals did not
make such a claim. Schonert-Reichl et al. (1996) suggest that perhaps adolescents who
possess an overall healthy sense of self-worth do not feel the need to seek the help of a
professional because of their prevailing sense of self-assurance and confidence. It may be
that seeking the help of a professional is seen as a threat to the individual's self-esteem. A
number of studies have provided evidence that individuais in need of help are often
reluctant to use the available resources because it represents an open acknowledgement of
failure (Nadler. Fisher, DePauIo, 1983). Similarly. Schonert-Reichl et al. (1996) found
that adolescents who do not utilize the services offered by professionals were more self-
conscious than adolescents who were users of professional services. It seems that the
need for ptivacy is an important aspect for adolescents. Research indicates that an
adolescents' reports of perceived obstacles to seeking help include: concems that family
and ftiends may find out and the belief that their problem was too intimate to discuss with
anyone (Dubow, Lovko, Kausch, 1990). it is clear that these findings suggest that self-
consciousness plays a compromising role in the utilization of help-seeking from mental
heai th professionals.
Summary of Goals and Main Hypotheses
4t present, there are a number of issues involving depression and help-seeking in
adolescents that still need to be addressed. The present study sought to determine the
extent to which personality variables such as perfectionism, seIf-criticism, dependency.
and self-concealment related to depressive symptoms and help-seeking attitudes in
female and male adolescents.
The first goal of this study was to assess overall levels of depressive symptoms
and overall help-seeking attitudes in adolescents. Consistent with other recent studies of
adolescents (Garland & Zigler, 1994; Allgood-Merten et al., t 990) it was expected that
overall levels of psychological distress would be relatively high in this sample.
The second goal of this study was to examine the extent to which the various
dimensions of trait perfectionism and perfectionism self-presentation are associated with
depression. Regarding the trait dimensions of perfectionism (i.e., self-orïented and
socially prescribed perfectionism) it was hypothesized that sociaily prescribed
perfectionism would be the dimension more closely linked with depression. This would
be in keeping with the findings reported by Hewitt et al. (1997) and by Boergers et al.
( 19%). One explanation for socially prescribed perfectionism k i n g linked more strongly
with adolescent depression involves the heightened concems that many adolescents
struggie with, d o n g with their excessive concerns with socid approval, acceptance, and
public failure (see Hewitt et al., 1997).
A related hypothesis was that perfectionism self-presentation would aiso be
associated with eIevated levels of depression among female and male adolescents.
Although this issue has not been investigated directly in an adolescent sample, a link
between perfectionism self-presentation and depression would be consistent with the
findings of research with university students which suggest that perfectionism self-
presentation is associated with psychological distress (see Hewitt et al., 1995).
Another purpose of this research is to examine the extent to which the constmcts
of dependency and self-criticism are associated with depression in adolescents. Past
research testing Blatt's model of depression has tended to show that both self-criticism
and dependency are associated with depression in adolescents (e.g., Fichman, Koestner,
& Zuroff, 1994), with self-criticism k i n g the more robust predictor. Similady, it was
hypothesized in the current research that self-criticism and dependency would be
correiated with depression in female and male adolescents.
Another prediction was that self-concealment would be correlated significantly
with depression in adolescents. Larson et al. (1990) confirmed that self-concealment in
university students was associated with increased depression, higher anxiety, and health
problems. A high level of self-concealment reflects a defensive orientation toward the
self and deficits in self-esteem which may be expressed in the fonn of depressive
symptoms.
Although the main focus of the current work is on the link between personality
factors and maladjustment, it is important to note that the current study also provides an
opportunity to examine the correlations arnong the personality variables. Several
associations were expected to be present. For instance, in terms of perfectionism, it was
anticipated that trait components of perfectionism would be associated with self-
criticism. Blatt (1995) has posited that there is a iink between perfectionism and self-
criticism in adults, so it is quite possible that socially prescribed perfectionism and self-
oriented perfectionism are associated with self-criticism in the current sample. Given that
perfectionism self-presentation and self-concealment both focus on not displaying or
revealing negative aspects of the self, it was aiso expected that self-concealment would
be associated with the various dimensions of perfectionism self-presentation.
The next series of hypotheses focuses on the correlates of help-seeking attitudes.
The first main hypothesis was that socially prescribed perfectionism and perfectionism
self-presentation would be associated with negative help-seeking attitudes, with
perfectionism sel f-presentation suggested as the best predictor of a negative attitude
toward help-seeking. Given what we know about the construct of perfectionism setf-
presentation, it was predicted that the nondisclosure factor should be the one that is most
relevant since the act of help-seeking would entail communication and disclosing of
one's shortcomings.
A second issue addressed in the present investigation concerned the relationship
between dependency and help-seeking behaviours. It was predicted that dependency
would be linked with positive help-seeking attitudes. Research on this interpersonal
inclination revealed that dependency predicted higher hedth service utilization in both
male and females (Bomstein et al., 1993). They also found that there is clear and
consistent evidence that help-seeking represents the essence of interpersonal dependency
(Bomstein et ai., 1993).
A third issue also addressed in this investigation concerns the examination of
depression and i ts link to negative help-seeking attitudes. It is predicted that depressed
adolescents are more likely to have negative attitudes toward seeking help. Garland et al.
