Influences on Stress Load in Young Girls with Major Depression

Research Article

J Pediatr & Child Health Care. 2023; 8(1): 1057.

Influences on Stress Load in Young Girls with Major Depression

Reinhold L*

University of Trier, Frauenstr 7, 54290 Trier, Germany

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

Received: January 12, 2023; Accepted: February 20, 2023; Published: February 27, 2023


Based on former empirical studies and theoretical models the present study investigated, whether stress symptoms, stress coping, and activity of HPA axis are different in girls with major depression compared to non-depressed 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 and stress coping were measured with validated German questionnaires. The cortisol awakening response was analyzed by collecting saliva samples. Depressed girls showed a greater stress load, which was significantly influenced by stress coping strategies. HPA axis activity was heightened in depressed girls, but does not seem to have an influence on stress load.

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


Depression in children and adolescents is frequent. In a representative sample from Germany a 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 framework for etiology and maintenance of depression in adolescents is not available at present. Reviewed are therefore 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 have a threefold greater risk 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 can be identified [6].

A high stress load in the form of learning difficulties is seen in Chinese school children and contributed to the development and maintenance of depressive symptoms [24].

Increased stress load because of parental depression was responsible for depression and anxiety symptoms after a time interval of 6 months in young adolescents [25].

A high stress load because of symptoms from a conduct disorder was predictive for the severity of depression after 5 years [26].

Stress load in form of racial defamation was closely related to depression in Malaysia in youngsters who were investigated in a multicenter study [27].

When adolescents of both sexes are infected by HIV they feel a very high stress load and are prone to develop severe depressive symptoms [28].

A further confirmation of stress load correlated to depression is seen in Chinese adolescents belonging to a minority [29].

School going adolescents whose stress load was high because of academic dissatisfaction, parental discord and domestic harassment reported a remarkable rate of severe depressive symptoms [30].

Adolescents in Iran felt a high stress load which was mainly caused by life dissatisfaction and could be significantly associated to depressive symptoms in this sample [31].

A very large sample (n = 22000) revealed significant correlations between stress load and depressive as well as anxiety symptoms in young Chinese adolescents [32].

A high stress load at the university and within the family increased depressive symptoms in young students significantly. [33].

Lacking relationships to peers were involved in stress load for a German sample of 446 adolescents and significantly correlated to increased depression scores [34].

The important role of close social relationships such as good friends as a protecting factor against stress load and consequently prevention of depressive symptoms was well demonstrated in a study from Spain [42].

A massive stress load because of maternal depression was responsible for depressed mood in a longitudinal study over a span of 15 years [43].

The stress load was also high in young students who were investigated in Mexico. They felt massively affected by very strict lockdown prescriptions and a poor quality of life, which both contributed to their depression [35].

Large stress load because of restrictions in school and family was significantly correlated to severe depression in 600 adolescents, who were investigated in the United Arab Emirates [51].

Results from a treatment study are reported by [36]. The participants had a high stress load by conflicts with their parents. The family intervention did not lead to a significant reduction of the depressive symptoms in the adolescents but instead depression persisted in pre-treatment severity after termination of treatment.

The perception of conflicts in the parental relationship and a lack of social support by the parents can be interpreted as variables of high stress load and are longitudinally associated to depression in young adolescents [38].

The Significance of Stress for the Depressive Disorder

A controlled study of [7] demonstrated 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].

A combination of increased cortisol and good skills to manage everyday life proved to be a protective factor for depression in Chinese adolescents whose stressor was household dysfunction. [45].

A high stress load of adolescents, mainly due to a low SES of parents could be linked to daily fluctuations in cortisol in the sense of biological sensitivity [49].

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 a longitudinal design the present study investigated differences in stress load and stress coping between depressed girls and controls. Coping related influences on stress load were also proved. Differences in activity of HPA axis are taken into account, too.


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 [14]. 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


The severity of depression was assessed by the Depression Inventory for Children and Adolescents (DIKJ) [15].

Coping Strategies

Reactions to stressful situations were obtained by the coping questionnaire for children and adolescents (SVF-KJ) [16]. The questionnaire measures reactions to stress, when a stress situation is imaged. It comprises strategies which reduce stress as well as strategies that enhance stress [9] subscales are provided.

Stress Load

Stress load was assessed by the questionnaire for stress and stress coping for children and adolescents (SSKJ) [17].

The subscales comprise 1. Stress vulnerability 2. Physical stress load such as headache, stomach ache or exhaustion.

Psychological stress load such as depressed mood and anxiety.

All participants collected saliva samples after awakening to determine cortisol.


The depressed girls had a mean value of 19.3 ± 7.5, the controls of 9.7 ± 6.4 on the Depression Scale.

The mean for the depressed girls was significantly higher and indicates clinically significant depression according to norm-tables for this questionnaire. The statistical analysis for comparison between depressed patients and controls with MANOVA for all three scales simultaneously was significant with F (3,144) = 16.2, p<.001.