MIDLANDS STATE UNIVERSITY

FACULTY OF SOCIAL SCIENCES

DEPARTMENT OF PSYCHOLOGY

A STUDY ON THE PREVALENCE OF DEPRESSION AMONGST ADOLESCENTS

OF KUNDAYI HIGH SCHOOL.

BY CORINA VIMBAINASHE MAKORE R1810010F

A DISSERTATION SUBMITTED TO THE FACULTY OF SOCIAL

SCIENCES IN PARTIAL FULFILMENT OF THE REQUIREMENTS
FOR THE BSc HONOURS DEGREE IN PSYCHOLOGY

GWERU, ZIMBABWE

APRIL, 2023

SUPERVISOR: MR MAMBENDE
i
 RELEASE FORM
MIDLANDS STATE UNIVERSITY

NAME OF AUTHOR: CORINA VIMBAINASHE MAKORE

TITLE OF DISSERTATION: A STUDY ON THE PREVALENCE OF DEPRESSION

AMONGST ADOLESCENTS OF KUNDAYI HIGH SCHOOL.

DEGREE IN WHICH DISSERTATION WAS PRESENTED: BSC HONOURS IN

PSYCHOLOGY

YEAR GRANTED: 2023

Permission is hereby granted to Midlands State University Library to produce copies of this
dissertation to lend or sell copies for scholarly purposes only.

The author reserves other publication rights and neither the dissertation nor may extensive
extracts from it be printed or otherwise produced without the author’s written permission.

Signed: ……………………………………

Address: 165 Acarcia Drive, Concession

Phone : 0771 178 908

Email Address: cmakore4@gmail.com

Date: MAY 2023

ii
DEDICATION
This research is dedicated to the adolescents that are fighting depression and also dedicated to
the Community of Concession.

iii
ACKNOWLEDGEMENTS

I would like to offer my heartfelt gratitude to my supervisor Mr Mambende for his unwavering
support, time and encouragement throughout this research. I would also like to acknowledge
the department of Psychology at MSU for their support in making this study a success. I would
like to also thank the township of Concession for allowing me to carry out my study. My
gratitude also goes to the staff at Kundayi High School who also assisted me during the study.
To my friends my fellow psychology students for the encouragement and for sharing every
moment with me, thank you so much. To my mother, thank you for always being there for me.

iv
 ABSTRACT

The purpose of this study was to reveal the prevalence of depression amongst the adolescents
of Kundayi High School as well as to also highlight the perceived causes of depression. The
studies pertaining to depression have been carried out at national and even international level
and so I feel it the same should be done locally with people we can actually relate. The
researcher used a simple-random sampling technique and a sample size of 100 students from
Kundayi High School that were both male and female, who were chosen and completed the
questionnaires of the Beck depression inventory. Extreme cases of depression were further
studied by use of semi-structured interviews. The researcher chose the sample from six
educational levels at Kundayi High School which were form 1 , form 2 , form 3, form 4 , form
5 and form 6. The descriptive quantitative research approach was considered appropriate in
measuring depression prevalence and the attributed causes behind depression according to the
students. The data was entered using Microsoft excel with the aid of graphs and analysed using
both descriptive statistics and thematic analysis for data collected from interviews. The analysis
of results showed that most students were depressed as characterised by large scoring found in
the results. Limitations of the research include that a small number of people were selected to
represent a large group. Generally, present study stated that most students at Kundayi High
School where at risk of being depressed at some point or another both at home and at school.

v
LIST OF ACRONYMS AND ABBREVIATION

ADAP Adolescent Depression Awareness Program

BDI Beck Depression Inventory

CBT Cognitive Behavioural Therapy

PHQ-9 Patient Health Questionnaire – 9

SHAZ Shaping the health of adolescents in Zimbabwe

UN United Nations

WHO World Health Organization

vi
Table of Contents
APPROVAL FORM .............................................................................. Error! Bookmark not defined.

RELEASE FORM ................................................................................................................................... ii

DEDICATION...................................................................................................................................... iii

ACKNOWLEDGEMENTS ................................................................................................................ iv

ABSTRACT…………………………………………………………………………………...v
LIST OF ACRONYMS AND ABBREVIATION ............................................................................. vi

CHAPTER 1 .......................................................................................................................................... 2

1.2 Background and Context ............................................................................................................... 2

1.3 Statement of the problem ............................................................................................................... 3

1.4 Significance of study ....................................................................................................................... 3

1.5 Objectives....................................................................................................................................... 4

1.6 Research Questions ......................................................................................................................... 4

1.7 Purpose of Study ............................................................................................................................. 4

1.8 Delimitations.................................................................................................................................... 4

1.9 Limitations ....................................................................................................................................... 5

1.10 Assumptions................................................................................................................................... 6

1.11 Definition of key terms ................................................................................................................. 6

1.12 Conclusion. .................................................................................................................................... 6

LITERATURE REVIEW .................................................................................................................... 7

2.1 Introduction ..................................................................................................................................... 7

2.2 Depression........................................................................................................................................ 7

2.3 Depression in adolescents ............................................................................................................... 7

2.4 Psychological Influences of Depression. ........................................................................................ 8

2.6 Economic influences of Depression. ............................................................................................ 16

2.7 Strategies that can help alleviate the effects of depression amongst adolescents. ................... 20

2.8 THEORATICAL FRAMEWORK .............................................................................................. 22

vii
2.9 Knowledge Gap ............................................................................................................................. 24

2.4 Chapter Summary. ....................................................................................................................... 24

CHAPTER 3 ........................................................................................................................................ 25

METHODOLOGY ............................................................................................................................. 25

Introduction ......................................................................................................................................... 25

3.2 Approach ....................................................................................................................................... 25

3.3 Research Design ............................................................................................................................ 26

3.4 Target Population ......................................................................................................................... 26

3.5 Sample Size and Sampling Method ............................................................................................. 26

3.6 Research Instrument .................................................................................................................... 27

The Beck Depression Inventory (BDI). ............................................................................................. 28

Interviews............................................................................................................................................. 29

3.7 Data Collection Procedure ........................................................................................................... 29

3.8 Data Presentation and Analysis ................................................................................................... 30

3.9 Ethical Considerations.................................................................................................................. 30

3.10 Chapter Summary. ..................................................................................................................... 31

CHAPTER 4 ........................................................................................................................................ 32

DATA PRESENTATION, INTERPRETATION AND ANALYSIS .............................................. 32

4.1 Introduction ................................................................................................................................... 32

4.2. Demographic characteristics of respondents ............................................................................. 32

4.2.1 Response Rate of respondents................................................................................................... 32

4.2.2 Age of the respondents............................................................................................................... 33

4.2.3 Gender of the respondents ........................................................................................................ 33

4.3 Data from interviews conducted on extreme cases of depression in adolescents. ................... 38

4.3.1 Response rate of interview ........................................................................................................ 38

4.3.2 Gender of participants ............................................................................................................... 39

4.4 Causes of depression ..................................................................................................................... 39

4.4.1 Theme 1 : Social determinants associated with the prevalence of depression. .................... 39

viii
4.4.2 Theme 2 : Economic determinants associated with the prevalence of depression. ............. 41

4.4.3 Theme 3 : Psychological determinants associated with the prevalence of depression. ....... 42

4.4.4 Theme 4 : Suggested interventions for adolescents with depression at Kundayi High School
.............................................................................................................................................................. 44

4.5 Conclusion ..................................................................................................................................... 44

CHAPTER 5 ........................................................................................................................................ 45

DISCUSSIONS, CONCLUSIONS AND RECOMMENDATIONS ............................................... 45

5.1 Introduction ................................................................................................................................... 45

5.2 Discussion of the results................................................................................................................ 45

5.2.1 Prevalence of depression amongst adolescents. ....................................................................... 45

5.2.2 The social causes of depression amongst adolescents. ............................................................ 47

5.2.3 The economic causes of depression amongst adolescents. ...................................................... 49

5.2.4 Psychological causes of depression. .......................................................................................... 50

5.2.5 Strategies that can be used to mitigate the effects of depression. .......................................... 51

5.2.5.1 Counselling .............................................................................................................................. 51

5.2.5.2 Educational programs ............................................................................................................ 52

5.2.5.3 Cognitive- Behavioural Therapy ........................................................................................... 52

5.3 Conclusions .................................................................................................................................... 52

5.3.2 Key Findings of the research..................................................................................................... 54

5.4 Recommendations. ........................................................................................................................ 55

5.5 Conclusion ..................................................................................................................................... 55

ix
APPENDICES

APPENDIX A……………………………………………………………………...60
APPENDIX B……………………………………………………………………...64
APPENDIX C……………………………………………………………………...65
APPENDIX D……………………………………………………………………...68
APPENDIX E……………………………………………………………………...69
APPENDIX F……………………………………………………………………...70
LIST OF FIGURES
Fig 1 The Social Causation Theory………………………………………………..17
Fig 2 The Beck’s Cognitive Triad of Depression………………………………….22
Fig 4.2.1 Respondents age………………………………………………………….33
Fig 4.2.3 Respondents gender………………………………………………………33
Fig 4.2.4 Respondents Educational level……………………………….………….34
Fig 4.2.5 Respondents Economic Background………………………….…………35
Fig 4.2.6 Prevalence of Depression…………………………………………….…..36

x
 CHAPTER 1

Research Topic
A study on the prevalence of depression among adolescents of Concession Township.

1.1 Introduction
According to Daryanavard et al (2011) studies from different parts of the world suggest that
the prevalence rates of depression among adolescents vary from 18.4 to 79.2 percent. These
studies go on to show that there is little evidence on the presumed causes of depression
specifically looking at adolescents. According to Jorns-Presentati (2021), studies in Africa have
also shown that the most recent systematic review focusing on Sub-Saharan Africa reported
that one in seven children and adolescents experiences significant psychological challenges,
and almost 10% qualify for a psychiatric diagnosis. Taking this into account, Zimbabwe is also
included and still has a long way to go in making mental health a priority especially amongst
adolescents in schools who are in present day abusing drugs such as crystal meth as an escape.

This chapter entails the background of the survey as well as what it aims to achieve.

1.2 Background and Context

According to the World Health Organisation (2021) depression is a common illness worldwide,
with an estimated 3.8% of the population affected, including 5.0% among adults and 5.7%
among adults older than 60 years and approximately 280 million people in the world have
depression. Taking a look into the African continent The World Health Organization (2019)
asserted that in Sub-Saharan Africa, there is limited epidemiological data on the prevalence of
depression in young people and that there is poor understanding of mental health illness, that
disorders such as depression are unrecognized and as such, remain untreated. Without
treatment, depression in adolescents may continue up to adulthood and might even result in
suicide. In Zimbabwe, according to Steel et al (2014) most research conducted in Zimbabwe
has been done in primary health care settings, and about 25% have reported depressive
symptoms also showing high vulnerability to depression among women and among people
living with HIV. Early international research suggested that the Covid-19 pandemic was
associated with elevated rates of depression and anxiety in adolescents (Duan et al 2020).
Research in Germany suggests that increases in depression, anxiety, and distress were

2
especially pronounced among those with pre-existing mental illness Bauerle (2020). According
Kessler (2007) if unaddressed, these conditions extend to adulthood resulting in poor health
outcomes, limiting opportunities for a productive adult life.

However, taking a look at the area under survey which is Kundayi High School, suicide rates
keep escalating as associated with psychological, social as well as underlying economic factors.
Also there has been an increase in the abuse of drugs and alcohol among the students as a way
to cope with depression. Kundayi High School is in Concession Township. It is situated in the
province of Mashonaland Central with a population of approximately 4,983 people who thrive
on mining in Mazowe and farming as their source of livelihood. The local Hospital and Clinic
serve as employment sources for many inhabitants of Concession whilst the presence of
primary and high schools pave way for children to attain considerable education. The best way
to deal with depression and its effects would be to take a closer look into what the root problems
might be.

1.3 Statement of the problem

According to Baxter (2013) 34% of adolescents globally aged 10-19 years, are at risk of
developing clinical depression which exceeds the reported estimates of individuals aged 18-25
years. With a doubt, the adolescents of Kundayi High School cannot be exempted as they are
prone to get depressed at some point owing to various factors and so this survey is going to
focus on the prevalence of depression in adolescents of Kundayi High School.

1.4 Significance of study

The importance of the survey study will not only be to find out the statistics of the prevalence
of depression in adolescents but also to uncover the economic, social and psychological factors
that are associated with depression thereby finding solutions or strategies that work best on
alleviating the effects of depression in adolescents .The survey will benefit various groups such
as the students who will better know how to deal or cope with depression, the parents who will
benefit by being able to be support systems for adolescents who will be on the verge of
depression, the school and its various stakeholders will benefit on awareness of the importance
of mental health and the need for school counsellors . This will help to better design
intervention programs that are centred on mental health and lastly the community of

3
Concession will benefit on becoming aware that they should be support systems and not
stigmatise or discriminate adolescents with depression.

1.5 Objectives

➢ To determine the economic and social factors that are associated with the prevalence of
depression amongst adolescents

➢ To determine the psychological factors that are associated with prevalence of

depression amongst adolescents of Kundayi High School

➢ Finding strategies that can help alleviate the effects of depression amongst adolescents

1.6 Research Questions

➢ What are the psychological factors that are associated with prevalence of depression
amongst adolescents of Kundayi High School?
➢ What are the economic factors that are associated with the prevalence of depression
amongst adolescents of Kundayi High School?

➢ What social factors are associated with the prevalence of depression amongst
adolescents of Kundayi High School?

➢ What strategies can mitigate effects of depression amongst adolescents of Kundayi

High School?

1.7 Purpose of Study

The purpose of the study is to make a survey on the prevalence of depression amongst the
adolescents of Kundayi High School as well as to find out the perceived factors that are
associated with escalation of depression. The main focus will be on the students of Kundayi
High School.

1.8 Delimitations

4
This survey will be limited to determining the economic, social and psychological factors
associated with depression and to come up with strategies and or interventions that are focused
on alleviating the effects associated with depression. The study will be sorely focused on
adolescents which are between the ages of 12 to 18 years. The researcher chose to focus on
adolescents as according to The World Health Organization (2022), it is estimated that 1 in 7
(14%) 12- 18-year-olds experience mental health conditions yet these remain largely
unrecognized and untreated. Being limited to working with adolescents will be ideal as it
provides the opportunity to address effects of depression in its early stages before it advances
into adulthood. The chosen geographical location will be Concession Township as it is beyond
the bounds of possibility to conduct surveys in the neighbouring towns in the same province as
Concession.

