Maternal Depression and Factors Predicting Depressive Symptoms of Adolescents in Bali, Indonesia

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Putu Ayu Emmy SavitriKarin

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☑ Oral presentation  Poster presentation

Title: Maternal Depression and Factors Predicting Depressive Symptoms of Adolescents in Bali, Indonesia

Author: Putu Ayu Emmy Savitri Karin, Nopporn Vongsirimas, Wimolnun Putdivarnichapong, Atittaya Pornchaikate Au Yeong

Abstract

Purpose: This study was conducted to investigate the predictive power of mothers’ depressive symptoms, perceived maternal parenting, perceived life stress, coping strategies, and resilience on adolescents’

depressive symptoms in Bali, Indonesia and to investigate the differences of these factors among adolescents of mothers with depressive symptoms and adolescents of mothers without depressive symptoms. The Transactional Model of Stress and Coping Theory by Lazarus and Folkman (1984) was used to guide the conceptual framework.

Design: This study was a descriptive correlational study.

Methods: A total of 243 adolescents aged 15 to 19 years old in one public school in Denpasar, Bali, Indonesia, and their mothers were recruited. The demographic data form, the Center for Epidemiologic Studies Depression Scale (CES-D), the Parental Bonding Instrument (PBI), the Negative Event Scale (NES), the Brief COPE Inventory (Brief COPE), and the 10-items Connor-Davidson Resilience Scale (CD-RISC) were used to measure the variables in this study. Data were analyzed by using descriptive statistics, multiple regression, and independent t-test.

Main findings: The mothers’ depressive symptoms, perceived maternal parenting, perceived life stress, coping strategies and resilience could explain 40.8% of the variance in depressive symptoms of adolescents (R²= .408, F = 32.61, p < .05). Perceived life stress (β= -.366, p < .05) was the strongest predictor of depressive symptoms in Balinese adolescents. In comparing the factors, only mothers’ depressive symptoms and perceived life stress in adolescents of mothers with depressive symptoms and adolescents of mothers without depressive symptoms were significantly different (t = -20.58, p < .05; t = -2.44, p = .015, respectively).

Conclusions and recommendations: The results guided nurses to understand what could be manipulated by nursing interventions to prevent depressive symptoms in adolescents and promote optimal mental health in the vulnerable population.

Keywords: Adolescents / Mothers / Depression

Corresponding Author/Presenter: (Putu Ayu Emmy Savitri Karin/[email protected])

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Maternal Depression and Factors Predicting Depressive Symptoms

of Adolescents in Bali, Indonesia

Putu Ayu Emmy Savitri Karin

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Background and Significance of Study

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Depression

The most common mental health problem

(World Health Organization [WHO], 2018)

322 million people suffer from depression

(WHO, 2017)

People living with

depression increasing by 18.4% from 2005 to 2015

(WHO, 2018)

27% of them live in South East Asia

(WHO, 2017)

7.2% adolescents have

severe depression

(Peltzer & Pengpid, 2018)

In Indonesia: 22%

adolescents aged 15 to 19 yo have

moderate depression

(Peltzer & Pengpid, 2018)

Adolescents: vulnerable population

Lack of empirical data

on depression in some

countries

(UNICEF, 2019)

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Adolescents

Depressive Symptoms

Onset of DS mostly occurs during adolescence

(Duchesne & Ratelle, 2014; Lewis et al., 2017)

Maturing brain systems, sex hormones,

stress hormones

(Sinclair, Purves-Tyson, Allen & Weickert, 2014)

Changing in

developmental task

(Erikson, 1968; Rassart et al., 2012)

Increasing risk having DS Memory, learning,

interpersonal relationships, social function

(Wang et al., 2016)

Risk for suicide

(American Association of Suicidology, 2014)

The impact could extend into adulthood

(Hammerton, Zammit, Thapar & Collishaw, 2015)

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Literatures Mothers depressive symptoms

(Barker et al., 2012; Hammen & Brennan, 2003; Howe, 2017;

Lewis et al., 2017; Vongsirimas et al., 2009)

Perceived maternal parenting

(Cumsille et al., 2015; del Bario et al., 2016; Khalid ett al., 2018)

Perceived life stress

(Damaiyanti & Rungreangkulkij, 2016; Moksnes & Lazarewicz, 2017)

Coping strategies

(Dunbar, 2013; Foland-Ross et al., 2014; Howe, 2017)

Resilience

(Anyan & Hjemdal, 2016; Ding et al., 2017; Moksnes & Lazarewicz, 2017)

Extend the study

To examine the predictive power of all variables on adolescents’ depressive

symptoms in Bali, Indonesia.

To examine the differences of

these factors among adolescents of mothers with DS and

adolescents of mothers

without DS.

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The Transactional Model of Stress and Coping Theory

(Lazarus & Folkman, 1984)

Cognitive Appraisal

(Mother depressive symptoms) (Perceived Maternal Parenting) (Perceived Life Stress)

Stress is result of transaction between an individual and environment that can influence individual’s health.

Transaction emphasize on:

Process involve interaction individuals with environment

Appraisal of the situation

Individual’s coping and available

resources

Coping Strategies

(Coping Strategies)

Available Resources

(Resilience)

Adaptational Outcome

(Depressive symptoms)

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Methodology

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Descriptive cross-sectional study

Sample: 243 adolescents Simple random sampling

Disproportionate random sampling 500 questionnaires were spread

Multiple regression, Independent t-test

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Psychometric Testing

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Ethical committee approval (COA No.IRB-NS2018/60.0211)

The school and local authorities in Denpasar, Bali, Indonesia.