( 1994) reported that mental health services are drasticalIy underutilized by children and
adolescents. One possible explanation put forth for this underutilization was that
generally. young people in need of psychological support have negative attitudes toward
seeking help. The central focus of Garland et al.3 (1994) study was based on an
underlying question as to how likely was a depressed individual, when confronted with a
stressful event, prepared to avail themselves of opportunities to seek help? The
characteristics of depression --- feelings of helplessness, hopelessness, and indifference
suggest that a depressed individual would be Iess likely to take the initiative towards
getting help. As expected, the findings spoke to the importance of identifying those who
reported more depressive symptoms and demonstrated depressive characteristics, as they
were more likely to have negative attitudes about seeking help (Garland et al., 1994).
The final set of issues tested in this research focused on whether the perfectionism
trait and self-presentation dimensions were unique predictors of levels of depression,
63
help-seeking attitudes, and self-concealment, over and above other personaii ty factors.
The issue is tested in a series of hierarchicai regression analyses. The main hypothesis
was that perfectionism self-presentation would prove to be a unique predictor of negative
help-seeking attitudes because of the presumed relevance of the unwillingness to disclose
personal imperfections in the help-seeking process.
Method
The participants in the present study were adolescents in grades 10 through 13 (5 1
males and 8 1 females) at three schools in the Toronto Catholic District School Board.
Participants' ages ranged from 15.0 years to 20.0 years, with a mcan age of 18.0 years.
The participants were individuaily tested. Of this sarnple, specifically for males, 0.76%
were 20 years old, 12.9% were 19 years old, 18.2% were 18 years old, and 6.8% were 17
years old. For females, 0.76% were 20 years old, 17.4% were 19 years old, 28% were 18
years old. 9.8% were 17 years old, 1.5% were 16 years old, and 3.9% were 15 years old.
Questionnaires were administered in the same order to al1 students. A letter describing the
study and informing parents of the persona1 and social benefits of participation were
given to al1 students (Appendix A). S~dents became participants in the study through
parental (Appendix B) and student consent procedures (Appendix C).
Procedure
After students had been recruited, informed consent statements were distrïbuted at
the time of data collection, and those 18 years and older wanting to participate were
instructed to sign the statement form and return it before receiving test materials. For
those younger than 18, parental consent was obtained. Of the 132 students, five did not
participate. Al1 of the non-participants were male students who did not retum their
parent/guardian consent form.
Once students had completed the questionnaires, they were given the opportunity
to ask questions before leaving the classroom.
64
Measures
AI1 Participants were administered the following measures (Appendix D):
The Child-Adolescent Perfectionism Scale (CAPS)
The CAPS (Flett, Hewitt, Boucher, Davidson, & Munro, 1997) is a 22-item
measure of perfectionism founded on the multidimensiond conceptualization of
perfectionism (Hewitt et al., 1990. 199 la) (see Appendix E). The CAPS provides
subscale measures of self-oriented perfectionism ( e g , "1 try to be perfect in everything 1
do") and socially prescribed perfectionism (e.g., "There are people in my life who expect
me to be perfect"). Participants provide 5-point ratings of the extent of their agreement
with each item. The scale was developed using the construction validation approach and
is closely modeled after its adult equivalent, the Mukidimensional Perfectionism Scale
(Hewitt, 1989; Hewitt et al., 1991a). Adequate levels of reliability and validity have k e n
established. The test-retest correlation was 1 = .74, p < -01, for self-oriented perfectionism
and the test-retest correlation was = .66. p < -01. for socially prescribed perfectionism
(Flett et al.. 1997). The internal consistency of each scale was assessed, and it was
established that the scales had adequate internai consistency. The alpha coefficient for the
self-oriented scale was -85. The item-total correlations ranged from -36 to -76. The alpha
coefficient for the socially prescribed perfectionism scale was -8 1. The item total
correlations ranged from .28 io -59.
A previous study with 13 1 high school students exarnined the correlations
between the CAPS and the Eating Disorder Inventory Perfectionism Subscale (EDI). The
analyses confirmed that there were strong, significant correlations between the CAPS
measures and the EDI perfectionism subscale. The correlations between self-oriented
perfectionism and the EDI rneasure were -4 1, pl < .O 1 for girls and -72, < .O 1 for boys.
The correlations between socially prescribed perfectionism and the EDI rneasure were
-45, < .O 1 for girls and -55, E < .O 1 for boys. Also, the correlations between the two
CAPS dimensions for boys versus girls was 1 = -32, < -05, and = -50, E < -01,
respectively.
Perfectionism Self-Presentation Scale (PSPS)
The PSPS (Hewitt, Flett, & Farlie, 1994) is a 27-item measure of three
dimensions of perfectionism self-presentation (Appendix F). The Need to Appear Perfect
subscale measures the desire to present oneself as perfect to others (e.g., "It is very
important that I always appear to be on top of things"). The Avoid Appearing Imperfect
subscale measures the desire not to appear less than perfect to others (e.g., "1 do not want
people to see me do something unless 1 am very good at it"). The Avoid Disclosure of
Imperfection subscale measures the need to avoid public admissions of imperfection or
failures le-g., "1 try to keep my faults to myself"). Participants rate their agreement with
items on a 7-point scale with higher scores indicating greater perfectionism self-
presentation. As indicated earlier, data supporting the reliability and validity of the PSPS
can be found in Hewitt et al. (1994). In a study conducted by Hewitt et al. (1995), it was
found in a sample of female university students that higher levels of perfectionism self-
presentation were associated wi th lower self-esteem in ternis of global self-esteem and
appearance self-esteem. To date, however, there is no psychometric information available
on the use of the PSPS with adolescents.