1.9 Limitations

The survey will be conducted in Concession Township at Kundayi High School and so this
will only be a representative population of the students of Kundayi High School thus may not
give us all the information that the survey requires. Also, it is important to note that the survey
will work with a limited sample and in this case that means part of the students and not all of
them hence can make it difficult to interpret the data that will be collected.

In addition, the survey intends to use psychometrically robust tools such as questionnaires and
interviews for research in order facilitate reliable assessment. However according to McLeod
(2018) a problem with questionnaires is that respondents may lie due to social desirability as
most people want to present a positive image of themselves and so may lie or bend the truth to
look good and so the problem here will be that the answers may not be truthful. With semi-
structured interviews, the problem is that some of the questions will be limited to rigid
responses which denies the interviewer the opportunity to probe further but however the
unstructured questions will allow the researcher to probe further and the interviewee to fully
express themselves. According to George (2022) participants cannot go much into detail with
their answers and there is little room for nuance such that if a participant does not truly identify
with any of the binary or multiple-choice answers, it can be difficult to know how much their
answer reflects their true feelings. However, this is why the researcher opted for semi-
structured interviews.

5
1.10 Assumptions.

➢ Test takers will comprehend the administered research questions.

➢ The selected participants will be willing to participate accordingly.
➢ Depression does exist among adolescents of Kundayi High School.
➢ Participants are going to be keen in taking part on the survey.

1.11 Definition of key terms

Depression

According to the National Institute of Mental Health (2016) depression is a mental state of low
mood and aversion to activity which affects more than 280 million people of all ages which is
about 3.5% of the global population. Sartorius et al (2004) further goes on to note that it is
classified medically as a mental and behavioural disorder, the experience of depression affects
a person’s thoughts, behaviour, motivation, feelings and sense of well-being. In this case,
depression can also be defined as a mood affecting disorder that shows its characteristics in
adolescents’ observable behaviour such as isolating themselves from their peers, not focusing
in school and not being a part of various school activities such as sports which might lead to
the use of drugs or alcohol abuse as a way to cope or a cry for help.

1.12 Conclusion.

This chapter covers the background and context of the study as which covers what motivated
the study as well as the importance or significance of the study. The chapter also includes
research questions that are posed in the research as well as the objectives that will guide this
study into being relevant.

6
 CHAPTER 2
LITERATURE REVIEW

2.1 Introduction

This chapter includes previous studies that have been done at different levels on depression as
a mental disorder that exists amongst adolescents as well as the theoretical framework and
expresses the knowledge gap that exists.

2.2 Depression

According to Ferrari et al (2012) depression is a major global public health problem and it is
the leading cause of disability, with an estimated global point prevalence of 4.7% and is the
eleventh leading cause of global disease burden. Lupien (2009) argues that the social pressures
on people are becoming more and more pronounced in a social environment that is developing
at an increasing rate hence prolonged exposure to stress can have a negative impact on brain
development and depression is one of the more typical disorders that accompany it. Taking that
into account, the World Health Organisation statistics (2019) note that there are more than 350
million people with depression worldwide, with an increase of 18% in the last decade and an
estimated lifetime prevalence of 15%. These statistics portray how depression has become a
disorder that threatens people globally across all age groups hence is a major concern.

2.3 Depression in adolescents

According to Hawton (2009) depression in adolescents is a major risk factor for suicide, the
second to third leading cause of death in this age group with more than half adolescent suicide
victims reported to have a depressive disorder at time of death. Fletcher (2008) further asserts
that depression in adolescents also leads to serious social and educational impairments and an
increased rate of smoking, substance misuse, and obesity. This simply goes on to show why
treatment of this disorder is of great value to the world at large. According to Nock and Green
(2013) most notably, an alarming 75 percent of individuals experiencing depression during
adolescence will make a suicide attempt in adulthood. However according to Auerbach (2015)
despite these unsettling statistics and associated negative consequences, the etiological
mechanisms contributing to the onset and maintenance of depression in adolescence remains
unclear.

7
The World Health Organisation statistics (2019) note that there are more than 350 million
people with depression worldwide, with an increase of 18% in the last decade and an estimated
lifetime prevalence of 15%. According to Belfer (2008) globally, depression is one of the
leading causes of illness and disability amongst adolescents. This is because of the transition
from childhood to adolescence comes with a lot of overwhelming changes that might
completely change their lives. According to Sawyer (2018) adolescence is a pivotal period of
human development often defined as occurring between 10-24 years of age characterized by
important physical and emotional changes that impact pathways of well-being throughout life.
According to The American Psychiatric Association Diagnostic and Statistical Manual of
mental disorders (2013), models of adolescent depression are conceptualized as presenting core
symptoms similar to symptom profiles observed among adults. The profiles came from studies
carried out predominantly in western, educated, industrialized, rich and democratic countries.
However, these symptom profiles did not really capture the heterogeneity of the experience of
depression around the world thus do not fully reflect experiences that are relevant to
populations in diverse global contexts. (Chevance et al, 2020)

According to Viduain et al (2021), in Brazil social isolation is found to be the defining feature
among of adolescent depression, among other non- DSM symptoms such as emptiness and
poor academic performance. Similarly in Malaysia, Kok et al (2017) argued that desiring
connectedness with others to be highly salient among depressed young people.

2.4 Psychological Influences of Depression.

According to Gilman (2017) depression can start early in the life course and if it remains
unmanaged, may increase the risk of substance abuse, chronic conditions such as
cardiovascular disease and premature mortality. The psychological determinants of depression
include self-esteem, negative – self-image, negative thinking amongst others. The World
Health Organization (2019) asserts that self-esteem is reported to have a significant impact on
important life outcomes during adolescence and adulthood such as the clear connection that
exists between higher self-esteem and positive outcomes. For example, looking at things such
as career success, good social relationships, positive perceptions by peers as well as a sense of
well-being.

8
According to Choo et al (2017), low-esteem is related to depression, substance abuse, anti-
social behaviour and suicide. The lack of internal control and the control by others on one’s
own personal life are associated with impaired cognitive, affective, and behavioural
functioning. According to Zineldin et al (2018) personal control on one’s own personal life can
be defined as the individual’s belief that he/she would behave in a manner that maximizes good
outcomes and or minimizes bad outcomes which impact the individuals’ well-being in a variety
of domains, hence the life quality.

Gerstof et al (2014) also asserts that the extent to which individuals believe that there is external
control by other people over their own life determine what happens in their lives reflects their
sense of being controlled by others. The perceptions of an individual’s internal control are
associated with their well-being and so the existence of a prolonged experience with a lack of
internal control has been associated with impaired cognitive, affective, and behavioural
functioning.

Global Related Studies - A cross-sectional study on Vietnamese students in 2019

The purpose of the study was to find out if there was a correlation between low self -esteem
and depression.

A cross-sectional design was employed for this study with participation of 1,260 students at
three secondary schools in urban and suburban areas in Cantho City in Vietnam. According to
Nguyen (2013) the data for this study was collected during the first academic semester, from
September to December 2011. All participants were invited to provide information using self-
report questionnaires. This was done at home or even after class anonymously to avoid
participant-bias as well as for confidentiality. A 10- item Rosenberg Self- esteem scale was
used to assess global self-esteem, with higher scores indicating more positive-regard.
According to Choo (2017) to address the issue of social ideation, additional questions on
whether the student had ever seriously considered suicide or made a suicide plan used a 3-point
scale (never, sometimes, and often) as well as a yes/no question was used identity students who
had attempted suicide.

The results showed that among the investigated variables, those that had a personal tutor or had
a supplementary class added to their classes were negatively associated with the risk of low-
self-esteem because they felt that they were not as equally intelligent as those that did not have

9
a personal tutor or a supplementary class. Also, participants that had their parents’ education
level at primary level or below, were often physically or emotionally abused at home or school,
when they had below average or very poor academic performance in the last semester or when
they reported experiencing high educational stress.

According to Birndof (2005) nearly 20% of the students had low self-esteem, with no
difference between girls and boys when the investigation on prevalence of low self-esteem
among secondary school students, the characteristics associated with low self-esteem, and
relationships among self-esteem, with no difference between girls and boys. According to Keng
et al (2018), the study also showed that there exists an association between the female gender
and emotionally unstable personality and as such, females are more prone to develop
emotionally unstable personality thus, females’ self-esteem may be more likely to fluctuate,
depending on how they themselves or others, especially their parents, evaluate their
achievements,

Regional Related Studies - Jimma University Study, Southwest Ethiopia

According to Bernal-Morales (2015) University students are a special segment of the society
at a specific developmental milestone that bridges a critical transitory period from adolescence
to adulthood and this transitional period embraces a very important process like endocrine
surge, emotional turmoil, and identity development which can lead to crises, which include
self-doubt, social withdrawal and loneliness.

Rodriguez (2015) argues that University students are challenged by geographic changes,
separation from family members, academic stress alongside financial difficulties urging the
student to develop coping mechanisms therefore University students worldwide are at higher
risk to develop mental health disorders particularly depression. However, there seems to be
scarcity of information on depression in regards to higher education institutions in Ethiopia, so
there was another study conducted to assess the prevalence of depression and its associated
factors among Jimma University students.

An institution-based quantitative cross-sectional study was conducted on a total of 556

sampled students that were selected by stratified sampling technique. All colleges in Jimma
University’s main campus were included and stratification was administered at department
level and the students’ current year of study. The Beck Depression Inventory (BDI-II) was used
to screen the depression severity among the students and data was collected by use of a
pretested structured and self- administered questionnaire.

10
In line with the above, the Questionnaire consisted of socio-demographic, social, economic and
environmental variables. Also, the questionnaire was translated to the local languages and
back-translated to English in order to test its consistency. From the total respondents the
majority were male which was 64.7% with an age minimum if 21 years and the other
respondents were mainly from the College of Health Sciences and 32.7% were first year
students. Among the respondents, 59.2% of the students had academic work overload and
overburdened by test schedules. The studies showed that about 66% respondents chewed khat
which is a drug and were drinking alcohol over the last 30 days, 44% smoked cigarettes and
28.6% of the participants reported the use of marijuana.

The study showed that nearly one-third of the participants had depression. Furthermore,
(28.2%), 40.6% of the participants were free from depression, 31.1% had borderline clinical
depression, 14.4 % had mild depression, 9.9% had moderate depression and lastly 4% of the
respondents had severe depression. The prevalence of depression among Jimma University
students was high and positively associated with being from the college of social science and
humanity, history of being hit by a sexual partner, having a mentally ill family member amongst
others and so establishment of depression screening services on the campus and designing
proper mental health intervention programs was recommended.

Local Related Studies – Harare, Zimbabwe

In a clinic-based case-control study, depression was significantly associated with the female
sex. After adjustment for age, sex and clinic site, depression was significantly associated with
the chronicity of illness, number of presenting complaints, lack of cash savings, job loss and
infertility in the previous year. Persistence of depression at 12 months was associated with
bereavement, higher morbidity scores, psychological illness and greater disability. It was also
found out that among the community sample of women, severe life events were significantly
associated with the onset of depression. According to The World Health Organization (2017)
significant events that led to depression in women were marital or other relationship crises,
deaths and events directly related to infertility or to an unwanted pregnancy. Women who had
severe event were less likely to develop depression if they had social support after the event
and more likely to become depressed if they had been separated from their mother in childhood
for more than a year. Events involving loss of primary sources of self-esteem seem to predict
depression in societies in which this has been studied and women in Zimbabwe have a high
rate of such events , which may partly explain their high incidence of depression. However, in

11
accordance to this study, the researcher will be mainly focusing on the psychological
determinants of depression in adolescents as opposed to just focusing on women. This is
because the researcher believes if depression is treated in its early stages in adolescents, it’s
effects will not be carried onto adulthood. Also, the researcher noted that this study is one-
dimensional as it only focuses on women when it could’ve also taken into account that men
can also be affected by depression which is why the researcher will focus on both males and
females between the ages of 10-19 years of age.

2.5 Social Influences of Depression.

Social determinants can be defined as the conditions which influence mental health conditions
that are presented by the environment in which people learn, live, work and are born. According
to Lee et al (2017) factors such as age, social or socio-economic status, stigmatisation have all
been linked to depression.

Global Related Studies – Nepal, South Asia.

According to Kohrt et al (2010), adolescents in Nepal grew up experiencing humanitarian

emergencies, including a decade long civil war and multiple environmental disasters among
other socio-cultural risk factors for mental disorders and 14 percent of the adolescents in Nepal
reported to have at least one psychosocial problem. A qualitative study was carried out which
involved key-informant interviews as well as focus group discussions with adolescents,
parents, educators, health workers and social workers. The adolescent sample included 12
participants of which included 7 individuals with a history of depression. Also, the respondents
were selected on the rationale that they either had direct experience on adolescent depression
or were key actors in shaping adolescent lives. According to Gale et al (2013) qualitative
interview and group discussion guides were structured according to Kleinman’s explanatory
model framework of mental illness and Engel’s biopsychosocial risk factors approach. The
qualitative interview guides were translated from English by bilingual Nepali mental
researchers. The interviews were conducted at several locations in the greater Kathmandu in
Nepal.

The adolescents described key symptoms of depression that were conceptualized to six clusters
which were loneliness, sadness, low mood and anhedonia, irritability and anger, somatic
problems, negative thoughts. However, loneliness was described to be interwoven through all
other aspects of depression by respondents. They reported to having powerful feelings of
wanting to be alone, social withdrawal away from family and friends as well as being unable

12
to open up and share one’s feelings. The respondents also reported that they did not necessarily
lack supportive or meaningful friendships but instead wished to be alone due to depression. In
this qualitative study with Nepal Youth and other stakeholders such as parents, educators and
social workers, the adolescents proved to be more susceptible to depression pointing out
loneliness as the more salient experience that came with being depressed.

Regional related studies - Jimma town, Southwest Ethiopia

The study was carried out in order to determine the prevalence and socio-demographic as well
as parental-related factors of depression among school adolescents in Jimma town found in the
Oromia regional state, South West Ethiopia on 30 May 2018.