Participants confidentiality being kept.

Participants voluntarily filled the questionnaires.

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Data Collection

Getting the approval

Meet the headmaster and teachers

Meet the students

Researcher collected all questionnaires

Identify classroom with high tendency

Inform teachers, gave the PHQ 9 screening

Questionnaires were kept in locked boxes

1

2 3 4

5 6

7

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Main Findings

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Characteristic of Samples

58 (23.9%)

75 (30.9%) 58

(23.9%) 51 (21.0%)

1 (0.4%)

0 10 20 30 40 50 60 70 80

15 16 17 18 19

Number of Participants

Adolescents Age

35.8%

64.2%

Gender

Male Female

86%

0.8%

9.5%3.3%

0.4%

Religion

Hindu Budha Muslim Christian Catholic 85.6%

11.1%

2.5%

0.8%

Ethnicity

Balinese Javanese Malays Batak

Adolescents

45.3%

20.2%

34.6%

Level of Ed.

Grade 10 Grade 11 Grade 12

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2 (0.8%)

3 (1.2%)

14 (5.8%)

70 (28.8%)

95 (39.1%)

50 (20.6%)

8 (3.3%) 1 (0.4%)

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

45.0%

27 - 29 30 - 34 35 - 39 40 - 44 45 - 49 50 - 54 55 - 59 > 59

Mother Age

Mothers

86%

0.8%

9.5%

3.3%

0.4%

Religion

Hindu Budha Muslim Christian Catholic 96.7%

2.1%

1.2%

Marital Status

Married Divorced Widow/other

1.2%

6.2%

48.1%

9.5%

35%

Married Sat.

Not satisfy

Less satisfy Satisfy

More than satisfy

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Rate of Depressive Symptoms in Bali

CESD ≥ 16

Adolescents 100

Mothers 54

100 (41.15%)

54 (22.2%)

0 20 40 60 80 100 120

Number of Respondents

Adolescents and Mothers with CESD Score ≥ 16

Adolescents Mothers

(M = 26.23, SD = 8.80, Range = 16 – 51) (M = 23.17, SD = 7.33, Range = 16 – 54) N = 243

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Correlation Analysis

Variables 1 2 3 4 5 6

Mother depressive symptoms 1

Perceived maternal parenting .072 1

Perceived life stress .155* .026 1

Coping strategies -.021 .053 .175** 1

Resilience -.094 -.057 -.201 .278 1

Adolescent depressive symptoms .203** .151* .505** .163* -.404** 1

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Objective 1

Variable b S.E

_b

β t p-value

(Constant) 4.947 4.751 1.041 .299

Mothers depressive symptoms 2.728 1294 .107 2.107 .036

Perceived maternal parenting .156 .077 .102 2.029 .044

Perceived life stress .163 .023 .378 7.099 .000

Coping strategies .242 .066 .196 3.635 .000

Resilience -.607 .090 -.366 -6.759 .000

R = .638, R

²

= .408, F = 32.611, p < .05

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Objective 2

Variables Adolescents of Mother

with DS

Adolescents of Mother

without DS t df p

M SD M SD

Mothers’ depressive symptoms 23.17 7.33 7.26 4.13 -20.58 241 .000 Perceived maternal parenting 21.30 7.84 20.09 6.68 -1.13 241 .262

Perceived life stress 43.96 27.91 34.81 23.20 -2.44 241 .015

Coping strategies 70.65 10.54 71.09 7.98 0.33 241 .740

Resilience 26.25 6.11 24.81 7.24 1.46 241 .145

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Mothers’ depressive symptoms significantly predict depressive symptoms in adolescents

(Lewis et al., 2017; Vongsirimas et al., 2009; Whelan et al., 2015)

Perceived maternal parenting significantly predict adolescents depressive symptoms

(Vongsirimas et al., 2009)

Perceived life stress had significant influence on adolescents’

depressive symptoms

(Damaiyanti & Rungreangkulkij, 2016; Moksnes & Lazarewicz, 2017; Vongsirimas et al., 2009)

Coping strategies has positively significant influence on adolescents’ depressive symptoms

(Dunbar et al., 2013; Arslan, 2017

)

Resilience significantly predict adolescents’ depressive

symptoms

(Moljord et al., 2014; Moksnes & Lazarewicz, 2017; Ding et al., 2017; Pereira et al., 2016).

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• Perceived life stress significantly different (Feurer, Hammen & Gibb, 2016)

Comparison

Changes + challenges  influence perception on daily hassle

Prefrontal cortex Amygdala

Hypothalamus Hippocampus

Stress regulation, Mood

Increase sensitivity toward stress

(Bale & Epperson, 2015; Eiland& Romeo, 2013; Moksnes et al., 2014; Sinclair, Purves-Tyson, Allen, & Weickert, 2014)

(Feurer, Hammen & Gibb, 2016; Tremolada, Bonichini & Taverna, 2016)

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Conclusion

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Psychiatric-mental health nurses should assist teachers at school to have the ability to assess and identify adolescents with depressed mothers and are at risk for impaired

educational, social, and emotional functioning.

It can be assumed that 59.2% of depressive symptoms among adolescents in Bali could be influenced by other factors  further investigation.

The results from this study supported the

Transactional Model of Stress and Coping Theory.

The applicability of the theory to maternal depressive symptoms and factors predicting adolescent depressed populations

appears to be validated by the findings of this study.

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