Influences on Stress Load in Adolescents with Major Depression

Research Article

Austin Child Adolesc Psychiatry. 2022; 6(1): 1021.

Influences on Stress Load in Adolescents with Major Depression

Reinhold Laessle* and Ulrike Schmidt

University of Trier, Frauenstr 7, 54290 Trier, Germany

*Corresponding author: Reinhold Laessle, University of Trier, Frauenstr 7, 54290 Trier, Germany

Received: February 23, 2022; Accepted: March 18, 2022; Published: March 25, 2022


Based on former empirical studies and theoretical models the present study investigated, whether stress symptoms, stress coping and somatic complaints are different between depressed girls and healthy controls. 148 girls with a mean age of 15 years were studied twice with 6 months between the two assessments. 74 fulfilled DSM IV criteria for major depression at first assessment. Stress symptoms, stress coping and somatic complaints were measured with validated German questionnaires. Depressed girls showed more stress symptoms and a higher stress vulnerability. On the other hand, in stress coping depressed girls preferred destructive strategies and had a lack of useful behaviors such as problem solving or search for social support. Stress load was significantly influenced by the severity of somatic complaints and also by inadequate stress coping such as resignation, but not by hyperactivity of HPA axis.

Keywords: Stress; Depression; Stress coping; Somatic complaints; Girls; Cognitive model


Depression in children and adolescents is frequent.

In a representative sample from Germany lifetime prevalence for depression in youth of 21% was found [1].

In Middle East countries 57% of youth have been observed to be depressed [2].

A unique and consistent model for etiology and maintenance of depression in adolescents is not available at present. Therefore, we review empirically supported factors, that have been proposed by [3] as a basis for explaining depression in adolescents.

Social factors

The risk to develop a psychiatric disorder in general is heightened for children from families with a low socioeconomic status. This has been already shown in a large epidemiological study by [4].

Children from families with a low income had a threefold greater probability to develop a depressive disorder. This has been confirmed in a study by [5].

Factors related to the families of depressed children

The families are characterized by the lack of positive supporting interactions with parents. These may be extremely focusing on conflicts and therefore provoke anger and aggression in children. Such conditions are especially present, when a high degree of parental psychopathology could be identified [6].

The significance of stress for the depressive disorder

A controlled study of [7] showed that psychosocial stressors reinforce the depression and are also more frequent as a consequence of depression.

This has been supported in a study of [8] by a longitudinal analysis.

Inadequate stress coping

Destructive stress coping in adolescents diagnosed as depressed has been found in [9].

Neuroendocrine findings

The severity of depressive symptoms is significantly correlated with cortisol levels during a laboratory stressor [10].

A long duration of depression leads to stress related hyperactivity of HPA axis [11].

A dysregulated feedback of cortisol secretion after stress is reported by [12]. Cortisol does not recover.

A lack of social support results in a hyperactivity of HPA axis. Not seeking social support then is responsible for the maintenance of depression as well as for hyperactivity of the HPA axis [13].

Somatic complaints in depressed youth

In a twin study with 1300 families explained variance in depression by somatic complaints was 44%. [14]

Complaints which were in particular related to sleep have been observed in 38% in a sample of [15].

The empirical literature shows, that depression in adolescents is characterized by a high stress load but on the other hand by inadequate stress coping. In addition somatic complaints are frequent. In a longitudinal design the present study investigated differences in stress load, stress coping, and somatic complaints between depressed girls and controls. Differences in activity of HPA axis are also taken into account.


All Patients were recruited from the Department of child and adolescent psychiatry in a general hospital in Trier and fulfilled DSM IV criteria for major depression which was proved by a structured clinical interview.

A control group was recruited by advertisements in the local newspaper.

The study was approved by the ethical committee of the University of Trier (17.2.2010).

All participants were paid for participation.

Patients and controls were assessed twice with a time interval of 6 months between the two measurement points (Table 1).