Using a cross-sectional survey, 546 adolescents who were screened for depression using the
patient health questionnaire from five randomly selected public and private schools .All
adolescents who were attending secondary school education between the ages of 10-19 years
in Jimma town were considered the source population and were randomly selected from their
schools. A multi-stage sampling technique using simple random sampling was used whereby
at the first stage, schools were stratified into public and private. The public schools in town
were six in number, and the private schools were eight. In the second stage, students from
randomly selected schools were stratified into grade levels from grades 9-12. Following the
proportional allocation of study participants based on class size, students were randomly
selected from each grade level using student registers. However, for this study, the researcher
will adopt a stratified simple random sampling technique whereby five students will be picked
from each class between the levels of form one to six. Similar to this study, the school
attendance register will be used where every fifth student will be picked. As for the data
collection procedure and measurements, the data were collected using a structured self-
administered questionnaire which included socio-demographic characteristics, substance use,
social support, adverse childhood experience, depressive symptom assessment. Adolescent
depression was assessed using a patient health questionnaire (PHQ-9A) which is a depression
screening tool that has 9 items which was administered in a local language and so for this study,
the researcher will also have the Beck Inventory for Depression (BDI) be translated into Shona
and English to accommodate all the students. Each student reported to self-rated health
questions, on a Likert Scale with five points (‘poor’ = 0, ‘fair’ = 1, ‘good’= 2, ‘very good’ = 3
, ‘excellent’ = 4) .

13
The ethical aspect ensured by providing information to the adolescents and information sheet
together with the consent form was sent to the family to obtain the consent of the family days
before data collection and the ethical approval was obtained from the Institutional Review
Board (IRB) of Jimma University Institute of Health. The classroom teaches facilitated the
distribution of study questionnaires for selected students during school hours. The results
showed that rate of response amongst the participants was 97.3% with the prevalence of
depression being found to be 28% whilst 1.3% of the students had severe depression.
According to Girma et al (2021), in the final analysis, it was concluded that sex, rural residence,
low social support and adverse childhood experience were found to be independently
associated with a higher score of depression.

Local Related Studies – Harare, Zimbabwe.

In order to understand the experience and manifestation of depression in adolescents

specifically those living with HIV and AIDS, a study was carried out in Harare. According to
Mavhu (2018), studies have found that adolescents living with HIV and AIDS are at risk of
depression which in turn affects adherence to medication. A body-mapping exercise was
conducted among 21 adolescents living with HIV between the ages of 15–19-year-olds who
had been diagnosed with major depressive disorder. However, for this study the researcher will
be focusing on the all the adolescents as a whole and not necessarily limited to those living
with HIV and AIDS.

Participants created a painted map of their bodies in order to help them in expressing their
emotional and somatic experiences in qualitative interviews. The participants attributed their
experiences of depression as having to do with their relationships and interactions with their
family members as well as peers. A sense of isolation was also said to be common, as well as
grief and loss, including ambiguous and anticipated loss. According to Mavhu (2018) the
participants’ idioms of stress included ‘thinking deeply’ (‘kufungisisa’), ‘pain’, darkness,
‘stress’. Participants acknowledged that they felt a sense of being different from others as a
common feeling due to both their HIV status and the impact HIV has had on their life
circumstances. The respondents also reported that a sense of isolation and fear of rejection was
also common as well as lack of hope for the future. Suicidal ideation was described including
slow suicide through poor adherence.

14
From this study, the researcher noted that it is of great importance to have a closer look at the
relationships between the adolescents and their peers as well as the interactions that they have
with their family members.

The effect of social media on depression as a variable

The researcher also noted that in this day and age social media was a powerful tool that was
involved or that spearheaded the interactions between adolescents and their peers. Also, the
researcher found out that the consistent use of social media for interactions came with anxiety
issues that were associated with the lack of social support or approval from the public or failure
to fit in according to certain societal standards which in most cases would lead to social
isolation and finally depression.

According to Carr and Hayes (2015) the term ‘social media’ refers to the various internet-based
networks that enable users to interact with others, verbally and visually. The Pew Research
Centre (2015) asserts that at least 92% of teenagers are active on social media and identified
the 13-17 age group as particularly heavy users of social media users, with 87% having access
to a computer, and 58% to a tablet device, also almost three-quarters of adolescents aged 15 to
17 use a smart phone and 68% of those aged 13 to 14. The researcher observed that most of the
schools have adopted the use of electrical gadgets such as phones and laptops which meant that
the targeted population of Kundayi High School students was no exception. According to Kim
(2017), understanding the impact of social media on adolescents’ well-being has become a
priority due to a simultaneous increase in mental health problems and as such, problematic
behaviours related to internet use are often described in psychiatric terminology, such as
‘addiction’. Social media however has its benefits such enabling people to express their
feelings and thoughts and in return receiving social support. McCrae, Gettings and Pursell
(2017) argue that research has also indicated a link between social media use and psychological
problems shown by a systematic review of 11 students measuring social media use and
depressive symptoms in children and adolescents showed a small but statistically significant
relationship. The link between social media and mental health problems has various
contributions as factors. A report by the Royal Society for Public Health, & Young Health
Movement (2017) suggested impaired sleep as a mechanism as internet use is a sedentary
behaviour which if in excess raises the risk of health problems. Another principal factor
influencing the relationship between social media use and mental health is social support. This

15
is because social media enables adolescent users to strengthen bonds with their peers and or
friends as well as forming new friendships online which in turn reduces loneliness and social
isolation and indirectly improves mental health.

However, according to Eaton and Bradshaw (2011) studies support that those with low social
support are more likely to suffer from mental health problems such as depression, anxiety and
psychological distress as compared to those with high social support from family, friends and
neighbours. Adolescents also tend to compare their lives to others on social media in order to
assess their opinion and abilities. According to Seabrook et al (2016) there is a correlation
between negative online interaction and depression, as such passive Facebook use predicts
social comparison as well as envy which in turn leads to depression.

In line with the above, according to Baker and Algorta (2016) adolescence is the period of
personal and social identity formation as explained by Erickson in 1950, and much of this
development is now reliant on social media. As such, due to the adolescents’ limited capacity
for self-regulation and being vulnerable to peer pressure, adolescents may not evade the
adverse effects of social media use, and as such they are at greater risk of developing mental
disorder.

2.6 Economic influences of Depression.

According to Pickett et al (2010) at a country level, it has been suggested that income inequality
may directly predispose individuals to poorer mental health and at an individual level, different
socio-economic measures have yielded varying relationships with depression. However, it
must be noted that there is not much evidence on low- and middle-class income countries and
as such, findings from high income countries have been generalized to the rest of the population
thus it can be misleading. According to Guan et al (2022) financial stress has been proposed as
an economic determinant of depression and that there is a positive association between
financial stress and depression found in both high-income and low-and middle-income
countries, but it is generally among populations with low income or wealth.

The Social Causation Theory by Keith Sawyer 2005.

16
Figure 1 The Social Causation Theory by Keith Sawyer 2005.

According to Lund et al (2010), the social causation theory is one of the theories that has been
proposed to explain possible mechanisms underlying the effect of poverty on mental disorders
as it states that stressful or financial circumstances might lead to the occurrence of new
depressive symptoms or maintain previous depression. It asserts that experiencing economic
hardship increases the risk of subsequent mental illness. This can be caused by poor living
conditions, low social capital, social isolation and lack of coping ability to negative life
circumstances. According to Lund and Cois (2018) individuals or households with limited
financial resources are more vulnerable to stressful life events such as economic crises and
public health crises which might increase the risk of mental health problems.

Global Related Studies – Asia, South America and the Middle East

Studies have consistently found that economic factors such as poverty, unemployment, and
income inequality are associated with an increased risk of depression among adolescents.
According to the UNFPA (2014) globally, one in four people are aged between 10 and 24 years
, making up 1.8 billion of today’s population and ninety percent of these young people live in
low-and middle-income countries .According to Goodman et al (2011) young people living in
poverty face multiple forms of cumulative disadvantage- such as violence, crime, lack of
educational or employment opportunities which can significantly limit their future life chances
and put them at higher risk of mental disorders.

17
The study conducted by the World Health Organisation (WHO) in 2016 found that poverty is
a major risk factor for mental health problems for adolescents in low- and middle- income
countries. The study surveyed over 70, 000 adolescents from 30 countries across Africa, Asia,
South America, and the Middle East. A cross-sectional research design was used in this study.
The survey used a standardized instrument called the Strengths and Difficulties Questionnaire
(SDQ) to assess mental health problems, including depression, anxiety and conduct disorders.
However, for this study the researcher will only be limited to one mental health problem which
is depression and its associated economic determinants. As opposed to the Strengths and
Difficulties Questionnaire (SDQ), for this study the researcher will be using the Beck
Depression Inventory (BDI). The questionnaire was translated into the local languages of the
participating countries to ensure that it was culturally appropriate and accessible to all
participants. The study also collected data on various socio-economic indicators, such as
household income, education, and living conditions, to assess the impact of poverty on mental
health outcomes. The data was analysed using statistical methods such as regression analysis,
to identify the relationships between poverty and mental health outcomes.

The study found that adolescents living in poverty were more likely to experience mental health
problems, with rates of depression and anxiety being particularly high. These problems can
have long-term consequences for an individual’s well -being and can affect their ability to
engage in education, work, and relationships. The study also highlighted the need for greater
investment in mental health services and support for vulnerable populations in low-and middle-
income countries. This includes providing access to affordable and effective mental health
treatments and interventions. Additionally, the study emphasized the importance of addressing
the social determinants of mental health such as poverty, to improve the overall well-being of
adolescents in these countries.

Regional related studies – Middle East and North Africa region

The study conducted in the Middle East and North Africa (MENA) region in 2017 aimed to
investigate the relationship between poverty and depression among adolescents. The study,
published in the Journal of Affective Disorders, included data from over 4,000 adolescents
from 4 countries. The survey used a standardized instrument called the Patient Health
Questionnaire -9 (PHQ-9) to assess depression. The purpose of the study was to shed light on
significant impact of poverty and other socio-economic factors on mental health outcomes in
the region.

18
The study found that poverty, unemployment, and low education levels were significantly
associated with higher rates of depression among adolescents in the region. The prevalence of
mental health disorders in the region is significant, and there are several factors that contribute
to this. These factors include social and economic determinants such as poverty,
unemployment, and social inequality, as well as political instability, conflict, and displacement.
The study however went on to highlight the need for greater investment in mental health
services, social welfare programs, and economic development to address the underlying social
and economic determinants of mental health outcomes in the region.

Local related studies – A Case study by SHAZ (Shaping the health of adolescents in Zimbabwe)

The study was conducted in 2005 whereby there was a sample size of 200 adolescent girls but
initially the researchers worked with 50 girls for the pilot study. The sampling procedure used
was the random sampling technique whereby study participants were recruited through
community events and referrals by the Chitungwiza Youth Forum. According to Chirwa et al
(2010) a randomization log was prepared to enrol girls into intervention and control groups in
blocks of 50. The blocks were chosen so that the life skills groups of 25 participants each would
form at similar rates.

For the data collection procedure, the Shona Symptom Questionnaire published in 1996 was
adopted. According to Dunbar (2010) This is a 14-item measure of non-psychotic
psychological morbidity intended to detect common mental disorders which is also a screening
tool developed in the local language and uses local idioms. However, the instrument was then
translated from Shona to English in order to allow the participants to choose the language that
they preferred the most. Aspects that were measured also included socio-economic issues such
as food security, being unable to buy medicine, changes in household location, unemployment
as well as homelessness.

The study results showed that the girls from lower income levels were more likely to experience
depressive symptoms due to issues such as food security, being unable to purchase basic
necessities, not reaching form 4 level and being homeless at some point in their lives. The study
also found out that poverty was associated with other risk factors for depression, such as family
conflict, lack of social support, and exposure to trauma.

19
2.7 Strategies that can help alleviate the effects of depression amongst adolescents.

Global Related Studies – The Adolescent Depression Awareness Program, (ADAP), USA

The Adolescent Depression Awareness Program (ADAP) in the United States of America is an
educational program that aims to increase awareness of depression and suicide among high
school students. The program is designed to be delivered by trained mental health
professionals, such as school counsellors or psychologists, to students in a classroom or group
setting. According to Cuijpers and Ryenolds (2017) the program was developed by the
American Psychiatric Association Foundation and is based on the idea that early intervention
can prevent depression from becoming severe. Likewise, for this study the researcher strongly
believes that if depression is treated in its early stages, it can be stopped from becoming an
ongoing mental health disorder into adulthood which is why the researcher chose the
adolescents between 10-19 years to make up the sample for the research.

The program involves a series of interactive presentations and workshops delivered by trained
mental health professionals, which cover topics such as the signs and symptoms of depression,
the importance of seeking help, and the role of social support. The program also includes a
toolkit for school staff, which provides guidance on identifying and referring students with
depression for treatment.

According to Merry et al (2011) the ADAP program has been evaluated in several studies,
which have found that it is effective in increasing depression knowledge and reducing
depressive symptoms among high school students. The program has been implemented in
schools across the United States and is considered a promising strategy for addressing the issue
of clinical depression amongst adolescents.

Regional Related Studies- The Strong Minds Program, Uganda

The Strong Minds program in Uganda is a group-based cognitive-behavioural therapy (CBT)

program that was originally designed to treat depression amongst women in low-income
settings. However, the program has been adapted to treat depression among adolescents.

According to Tuisku et al (2014) the program is delivered by trained lay counsellors who are
selected from the local community. The counsellors receive a two-week training course on the
CBT approach, during which they learn how to identify symptoms of depression, conduct
group therapy sessions, and provide support to participants. The Strong Minds program

20
consists of 12 weekly group therapy sessions that last for two hours each. The sessions focus
on teaching participants coping skills and strategies to manage their depression symptoms.
Participants are also encouraged to provide support to each other and to practice the skills they
learn outside of the therapy sessions.

A study conducted in Uganda found that the Strong Minds program was effective in reducing
symptoms of depression among adolescents. The study found that participants who received
the program had significantly lower depression scores compared to those who did not receive
the program. The study also found that the program was cost-effective and feasible to
implement in low-resource settings. According To Nakku et al (2016) overall, the Strong Minds
program in Uganda provides a promising model for delivering group-based CBT interventions
for depression in resource-limited settings.

Local Related Studies – The Friendship Bench Program, Zimbabwe.