The Adolescent Demessive Exwriences Ouestionnaire (DEO-A)
The Depressive Experiences Questionnaire (DEQ) was devejoped based on the
notion of a continuity between norrnality and pathology (Blatt. 1974) (Appendix G). The
items included assess everyday life experiences generally associated with depression, but
are not necessarily symptoms of depression in their own right. Specifically, life
experiences were assessed in two broad dornains: Factor 1, Dependency, involves
interpersonal relationship items concerned with abandonment, loneliness, helplessness
and feelings of rejection by others. Items on Factor 2, Self-Criticism, involve criticism
toward the self for failing to meet expectations and standards, which result in an
unsatisfied sense of self. Here. the terrn dysphoric experiences describe a personality
ges ta1 t reflecting day-to-day concems in l i fe situations. Normal levels of concerns
reflected in these configurations cm denote a good investment in persona1 relations or
achievernent. while, an unhealthy investment can be extremely detrimental resulting in
high levels of depression.
The DEQ consists of 66 items rateci on a 7-point scale that provide scores on two
types of dysphoric tendencies --- Dependency and Self-Criticism --- along with a third
factor called Efficacy, which depicts a sense of well-being. An example of an item on the
Dependency factor is "1 often think about the danger of losing someone who is close to
me." An example of a SeIf-Criticism item is, ''1 often find that 1 don? live up to my own
standards or ideals." The third factor, Efficacy, is reflected in the item, "1 set my goals
and standards as high as possible" (Blatt & Luthar, 1995). Test-retest reliabilities of the
scale are high (Zuroff, Moskowitz, Wielgus, Powers. & Franko, 1983), interna1
consistency and discriminant vaiidity have been demonstrated (e-g., Blatt et al.. 1982)-
The reduced version, a 20-item scaie (Fichman et al., 1994) of the DEQ-A was
designed for use with children and adolescents. The wording was simplified and the items
were changed to make it more directly relevant to the concems of adolescents (Blatt,
Schaffer, Bers, & Quinlan, 1992). The participants respond on a 5-point scaie. Adequate
levels of validity for the three scales have been documented with adolescent samples
(Blatt et al., 1992~).
Ten-day test-retest reliability coefficients for the Adolescent DEQ-A (44-i tem)
have been found to be -86, -79, and -65 for Dependency. Self-Criticism, and Efficacy
respectively (Blatt et al., 1992~). However, less is known about the 20-item version.
Self Concealment Scale ( S C S )
The Self-Concealment Scale (SCS) was developed to mesure the inclination for
actively concealing personal information frorn others, specifically information that is
perceived as distressing or negative (Appendix I)- Self-concealment is related to, but
theoretically and empirically distinct from, self-disclosure (Larson & Chastain, 1990).
The SCS contains I O items that refer to (a) a self-reported inclination to keep things to
oneself (e-g., "There are lots of things about me that 1 keep to myself '); (b) information
of a highly distressing secret or negative thoughts about themselves that have been shared
with one or two persons or no one at al1 (e-g., "1 have negative thoughts about myself that
1 never share with anyone"); and (c) uneasiness about the disclosure of concealed private
information (e-,o., "If 1 shared al1 my secrets with my friends, they'd like me less")
(Larson et al., 1990).
The interna1 consistency estimate of Cronbach's alpha showed a = .83 (N = 306).
Test-retest reliability, as was assessed in an independent sample of female graduate
counseling psychology students (n = 43) with a 4-week interval between testing revealed
r = .8 1 (Larson et al., 1990).
The Center for E~idemioiogic Studies ïk~ression Scale (CES-Dl
The Center for Epidemiologic Studies Depression Scale (CES-D; Radloff, 1977)
scale is a short, 20-item self-report scale created to measure current level, of depressive
symptomatology in the generai population and asks respondents to rate the frequency of
each symptom during the past week (Appendix H). The fundamental elements of
depressive symptornatology were identified from the clinical literature and factor analysis
studies. These components included: depressed mood; feelings of shame and
worthlessness; feeIings of helplessness and hopelessness; psychomotor agitation; changes
in appetite; and sleep disturbance. Only a few items were chosen to represent each
component (Radloff, 1977) The possible range of scores is zero to 60, with higher scores
revealing more symptomatology in individuals. Measures of intemal consistency
(coefficient alpha and the Spearman-Brown split-halves method) were high in the general
population (approximately -85) and even higher in the patient sample (approximately .90)
(RadIoff, 1977). This measure has been widely used and has demonstrated its usefulness
as a screen instrument with adolescents (Allgood-Merten et al., 1990; Ganïson,
Shoenbach, & Kaplan, 1985; Schoenbach. Kaplan, Grimson, & Wagner, 1982).
Heip-Seekine Scale
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).
