How Do Adolescents and Others Around Them Conceptualize Depression? Toward a Contextually Grounded Understanding of Depression During Adolescence in India

Abstract

For decades, research has examined etiology and presentation of depressive symptoms among adolescents, with the bulk of this work based on samples from North America and Europe. Little is known about the explanatory models and clinical presentations of depression around the world. Focusing on India, a country with the world’s largest adolescent population, our aim was to explore explanatory models and phenomenology of depressive symptoms during adolescence using a qualitative method. Semi-structured individual interviews were conducted with 80 informants (n = 10 adolescents diagnosed with major depressive disorder [MDD], n = 10 parents of adolescents with MDD, n = 36 adolescents with no known psychiatric history, n = 24 teachers). Qualitative thematic analysis yielded 22 themes across three domains. Explanatory models about causes of depression included family-related challenges, peer or romantic relationship issues, academic pressures, physical health problems, and individual traits. Phenomenology of depression included symptom clusters consistent with the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5, American Psychiatric Association, 2013; affective symptoms, cognitive symptoms, somatic symptoms), and culturally salient indicators not included in the DSM-5 (social disengagement, academic disengagement, anger and aggression, media use, and additional somatic symptoms not captured by DSM-5). Participants considered acceptance and support from others, engagement in pleasurable activities, internal will power and motivation, professional counseling, and adult supervision and monitoring as contributing to healing. These findings highlight the salience of interpersonal relationships in the etiology and phenomenology of depressive symptoms and call for a contextually grounded conceptualization of depressive symptomatology.