Personality, Help-Seeking Attitudes, and Depression in Adolescents

Tessa DeRosa

A thesis submitted in confonnity with the requirements for the degree of Doctor of Philosophy

Department of Human Development and Applied Psychology Ontario Institute for the Studies in Education

University of Toronto

O Copyright by Tessa DeRosa 2000

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Personality, Help-Seeking Attitudes, and Depression in Adolescents Tessa DeRosa, Doctor of Philosophy, 2000

Department of Human Development and Applied Psychology University of Toronto

Abstract

Although there has been increased attention on individual differences among

adolescents in their levels of adjustment, several factors still have not received extensive

investigation. The current research investigated whether personality variables such as

perfectionism and self-criticism are associated with depression and negative attitudes

towards help-seeking in a sarnple of adolescents. A total of 1 32 Cath01 ic high school

students (5 1 males, 8 1 females) completed the Child-Adolescent Perfectionism Scale, the

Perfectionism Self-Presentation Scale, the Adolescent Depressive Experiences

Questionnaire. the Self Concealment Scale, the Center for Epidemiologic Studies

Depression Scale, and the Help-Seeking Scale. Descriptive analyses of the data indicated

that the sample as a whole was characterized by high levels of depressive symptoms,

consistent with past research on adolescent samples. Correlation analyses showed that

higher levels of depressive symptoms were associated with socially prescribed

perfectionism, dimensions of perfectionism self-presentation, self-criticism, dependency,

and sel f-concealment. Correlational analyses showed that negative help-seeking attitudes

were not correlated significantly with depression, but negativc help-seeking attitudes

were associated with a dimension of perfectionism self-presentation and lower levels of

dependency. Hierarchical regression analyses showed that perfectionism did not account

for a significant degree of unique variance in depression scores once self-criticism and

dependency had been entered into the equation. However, a dimension of perfectionism

self-presentation (Le., an unwillingness to disclose imperfection to others) did predict

significant variance in negative help-seeking attitudes, over and above self-criticism and

interpersonal dimensions of perfectionism as well as trait dimensions and self-

presentational dimensions of perfectionism in adolescents as they relate to depression and

attitudes towards help-seeking. The results are discussed in terms of their clinical

implications and possible delivery options of mental health services for those at risk.

Dedication

In loving memory of my grandfather Louis Leon Smith.

Acknowledgements

The collaborative efforts of a project of this magnitude cannot be understated.

This has been a long journey and like many joumeys your ability to persevere is a

function of what you take with you and what you pick up dong the way. I am deeply

indebted to Dr. Gordon Flett's tireless efforts and encouragement. His contribution to my

academic development is testimony to his considerable cornpetence not only as a scholar.

but also as an educator. 1 would also like to thank Dr. Solveiga Miezitis for her wisdom,

support and encouraging words.

1 was blessed at the outset with a truly supportive family, which has shouldered

the tremendous financial burden of schooiing a foreign student. But, more importantly

they have given me the opportunity to allow my personal and intellectual interests to

mature. My grandmother has been the pillar upon which 1 have leaned for much of my

life. Through her vision. my education has become a reality. 1 would like to thank my

mother for her support and friendship. She has always found a way to help me, at any

cost. 1 would also like to thank my father for his encouragement and support. 1 would like

to thank Sandra Foster for the many years she h a , and continues to be by my side. 1

would also like to thank Tom Martin for his statistical guidance and expertise. I am also

indebted to Averil Massie, who provided an invaluable critique of my thesis. In addition,

I would Iike to thank Jeanie Stewart, IT analyst, for her patience and assistance in the

organizational structure of my thesis. Finally, 1 would like to thank rny husband Bobby

for his companionship, love and support which has enabled me to becorne the person that

I am today. He is truly a blessing in my life. 1 would also like to thank the staff and

students at the Toronto Catholic high schools who took the time to participate in my

study and this study reflects their contribution.

