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Unconditional Self-Acceptance, Functional and Dysfunctional
Negative Emotions, and Self-Esteem as Predictors for
Depression in Adolescents: a Brief Pilot Study Conducted in
Romania
Geanina Cucu-Ciuhani, Ioana Elena Dumitru
*University of Pitești, Romania
Abstract
Introduction: Depression has a high prevalence in adolescents, as they are passing
important biological, cognitive and social changes, and are more vulnerable to negative emotions.
Although the relationship between the unconditional self-acceptance, self-esteem, and depressive
symptoms has been extensively studied over the past decades, there is not enough evidence about
the exact way these variables can lead to depression in adolescents.
Objectives: The aim of this study was to examine the relationship between the unconditional
self-acceptance, self-esteem, functional and dysfunctional negative emotions, as predictors for the
level of depression in Romanian adolescents.
Methods: We ran the study on a sample of 300 Romanian adolescents, aged 14 to 17, in
order to examine the predictors for the level of depression, taking into account the level of the
subjects’ unconditional self-acceptance, their self-esteem, and their functional and dysfunctional
negative emotions. The measures were the Unconditional Self-Acceptance Questionnaire, the
Rosenberg Self-esteem Scale, the Emotional Distress Profile, and Beck’s Depression Inventory.
Results: The results show that the variance of the level of depression (F(1; 298) = 473, p =
.0001) is significantly explained by the level of unconditional self-acceptance (ΔR2= .614, p =
.0001), by the level of self-esteem (ΔR2= .615, p = .022), and by the level of emotional distress
(ΔR2= .653, p = .0001). Limitations: Due to the lack of financial support, the sample was
representative only for one region of Romania, the South Muntenia Region.
Conclusions: We identified significant correlations between unconditional self-acceptance,
self-esteem, and functional and dysfunctional negative emotions and the level of adolescent’s
depression, and we also described the prediction equation for depression by considering these three
variables.
Keywords: depression in adolescents, unconditional self-acceptance, self-esteem, functional
emotions, dysfunctional emotions
i (^) Corresponding author: Geanina Cucu-Ciuhan, University of Pitești, Târgu din Vale no. 1, Pitești, Romania. Email:
geanina.ciuhan@upit.ro.
1. Introduction In adolescence, the depressive symptoms and depression diagnosis prevalence is increasing and it is usually associated with self-harm, academic failure and poor mental health in adulthood (Kilford & all, 2015). In 2013, the National Institute of Mental Health in USA reported that 2.8% of children (8–11 YO) and 4.8% of adolescents (12– 15 YO) are affected by depression (Keith, 2013). This means that as many as one in every 33 children and one in eight adolescents undergo depression. Unfortunately, an important number of children with mental health problems do not get the help they need. In USA, suicide is the third leading cause of death for 15–24 year-olds (NIMH, 2013). The 2014 data published by the European Health for all Databases (HFA-DB) puts Romania on the second place in Europe when it comes to the incidence of mental disorders, with over 1400 cases diagnosed per 100.000 habitants (HFA-DB, 2014). Among this, depression is the most common diagnosis, about 6.66% of Romanian adults suffering from major depression. There are no recent national studies about the occurrence of the depression diagnosis in the Romanian adolescent population, but the number of teenage patients referred to by the psychiatric clinics for suicide attempt has dramatically increased, media reporting about almost 200% in the past decade. In 2010, the NGO “Save the Children” conducted in Romania a complex study about the mental health services for children in our country. According to their data, at that moment, there were 880,709 children registered with a psychiatric disorder, out of which 154,124 were diagnosed with depression (Grădinaru & Stănculescu, 2010).
Particularities of adolescent’s depression in Romania Adolescents with major depression display symptoms such as: low self-esteem, decreased energy, loss of interest in regular activities and/or in activities he/she once enjoyed, feelings of excessive guilt, persistent feelings of sadness, feelings of helplessness or hopelessness, feelings of being inadequate, changes in appetite or weight, difficult concentrating, sleep problems, irritability, aggression, hostility, frequent complaints of headache, fatigue, and stomach pains. If the depression is criticized, the adolescent may experience more serious and critical symptoms as feelings of wanting to die and suicidal thoughts or attempts, or other self-destructive behavior. The main causes of adolescent depression in Romania are: family stress, lack of communication
with the parents, physical and emotional abuse, trauma, the teenagers’ inability to cope with the dominant attitude of their parents, the parents’ constant pressure for high standard school performances, low economic status, etc. One specific national cause is the lack of parental presence, in the families where the child is raised by relatives (grandparents or others) when the parents are abroad, to work. In these cases, the adolescent sees his/her parents only a few times per year and this situation goes like this starting with early childhood. Another specific local phenomenon associated with adolescent depression is the running away behavior. Over the past few years, in Romania, there were an important number of mediatized cases of teenagers running away from home. Most of them were girls aged 13 to 16 and their running away destination was the orthodox monasteries. Usually, the teenager who is physically and/ or emotionally abused in the family, feels like he/she has no one to talk to and finds willingness in a confessional relationship. All these facts and observations emphasize the role of parent- child relationship in the young person’s development and, implicitly, in the onset of depression in adolescents.