Table 3
Correlational Analyses Usine the Total Sarnple
Variables 1 2 3 4 5 6 7 8 9 10 1 1
1 Hclp-Secking" --
2 Dcpcndencyb 0.32** -- 3 ~clf-criticisrnb -0.11 0.27**--
3 ~ f f i ç a c ~ ~ 0.06 O. 15 -0.28** --
5 Self-Concealment' -0.07 0,30** 0.45** O. 12 -- 6 ~ ~ ~ c a r ~ -0.02 0.23** 0.17* 0.14 0.32** - 7 ~ v o i d ~ 0.00 0.42** 0.35** 0.15 0.50** 0.64** -- S ~on-Disclosurcd -0.36** 0.05 0.27** 0.07 0.50** 0.42** 0.49** --
9 Self 0.10 O. 14 0.03 0.25** 0.19* 0.61 ** 0.46** 0.38** -- 10 Social' -0.10 0.17 0.31** OZ** 0.38** 0.34** 0.40** 0.42** 0.48** -- 1 1 ~eprcss ion~ -0.03 0.28** 0.39**-0.10 0.30** 0.09 0.20* 0.22* 0.10 0.30** --
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** --
9 Self 0.07 -0.09 -0.19 0.34* 0.18 O-61** 0.25 0.41** -- 1 O Social' -0.14 0.08 0.59** 0.05 0.39** 0.28* 0.29* 0.41** 0.22 -- 1 1 ~e~ress ion ' -0.05 0.29* 0.55**-0.14 0.36** 0.08 0.17 0.13 0.01 0.26 --
Note.
' 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-
seeking, (Fchm,, (7,116) = 0.35, > -90). for Depression, (Fchmge (7,116) = 0.72, Q > .60),
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
Nntc.
" Adolcsccnt Deprcssivc Experiences Questionnaire Pcrfcctionistic Self-Presentation Scale Multidimensional Perfectionism Scale
Std. B = Standardized Regression Coefficient Sig t = All single predictor values reported as measured with al1 predictors in the mode1
The five perfectionism predictor variables in the second block were able to
account for about 16% of additional variance in help-seeking, (Fchmge (5,124) = 5.78, Q <
.O0 1 ). As expected, the need to avoid disclosure of imperfection was significant (F(l, 124)
= 20.34.2 < -00 1 ). Individuals high on this perfectionism factor were less likely to
actively seek-help for their problerns. Self-oriented perfectionism was also a significant
predictor (F(1,124) = 7.45, < .05), with greater self-oriented perfectionism k ing related
to active help-seeking. However. it should be noted that the zero-order correlations did
not suggest a positive link between self-oriented perfectionism and help-seeking
attitudes.
Personaiitv Predictors of ih~ression
A test of normality of the residuals using Kolmogorov-Smirnov was performed to
justify the use of the transformed variable for the depression scale. While the residuals of
the transformed variable fit within the bounds of normality, (F( 1 30) = -053, p > 20) those
of the untransformed variable did not (F(130) = -097, p < -004).
The outcome measure in the second anal ysis involved depression symptom report
scores. Results are displayed in Table 7. Acting together, dependency and self-criticism
accounted for 26% of the variation in depression scores (Fch, (2,129) = 22.68. E <
-00 1 ). Acting alone, dependency was significant as a predictor of depression (F( 1,124) =
5 . 2 4 , ~ < . O s ) . Seif-criticism was also significant (F( 1,124) = 22.47, p < -00 1). Higher
levels of dependency and self-criticism were associated with greater depression. Results
for the perfectionism dimensions were not significant with depression as the criterion.
Perfectionism explained no variation in depression scores (Frhmgc (5,124) = 1.19, p < -3 1 ).
Table 7
Results of Hierarchical Regression for the Prediction of Devression
Predictors RZchange Fchanae Sig Fchange - Std. B t Sig; t
BIock One DEQ 0.26 22.68 0.001 *** Dependency" 0.20 2.29 0.05 Self-Criticism" 0.41 4.74 0.001***
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
" Adolescent Depressive Experiences Questionnaire h Pcrfectionistic Self-Presentation Scale ' Multidimensional Perfectionism Scale
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
Note.
" Adolcscent Depressive Experienccs Questionnaire Pcrfectionistic Self-Prcsentation Scalc ' Multidimensional Perfcctionism Scale
Std. B = Standardized Regression Coefficient Sig t = AII single predictor values reported as measured with al1 predictors in the modcl
Discussion
As indicated earlier, the focus of the current study was to examine the extent to
which personality vulnerability factors are associated with psychological distress and
help-seeking attitudes in a sample of adolescents. Specifically. the current research
investigated the degree to which measures of perfectionism, self-criticism, dependency,
and self-concealment were associated with levels of depressive syrnptoms and negative
orientations towards seelung help. These issues were assessed by conducting a cross-
sectional study with a sample of Catholic high school students from Toronto.
The discussion section is organized according to the main goals of the current
study. First. the discussion focuses on the levels of depression found in the current study.
and how the current findings compared with past findings. This section includes a
discussion of whether males and females differed in levels of depression and related
variables. The next section of the discussion focuses on the results of the correlational
analyses that sought to determine the link between the personality factors and depression.
The third section of the discussion focuses on the personality factors that were associated
with help-seeking attitudes. The discussion concludes with an analysis of the limitations
of the current study as well as possible directions for future research.