The Friendship Bench program in Zimbabwe is a mental health intervention that involves
training grandmothers in communities to provide basic talk therapy to adolescents with
depression. The program is based on a form of talk therapy known as problem solving therapy
(PST). According to Chibanda (2017) the program was developed in response to the high
prevalence of depression in Zimbabwe, particularly among women and girls. However, for this
study the researcher will not be limited to coming up with interventions that focus on girls and
women but rather both boys and girls.

The program is delivered by trained lay counsellors, who are known as community
‘grandmothers. The grandmothers are selected from the local community and receive training
in basic talk therapy techniques such as active listening and problem-solving skills. The
Friendship Bench program consists of six to eight weekly therapy sessions delivered by the
grandmothers in a quiet and private outdoor setting. The sessions focus on teaching coping
skills and strategies to manage depression symptoms, such as stress reduction and problem-
solving.

The Friendship Bench program has since been expanded to other countries, such as Malawi
and Zambia, and has gained recognition for being the mental health intervention for depression
in low-income countries that is promising

For this study, the researcher will be adopting a cost-effective intervention program which
involves engaging The Friendship Bench to train the teachers at Kundayi High School to be

21
able to offer counselling services to students with depression. This training programme will be
extended to parents and even pastors of local churches in order to widen the pool of people that
can help the students.

2.8 THEORATICAL FRAMEWORK

Figure 2 The Beck's Cognitive Triad of Depression 1967

Aaron Beck is a major cognitive theorist who studied suffering from depression and identified
three mechanisms that he argued were the causes of depression. According to McLeod (2015)
the three mechanisms that are responsible for depression include the cognitive triad (of negative
automatic thinking), negative self -schemas and errors in logic for instance faulty information
processing. The negative triad consists of three negative thoughts which are negative thoughts
about the self, negative thoughts about the world and the future. According to Gross (2015) as
these three components interact, they interfere with normal cognitive processing, leading to
impairments in perception, memory and problem solving with the person becoming obsessed
with negative thoughts. Beck assumed that individuals on the verge of depression developed
what was known as a negative self- schema which are a set of negative beliefs and expectations
of themselves. This theory will work well for this study as it not only explores the external
determinants of depression but also looks at the thought processes that occur internally in an

22
individual. It is quite common that most adolescents develop a negative self-schema as they
compare themselves to other students in terms of factors such as their backgrounds, sporting
activities as well as their academic performances which will end up resulting in negative beliefs
that they cannot have the same achievements like the other students.

There are various experiences that can result in the development of negative schemas such as
bullying, parent or even a sibling, neglect or abuse, death of a spouse as well as bullying.
However, it must be noted that a negative self-schema predisposes the individual to depression,
and therefore someone who has acquired a cognitive triad will not necessarily develop
depression. A stressful life event might need to occur later in life so that the negative schema
will develop. According to Cardwell et al (2015) people with negative self-schemas become
prone to making logical errors in their thinking and they tend to focus selectively on certain
aspects of a situation while ignoring equally relevant information. Likewise, the researcher
noted that issues such as bullying, neglect from parents or caretakers and even death of a loved
one were some of the common issues that the researcher had to pay attention to as they led to
negative self-schemas and eventually would lead to depression.

There are a several systematic negative bias in information processing known as logical errors
that include arbitrary interference which is drawing a negative conclusion in the absence of
supporting data, selective abstraction which is focusing on the worst aspects of any situation,
magnification and minimisation that make a problem seem bigger than it is, personalization
whereby is negative events are interpreted as their fault and dichotomous thinking where
everything is seen as black and white and there is no in between. With adolescents, it most
likely is the case that they usually adhere to selective arbitration whereby they focus on the
worst aspects of any situation for example, students take failure of an exam or assignment very
seriously to the extent that they forget they can work harder next time and that there is room
for improvement which goes in line with this theory hence showing it is highly appropriate for
this study.

Later, physiological elements were added to the original cognitive model, showing how can
also the physiology of the body might be affected. According to Beck (2008), when the
physiology of the body is affected, this gives rise to change in the brain and effect the release
of stress related hormones such as cortisol and serotonin. Beck and Haigh (2014) developed
the generic cognitive model in order to generalize and advance its findings as well as

23
approaches across a wide range of disorders and environmental triggers thus adding an
expanded theory of modes and early schema activation.

The researcher will be working with the Beck’s Cognitive Triad of Depression because in
addition to focusing on the observable determinants of depression such as interaction with peers
and neglect from parents or caretakers, the theory gives the researcher a chance to explore the
internal determinants of depression which differ between individuals and eventually manifest
themselves in the forms of stress, anxiety and finally depression. The researcher will be able to
identify if there is any development of negative self-schemas and be able to stop them from
evolving before they manifest themselves in observable behaviour.

2.9 Knowledge Gap

It can be noted that the inhabitants of Concession Township or Zimbabwe at large believe
disorders like depression are most prevalent in Western countries and not Africa. There is also
a belief that stress related behaviours only affect adults because of the various responsibilities
and roles they partake in. This simply puts across the fact that Zimbabweans do not take mental
health issues seriously especially amongst adolescents which also results in them not fully
knowing when treatment is to be administered and when one is or on the verge of being
depressed. In addition, spiritual rather than bio-medical models are adopted to explain
depression therefore this study will shed more light in helping people adopt validated mental
health care which includes the diagnosis, prevention and treatment of depression amongst
adolescents.

2.4 Chapter Summary.

This section includes the previous and current studies that have been done on depression
together with the related causes such as economical, psychological and social factors. There is
also the theoretical framework that explains in detail the theory on which this survey is based
on.

24
 CHAPTER 3
METHODOLOGY

Introduction

This section will focus on the approach that will be used to conduct this survey as well as the
data collection procedures and analysis, target population and the research design that will be
adopted including the research instrument deemed to be ideal for the survey.

3.2 Approach

For this survey, the researcher opted for both qualitative and a quantitative approach. A
quantitative approach uses statistical data as a tool for saving time as well as resources and
places emphasis on the numbers and figures in the collection and analysis of data (Bryman
2012). The quantitative approach proved to be quite useful in that the researcher was able to
find out how many adolescents at Kundayi High School had been affected by depression and
so in simple terms the data was gathered easily and quickly using the Beck Depression
Inventory. In addition, the quantitative research approach produced objective data which was
communicated through statistics and numbers. For instance, in this case the numbers of
depressed adolescents thereby obtaining accurate results. Shank and Brown (2007) further
assert that the research using quantitative data approach is conducted in a general or public
fashion because of its clear objective and guidelines and can therefore be repeated at any other
time or place and still get the same results.

The researcher also found out that by using the quantitative research approach one was able to
further generalise results obtained to wider populations and in this case, adolescents affected
by depression at national level. In regards to this survey study, the quantitative approach proved
to be focused in that the researcher was strictly dealing with adolescents of Kundayi High
school thus was beneficial to the research as the data was collected on a school premises which
also proved to be less time consuming.

However, the researcher also opted for a qualitative approach as interviews were also used in
the research. The Beck Depression Inventory (BDI) was limited to finding out the prevalence
of depression whereas the interviews were useful in that they brought to light the social,

25
economic and psychological causes of depression and the interventions that could be adopted
in mitigating the effects of depression. The researcher opted for interviews because they
provide in-depth information on the participants as they get to ask open-ended questions as
well to do follow-up questions on the responses provided.

3.3 Research Design

The researcher adopted a descriptive study design. This was because the survey was
explanatory in nature considering that it was based on the prevalence of depression in
adolescents of Kundayi High School students. According to Shields (2013) descriptive research
is used to describe characteristics of a population or phenomenon being studied. The researcher
used this design to find out the social, economic as well as psychological factors that are
associated with the prevalence of depression in adolescents of Concession Township which
helped in coming up with strategies aimed at alleviating the related effects. This allowed the
researcher to fully explain that factors such as social media, the influence of social support
from peers and family members played a pivotal role in driving adolescents into depression. It
also helped by probing the ‘how’ part of what would have been done by the peers and family
members that would have led to adolescents being depressed.

3.4 Target Population

The study survey was conducted in Concession Township which is situated in Mashonaland
Central Province. The targeted group for research was the students of Kundayi High School
between the ages of 12-18 years. After having accessed the school records, the researcher
concluded that the estimated population of the school was 300 students in total thus the number
would be challenging to work with. A choice was made to work with at least 15 to 16 years
students from each class from the 6 levels that were present at the school. The research aimed
to gather information on depression amongst adolescents as opposed to studies that usually
only focus on adults affected by depression.

3.5 Sample Size and Sampling Method

A total of 16-17 students was drawn from each class at Kundayi High School and since the
adolescent group comprised of ages between 12-18 years of age, levels of form 1 to form 6 all

26
proved to be appropriate for the sample size. The researcher ended up working with a total of
100 students from the school. This sample size comprised of both males and females on each
group since the population of males at the school was lesser than that of girls. The researcher
also had to incorporate that the sample group comprise of students that were from urban and
rural areas for diversity. The sampling method that was used was the systematic random
sampling technique. According to Simkus (2022) systematic sampling is a method of random
sampling where researchers select members of the population at a regular interval. In relation
to this study, the researcher chose a sample of 15 participants from the overall number of
educational level for example 15 form 1s. This way, there will be guarantee that the sample
represents specific sub-groups or strata thereby reducing sampling errors.

Table 3.5.1 Sample size according to educational level

LEVEL NO OF SAMPLE SIZE

FORM ONE 15

FORM TWO 15

FORM THREE 18

FORM FOUR 18

LOWER SIX 17

UPPER SIX 17

TOTAL 100

3.6 Research Instrument

For this survey, the researcher administered questionnaires and also conducted interviews. It
ought to be noted that in as much as the questionnaire helped to collect data, it also proved to
be a screening tool that was used to find out the adolescents that were on the verge of depression
or that were already showing symptoms of depression. The researcher chose to work with an
already existing inventory which was the Beck Depression Inventory which was easy
administer. The interviews on the other hand helped the research in-depth information about
the participants that had extreme cases of depression.

27
The Beck Depression Inventory (BDI).

In addition to the above, Beck Depression Inventory (BDI) was created by Aaron T. Beck.
According to Osman et al (2004) the Beck Depression Inventory (BDI) is widely used to screen
for depression and to measure behavioural manifestations as well as severity of depression and
the BDI can be used for all ages from 13 to 80. The inventory contains 21 self-report items
which individuals complete using multiple choice responses. According to Beck (1972) the
BDI is composed of items relating to symptoms of depression such as hopelessness and
irritability, cognitions such as guilt or feelings of being punished, as well as physical symptoms
such as fatigue, weight loss, and satisfaction. The test-retest reliability of the BDI ranges from
0.73 to 0.92 which in turn shows that the scores are consistent over time. The internal
consistency of the BDI is 0.9 which means that the items on the BDI relate to each other
accurately and measure the same construct which is depression.

According to Lee et al (2017), the Beck Depression Inventory also has good convergent and
discriminant validity which means that the BDI correlates highly with other measures of
depression such as the Patient Health Questionnaire-9 and that the BDI does not correlate
highly with measures of other psychiatric symptoms such as anxiety. The BDI was adopted
because it relies on the adolescents’ perception of what they will be feeling or their symptoms
hence proves to be highly accurate as it only assesses symptoms of depression. The BDI also
showed to be universal in nature as it applied to every student who it was administered to
despite their culture or ethnicity and even race, it applies to everyone. The BDI is categorised
into the 4 major domains, from 21 questions, namely emotional, cognitive, motivational and
physiological domains that are used to assess severity of depression symptomatology and each
of the items of the BDI is scored using a 4-point Likert Scale that ranges from 0-3. It is
important to note that the total score is 63, with classifications such as 0-13 representing
minimal depression, 14-19 representing mild depression, 20-28 indicating moderate depression
whilst 29-63 scores represent severe depression or major depressive disorder. This was useful
to the researcher in categorising the depression stages that the adolescents were experiencing
thus also showing prevalence of depression.

However, it can be noted that the BDI has some limitations that need to be paid attention to
such just like other self-report inventories such as exaggeration of scores by the respondents.
According to Bowling (2005) like every other questionnaire, the way the instrument is
administered can have an effect on the final score such as if the patient is asked to fill out the

28
form in front of the other people in a clinical environment, for instance, social expectations
have been shown to elicit a different response compared to administration via a postal survey.

Interviews.

The researcher also opted for interviews because they cater for participant engagement as
participants will be fully willing to share their experiences on a one-on-one basis. Interviews
are also ideal in that the researcher can also take note of non-verbal cues of the participant
which can give more information about the subject at hand. Non -verbal cues such as facial
expressions provide additional insights into their responses. According to Seidman (2013)
interviews can be a valuable research method for collecting in-depth, nuanced information from
participants, fostering participant engagement and empowerment as well as providing
flexibility in data collection.

The researcher decided to work with semi structured interview in the research pertaining the
perceived social, economic and psychological causes of depression in adolescents for various
reasons. The researcher also made use of an interview guide that had a set questions of which
the participants had to give responses to. The researcher decided to use semi structured
interviews because they allowed the research to probe further by use of different kinds of
questions to the participants. It is also important to note, questions that probe further are
essential when it comes to issues that have to do with reliability and getting a clear idea of what
the participants will be going through as it provides clarity.

3.7 Data Collection Procedure

In order to be able to collect data from the school, permission was sought from relevant
authorities and in this case, it was the Mazowe Rural District Council whose head office was
situated in Concession Township as well as the Headmaster of Kundayi High School in order
to keep up with the psychological ethics of research. The Mazowe Rural District Council gave
the researcher permission which allowed the researcher to be able to conduct the survey at their
school of choice. Likewise, the Headmaster of Kundayi High School also gave the researcher
the permission to conduct their survey at the school on speculated time frames in order to not
disturb the students on their day-to-day business at the school. The researcher collected data
quantitatively at the school. The researcher had a routine whereby they would administer forms

29
of the BDI and would leave the students to fill them out during their free time in between
lessons. The researcher also received help from the teachers who would in turn collect those
forms just before break time at 1000hrs once the students had completed them. It was quite
difficult to discern on the time that was actually taken on filling out the forms since the
researcher was under strict guidance from the school that they had to leave the forms and come
for them at a later time and so the researcher would only collect the forms at a later time. The
researcher returned at a later date to conduct interviews on the participants that had extreme
cases of depression.