Adolescents’ vulnerability to depression The cognitive theories of depression postulate that depressive disorders in adolescence result from an interaction between the teenager’s individual vulnerability to depression and environmental stressors that activate the disorder (Abela & Hankin, 2008). Depressed and depression- vulnerable adolescents have the tendency to exhibit attentional , interpretation, inferential, and memory biases for salient stimuli (Hankin & all, 2009). Beck’s cognitive theory postulates that social and affective information is biased by the individual’s rigid negative schema and dysfunctional attitudes (Beck, 1987). The hopelessness theory talks about the individual’s negative cognitive style – the person has the tendency to make negative inferences about the causes of his life events and about his/ her implication in these events (Abramson, Metalsky, & Alloy, 1989). For example, the adolescent has the tendency to catastrophize and interprets his school achievements as “I am at the bottom of my class, so it is normal to have low grades. No matter how much I try to learn, I will never achieve more than a passing grade”; or he interprets his inability to socialize as “I am one of the freaks in my class, so no matter what I do, I will never get more popular.”
at the time of the study, recruited from 5 high schools in the Argeș County, Romania. The sample distribution by age and gender is presented in Table 1. All adolescents were asked if they had a current or past diagnosis of depression, anxiety or other mood disorder and if they are taking any medication for this kind of condition, and the ones who gave positive answers to any of these questions were excluded from the study. All the participants provided informed consent forms signed by their parents.
Procedures All participants filled in four questionnaires: Unconditional Self-Acceptance Questionnaire (USAQ, Chamberlaine & Haaga, 2001), Rosenberg Self-Esteem Scale (Rosenberg, 1965), Emotional Distress Profile (Opriș and Macavei, 2005) and Beck’s Depression Inventory (Beck, Rush, Shaw, & Emery, 1979). The variables taken into account in this study were: unconditional acceptance of oneself, self- esteem, functional negative emotions – sadness, lowness, dysfunctional negative emotions – sadness, lowness, functional negative emotions – fear, dysfunctional negative emotions – fear, and the level of depression.
Measures Unconditional self-acceptance The unconditional self-acceptance was measured with the Unconditional Self-Acceptance Questionnaire (USAQ, Chamberlaine & Haaga, 2001). The questionnaire measures unconditional acceptance of oneself as a protective factor that prevents the onset of certain forms of psychopathology in contact with negative life situations, starting from Albert Ellis theory on unconditional self-acceptance. As said, the person is accepting him/herself fully and unconditionally, regardless of whether they behave intelligently, correctly, or competent and whether people approve of, respect him/her or love him/her. Studies show that, if the individual uses this way of evaluating him/herself in the everyday life, this way of thinking can be a protective factor during the life stress events (Chamberlain and Haaga, 2001). The construction of the questionnaire is based on the concept of self-esteem, which describes judgments of value that each individual has about himself/ herself, as a component of the person’s cognitive schema. We used the Romanian version of the scale, for which we calculated the internal consistency in order to determine whether the way in which items are
organized on the scoring sheet may have some impact on the score itself, which depends on the number of used items and on the number of subjects. The Cronbach's alpha was .817 in the current study, indicating a high items’ reliability.
Self-esteem The adolescent’s self-esteem was measured with the Rosenberg Self-esteem Scale (Rosenberg, 1965). The scale is a widely used self-report instrument to evaluate the individual’s self-esteem. We used the Romanian version of the scale, for which we calculated the internal consistency in order to determine whether the way in which items are organized on the scoring sheet may have some impact on the score itself, which depends on the number of used items and on the number of subjects. The Cronbach's alpha was .919 in the current study, indicating a very high items’ reliability.