De~ression in Adolescents
A key finding that emerged from this research was that the mean level of
depression was found to be quite high. In fact. the mean score for the sample as a whole
was higher than the recommended cut-off point of 16 on the CES-D (Radloff, 1977). This
finding is not unique because a number of studies have found that levels of depression are 89
elevated among adolescents. For instance, a study of 220 students in grades six through
twelve found that 57% of the students reported symptoms of depressed mood with the
CES-D as the depression measure (see Culp, Clyman, & Culp, 1995). Although concems
have been raised about a possible epidemic in adolescent depression and suicide over the
past decade (see Peterson et al., 1993), the current study suggests that the problem may
be even greater than previously recognized. In their review paper, Peterson et ai. (1993)
analyzed the findings of 14 studies and reported that the median level of depression was
35% across samples in research with measures similar to the CES-D. That is, slightly
over one-third of the sample tends to be depressed. However, the results of the current
study indicate that the majority of adolescent students tend to experience at least mild
levels of depression. Clearly, scores on a self-report measure cannot be equated with
diagnosed depression based on diagnostic interviews and clinician ratings (for
discussions, see Coyne, 1994; Flett, Vrenburg, & Krames, 1997). Still, there is some
cause for concern given the growing evidence that the experience of elevated symptoms
of depression is a clear risk factor for the subsequent experience of a major depressive
disorder (see Fiett et al., 1997; Gotlib, Lewinsohn, & Seeley, 1995). In addition, in a
recent study with the CES-D, Gotlib et al. (1995) found that elevated scores on the CES-
D were associated with extensive psychological impairment in adolescents. The current
findings cornbined with previous findings underscore the serious problems associated
with depression in adolescents.
Previous studies of levels of depression in adolescents have typically found that
levels of depression are higher in females than in males and as was discussed in the
introduction section, several studies have sought to identify factors that can account for
these differences (e-g., Sethi & Nolen-Hoeksema, 1997). However, it was found in the
current study that there were no significant gender differences in terms of the Ievels of
depressive symptoms. One possible explanation is that sex differences do not exist when
considering the intensity of symptomatology, but differences do exist in the expression of
depression (Harnmen et al., 1977: Teri, 1982). Males tend to distract themselves. whereas
fcmales ruminate on their depressive mood (Nolen-Hoeksema, 199 1). Also, there is
evidence in university students, regardless of gender, that they share similar life
experiences. This commonality of life experience may help to explain the lack of
significant difference in levels of depression in the current sample (Vredenburg et al.,
1993). Moreover. Coyne (1994) suggest that the results may be artificial based on the
degree of how the adolescents were assessed in this study. Thus, including other
rneasures would be necessary.
Although the gender difference in depression was not evident in the current study,
it was the case that females in the current research had more positive attitudes toward
seeking help. This is a finding that has k e n reponed in numerous studies (e.g.. Feldman.
Hodgson. Corber. & Quinn, 1986; Garland et al.. 1994), including the recent study on
barriers to help-seeking by Kuhl, Jarkon-Horlick. and Momsey (1997). Kuhl et al. found
that adolescent males were much more likely to perceive barriers to seeking help from a
professional. The barriers that were identified included a belief that parents and friends
should be relied upon for help, a belief that help should come from oneself, and a belief
that the help provided by a professional would not be useful.
It is important to jointly examine the possibility of gender differences in
depression and help-seeking attitudes because one reasonable interpretation of the current
findings is that femaie and male adolescents have equivalent levels of depression, but the
more negative attitudes arnong males may result in them k ing less likely to actudly seek
help. Clearly, this issue should be exarnined in further research, but at ieast one thing to
consider is outreach programmes that include a focus on arneiiorating depression in
young males in addition to depression in young females.
In addition to having more negative help-seeking attitudes, males were higher in
two elements of perfectionism self-presentation (the need to appear perfect and the need
to avoid disclosure of imperfection). In this context, the results maybe exptained by
males being less willing to disclose persona1 information. As mentioned above, men tend
to avoid their problems and they are less willing to seek help. They are more likely to
deaf with their problems on their own and disclosing and seeking help is ego threatening.
This self-presentational style may be seen as a possible regulator of helping them deai
with their life problems.
Further, no significant gender differences in mean levels of dependency and self-
criticism were found. This is in contrast to the work by Fichman and colleagues (1994)
whose findings revealed that females indicated higher levels of dependency, while no
gender differences in self-criticism were found. Thus, the present study did not replicate
Fichman et al .' s ( 1 994) gender differences in dependenc y, but did produce similar
findings in a lack of difference in self-criticism.
Personalitv and De~reSsion
The second main goal of this research was to examine the association between
dimensions of perfectionism and depression in adolescents. Resuits with the total sample
showed that self-oriented perfectionism was not correlated significantly with depression.
However. as expected socially prescribed perfectionism was associated with elevated
levels of depression. This finding accords with previous research by Hewitt et al. (1997)
and Hankin et al. (1997), as well as with results linking suicida1 tendencies with socially
prescribed perfectionism (Boergers et al., 1998). Separate analyses for males and females
found that the same general pattern was evident for both individuals, though the
correlation between socially prescribed perfectionism and depression in males did not
reach conventional levels of significance.
The current study also provided an initial assessment of the link between
perfectionism self-presentation and depression in adolescents. The analyses conducted on
the data from the total sample showed that an unwillingness to disclose imperfections and
a need to avoid reveding imperfections were both associated with elevated levels of
depression. Once again, the same general pattern was evident for males and females but
only the correlations for females attained conventional levels of statistical significance.
Thus, these findings for the total sample and female adolescents replicate previous
research which suggests a link between perfectionism self-presentation and psychological
distress in university students (Hewitt et al., 1994).
Additional analyses examined the extent to which dependency and self-criticisrn
were associated with depression. As expected, the analyses revealed that both
dependency and self-criticism were correlated with depression in this sample. This
finding replicated the results reported by Fichman et al. (1994) and was based on the
same version of the DEQ-A used by Fichman et al. (1994). It is noteworthy that the
current findings also replicate a previous study by L u t h et al. (1995) which used an
expanded version of the DEQ-A which is quite different from the one used in this study.