Table of Contents

. . Abstract ............................................................................................................................... 11

Dedication .......................................................................................................................... iv ............................................................................................................. Acknowledgements v

......................................................................................................................... Introduction 1 ................................................................................................................ Literature Review 3

..................................................................................................................... Introduction 3 Depression ....................................................................................................................... 3

............................................................................................................... Comorbidity ... 13 Sex Differences and Depression ................................................................................. 14 Classification of Depression .......................................................................................... 21

......................................................................................... Depressive Disorders 2 1 Depressive mood ................................................................................................. 22 Depressive syndromes ......................................................................................... 23 Major depressive disorder .................................................................................... 24

Dysthymia ............................................................................................................. 25 ............................................................................................... Help-Seeking Behaviour 26

Sex Differences and Help-Seeking Behaviour ......................................................... 31 ............................................................... Adolescence and Help-Seeking Behaviour 32

Perfectionism ................................................................................................................. 37 ........................................................................... Trait Dimensions of Perfectionism 38

Dimensions of Perfectionism Self-Presentation ...................................................... 39 ............................................................................... Perfectionism and Depression 4 3

Perfectionism and Depression in Adults ............................................................... 43 .......................................................... Perfectionism and Depression in Adolescents 50

Perfectionism and Help-Seeking Behaviour ........................... .. ....................... 5 5 .......................................................................................................... Sel f-Concealment 56

Summary of Goals and Main Hypotheses ...................... .. ............................................. 59 iMethod .............................................................................................................................. 64

Participants .................................................................................................................... 64 ....................................................................................................................... Procedure 64

Measures ............ ... ......................................................................................................... 65 The Child-Adolescent Perfectionism Scale (CAPS) ............................................ 65

.......................................................... Perfectionism Self-Presentation Scaie (PSPS) 66 The Adolescent Depressive Experiences Questionnaire (DEQ-A) ........................... 67

.................................................................................. Self Concealment Scale (SCS) 68 The Cen ter for Epidemiologic S tudies Depression Scale (CES-D) .......................... 69

................................................................................................... Help-Seeking Scale 70 Results ............................................................................................................................... 71

..................................................................................................... Descriptive Analyses 71 MANOVA of Scales by Gender .................................................................................... 74 Correlational Analyses .................................................................................................. 76 Correlations Correlations Correlations Correlations Correlations

with with with with with

............................................................. Self-Oriented Perfectionism 76 Socially Prescribed Perfectionism ................................................... 79 Dependency ...................................................................................... 80 Self-Criticism ................................................................................. 81

............................................................................. Sel f-Conceal ment 82 v i

.................................................................................... Correlations with Help-Seeking 82 Correlations with Depression ...................................................................................... 83

...................................................................................................... Multiple Regression 83 Personality Predictors of Help-Seeking ....................................................................... 84 Personality Predictors of Depression ............................................................................ 86 Personality Predictors of Self-Concealment ................................................................. 87

Discussion ...................... ... ........................................................................................... 89 .......................................................................................... Depression in Adolescents 8 9

Personality and Depression ........................................................................................... 92 Correlates of Help-Seeking Attitudes ........................................................................... 95

.................................................................................................. Psychometric Results 102 Limitations .............................. ... .......................................................................... 103 Future Directions ......................................................................................................... 107

................................................................................................................. Implications 109 Summary ......................................................................................................................... 1 1 1 References ........................ ... ...................................................................................... 113 Appendices ...................................................................................................................... 133

List of Tables

Table 1 .................................................................................. Reliabilities using the Total Sarnple 72

Table 2 Analyses of Variance and Mean Scores for Males and Females ................................... 75

Table 3 ................................................................ Correlational Analyses using the Total Sample 77

Table 4 Correlational Analyses for Males .................................. .. ............................................ 78

Table 5 Correlational Analyses for Females .................................................................................. 79

Table 6 ........... Results of Hierarchical Regression Analyses for the Prediction of Help-Seeking 85