Functional and dysfunctional negative emotions Functional and dysfunctional negative emotions were measured with the Emotional Distress Profile (Opriș and Macavei, 2005). This is a 26-item scale that allows calculating both an overall score of distress and it separates scores for “functional fear/ dysfunctional fear”, “sadness/ functional depression” and “sadness/ dysfunctional depression”. The Romanian scale was designed starting from the items of the Profile of Mood Disorders , Short Version (DiLorenzo, Bovbjerg, Montgomery, 1999). There were words added to these items to describe identified emotions as they appear in a Romanian dictionary of synonyms. We calculated the internal consistency in order to determine whether the way in which items are organized on the scoring sheet may have some impact on the score itself, which depends on the number of used items and on the number of subjects. The Cronbach's alpha was .793 in the current study, indicating a high items’ reliability.
Depression The level of depression was measured with the Beck’s Depression Inventory (Beck, Rush, Shaw, and Emery, 1979). We used the Romanian version of the scale, for which we calculated the internal consistency in order to determine whether the way in which items are organized on the scoring sheet may have some impact on the score itself, which depends on the number of used items and on the number of subjects. The Cronbach's alpha was .916 in the current study, indicating a high items’ reliability.
4. Results Descriptive analysis Mean scores and standard deviations for each measure are presented in Table 2. Analysis was conducted to determine the distribution of scores in the study sample, for each variable of the present study. The scores on unconditional self-acceptance indicate a medium to high level of self-acceptance among the adolescents in the study, with a mean of 75.99 and a median of 70.50, suggesting that most of the adolescents in the study sample have a positive opinion about themselves. The SD is 26.92, which indicates a high variability of the scores. The scores on self-esteem indicate a medium level of self-esteem among the adolescents in the study, with a mean of 27.94 and a median of 27.50. The SD is 8.06, which indicates a slight variability of the scores. The scores on emotional distress indicate that the adolescents in the study sample have a medium to high level of emotional distress, but with a high variability of the scores. For the functional negative emotions – sadness, lowness, the mean is 26.81 and SD is 13.15, for the dysfunctional negative emotions – sadness, lowness, the mean is 26.20 and SD is 13.34, for the functional negative emotions – fear, the mean is 21.13 and SD is 10.95, and for the dysfunctional negative emotions – fear, the mean is 43.78 and SD is 22.67. The results show that the adolescents participants in the study have a medium to high level of dysfunctional negative emotions, especially fear. The scores on depression indicate that the adolescents in the study sample have a medium level of depression, with a mean of 19.26. The SD of 12. shows that the scores have a high variability, an important number of subjects obtaining clinically significant high scores on depression.
Correlational analysis Table 3 presents the correlations between variables. The first hypothesis was supported by significant correlation that indicates small to moderate effect sizes. A high level of depression was associated with a low level of unconditional self-acceptance (r = -.783; p = .0001), low self-esteem (r = -.624; p = .0001), high functional negative emotions – sadness, lowness (r = .234; p = .0001), high dysfunctional negative emotions
- sadness, lowness (r = .332; p = .0001), and low dysfunctional negative emotions – fear (r = -.187; p = .0001). There was no significant correlation between the level of depression and the functional fear. This
means that the adolescents participants in the present study who have a high level of depression manifest high functional and dysfunctional sadness and lowness, but a low level of dysfunctional fear.