In contrast to the findings obtained with the perfectionism mesures, significant
correlations were obtained for both males and females. It should also be noted that from a
comparative perspective, self-criticism was a more robust predictor than the other
personality variables, including the perfectionism dimensions. Thus, a self-cntical
orientation appears to be central to the experience of depression in adolescents, but the
significant resuits involving dependency and socially prescribed perfectionism still
indicate that interpersonal concems also play a role.
Parenthetically, it should be noted that self-criticism was associated with socially
prescribed perfectionism in both males and females. However, self-criticism was not
associated with self-oriented perfectionism. Other research with adults had pointed to a
closer association between socially prescribed perfectionism and self-criticism than
between self-oriented perfectionism and self-criticism (Hewitt et al., 1993b). Thus, self-
critical forms of perfectionism (see Blatt, 1995) seem to involve a sense of self-criticism
for not having lived up to the pressures to be perfect that are imposed by significant
others or society as a whote.
As stated in the introduction section of this thesis, another goal of this study was
to examine the lin k between self-concealment and depression in adolescents. Indeed, self-
concealment was correlated significantIy with depression for both males and females, and
these associations were arnong the most robust findings in this study. Overall, the
findings suggest that the tendency for depressed adolescents to be self-critical extends to
a related tendency for depressed adolescents to be high in self-concealment. The apparent
tendency for distressed adolescents to try to hide negative aspects of themselves from
others has serious implications in terms of their tendency to avoid seeking available
forms of social support. Self-concealment is associated with an unwillingness to disclose
imperfections to others, and this points to the possibility that certain depressed
adolescents c m become very isolated and withdrawn from the very people who may
provide them some comfort.
Correla tes of HebSeekinp Attitudes
The results of the current snidy did not support the hypothesis that depressed
individuals would indicate negative attitudes toward help-seeking. These findings
contrast with the findings of Garland et al. ( t 994). The replicability of findings using
their measure h a not yet k e n tested, A factor that rnay account for the difference is the
measure used to assess depression. Garland et al. ( 1994) used a different measure of
depression (i.e., The Children's Depression tnventory; CDI), whiie the present study used
the CES-D. which contains more items pertaining to the affective component and
depressed mood. One could speculate then, that the differences were due to this factor. It
is unlikely that the discrepancy in results was due to sample differences. Both studies
investigated an adolescent sample. In fact, in their study, Garland et al. ( 1994) split their
findings for older and younger adolescents. The sample consisted of middle school and
high school students. One could further speculate that the link with help-seeking was not
as strong for this study.
Although help-seeking attitudes and depression were not correlated in the overall
sample, there was an association between depression and self-concealment. This follows
with the findings of Cepeda-Benito et al. (1998). They found a positive association
between distress and self-concealment (-44). They suggest that self-concealment not only
contributes to greater emotional adversity, but also presumably diminishes the possibility
of recovery as a result of the individuals aversion to treatment.
As predicted, it was shown that strong needs to avoid exposing imperfection in
the self was related to negative help-seeking attitudes. This was true for both males and
fernales. Since the act of seeking help would involve imparting one's shortcomings and
flaws. these individuals seem to be less likely to seek solace by confiding in others. For
these individuals, it is important to present and maintain an image of flawlessness to
others (Hewitt et al., 1995).
Unexpectedly, there was the lack of a significant correlation between socially
prescribed perfectionism and negative help-seeking attitudes. Based on previous findings,
one might expect that people high on this dimension would be reluctant to seek help-
Onwuegbuzie et al. (1999) found that a fear of seeking help was correlated with socially
prescribed perfectionism. Indeed, if the adolescent perceives that others hold exceedingly
high expectations of them, then seeking help may be construed as not having lived up to
others' expectations and ideals of perfection.
There is increasing evidence that fear of negative evaluation is a cmcial element
in both perfectionism and statistics anxiety (Onwuegbuzie et ai., 1999). The authors felt
that the study was justified given that at least one research methodology and statistics
course is a degree pre-requisite for most graduate students as well as the fact that most
theses and dissertations involve statistical analyses. The work of Hewitt et al. (199 1 b) has
established that increases in high anxiety for socially prescribed perfectionists are due to
feelings of powerlessness resulting from extemall y imposed standards by significant
others. Consequently, one explanation proposed by Onwuegbuzie et al., (1999) is that the
increase in anxiety level may correspond to the lecture content and assigned tasks given
by the instructor. That is, the socially prescribed perfectionists perceives the expectations
as being unrealistic which results in increases in their anxiety level. Given that the fear of
external negative evaluation is an important component for both socially prescribed
perfectionism and statistics anxiety a relationship between the two is very likely.
Further, it may be that the relationship between socially prescribed perfectionism
and statistics anxiety may stem from the increasing evidence that high levels of socially
prescribed perfectionism leads to low self-effort and expectations resulting from the
discrepancy between the perfectionists' actual functioning and perceived unrealistic
social standards (Hewitt et al., 199 1 b).
Potentiatly, therefore, the association between socially prescribed perfectionism
and fear of asking for help can be explained by the extreme need to avoid social
exposure. Onwuegbuzie et al. ( 1 997) reported that students indicating high levels of
statistics anxiety were more prone to feelings of incornpetence, which is a great source of
embarrassrnent for them and must be actively concealed from others. If is likely then that
l i ke statistics-anxious students' fear of exposure is a driving force for socially prescribed
perfectionists' reluctance to seek help from others given that they do not want to have
their percei ved ignorance exposed.