3.8 Data Presentation and Analysis

The data collected from questionnaires was computerised and would be presented using
quantitative means and presented in the form of pie charts as well as bar graphs as these will
clearly show the levels of participants that are either on the verge of depression and those that
are already dealing with depression. The quantitative means of data presentation made analysis
easier as they showed the exact statistics of adolescents at Kundayi High School that were
experiencing depression by use of tables, graphs and charts for presentation which proved to
make comparative analysis easier as well as to show the statistical differences that existed
amongst the students. However, the data collected from interviews will be presented
thematically according to the common themes picked out from the data collected as well as
from the important aspects of the research topic hence there will be the use of thematic analysis.
Descriptive analysis will be adopted for both the data collected quantitatively.

3.9 Ethical Considerations

According to Bhasin (2020) ethical consideration is a collection of principles and values that
should be followed while doing human affairs as they make sure that no one acts in such a way
that is harmful to society or an individual and refrains people and organizations from indulging
in vicious conduct. Initially, permission was obtained from the relevant authorities and when
the survey had started the researcher made efforts in order to guarantee confidentiality in the
sense that the participants’ identities were be protected. The objectives and or intentions of the
research were made clear to the participants that the researcher wanted to determine the social,
economic and psychological determinants on the prevalence of depression in adolescents which
would in turn help come up with strategies to alleviate the associated effects. This was done
through a debrief by the researcher before each group had the questionnaires were administered

30
to them. The languages Shona and English were used in order to accommodate all the students
during the debrief as well as on the questionnaires. The researcher also made it clear that only
those who were willing will be part of the survey would participate and had the liberty to
withdraw any time that they felt like they were no longer interested. The researcher also notified
the participants that interviews would be recorded for the sake of data collection but however
the participants pointed out that they were not comfortable with being recorded.

3.10 Chapter Summary.

This above section includes the approach that was used to conduct this survey as well as the
data collection procedures and analysis, target population and the research design that was
adopted including the research instrument that deemed to be ideal for the survey. The ethical
considerations were also included in this chapter.

31
 CHAPTER 4

DATA PRESENTATION, INTERPRETATION AND ANALYSIS

4.1 Introduction

This chapter includes findings that are based on the administered questionnaires given to high
school adolescents on the study of depression. The data is presented using quantitative means
in the form of graphs and diagrams demonstrating the various levels of depression and the
distribution of patterns of depression among students.

The survey had a total 100 adolescents who were students at Kundayi High School. They were
between the ages of 12 and 18 years. These students were from the educational levels from
form 1 to form 6. Their economic backgrounds were low-income, middle-income, and high-
income classes. The survey comprised of both males and females from the school. Most of the
students come from Concession and Glendale but some were from Collingwood and
Summerset Farms. All of the students were Zimbabwean.

4.2. Demographic characteristics of respondents

4.2.1 Response Rate of respondents.

The survey had a total population of 100 respondents and out of those respondents 49 were
males and 51 were females. All the participants completed the questionnaire which gave a
response rate of 100%.

Table 4.2.1 Response rate

Number of respondents Responses Response rate

49 males 49 100%
51 females 51 100%

32
4.2.2 Age of the respondents

AGE OF RESPONDENTS

50
40
30
20
10
0
12-14 years 15-17 years 18 years +

Fig 4.2.2 respondents’ age

According to Baxter (2013) 34% of adolescents globally aged 10-19 years, are at risk of
developing clinical depression which exceeds the reported estimates of individuals aged 18-25
years. However, the researcher chose to work with participants that were between the ages of
12-18 years of age because according to The World Health Organization (2022), it is estimated
that 1 in 7 (14%) 12- 18-year-olds experience mental health conditions yet these remain largely
unrecognized and untreated. It is wise, from the researcher’s point of view, that depression is
treated in its early stages before it reaches adulthood. Also, the researcher noted that the ages
between 12- 18 years are when puberty takes place and so the physical changes that occur on
the adolescents can also lead to anxiety and loss of confidence that might also lead to
depression. However, the sample size had 2 participant that exceeded the age limit and was 19
years of age but still managed to provide appropriate information that was vital for the research.

4.2.3 Gender of the respondents.

Gender of respondents
51.5
51
50.5
Number

50
49.5
49
48.5
48
Males Females
Gender

Fig 4.2.3 respondents’ gender

33
The research sample had 49 males and 51 females giving a total of 100 participants. The
researcher opted for both males and females because they both go through the same adolescent
stages and are at risk of being depressed due to psychological determinants such as negative
thought processes, low self-esteem which might be caused by physical changes that go through
their bodies. Both males and females were chosen because the school is mixed and not a single
sex school.

4.2.4 Educational level of the respondents.

EDUCATIONAL LEVEL
Educational level Form Educational level Number
18

18

17

17
15

15
NUMBER

6
5
4
3
2
1

1 2 3 4 5 6
LEVEL

Fig 4.2.4 respondents’ educational level

The participants involved in the research belonged to educational levels ranging from form 1
up to form 6 from Kundayi High School. The researcher noted that compiling data from all
levels would give a clear representation of the prevalence of depression amongst the school as
a whole. The age group for the target population was 12-18 years meaning it would involve all
educational levels that existed at the school.

34
4.2.5 Economic background of respondents

Economic Background

3%

Low-income
42% Middle-income
55%
High-income

Fig 4.2.5 Respondents economic background

The Concession township residents mainly thrive on mining; however, others are farmers while
others are employed formally within the government. The researcher concluded that out of the
100 participants that took place in the survey, 55 participants came from low-income economic
background which gave 55%. The researcher also identified that 42 participants were from
middle income economic backgrounds which gave a total of 42%. Lastly the remaining 3
participants were from high -income economic backgrounds which gave a total of 3% of the
selected sample population.

35
4.2.6 Prevalence of depression at Kundayi High School

Table 4.6 the prevalence of depression

Score Level Level of depression Number of people

1-10 These ups and downs are considered normal 37
11-16 Mild Mood Disturbance 20
17-20 Borderline Clinical Depression 17
21-30 Moderate Depression 14
31-40 Severe Depression 8
Over 40 Extreme Depression 4
Total 100

Level of Depression
40

35

30

25
NUMBER

20

15

10

0
Normal Ups and Mild mood Borderline Moderate Severe depression Extreme depression
downs disturbances depression depression
TYPES OF DEPRESSION

Fig 4.2.6 Level of depression amongst students.

The Beck Depression Inventory that was used as a research instrument is a questionnaire that
involves 21 questions on depression. The score ranges from 1-10 which is interpreted as “Ups

36
and downs that are considered normal” to scores that are over 40 and are considered as
“Extreme Depression”.

“These ups and downs are considered normal”

During the course of their day, as students, participants come across small obstacles that can
however be overcome by putting little or no effort at all. 37 % of the students had scores that
fell into the category of “these ups and downs are considered normal” which as illustrated by
the table was between 1-10.For example, the researcher noted that sadness by these participants
was attributed to things such as their friend not attending school that day or other minor
inconviniences.

“Mild Mood Disturbance”

According to Biss et al ( 2010) mood is defined as an affective state that is less specific, less
intense and less likely to be provoked or instantiated by a particular stimulus or event with
having either a positive or negative valence. The participants who were in this category as the
researcher noted had faced an unxpected event such as being punished for noise with the rest
of the class or simply an argument with a classmate which would ruin most part of their day.
The researcher also noted that participants whose scores were in this category were going
through puberty hence mood swings were to be expected. This category constitued of 20 % of
the chosen sample.

“Borderline Clinical Depression”

A total of 17 which was 17% participants had scores that were considered as reflecting
“Borderline Clinical Depression”. The researcher noted that the participants admiitted to
having appetite changes, feelings of emptiness as well as sadness that had gone for quite some
time and were not caused by daily inconviniences that affected their mood.

“Moderate Depression”

According to the scale for grading scores, 14 participants had moderate depression which was
14% of the total sample that was used. This was derived from their questionnaires that
suggested that these students at Kundayi High School were experiencing moderate depression
as depicted by their responses such as worry over weight loss and disturbances in sleep patterns.
The researcher noted that this moderate depression was caused by social issues such as the

37
pressure and discrimination that came from peers during their interactions in person as well as
the influence of social media as well.

“Severe Depression”

From the survey, the researcher noted that 8 respondents had severe depression thereby
constituting 8% of the selected sample. The participants’ responses from the questionnaire
depicted that they had difficulties being optimistic about the future. For example form 4
students who were in despair that they would come back to Kundayi High School for Lower 6
and Upper 6 due to financial constraints such as the parents or guardians not being able to cater
for shool fees and new uniforms hence were suffering from severe depression as their future
from their perspective was bleak.

“ Extreme Depression”

The precentage that constituted participants with severe depression was 4% of the selected
sample. This goes on to show that indeed most of the adolescents from Kundayi High School
were suffering from depression due to reasons such as having negative feelings, low-self
esteem when they were in the presence of other learners or their friends. Also, extreme
depression arose from not being able to have a complete uniform set or books to use since they
could not afford them which would also lead to extreme depression.

As depicted by Table 4.41 on the extent of depression , the questionnaire assisted the researcher
in determining the prevalence rates of depression amongst the adolescents of Kundayi High
School . For example, a total of 43% of the students at the school are experiencing depression
from borderline depression to extreme depression as depicted by the findings sorely based on
depression symptoms. However, an interview was adopted in bid to look at the determinants
of those depressions symptoms.

4.3 Data from interviews conducted on extreme cases of depression in adolescents.

4.3.1 Response rate of interview

The interview was narrowed down to 12 participants based on their scores.These participants
had high scores that were over 40 thereby depicting extreme depression symptoms thereby the
researcher decided to interview them inorder to determine the causes of the depression.12
participants took part in the survey meaning there was a 100% response rate.

38
4.3.2 Gender of participants

Table 4.3.2 Gender of participants

Gender Number
Females 5
Males 7
Total 12

The interview had 5 females and 7 males which made a total of 12 participants. The male
participants had high scores from the questionnaire and the researcher noted that they were
experiencing extreme and severe depression because they find it hard to open up due to the
socialisation they receive to be masculine and strong even if they experience traumatic events.

4.4 Causes of depression

Table 4.7.1 causes of depression amongst students of Kundayi High School.

Number of Signs of depression Main Causes

Participants of depression
2-4 Isolating oneself from others Social
4-6 Stressing about not having complete uniform and Economic
stationery
6-8 Sleep disturbances Psychological
8-10 Aggression Psychological
10-12 Stressing about accomodation arrangement at home Economic

4.4.1 Theme 1 : Social determinants associated with the prevalence of depression.

➢ Participants pointed out that they faced social problems in their daily lives that would
cause them to have overwhelming sadness. These issues included failure to makes
friends that were in the same class as themselves. The participants also explained how
they were not part of any social clubs like the Scripture Union, Chess or even the Music
Club where they could interact with other school children .

39
“I often isolate myself because I feel that I do not belong in those social circles. I also
consider myself an introvert and so it becomes hard to make friends let alone to be part of
conversations as I think that if I provide my input or insight on the matter, no one will listen
to me”. Participant X

➢ Social isolation was also seen to be a determinant of depression as the participants

pointed out that they preferred to be alone or to isolate themselves during times when
others would interact and make conversations. As such, being alone would result in
these participants developing negative thoughts and emotions therefore it can be noted
that isolation causes depression because humans are considered to be social beings thus
have an innate need for social interaction and connection. It can also be noted that when
adolescents are isolate themselves, they tend to feel lonely.
“ I personally prefer being alone. When others go to the grounds I go and hide in the
classrooms away from the teachers and my classmates.” Participant Q

➢ It can also be noted that lack of social support from friends, parents and guardians also
led to depression amongst these participants. Adolescence is a critical stage that
involves puberty which comes with a lot of body changes that are often confusing and
alarming. However, with the support of one’s family, it does not get to be a difficult
stage. The participants highlighted that sometimes they would get discouragement from
their parents on various issues such as education thus led to their depression. Lack of
social support results in adolescents feeling disconnected from the real world and being
unsupported often leads to feelings of worthlessness, despair and even overwhelming
sadness.
“ I once failed to come up with 5 subjects during the second term of form four. I remember
my father shouting at me and telling me that I would never be anything in life. He said you
are a man and you should never fail because one day you will fail to take care of your family”

➢ Most of these participants’ parents and guardians proved to be very strict towards them
in such a way that they felt that they had to constantly prove themselves. Failure was
unacceptable and so they would become anxious whenever they failed as they would
be afraid of disappointing their parents. The participants explained that anxiety would
lead to panic attacks which in turn led to stress and finally a depressive state.
Relationships between adolescents and their parents proved to be also an important
factor because any inconvinience would disrupt their daily routines and their sense of

40
 purpose as the adolescents ruminate on negative feelings and thoughts which can
intensify symptoms of depression.

➢ The researcher noted that the students from Kundayi High School were experiencing
severe and extreme depression due to social factors such as the relationships they had
with their peers as well as their families and how those relationships made them feel
such as lack of confidence around them, fear of disappointing them and feeling that
they did not fit in which would lead to isolation . This would in turn lead to negative
feelings and thoughts .

4.4.2 Theme 2 : Economic determinants associated with the prevalence of depression.

➢ The participants pointed out that they also had economic challenges that also led to
extreme and severe depression symptoms such as loss of interest in certain things such
as sports, weight loss as well as mood disturbances. The researcher noted that due to
financial constraints , some participants did not have adequete learning material such
as stationery and others did not have a complete set of uniforms which made them lose
their confidence. This can often lead to feelings of hopelessness as individuals feel that
they would have lost control over their own lives.
“ At assembly every Monday and Friday students are required to have their blazers on.
Prefects pick those without blazers and are told to stand aside because they would have
disobeyed the rules not knowing that some of us actually don’t have blazers. Punishment
will follow soon after assembly” Participant Y

➢ The researcher also concluded that depression would come as a result of the economic
background or the situation at home.For instance in terms of accomodation settings,
some of the participants lived in a one room with a family that had 5 members or so.In
this regard, some of the participants felt ashamed when they compared themselves to
other students that were living in full houses . They also mentioned that it was hard to
study with their siblings around and sometimes they would not have electricity, in turn,
their school work would suffer thus also leading to depression after they had gotten
sub-standard results. Individuals often experience chronic stress when they fail to
achieve what they want in lif which usually leads to stress.
“Sharing the room with my parents and younger siblings is a challenge because they expect
me to carry out duties soon after school which hinders me from doing my school work. Also,

41
when I try to study, my younger siblings will be making noise in the room or my mother will
say switch off the light we want to sleep” Participant T

➢ In light of the above, the researcher also noted that depression was also due to economic
reasons such as fear of dropping out due to failure of paying fees. The students mainly
in form 4 and form 6 pointed out that there were times when they would be sent back
home because they would not have paid fees and so they feared that they would fail to
register on time and have to drop out of school hence led to stress and eventually
depression. It can be noted that fear contributes to depression as it disrupts individuals’
sense of security as well as their sense of safety. Fear also leads to negative thought
patterns that also lead to depression.
“At times we get sent back home because we would not have completed payement fees. We
miss some lessons on the day we get sent home and sometimes for the rest of the week and
being in form 4 these lessons will be important as they help us prepare for mid term
examinations” Participant R

4.4.3 Theme 3 : Psychological determinants associated with the prevalence of

depression.