Multiple linear regression for the prediction of depression We used the multiple linear regression model in order to explore the relationship between three explanatory variables (unconditional self-acceptance, self-esteem, and the four dimensions of the emotional distress) and the criterion variable represented by the level of depression. Our goal was to find out if the unconditional self-acceptance, self-esteem, and emotional distress significantly predict depression in adolescents. Table 4 presents the results of the linear regression model. The results show that the variance of the level of depression (F(1; 298) = 473, p = .0001) is significantly explained by the level of unconditional self-acceptance (ΔR^2 = .614, p = .0001), by the level of self-esteem (ΔR^2 = .615, p = .022), and by the level of emotional distress (ΔR^2 = .653, p = .0001). In table 5 we present the significant differences between the three prediction models of the level of depression. The results show that there are significant differences between: a. Prediction model 2 (F(2; 297) = 237.69 and p = .0001) and 1 (F(1; 298) = 473.77 and p = .0001), stating the inferiority of the model that predicts the level of depression depending on the level of unconditional self-acceptance; b. Prediction model 3 (F(6; 293) = 91.98 and p = .0001) and 2 (F(2; 297) = 237.69 and p = .0001), stating the inferiority of the model that predicts the level of depression depending on the level of unconditional self-acceptance and on the self-image. The comparison between the three prediction models shows the superiority of the prediction model 3 (F(6; 293) = 91.98 and p = .0001), which predicts the level of depression depending on the level of unconditional self-acceptance, on the self-image and on the degree of emotional distress. In Table 6 we present the standardized and non-standardized coefficients for the prediction of depression level. By analyzing the final prediction model, we can see that all the predictors taken into account in the current study are significant: unconditional self-acceptance (β = -.306, p = .0001), self-esteem (β = -.149, p = .008), functional negative
Table 2 Means and standard deviations
Unconditional self- acceptance
Self- esteem
Functional negative emotions – sadness, lowness
Dysfunctional negative emotions – sadness, lowness
Functional negative emotions – fear
Dysfunctional negative emotions – fear Depression Mean 75.99 27.94 26.81 26.20 21.13 43.78 19. Median 70.50 27.50 23.00 22.00 19.00 54.00 19. Mod 96 a^40 24 21 19 65 Standard Deviation 26.925^ 8.062^ 13.152^ 13.346^ 10.955^ 22.673^ 12. Variance 724.976 65.000 172.975 178.127 120.002 514.077 166. Skewness .065 - .321 2.658 2.658 3.403 - .070. Kurtosis - 1.565 - .331 6.102 6.085 12.593 - 1.671 -. Minim 33 10 12 10 10 10 1 Maxim 121 40 83 83 83 83 55
Table 3 Pearson correlation coefficients among study variables
Variables Depression Unconditional self-acceptance r -.783** Self-esteem r -.624** Functional negative emotions – sadness, lowness r .234** Dysfunctional negative emotions – sadness, lowness r .332** Functional negative emotions – fear r -.037+ Dysfunctional negative emotions – fear r -.187** Note: **p < .01, +p =.
Table 4 Multiple linear regression for the prediction of depression
Model R R Square
Adjusted R Square
Std. Error of the Estimate
Change statistics R Square Change F Change df1 df
Sig. F Change 1 .783a^ .614 .612 8.026 .614 473.077 1 298. 2 .785b^ .615 .613 8.020 .002 1.508 1 297. 3 .808c^ .653 .646 7.668 .038 7.971 4 293.
a. predictors: (constant), unconditional self-acceptance
b. predictors: (constant), unconditional self-acceptance, self-esteem
c. predictors: (constant), unconditional self-acceptance, self-esteem, the four dimensions of the emotional distress (functional negative emotions – sadness, lowness, dysfunctional negative emotions – sadness, lowness, functional negative emotions – fear, dysfunctional negative emotions – fear)
d. criterion: depression
Table 5 Significant differences between the prediction models of the level of depression
Model Sum of Squares Mean
df Mean Levene Test (F)
p
1 Regression 30477.718 1 30477.718 473.077 .000a Residuum 19198.479 298 64. 2 Regression 30574.720 2 15287.360 237.696 .000b Residuum 19101.477 297 64. 3 Regression 32449.390 6 5408.232 91.985 .000c Residuum 17226.806 293 58.
a. predictors: (constant), unconditional self-acceptance
b. predictors: (constant), unconditional self-acceptance, self-esteem
c. predictors: (constant), unconditional self-acceptance, self-esteem, the four dimensions of the emotional distress (functional negative emotions – sadness, lowness, dysfunctional negative emotions – sadness, lowness, functional negative emotions – fear, dysfunctional negative emotions – fear)
d. criterion: depression
Table 6 Standardized and non-standardized coefficients for the prediction of depression level Model B SE B β t p 1 (Constant) 47.756 1.390 34.368. Unconditional self- acceptance
2 (Constant) 48.913 1.678 29.150. Unconditional self- acceptance - .350^ .027^ - .732^ - 13.210^. Self-esteem - .109 .089 - .068 - 1.228. 3 (Constant) 46.623 2.351 19.828. Unconditional self- acceptance - .306^ .027^ - .638^ - 11.444^. Self-esteem - .149 .086 - .093 - 1.739. Functional negative emotions – sadness, lowness
Dysfunctional negative emotions – sadness, lowness
Functional negative emotions – fear - .034^ .043^ - .029^ .791^. Dysfunctional negative emotions – fear - .077^ .023^ - .135^ 3.390^. a Criterion: depression