One explanation for the lack of a correlation between socially prescribed
perfectionism and negative help-seeking attitudes is perhaps, socially prescribed
perfectionism is not as relevant to understanding help-seeking attitudes and mental
distress in adoiescents as first assumed. What may be of more relevance is the
nondisclosure factor of perfectionism self-presentation. Also, perhaps this hypothesis, in
future studies, might receive stronger support if examined among a larger adolescent
sample. This suggests that there is a need for further study.
With respect to having positive attitudes toward help-seeking, the findings
support previous work indicating that individuals high on dependency would be more
likely to have an orientation toward seeking help. However, for males this was not true.
There is extensive literature on help-seeking and dependency in adults, yet the link
between dependency and help-seeking attitudes in adolescents has not received as much
attention. Indeed, previous research indicated that college students exhibited a positive
relationship between interpersonal dependency and medical help-seeking behaviour.
They showed higher rates of health care usage in that they made more trips to the health
center and private clinics than nondependent individuals (Borstein et al., 1993). It may be
there is no association with depression and help-seeking because dependency was also
correlated with depression. There may be a subset of people who are dependent
adolescents who are positively inclined toward help-seeking.
The central focus of Bornstein's (1998) research was to examine the effects of
implicit and self-attributed dependency strivings on laboratory and field measures of help
seeking. McClelland, Koestner, and Weinberger ( 1989) reasoned that while objective and
projective measures are creatzd to measure like constructs, they often assess the many
aspects of an individual's motive and intentional state. They suggest that generally self-
report measures assess self-attributed needs, that is, the motives that are readily
acknowledged as being representative of the persons' mundane functioning and daily
experiences. On the other hand, projective tests assess an implicit need, such as the drive
that governs automatic and unconscious behaviour, often without any awareness by the
individual that these drives or motives influenced their behaviour. In the first study,
college students were pre-screened with commonly used objective and projective
dependency tests. They then endured an information manipulation designed to stress the
salience of dependency-related issues. As expected, the results revealed that dependency
status (low dependency, high dependency, unacknowledged dependency, and dependent
self-presentation) and information manipulation (informed vs. uninformed) did interact
and influenced the frequency of help-seeking behaviour. By altering the individuals'
consciousness of the dependency help-seeking relationship, their willingness to seek and
ask for assistance was affected (Bornstein. 1998).
Study 2 was conducted to examine the interaction of implicit and self-attributed
dependency strivings to help-seeking behaviour in a field setting. It was hypothesized
that implicit and self-attributed dependency needs would differentially predict direct and
indirect help seeking, as both of these types of help-seeking differ in relation to their
perceived rdevance to dependency.
Taken together, the results of these studies are interesting because of their
im~lications regarding the important role the dependency status plays in predicting help- L
see k
seek
ng behaviour across a variety of settings (Bornstein, 1998).
The present results showed that self-criticism was not correlated with help-
ng. One recent study found that adolescents who seek help from professionals have
lower self-worth compared to adolescents who reported not seeking professional help
(Schnort-Reich1 et al., 1996). Additionally, they found that adolescents who did not seek
professional help were more seIf-conscious than adolescents who did seek help. The
authors found that the need for privacy seemed to be an important issue for adolescents.
This fits with the current findings of the apparent unwiilingness of those high on non-
disclosure of imperfection to not want to seek help, as these individuais are very self-
conscious and private. Schonert-Reich1 et al. (1996) suggest that it may be that those
adolescents with high self-worth do not feel the need to seek medicai help because of
their global sense of efficacy and autonomy and medical service utilization may be a
threat to their self-esteem.
Overall, one might predict a link between self-criticism and negative help-seeking
attitudes, given that self-critical individuais are characteristically self-reliant individuais
and they seek autonomy. The factor that rnay account for the difference is that in the
study conducted by Schonert-Reich1 e t al. (1996), they focused on reports of actual help-
seeking behaviour while the present study focused on help-seeking attitudes. This is an
important area to consider in future investigations.
Additional findings confirmed that socially prescribed perfectionism and self-
presentation dimensions were associated with self-concealment. This finding was of
particular interest, as it has never k e n investigated in adolescents before. Self-
concealment has generally been studied in university students. Individuals characterized
by socially prescribed perfectionism and the three dimensions of perfectionism self-
presentation were more likely to hide distressing and potentially embarrassing personal
facts. Thus, the overail pattern of results with adolescents correspo~ded to previous
findings, that people high in perfectionism are high self-concealers.
In a study of undergraduate psychology students, Frost et al. ( 1 997) found that
individuals high in perfectionistic concern over mistakes reported more wony about the
reactions of others to their errors than did students indicating low concern. The
researchers concluded that this concern was not based on the belief that their mistakes
might cause h m to other people, but seemed to stem from the beiief that others would
think poorly of them for their mistakes. Consequently, as a result of this preoccupation
high concem participants reported a greater need of wanting to conceal their errors from
others. Frost and Marten (1990a) suggest that the constant avoidance by perfectionists of
any type of extemal observation or evduation by others may be a key element in
explaining the poor performance of perfectionists compared to nonperfectionists as
demonstrated in a writing task study. Perfectionists' attempt at avoiding disclosure of
their mistakes is achieved by avoiding review and feedback from others on their written
work. Often, the development and improvement of one's writing skills is benefited by
con t i nual practice and feedback and consequentl y, perfectionists writing ability may
remain underdeveloped and limited (Frost et al., 1997). These findings corroborate with a
previous study by Frost, Turcotte, Heimberg, Mattia. Holt, and Hope (1 995) showing that
individuals high in concern-over-mistakes reacted more negatively to mistakes than did
their lower counterparts. High-perfectionistic-concern-over-mistake individuals displayed
a more negative affect, lowered confidence regarding their proficiency to do a task, and
they believed that others would judge them more harshly and view them as less
intelligent. They were also less willing to share their results and they reported being more
l i kel y to conceal their performance outcorne.