➢ Severe and extreme depression being experienced by the adolescents is also as a result
of psychological factors such as childhood trauma, low self-esteem, negative – self-
image, negative thinking amongst others. The World Health Organization (2019)
asserts that self-esteem is reported to have a significant impact on important life
outcomes during adolescence and adulthood such as the clear connection that exists
between higher self-esteem and positive outcomes. The students at Kundayi High
School that had severe and extreme depression was as a result of low-self-esteem as
well as negative thinking.
➢ The researcher also noted that some of these participants had undergone traumatic
events during their such as the death of a loved which they failed to deal with. Traumatic
events can be too much to remember and so individuals might repress or supress those
memories but with time they can manifest in the form of aggression, stress, anxiety and
depression. The participants with severe and extreme depression at Kundayi High
School attributed the overwhelming sadness they felt to the death of a loved one.
Traumatic events can change the perspective of an adolescent and traumatic events also

42
 increase vulnerability. This can affect the adolescents’ ability to cope with stress as well
as regulation of their emotions
“I hear my classmates and friends talk about their fathers and it makes me think of mine. It
hurts that he is no longer here and that saddens me a lot that I usually end up thinking about
it a lot” Participant K

➢ Some of the participants at Kundayi High School also mentioned abuse as a

factor that caused their depression. This mostly included physical and emotional
abuse. The researcher observed that others did not feel comfortable talking
about sexual abuse they had gone through or to go on record. The students at
Kundayi High School were depressed due to the physical, emotional and sexual
abuse that they had gone through. Abuse often leads to disruptions in attachment
to parents or guardians of the adolescent as well as other key figures that may
exist in the adolescent’s life. It can be also be noted that abuse also often leads
to lack of trust and inability to form relationships leading to feelings of isolation
and loneliness.
“Ever since I was a child my step-mother would beat me and scold me over little things and
my father did not stop her. This continued for years until they separated but I will always
remember because of the scars I have on my body” Participant O

➢ Having a long-term physical health condition also contributed to depression

amongst some of the students at Kundayi High School. Physical health
conditions such as diabetes, heart disease asthma was seen to be causing
depression amongst these students because they hindered them from
participating in the same activities like the other students for example long
distance running or marathons. The participants pointed out that they also faced
discrimination from other students and would be called “not normal” when they
got asthma attacks or fainted due to low blood sugar levels hence led to
depression as they wanted to be like the other students without any physical
health conditions. It is important to note that having a long -term physical health
condition can result in loss of independence as individuals fail to perform daily
activities which can often lead to feelings of frustration and hopelessness.
“During interhouse competitions at the school, I cannot participate in events such as long-
distance race because of my heart problem. I tried it once before and ended up feeling dizzy
and waking up at the sick bay where they said I had fainted. The other kids at school made

43
fun of me saying I was weak and running was not my area and that hurt because I loved
running” Participant P

4.4.4 Theme 4 : Suggested interventions for adolescents with depression at Kundayi

High School

Table 4.9 Suggested mitigatory measures

Measure Number of participants

1. Counselling 6
2. Cognitive-Behavioural Therapy 2
3. Educational Programs 3
4. Other 1
Total 12

The findings show that the participants mostly opted for counselling as an intervention that
would help them overcome depression because they were more familiar with it. However, other
participants were of the opinion that education-based programs were ideal in order to help them
deal with depression and not only them but other students that were on the verge of being
depressed. 2 participants opted for Cognitive-Behavioural Therapy whilst 1 participant was in
the opinion that other interventions would help but did not specify as to what they had in mind.

4.5 Conclusion

The research came up with many factors that led to depression amongst the adolescents at
Kundayi High School from form 1 to form 6. The findings also suggested that the cases and
patterns of depression differed from one individual to the next due to the different causes that
were unique to each case. Some of the Kundayi High School students were extremely depressed
and others were depressed less but the findings suggest that the causes depression were largely
social, economic and psychological factors. Issues such as economic factors proved to be a
challenge as the students felt they could not do anything about it as opposed to other factors
that were psychological and social.

44
 CHAPTER 5

DISCUSSIONS, CONCLUSIONS AND RECOMMENDATIONS.

5.1 Introduction

This research had aimed to look at the prevalence of depression amongst adolescents of
Kundayi High School. The research adopted both a qualitative and a quantitative approach as
the quantitative approach showed prevalence of depression and qualitative approach gave an
insight on the presumed psychological, social and economic causes of depression amongst
adolescents at Kundayi High School. Data was collected using the Beck Inventory and as well
as interviews. Descriptive analysis was adopted for data analysis and the results were shown in
chapter 4, this chapter will be focusing on the discussion of results, coming up with
recommendations and the conclusion.

5.2 Discussion of the results.

This chapter includes discussion of the findings of the research according to the three objectives
of the study as well as the three research questions of this study. In relation to the Prevalence
of depression amongst adolescents of Kundayi High School, recommendations and conclusions
will also be made. The research aimed to show the prevalence, causes and intervention
strategies that could be adopted in terms of depression amongst the adolescents of Kundayi
High School.

5.2.1 Prevalence of depression amongst adolescents.

The findings of this study illustrated that there was a moderate prevalence of depression
amongst adolescents at Kundayi High School. The researcher noted that participants
experienced depression at some points varying from mild depression to extreme depression but
it turns out that most of them were not aware that they were depressed. Due to lack of adequate
knowledge of what depression is, students simply ignored the symptoms and did not know how
they could get assistance in order to overcome these depressive episodes that they felt were
normal and would disappear over time.

45
It is important to note that moderate prevalence of depression was mostly among the O level
students and A level students of Kundayi High School whose ages varied between 15-19 years
of age. However, they were willing to participate effectively and take part in the interviews
conducted where they spoke freely without any hesitation. The researcher also noted that the
moderate prevalence of depression amongst adolescents manifested itself through the
participants’ lack of interest on activities that used to excite them, weight loss, having
overwhelming feelings of sadness as well disturbances in their normal sleeping patterns. The
participants’ responses also highlighted that they also had lost interest in the people around
them as well as having difficulties in decision making thus highlighting moderate depression.

The prevalence of depression at Kundayi High School remained subtle and unnoticed due to
reasons such as lack of adequate knowledge on depression as a mental disorder which can lead
to misunderstanding of symptoms, stigmatization, lack of resources, busy schedules among
others.

Lack of adequate knowledge about depression

The students at Kundayi High School exhibited very little knowledge on what depression was.
Participants noted that they thought depression was a serious mental disorder that was most
likely to affect older people due to the stresses that they faced as parents. The participants also
showed that they misunderstood symptoms. According to Merikangas et al (2010) depression
can present itself differently in children and adolescents than it does in adults. The participants
pointed out symptoms such as difficulty concentrating in class and so it may be difficult for
teachers to identify that a student is depressed.

Stigma

Fear of being stigmatized also led to depression being unnoticed at Kundayi High School as
the students felt that they would be criticised for speaking openly about the symptoms that they
were experiencing. According to Swanson (2010) , mental health issues are still stigmatized
in many societies in which can result in students feeling ashamed or embarrassed to seek help
for their symptoms. The stigma also seemed to have prevented the teachers at Kundayi High
School from recognizing students that had depression as well as addressing the signs and
symptoms of depression in students.

Lack of resources.

46
It can be noted that Kundayi High School lacks resources that are able to provide mental health
services and support to students. These resources include school counsellors as well as
psychologists who are there to make sure that mental health is a priority. The school however
adopted the system of making senior teachers the counsellors of the school but it is important
to note that these teachers may not have adequate training on how to recognize the signs of
depression amongst students. Teachers may also fail to have knowledge as to how to address
mental health issues in the classroom setting.

School schedules

The researcher noted that Kundayi High School had quite a busy schedule especially amongst
the Ordinary Level students as well as the Advanced Level students. It can also be noted that
one teacher will be responsible for various classes across all educational levels and in this
regard, due to several demands over busy schedules, it can be very difficult for them to identify
or to notice changes in behaviours of the students in their various classes. Also, it can be
difficult to provide individual attention to students who might be on the verge of depression or
who might actually have depression symptoms.

However, in comparison to a study conducted in Jimma town on the depression amongst

adolescents, the prevalence was high as compared to that of Kundayi High School. According
to Rodriguez (2015) the prevalence of depression among Jimma University students was high
and positively associated with being from the college of social science and humanity, history
of being hit by a sexual partner, having a mentally ill family member amongst others. The
adolescents that were facing depression resorted to taking drugs in order to cope whereas the
students at Kundayi High School did not resort to such measures.

5.2.2 The social causes of depression amongst adolescents.

The majority of the participants acknowledged that relationships with parents and peers played
a pivotal role in leading to depression. The findings suggested that students who were taking a
strain from their relationships with their parents as well as their peers often have feelings of
helplessness and negative thought patterns that they are not good enough. According to
Rudolph et al (2008) adolescents who have strained or difficult relationships are at higher risk
for developing depression. The participants admitted that they did not feel emotionally
supported by their parents and that they often felt alone and isolated. The researcher also noted

47
that these participants had developed a negative-self image because of the critical or negative
feedback that they had received from their parents.

However, on the contrary, some studies show that sometimes it is not always strained
relationships with peers that cause depression but rather personal reasons. A study that was
conducted in Nepal concluded that some participants attributed depression to isolation.
According to Gale et al (2013) the respondents also reported that they did not necessarily lack
supportive or meaningful friendships but instead wished to be alone which led to depression.

The researcher noted that most of the participants also attributed depression to lack of social
support. Similarly, a study was carried out in Jimma town to determine the social causes of
depression amongst adolescents between ages of 10-19 where a questionnaire was used to
collect data. The participants pointed out that amongst other factors, lack of social support
made them feel that they did not have emotional comfort and a sense of belonging. According
to Girma et al (2021), in the final analysis, rural residence, low social support and adverse
childhood experience were found to be independently associated with a higher score of
depression. Likewise, the participants’ responses were that lack of social support emotionally
made them feel overwhelmed by stressors and that they were unable to cope.

The findings from the study demonstrated that social media also played a role in the prevalence
of depression amongst adolescents at Kundayi High School. According to Carr and Hayes
(2015) the term ‘social media’ refers to the various internet-based networks that enable users
to interact with others, verbally and visually. The responses given by participants were that
they were active on social media and that the interactions they had sometimes led them to social
comparison whereby they compared their lives to that of other individuals constantly thus
would result in feelings of low-self-esteem, inadequacy and finally depression. According to
Seabrook et al (2016) there is a correlation between negative online interaction and depression,
as such passive Facebook use predicts social comparison as well as envy which in turn leads
to depression. Similarly, a study was conducted in the United States of America whereby the
survey sample involved a nationally representative sample of U.S young adults where it was
found that individuals who spent a lot of time on social media had a higher risk of getting
depressed. According to Lin et al (2016) the study found that young adults who spent more
than 2 hours per day on social media had twice the odds of reporting symptoms of depression
compared to those who spent less than 30 minutes per day on social media.

48
5.2.3 The economic causes of depression amongst adolescents.

The responses indicated that there were participants who highlighted that economic factor led
to depression such as financial constraints which made them not able to afford resources for
school. Students from low-income households highlighted that they often stressed about having
to drop out of school as well as not being able to afford stationery and a complete set of
uniforms. Similarly, a study was conducted by the World Health Organization that had the aim
of determining how economic factors influenced depression in adolescents. According to
Goodman et al (2011) the study found that adolescents living in poverty were more likely to
experience mental health problems, with rates of depression and anxiety being particularly high
which can have long-term consequences for an individual’s well -being and can affect their
ability to engage in education, work, and relationships.

The findings also suggest that most of the participants strongly agreed that the economic
background or situation at home also led to stresses that often led to depression. The students
highlighted those issues to do with accommodation settings had an effect on their school work
as sometimes they failed to study at home which would lead to poor grades and eventually
depression about it. Similarly, a study was conducted in the Middle East and North America
with the aim of establishing the relationship between poverty and depression amongst
adolescents. Likewise, the study used a questionnaire known as the Patient Health
Questionnaire-9 (PHQ-9) just as this research used the Beck Depression Inventory (BDI) as an
instrument. According to Reiss (2013) the study found that poverty, unemployment, and low
education levels were significantly associated with higher rates of depression among
adolescents in the region.

Fear of dropping out due to failure of paying fees was also rated by participants as an economic
cause of depression. The participants pointed out that they were sent back home on several
occasions because they owed the school. In this regard, the students at Kundayi High School
admitted to having feelings of hopelessness. Their responses highlighted that they were not
particularly looking forward to the future because it was unclear whether they would get to
achieve their goals or not. Similarly, a study was conducted by the Shaping the Health of
Adolescents in Zimbabwe (SHAZ) with the aim of establishing the relationship between
poverty and depression by use of a questionnaire as a research instrument. However, unlike
this research that included both males and females, the study by SHAZ was limited to
population samples of females only. According to Chirwa et al (2010) the study results showed

49
that the girls from lower income levels were more likely to experience depressive symptoms
due to issues such as food security, being unable to purchase basic necessities, not reaching
form 4 level and being homeless at some point in their lives. Financial constraints often lead to
depression because they lead to feelings of despair when individuals feel they cannot control
what will be happening in their lives.

The findings of the economic causes of depression are in line with the Social Causation theory
that attributes depression to economic difficulties. According to Lund et al (2010) Social
Causation theory asserts that experiencing economic hardship increases the risk of subsequent
mental illness and this can be caused by poor living conditions, low social capital, social
isolation and lack of coping ability to negative life circumstances. This goes on to show how
the findings were in line with the Social Causation theory that was adopted in this research
pertaining to the relationship between economic factors and depression.