Table 7 Results of Hierarchical Regression Analyses for the Prediction of Depression ............... 87

Table 8 .... Resul ts of Hierarchical Regression Analyses for the Prediction of Self-Concealment 88

viii

List of A~pendices

Appendix A Description Ietter of the study .............,......-.~.......-...................................................... . . . . 133

Appendix B Paren t/Guardian consent forrns .. .... .. .. .... . ...........-.-..-. .. .-.-.... ........ . . . . . . . . . . . 1 34

Appendix C S tudent consent forms ................-.--.---.- -..-----..----................. . . . . . ............ 1 35

Appendix D Introduction to the study ....................................................................................... 136

Appendix E Children and Adolescent Perfectionism Scale (CAPS) ........................... . .-................ 137

Appendix F Perfectionism SeIf-Presentation Scale (PSPS) .............................................................. 139

Appendix (3- The Adolescent Depressive Experiences Questionnaire (DEQ-A) ............................. .... 141

Appendix H The Center for Epidemiologic Studies Depression Scale (CES-D) ................................ 143

Appendix 1 Self-Concealment Scale ( S C S ) ............... .. ................. ............. . ................. . ............. 144

Appendix J Heip-Seeking ScaIe .................... - .-.......... - - - - - ........................................ - ...................... 145

Introduction

A growing number of investigations point to the potential rate of personality

factors in maladjustment. This study examines the relationship between personality as it

relates to depression and help-seeking khaviour. Specifically, this research attempts to

determine if personality variables such as perfectionism are related to depression and

attitudes toward help-seeking. Before describing the study in detail, it is essential to

examine relevant literature involving the variables in this study.

The past decade has witnessed a rapid expansion of clinical and theoretical

interest in personality and depression. This interest is important because it may help to

identify persons at-risk as well as identify variables related to the triggering of

depression. Additionaily, it may uncover the necessary treatment interventions needed for

this particular population (Hewitt & Flett, 1993a). A central goal of the current research

is to examine the extent to which personality factors such as perfectionism, self-criticism,

and dependency are linked with depression in adolescents. If it can be established that

these factors play a role, then appropriate interventions can be designed.

Many people experience psychological problems, but few seek heip through

counselling. Numerous factors are associated with negative help-seeking tendencies,

including the experience of depression. Currently, little is known about the role of

personality and self-concealment and negative help-seeking attitudes, especially in

adolescents.

As indicated above, the current research will examine personaiity and help-

seeking in adolescents with a particular focus on perfectionism. The main hypothesis of

this study is that two forms of perfectionism (i.e., socially prescribed perfectionism and

perfectionism self-presentation) will be associated with negative help-seeking attitudes.

1

Socially prescribed perfectionism is identified with a perception of helplessness

asociated with the notion that other people have unrealistic perfectionistic standards for

the self and it is impossible to attain these socially presctibed standards of perfection.

Perfectionism self-presentation is defined as the social facets of perfectionism and

involves the need to appear perfect and avoid displaying faults to others. The general

premise is that these elements of perfectionism, based on previous theories, will be

associated with negative attitudes as the act of seeking help represents an open admission

of faiiure.

The organization of the introduction section is as follows. First, background

literature in each area is described. The introduction focuses on depression in children

and adoIescents highlighting and providing background on the nature of depression and

the subsequent classification and characterization of depressive disorders in the field of

psychology. This section was written to provide knowledge on the standards for the

categorization of depressive disorders and to illustrate the complexity of depression

especially in adolescents. The second section reviews sex differences and help-seeking

behaviour in adolescents. Third, perfectionism is explored in considerable detail with a

focus on the different personality factors. The fourth section focuses on the psychological

construct. self-concealment. The fifth section details the goals of the present study and a

summary of the main hypotheses. Details of the positive and negative findings of this

study and its limitations are also discussed. Finally, implications for advancements and

suggestions for future research are explored.