Intuitively, it was predicted that the perfectionkm self-presentation factors would
predict negative help-seeking attitudes over and above other personality factors. As
expected, a significant result was found for the non-disclosure dimension of
perfectionism self-presentation. These individuals are less likely to seek professional help
and their decision to seek help is guided by their inability and unwillingness to share
persona1 information. This facet of perfectionism is driven by their intense need to
present an ideal image of the self. This may be due, in part, to their reluctance to privately
or publicly acknowledge and admit to any persona1 shortcomings or inadequacies (Hewitt
et al.. 1995).
Cepeda-Benito et al. (1998) found that self-concealment was positively associated
with personal distress and a de-emphasis on psychological treatment and intervention.
Specifically, those inclined to keep secrets were more likely to avoid rather than seek
help. In contrast, Kelly et ai. (1995) reported that their study showed that high self-
concealers had a more positive orientation toward seeking help compared to those
indicating Iow levels of self-concealment. In addition, it was also shown that high self-
concealers reported greater service utilization and obtaining some fonn of counseling.
Although results of the current study did not yield a relationship between self-
concealment and help-seeking, future research needs to further clarify the relationship
among self-concealment, perfectionisrn, and help-seeking pathways in adolescents.
Psvchometric Results
The new measure of perfectionism demonstrated excelIent psychometric
properties. Also, the findings in this investigation provide evidence for the reliability of
this rneasure as well as preliminary data regarding its validity, in that the perfectionism
dimensions were correlated with one another. The Perfectionism Self-Presentation Scale
was also correlated with self-concealment, which is also evidence of the validity of the
scale with adolescents. In addition, there was good internal consistency with the Child-
Adolescent Perfectionism and Perfectionism Self-Presentation scales.
In the present sarnple, coefficient alpha was -8 1 for help-seeking, -64 for thc self-
criticisrn scale. -72 for the dependency scale and .46 for the efficacy scale. Help-seeking,
self-criticism (note this item was somewhat lower) and dependency al1 had acceptable
reliability this was not so for the efficacy scale. The efficacy scale yielded a low internal
consistency partiaily due to the low number of items, further examination of the item
content shows that the items tap a number of concerns and some items have tangential
relevance to the effkacy construct and does not directly tap perceptions of capability. For
example, ''1 am a very independent person." " 1 enjoy competing with others."
It is important to mention the limitations of this study. First. the study sampled
adolescents mainly from working and middle socio-demographic categories and therefore
discretion is necessary when generalizing to individuals from other backgrounds. Also,
the issue of representativeness 1s relevant for this study as we relied on a volunteer
sample. The question that arises is, can you apply the current findings to other sectors?
Further. the sample was drawn from a population of adolescents attending a Catholic
secondary school and consequently findings are not generalizable to those adolescents
not attending school or institutionalized. Certainly, additional research should attempt to
recognise the help-seeking attitudes when faced with negative expetiences of those
adolescents not in school andor institutionalized. Another limitation is that a cross-
sectional design was ernployed with a modest sample size to examine patterns in help-
seeking attitudes and depression. As a result, it is impossible to definitively test the causal
direction of the relationships depicted in the mediated rnodel.
-4 second potential limitation includes the sole reliance on adolescents' self-
report, for both the measures of personal and social characteristics and those of help-
seeking attitudes. Funher Hewitt et al. (1997) suggests that there may be some shared
variance among the correlations due to the exclusive use of self-report measures.
Although this may be a particularly serious concern, some believe that an adolescent's
self-perceptions, as assessed through personality instruments, are strongly associated with
their understanding of their help-seeking attitudes (Schonert-Reich1 et ai., 1996). While
there may be inherent problems with the use of self-report measures such as accuracy and
recall, it can, however, be argued that the most accurate source is the adolescents
themseIves --- they have the greatest understanding of their experiences and feelings.
Despite this, future studies would benefit from the inclusion of assessrnents other than
self-report rneasures involving more objective measures such as multiple reporters and
behavioural observations in order to achieve a greater understanding about the nature of
help-seeking attitudes in adolescence.
Interpretations of the present findings are further limited since the study relied on
measures that assessed help-seeking attitudes as opposed to behaviour. There may be
some discrepancy between how the adolescent feels about seeking help and actually
availing themselves of opportunities for help. Assessments of adolescents' reasons for not
seeking help or adolescents' perceptions of the obstacles to seeking help were not
explored in this study. The reliance on depression symptom reports versus the use of
theoretical assumptions of depression presents a simiIar limitation. Measures that tapped
behaviours may have proven more beneficial in understanding depression.
Future research that uses measures reflecting al1 three conceptualizations of
depression is important in broadening our knowledge of the relations among depressed
mood. syndromes, and disorders. It is evident that al1 three of these conceptualizations of
depression are worthy of researchers' attention when concerns about the evolutionai and
psychological processes dunng adolescence aise (Compas, Ey, & Grant, 1993).
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.
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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.