5.2.4 Psychological causes of depression.

The findings suggest that experiencing traumatic events such as the death of a loved one can
lead to depression amongst adolescents. The participants that had depression acknowledged
that they had experienced a loss of a loved one which often led to overwhelming feelings of
sadness and loneliness. The findings also suggested that the participants had depression
because they had failed to cope with the sudden loss of a loved one. According to the Journal
of Affective Disorders (2018) a study was conducted with the aim to explore the relationship
between complicated grief and depression and the results of the study showed that individuals
who experienced complicated grief were at a higher risk of developing depression. The loss of
a loved one can trigger a wide range of responses that are mainly psychological such as anger,
guilt as well as confusion which can be very intense and can interfere with an individual’s daily
activities as well as relationships.

Abuse was also rated as a cause of depression by the students at Kundayi High School. All
educational levels from form 1 to form 6 agreed that being a victim of abuse led to depression.
The participants admitted to having feelings of fear, shame and guilt as a result of being abused
physically, emotionally and even sexually. Research has shown that adolescents who have been
abused are at greater risk of being depressed. According to The Journal of Child Abuse and
Neglect (2019) adolescents who have experienced abuse (physical, emotional, or sexual) are

50
more likely to report symptoms of depression and anxiety. However, the researcher noted that
the findings suggested that effects of abuse on mental health were moderated by factors such
as social support thus abuse often leads to depression in adolescents unless they receive social
support to help them get through the effects of abuse.

The findings also suggested that having a long-term physical health condition also led to
depression. The responses showed that students at Kundayi High School who had long-term
physical health conditions highlighted how it was difficult for them to engage in activities like
other students which would lead to feelings of frustration and sadness that health conditions
limited them in doing what they desired. Findings also suggested that when students with health
conditions tried to engage in a sporting activity, they would end up failing to achieve that and
would mostly get made fun of for trying to do things that they were not able to execute.

The findings of the research were in line with the theory adopted for this research which was
the Beck’s Cognitive Triad of Depression (1967). According to McLeod (2015) the three
mechanisms that are responsible for depression include the cognitive triad (of negative
automatic thinking), negative self -schemas and errors in logic for instance faulty information
processing. The negative triad consists of three negative thoughts which are negative thoughts
about the self, negative thoughts about the world and the future. In regards to this study, these
mechanisms did not work on their own but rather are manifestations of factors such as abuse
and experiencing traumatic events which eventually lead to depression.

5.2.5 Strategies that can be used to mitigate the effects of depression.

5.2.5.1 Counselling
One major aspect that was highlighted in the study as a measure that can be taken to assist
adolescents with depression is that of counselling. Counselling can be considered as effective
treatment towards individuals with depression and so can benefit greatly the adolescents of
Kundayi High School as they can be taught ways on how to cope with depression. According
to Rohde et al (2019) counselling works by providing a supportive and safe environment for
depressed adolescents in order for them to fully express their feelings with fear of being judged.
In other words, counselling provides a safe space where depressed adolescents feel understood
and can open up freely. Adolescents with depression can also use counselling as a way to
identify negative thought patterns and be assisted by counsellors in coming up with more
positive ways of thinking. The findings demonstrated that the majority of the students at
Kundayi High School opted for counselling as an intervention.

51
5.2.5.2 Educational programs

The findings of the study suggested that a number of participants had opted for educational
programs as an intervention to depression. Educational programs can help the depressed
adolescents of Kundayi High School by providing them with the relevant information that they
require about depression as well as information on the skills they can use to better manage their
symptoms in order to improve their mental health. According Kovacs et al (2016) educational
programs work by raising awareness about depression as well as reducing stigma that is
associated with mental illness. These educational programs can also assist the adolescents of
Kundayi High School by making them comfortable in seeking help and to gain support in their
fight against depression. According to educational campaigns help depressed adolescents build
resilience which is the ability to bounce back from adversity. Resilience can be achieved
through being taught problem-solving skills, social support strategies and even stress coping
mechanisms. By taking part in educational programs, adolescents with depression can get to
experience social support through meeting and interacting with individuals that have the same
problem or have similar experiences.

5.2.5.3 Cognitive- Behavioural Therapy

It is also important to note that Cognitive behavioural therapy is another intervention that was
opted for by the students of Kundayi High School. It can help them in identifying negative
thought patterns from which depression stems. According to Goodyer et al (2017) Cognitive-
Behavioural Therapy can help depressed adolescents identify negative thought patterns that
contribute to their depression such as self-blame, hopelessness, and worthlessness. Adolescents
who successfully recognize these patterns of thought can learn to overcome and replace them
with positive thoughts as well as realistic ways of thinking. Adolescents at Kundayi High
School can benefit greatly as they can get encouragement to indulge in activities that they love
and find fulfilling as opposed to isolating themselves all the time and making room for
overthinking thus improving their overall sense of well-being.

5.3 Conclusions

The research focused on the prevalence of depression amongst adolescents with the perceived
social, economic, psychological causes as well as the interventions that can be used in
mitigating depression effects. It can be noted that the researcher explored the lives of the

52
adolescents who were living with depression and it came to light that they were living difficult
lives on and off the school due to the symptoms that came with depression considering that
they were untreated. The researcher also came to a conclusion that the prevalence of depression
was to a moderate level amongst adolescents of Kundayi High School. The objectives of the
study were to determine the perceived economic, social and psychological factors that caused
depression as well as to come up with interventions to alleviate the effects of depression
amongst adolescents. The objectives of this study were fulfilled seen in Chapter 4 where these
perceived causes were explored in detail shedding light to how depression was caused under
various themes and explanations. Also, the findings in Chapter 4 were strongly aligned with
the theoretical framework that was used for this study in that negative thought processes that
stem from issues such as abuse can lead to depression amongst adolescents.

Therefore, it can be concluded that depression in adolescents can make their lives difficult at
school and at home as well. This is because due to symptoms of depression such as suicidal
ideations, lack of appetite as well as overwhelming sadness amongst other factors, adolescents
find it hard to focus or concentrate on their schoolwork and end up getting low scores which in
turn lead to stress and depression. Likewise, at home things get difficult because depression
symptoms also cause a disruption in the attachment that adolescents might have with their
parents or guardians. They end up isolating themselves hence are not fully active in family
dynamics as they prefer to keep to themselves than to rather interact with other family members
and open up about the problems that they will be facing.

However, the researcher also concluded that factors that cause depression initially come from
both home and at school. Adolescents who do not receive social support from their parents tend
to get depressed as they feel that they are alone and are not recognized for the efforts that they
put. Likewise, problems that come from home such as experiencing abuse or not being able to
afford decent housing, food and school resources can also lead to depression amongst
adolescents. Looking at the school side, the researcher concluded that stresses stem from failure
to make friends, being bullied by peers as well as bad social interactions with peers. Due to
isolation, some adolescents fail to make friends because they feel inferior to other children
hence end up not making any friends at all. However, having peers that constantly bully an
individual can also lead to depression as evidenced by how some adolescents intentionally miss
school due to fear of being bullied as well as having bad grades because they fail to focus
during class due to fear of what will happen once the teacher is no longer in sight.

53
The researcher also concluded that Kundayi High School does not have resources to deal with
depression or other mental illnesses which is why depression prevalence remained subtle and
unnoticed. The students’ only option of getting help for depressive symptoms was confiding in
senior teachers who were made gatekeepers of dealing with such cases but were however not
trained enough to be able to recognize or acknowledge depressive symptoms on a student. The
researcher also concluded that stigma and discrimination were also playing a role in depression
prevalence being subtle at Kundayi High School as the students feared that they would be
discriminated for having a mental illness and for trying to seek help in the process.

The researcher concluded that the prevalence of depression at Kundayi High School would be
better dealt with if the school included the community of Concession. This is because some
principles and knowledge come from the homes that students are raised in and so if depression
awareness begins at home, there would not be issues such as stigma to deal with. Also, if
members of the community were to have knowledge on depression, then people would change
the way that they interact with one another.

5.3.2 Key Findings of the research

➢ Depression amongst adolescents does exist and the challenging part of it all is that the
adolescents do know how to explain the depressive symptoms but have no idea that they
have depression.
➢ Adolescents with depression have a difficult time taking care of themselves and
overcoming depressive symptoms thus their schoolwork and social relationships tend to
suffer.
➢ Most people do not have relevant information on what depression really is and how it can
be overcome.
➢ Many schools in Zimbabwe are yet to adopt mental health resources such as school
counsellors and therapists that help students with depression.
➢ Social support from friends and family plays a key role in adolescents’ lives as it gives
them a sense of purpose in this world.
➢ Depression if untreated in its early stages of adolescents can follow one into adulthood and
can have severe effects on various aspects of their lives.
➢ The theoretical framework used for the research proved to be relevant as it was closely
aligned with the findings of the research pertaining to the causes of depression.

54
5.4 Recommendations.
The school

In regards to the study that was being conducted on the prevalence of depression amongst
adolescents, the researcher recommends that intervention strategies need to be adopted in
schools in order to mitigate the effects of depression such as having school counsellors and
therapists. This is mainly because most of the difficulties that the adolescents are facing are
because of the effects of depression. The school should also establish social clubs that promote
mental health as well as enforce laws that do not promote stigmatization.

The educators

The educators should receive relevant training on skills that will enable them to identify
students with depression as well as how to offer them counselling within the school premises.
The educators should also be equipped on providing awareness to students and parents on
issues to do with depression.

The students

The students are should be open about issues to do with mental illness as well as to openly
discuss them. The students should also attend and take part in mental health awareness
campaigns in order to promote mental health for themselves and the people around them.
Students should also involve their parents on what will be happening in their lives and be
cautious of who they surround themselves with in terms of peers.

5.5 Chapter Summary

This chapter included the discussions of results or findings, conclusions and recommendations
given by the researcher. The discussion of results as well as the conclusions were sorely based
on the research questions.

55
REFERENCE LIST

American Psychiatric Association (2013) Diagnostic and statistical manual of mental

disorders. Arlington: American Psychiatric Association.

Baird S, Chirwa E, McIntosh C, Ozler B (2010). The short-term impacts of a schooling

conditional cash transfer program on the sexual behavior of young women. Health Econ

Beck A. T. (2008) The evolution of the cognitive model of depression and its neurobiological
correlates. The American journal of psychiatry, 165(8), 969–
977. https://doi.org/10.1176/appi.ajp.2008.08050721

Beck, A. T., & Bredemeier, K. (2016). A unified model of depression: Integrating clinical,
cognitive, biological, and evolutionary perspectives. Clinical Psychological Science, 4(4),
596–619. https://doi.org/10.1177/2167702616628523

Beck, A. T., & Haigh, E. A. (2014). Advances in cognitive theory and therapy: the generic
cognitive model. Annual review of clinical psychology, 10, 1–
24. https://doi.org/10.1146/annurev-clinpsy

Belfer M L (2008) Child and adolescent mental disorders: the magnitude of the problem across
the globe. J Child Psychol Psychiatry;49(3):226–36.

Biss, R. K.; Hasher, L.; Thomas, R. C. (2010). "Positive mood is associated with the implicit
use of distraction". Motivation & Emotion. 34 (1): 73–77. doi:10.1007/s110

Chevance A, Ravaud P, Tomlinson A, Le Berre C, Teufer B, Touboul S. (2020) Identifying

outcomes for depression that matter to patients, informal caregivers, and health-care
professionals: Qualitative content analysis of a large international online survey. Lancet
Psychiatry;7(8):692–702.

Chibanda, D., Bowers, T., Verhey, R. (2015) The Friendship Bench programme: A cluster
randomised controlled trial of a brief psychological intervention for common mental disorders
delivered by lay health workers in Zimbabwe. Int J Mental Health Syst 9, 21.
https://doi.org/10.1186/s13033-015-0013-y

Choo CC, Harris K .M, Chew PKH, Ho RC (2017). What predicts medical lethality of suicide
attempts in Asian youths? Asian J Psychiatry 29: 136–41. doi: 10.1016/j.ajp.2017.05.008

56
Cuijipers, P. Reynolds, C, F. (2017) Managing Depression in Older Age: Psychological
interventions. Oxford University Press

Dunbar M.S, Maternowska MC, Kang M S, Laver S .M, Mudekunye-Mahaka I, Padian N S.

(2010) Findings from SHAZ!: A feasibility study of a microcredit and life-skills HIV
prevention intervention to reduce risk among adolescent female orphans in Zimbabwe. J Prev
Interv Community; 38(2): 147-61.

Gerstorf D, Heckhausen J, Ram N, Infurna F, Schupp J, Wagner G (2014). Perceived personal

control buffers terminal decline in well-being. Psychol Aging.; 29:612–25.

Gilman S.E., Sucha E., Kingsbury M., Horton N.J., Murphy J.M., Colman I. (2011) Depression
and mortality in a longitudinal study. Canada Medical Association Publishers

Girma S, Tsehay M, Mamaru A, Abera M (2021) Depression and its determinants among
adolescents in Jimma town, Southwest Ethiopia. doi:10.1371/journal.pone

Goodman A, Joyce R, Smith J P (2011) The long shadow cast by childhood physical and mental
problems on adult life. Proc Natl Acad Sci. ;108(15):603. doi: 10.1073/pnas.1016970108

Goodyer, I. M., Reynolds, S., Barrett, B., Byford, S., Dubicka, B., Hill, J. Fonagy, P. (2017).
Cognitive behavioural therapy and short-term psychoanalytical psychotherapy versus a brief
psychosocial intervention in adolescents with unipolar major depressive disorder: A
multicentre, pragmatic, observer-blind, randomised controlled superiority trial. The Lancet
Psychiatry, 4(2), 109–119.

Keane L, et al. (2017). Review: Low self-esteem and internalizing disorders in young people:
A systematic review.pubmed.ncbi.nlm.nih.gov/32680408/

Keng S L, Lee Y, Drabu S, Hong R Y, Chee C Y I, Ho C. (2018) Construct validity of the

McLean Screening Instrument for Borderline Personality Disorder in two Singaporean
samples. J Pers Disord (2018), 30 (44):450-569. doi: 10.1521

Kohrt B . A, Jordans M , J D, Tol W .A, Perera E, Karki R, Koirala S, (2010) Social ecology
of child soldiers: child, family, and community determinants of mental health, psychosocial
well-being, and reintegration in Nepal. Transcult Psychiatry.;47(5):727–53

Kok J . K, Lai W.Y. (2017) Not myself and the connected self: cases of youth depression and
recovery in Malaysia. Br J Guid Couns.45(1):32–41.