Literature Review

In spite of the increased attention k ing given to the research of chiidhood and

adolescent depression, Our understanding has been hampered, in part, by the small gains

in methodology and conceptualization of adolescent depression. Research has failed to

keep up with the burgeoning adult Iiterature. Further, the extent to which there is

universality of the adult findings to adolescents is not full y understood. However, the

increasing literature devoted to depression in adolescence does suggest that adolescents

are substantiall y more depressed than children and that they may in fact be more

depressed than adults (Angold, 1988; Shoenbach, Garrison, & Kaplan, 1984). Hence,

from a treatment perspective, given the increase in the rate of adolescent suicide (Wright-

Strawderrnan & Watson, 1992) and the evidence, which points to the fact that greater

depression increases the Iikelihood of having further episodes, it is cntically important

that more research attention be given to the study of depression in this age group

( Allgood-Merten, Lewinsohn, & Hops, 1990).

Over the last 20 years, depression in children and adolescents has becorne an area

of extensive research, particularIy in the disciplines of psychiatry, psychology, and

related fields (Reynolds & Johnston, 1994). Further, the research in these fields confirm

that childhood affective disorder is a documented clinical occurrence (Miezitis, 1992).

Interestingly enough, the majority of research on depression in children and adolescents

was not conducted until the mid- 1970s. The reason for the delay in our focus on

3

depression in young people may be due in part to the existence of several widespread

myths about the perception of this disorder. The first myth suggests that perhaps

depression is entirely nonexistent, that it is very uncommon if not impossible in children

and adolescents. A second explanation is that it is a passing and fleeting phase. The third

myth suggests that developmentally normal persons tend to have a propensity towards

this disorder. Finally, if it does exist, it cm take the form of "masked depression" in that

the dysphonc mood may be concealed as "depression equivalents" such as somatic

complaints, behaviour and conduct problems, school difficulties, or "adolescent turmoil"

instead of being directly expressed (Haggerty, Sherrod, Garmezy, & Rutter, 1994).

According to Carlson (198 l ) , it is true that the symptoms of adolescent depression are

quite difficult to discem from "adolescent tumoil". As a result, children and adolescent

depression have been frequently underdiagnosed and untreated. Unfonunately, as a result

of the misdiagnosis, a majority of psychiatrically il1 adolescents become psychiatrically

i l 1 adults. However, current findings with adults indicate that depression is a widespread

reaction that occurs in a large segment of this population at various times in their lives. It

is speculated that this response pattern can begin as early as childhood (Miezitis. 1992).

The perception of self as described in terms of one's self-concept in relation to

one's intellecnial functioning and the evaluation of the self in different areas of

functioning, as well as, self-esteem as it applies to one's emotional state and self-worth is

considered to be a central construct in the understanding of depression by several

theorists (Miezitis, 1992).

Several groups of investigators from a variety of theoretical traditions have

similarly outlined two personality configurations that presumably develop based on the

quality of interpersonal relationships and appear as distinct preernptory concems that

increase a person's risk for chronic depression (Blatt & Maraudas, 1992). The two

personality configurations referred to as dependency and self-criticism which Blatt and

Zuroff (1 992) discuss, differ in the degree of emotionai distress that they display in

response to the nature of life events and life experiences that precipitate their depressive

episodes. Among dependent individuals, incidents of rebuff and rejection in important

relationships are Iikely to trigger feelings of depression. The dependent personality style

is distinguished by a desperate need to maintain positive interpersonal relations (Luthar &

Blatt, 1995). Self-critical individuaIs, in contrast, derive their feelings of self-worth

mainly from successes in persona1 accomplishments. Depression is initiated by some

disruption in their self-schema or identity. They tend to be particularly insecure about life

events representing personal failures (Blatt et al., 1992d). These individuals constantly

strive for extreme goals and perfection, are often very cornpetitive, work hard, maintain

excessive self-standards, and often attain a great deal; but with little acknowledgement or

satisfaction. They repeatedly engage in stringent self-evaluation, they are highly critical

of others as this is related to their intense competitiveness. Also, by overcompensating,

their intent is to receive praise and approval from others (Blatt, 1974). The dependent

individual, however, has a constant need to keep in close physical contact with need-

gratifying others, has a constant need to feel safe, protected, cared for, and loved.