57
Kovacs, M., Bender, P., & Gatsonis, C. (2016). Psychotherapy for adolescent depression: A
meta-analysis of comparative treatment trials. American Journal of Psychiatry, 173(10), 1053–
1063. doi: 10.1176/appi.ajp.2016.15091286

Lee E .H, Lee S. J, Hwang S. T, Hong S .H, Kim J .H (2017) Reliability and Validity of the
Beck Depression Inventory-II among Korean Adolescents. Psychiatry Investig.;14(1):30-36.
doi:10.4306/pi.2017.14.1.30

Lee J., Jang S.-N., Cho S.-I. (2017) Gender differences in the trajectories and the risk factors
of depressive symptoms in later life. Int. Psychogeriatr. ; 29:1495–1505.
doi: 10.1017/S1041610217000709

Merikangas, K. R., He, J., Burstein, M., Swanson, S. A., Avenevoli, S., Cui, L., & Benjet, C.
(2010). Lifetime prevalence of mental disorders in U.S. adolescents: Results from the National
Comorbidity Survey Replication--Adolescent Supplement. Journal of the American Academy
of Child & Adolescent Psychiatry, 49(10), 980-989.

Nakka, J. E Rathod, S. D, Kizza, D, Breur, E, Mutyaba K, Baron E, Ssebunnya , J. (2016) The

recognition of depression by primary care clinicians in rural Uganda : A qualitative study,
Family Practice , 33/6, 690-695

Nguyen D .T, Dedding C, Pham T .T, Wright P, Bunders J (2013) Depression, anxiety, and
suicidal ideation among Vietnamese secondary school students and proposed solutions: a
cross-sectional study. BMC Public Health 13(1195). doi: 10.1186/1471-2458-13-1195

Nguyen DT, et al. (2019) With anxiety, depression, and suicidal ideation in Vietnamese
secondary school students: A cross-sectional study frontiersin.org/articles/10.3389/fpsyt

Phan T, Carter O, Adams C, (2016) Discriminant validity of the Hospital Anxiety and
Depression Scale, Beck Depression Inventory (II) and Beck Anxiety: Inventory to confirmed
clinical diagnosis of depression and anxiety in patients with chronic obstructive pulmonary
disease. Chron Respir Dis.13(3):220-228. doi:10.1177/1479972316634604

Reiss, F. (2013). Socioeconomic inequalities and mental health problems in children and
adolescents: A systematic review. Social Science & Medicine, 90, 24-31.

Rudolph, K. D., Flynn, M., & Abaied, J. L. (2008). A developmental perspective on

interpersonal theories of youth depression. In J. R. Z. Abela & B. L. Hankin (Eds.), Handbook
of depression in children and adolescents (pp. 79-102). Guilford Press.

58
S. Beshai (2017) Relapse and recurrence prevention in depression: Current research and future
prospects Clin. Psychol. Rev https://doi.org/10.1097/00004583-199307000-00003

Sawyer SM, Azzopardi PS, Wickremarathne D, Patton GC (2018) The age of adolescence.
Lancet Child Adolesc Health.;2(3):223–8.

Seidman, I. (2013). Interviewing as qualitative research: A guide for researchers in education

and the social sciences (4th ed.). Teachers College Press.

Shields, Patricia and Rangarajan, N. (2013) A Playbook for Research Methods: Integrating
Conceptual Frameworks and Project Management. Stillwater, OK: New Forums Press.

Tuisku, V. Pelkonen, M , Karlsoson, L , Kivirunsh , O, Martinnen , M (2014) Depressed

adolescents as young adults; Predictors of suicide attempt and non-suicidal self-injury during
8-year follow -up. Journal of Affective Disorders, 152-154, 306-313

UNFPA (2014) State of world population United Nations population

fund. https://www.unfpa.org/swop

Viduani A, Benetti S, Martini T, Buchweitz C, Ottman K, Wahid S. S, (2021) Social isolation

as a core feature of adolescent depression: a qualitative study in Porto Alegre, Brazil. Int J Qual
Stud Health Well Being. 2021;16(1):1978374. Article PubMed

Wang F .M, Davis M . F, Briggs F .B (2021) Predicting self-reported depression after the onset
of multiple sclerosis using genetic and non-genetic factors. Mult Scler.;27(4):603-612.
doi:10.1177/1352458520921073

Willis N, Mavhu W, Wogrin C, Mutsinze A, Kagee A (2018) Understanding the experience

and manifestation of depression in adolescents living with HIV in Harare, Zimbabwe. PLoS
ONE 13(1): e0190423. doi:10.1371/journal.pone.

World Health Organization. Maternal, newborn, child and adolescent health: adolescent
development.https://www.who.int/maternal_child_adolescent/topics/adolescence/developmen
t/en

Zineldin M (2018) Cognitive and Brain Reserve (CBR): Tools to reduce the risk of dementia
and Alzheimer. Adv Alzheimer’s Dis. 7:93–102.

59
APPENDIX A: BECK DEPRESSION INVENTORY

Beck's Depression Inventory

This depression inventory can be self-scored. The scoring scale is at the end of the
questionnaire.

1.
0 I do not feel sad.
1 I feel sad
2 I am sad all the time and I can't snap out of it.
3 I am so sad and unhappy that I can't stand it.
2.
0 I am not particularly discouraged about the future.
1 I feel discouraged about the future.
2 I feel I have nothing to look forward to.
3 I feel the future is hopeless and that things cannot improve.
3.
0 I do not feel like a failure.
1 I feel I have failed more than the average person.
2 As I look back on my life, all I can see is a lot of failures.
3 I feel I am a complete failure as a person.
4.
0 I get as much satisfaction out of things as I used to.
1 I don't enjoy things the way I used to.
2 I don't get real satisfaction out of anything anymore.
3 I am dissatisfied or bored with everything.
5.
0 I don't feel particularly guilty
1 I feel guilty a good part of the time.
2 I feel quite guilty most of the time.
3 I feel guilty all of the time.
6.

0 I don't feel I am being punished.

60
1 I feel I may be punished.
2 I expect to be punished.
3 I feel I am being punished.
7.
0 I don't feel disappointed in myself.
1 I am disappointed in myself.
2 I am disgusted with myself.
3 I hate myself.
8.
0 I don't feel I am any worse than anybody else.
1 I am critical of myself for my weaknesses or mistakes.
2 I blame myself all the time for my faults.
3 I blame myself for everything bad that happens.
9.
0 I don't have any thoughts of killing myself.
1 I have thoughts of killing myself, but I would not carry them out.
2 I would like to kill myself.
3 I would kill myself if I had the chance.
10.
0 I don't cry any more than usual.
1 I cry more now than I used to.
2 I cry all the time now.
3 I used to be able to cry, but now I can't cry even though I want to.
11.
0 I am no more irritated by things than I ever was.
1 I am slightly more irritated now than usual.
2 I am quite annoyed or irritated a good deal of the time.
3 I feel irritated all the time.
12.
0 I have not lost interest in other people.
1 I am less interested in other people than I used to be.
2 I have lost most of my interest in other people.

61
3 I have lost all of my interest in other people.
13.
0 I make decisions about as well as I ever could.
1 I put off making decisions more than I used to.
2 I have greater difficulty in making decisions more than I used to.
3 I can't make decisions at all anymore.
14.
0 I don't feel that I look any worse than I used to.
1 I am worried that I am looking old or unattractive.
2 I feel there are permanent changes in my appearance that make me look
unattractive
3 I believe that I look ugly.
15.
0 I can work about as well as before.
1 It takes an extra effort to get started at doing something.
2 I have to push myself very hard to do anything.
3 I can't do any work at all.
16.
0 I can sleep as well as usual.
1 I don't sleep as well as I used to.
2 I wake up 1-2 hours earlier than usual and find it hard to get back to sleep.
3 I wake up several hours earlier than I used to and cannot get back to sleep.
17.
0 I don't get more tired than usual.
1 I get tired more easily than I used to.
2 I get tired from doing almost anything.
3 I am too tired to do anything.
18.
0 My appetite is no worse than usual.
1 My appetite is not as good as it used to be.
2 My appetite is much worse now.
3 I have no appetite at all anymore.

62
19.
0 I haven't lost much weight, if any, lately.
1 I have lost more than five pounds.
2 I have lost more than ten pounds.
3 I have lost more than fifteen pounds.
20.
0 I am no more worried about my health than usual.
1 I am worried about physical problems like aches, pains, upset stomach, or
constipation.
2 I am very worried about physical problems and it's hard to think of much else.
3 I am so worried about my physical problems that I cannot think of anything else.
21.
0 I have not noticed any recent change in my interest in sex.
1 I am less interested in sex than I used to be.
2 I have almost no interest in sex.
3 I have lost interest in sex completely.
INTERPRETING THE BECK DEPRESSION INVENTORY
Now that you have completed the questionnaire, add up the score for each of the twenty-one
questions by counting the number to the right of each question you marked. The highest
possible
total for the whole test would be sixty-three. This would mean you circled number three on all
twenty-one questions. Since the lowest possible score for each question is zero, the lowest
possible score for the test would be zero. This would mean you circles zero on each question.
You can evaluate your depression according to the Table below.
Total Score____________________Levels of Depression
1-10____________________These ups and downs are considered normal
11-16___________________ Mild mood disturbance
17-20___________________Borderline clinical depression
21-30___________________Moderate depression
31-40___________________Severe depression
over 40__________________Extreme depression

63
APPENDIX B: SUPERVISOR – STUDENT AUDIT SHEET

64
APPENDIX C : INFORMED CONSENT
INFORMED CONSENT FORM
Preamble
My Name is Corina Makore, currently studying for a Bachelor of Science in Psychology
Honours Degree at the Midlands State University. I kindly ask for your permission and consent
to take part in my research.

The title of the research is: A study on the prevalence of depression amongst adolescents of
Kundayi High School. All the information that is to be supplied is to be evaluated with the
highest degree of confidentiality and will only be used for academic purposes only.

Consent acknowledgment
You are being invited to take part in a research project. Please take some time to read the
information here, which will explain the details of this project. Please ask the researcher any
questions about any part of this project that you do not understand, for it is very important that
you clearly understand what this research entails and how you could be involved. Please also
note that your participation is entirely voluntary and you are free to decline to participate.
Saying no will not affect you negatively in any way whatsoever. You are also free to withdraw
from the study at any time, even if you agree to take part at this point.

What is the purpose of this study?

The research is being conducted in line with the requirements of the midlands state university
that every undergraduate must write a dissertation. This particular seeks to find out the
prevalence of depression amongst. The study was guided by the following questions.

1. What are the psychological causes of depression amongst adolescents?

2. What are the economic causes of depression amongst adolescents?
3. Which social causes of depression amongst adolescents?
4. What interventions can be used to mitigate the effects of depression amongst
adolescents?

What are the possible risks in taking part in this research?

It is unlikely that you will experience physical harm by participating in this study. However,
the study may make you feel uncomfortable as you talk about your health problems. You may

65
feel embarrassed or shy. Sometimes painful information is shared. These are the main risks.
You should feel free to mention your feelings or concerns to any member of the study team.

SIGNED…………………………………

66
APPENDIX D : INTERVIEW GUIDE

MIDLANDS STATE UNIVERSITY

FACULTY OF SOCIAL SCIENCES
DEPARTMENT OF PSYCHOLOGY

Interview guide on the prevalence of depression amongst adolescents at Kundayi High

School.

Gender: ……………………………….

Age …………………………………

Educational Level…………………………

SECTION A: To determine the social factors that are associated with the prevalence of
depression amongst adolescents at Kundayi High School.

1. Do you have any friends?

2. How often do you interact with other students?
3. Are you active on social media? Yes No
4. What is your social family setting?
Single parent Extended Step Traditional nuclear
5. Are you part of any social clubs at the school?
6. How is your relationship with your parents/guardian?

SECTION B: To determine the economic factors that are associated with the prevalence of
depression amongst adolescents at Kundayi High School.

1. Have you missed school before due to financial reasons?

2. Do your parents or guardians go to work? If yes, is it formal or informal employment?
3. What best describes your accommodation arrangement?
Hut Homestead Full house Hostel Room/rooms in house

67
 4. How often do you have pocket money for school?
5. Do you always have uniforms and stationery to use for school?

SECTION C: To determine the psychological factors that are associated with the
prevalence of depression amongst adolescents at Kundayi High School.

1. Do you have any childhood experiences that traumatised you?

2. Do you have a long-term physical health condition?
3. Have you ever experienced any type of abuse?
4. Have you experienced discrimination, stigmatisation or bullying?

SECTION D: To find strategies that can help alleviate the effects of depression
amongst adolescents at Kundayi High School.

1. What can the school do differently in order to mitigate depression?

2. What type of intervention would be suitable in eliminating depression in the school?
Counselling Educational Program Cognitive-Behavioural Other

68
APPENDIX E : TURNITIN REPORT

69
 APPENDIX F : MARKING GUIDE

MARKING GUIDE

Name of student: REG No:

ITEM POSSIBLE ACTUAL COMMENTS

SCORE SCORE

A RESEARCH TOPIC AND ABSTRACT 5

clear and concise

B PRELIMINARY PAGES: 5
Title page, approval form, release form, dedication,
acknowledgements, appendices, table of contents.

C AUDIT SHEET PROGRESSION 5

D CHAPTER 1 10
Background, statement of problem, significance of the
study, research questions, objectives, hypothesis,
assumptions, purpose of the study, delimitations,
limitations, definition of terms

E CHAPTER 2 15
Addresses major issues and concepts of the study. Findings
from previous work, relevancy of the literature to the study,
identifies knowledge gap, subtopics

F CHAPTER 3 15
Appropriateness of design, target population, population
sample, research tools, data collection, procedure,
presentation and analysis

G CHAPTER 4 15
Findings presented in a logical manner, tabular data
properly summarized and not repeated in the text

H CHAPTER 5 20
Discussion (10)Must be a presentation of generalizations
shown by results: how results and interpretations agree with
existing and published literature, relates theory to practical,
implications, conclusions (5)Ability to use findings to draw
conclusions Recommendations (5)

I OVERALL PRESENTATION OF DISSERTATION 5

70
J REFERENCES 5

K TOTAL 100

Marker… Signature ... Date...

Moderator……………………….Signature………………………Date………………..

71