Relationships are valued primarily for the care, cornfort. and satisfaction they can provide

because they do not possess a fixed and consolidated intemal mental mode1 of

pleasurable and gratifying experiences or of the attributes of others who can provide

happiness and contentment. These individuals rely intensely on others to provide and

maintain a sense of well-king, and consequently, they attempt to minimize overt

conflicts, avoid expressing anger, conform, and constantly placate others for fear of

abandonment and loss of love that the interpersonal relationship can provide. Clearly,

maintaining a good relationship with others is paramount. as separation from others and

desertion is a source of intense fear and anxiety (Blatt et al., 19924).

A wide range of empirical and clinical research reveaied that an unsettled

relationship between parent and child may cause the child to develop a broad range of

disorders such as a distorted working mode1 (Main, Kaplan, & Calcium, 1985) or

cognitive representations (Blatt, 1974) of self and others. It is felt that many of these

misrepresentations may predispose one to a higher risk of depression. The lack of

consistent care, discipline, or parental support in addition to the use of excessive parental

influence, control, disapproval and rejection are associated with depression (e.g.,

McCranie & Bass, 1984; Lekowitz & Tesiny, 1984; Zemore & Rinholm, 1989; Miezitis,

1992). These inconsistencies in the early caring parental relationship cm create a

damaged and distorted mental representations or interna1 working models of tnisted

relationships, such that an individual may experience a number of things: the need for

constant encouragement and reassurance; separation anxiety; or the continuous

expectation of rejection and criticism, avoiding and resisting interpersonal involvement

(Blatt & Homann, 1992). The experience of parental scorn, neglect. disapproval, extreme

authority and criticism are internalized and this exemplifies the child's foundation of the

self and of others in caring relationships. These exemplifications' can cause some

individuals to have an impaired cognitive schema. This has k e n referred to as the

"depressive triad" indicating how the individual feels about themselves, their

environment, and the future (Beck, 1967). The general finding of the disruption between

these two types of caring relations demonstrate that the first is around the issue of

consonance and consistency of care. The second is around issues of excessive control,

force, and independence between parent and child, and how they correspond to the two

types of depression which is also based on issues of interpersonal associatedness such as

dependency and the second is on issues of self-importance and self-worth (i.e., self-

criticism: Bowlby, 1973, 1980; Btatt 1974, 199 1 ; Blatt, Quinlan, Chevron, McDonald, &

Zuroff, 1982; Arieti & Bemporad 1978, 1980; Beck, 1983)-

The recent work of Luthar and Blatt ( 1995) exarnined whether a sample of inner-

city adolescents with different dysphoric tendencies varied in the types of life experiences

to which they were most vulnerable. The expectation in this study, based on previous

research, was that inner-city adolescents high in self-criticism would exhibit high levels

of depression and anxiety due to academic difficulties and interpersonal problems. By

contrat . among those with dependent personality types high levels of distress would only

be associated with difficulties in interpersonal relationships.

The results of this study concur with other investigations in several respects. As

expected, levels of self-criticism revealed nonspecificity of effects, so that adolescents

high in sel f-criticism revealed greater depression related not on1 y to educational

accomplishments, but to close interpersonai relations as well. Greater levels of depression

was seen among those high in self-criticism in response to increasingly negative ratings

by teachers and peers, as opposed to those adolescents whose scores indicated low levels

of self-criticism. Conversely, results involving grades indicated that adolescents lower in

self-criticism as compared to those higher in self-criticism exhibited less, rather than

more variation in depression. In fact, they seemed to be relatively unaffected by their

poor academic achievement (Luthar et al., 1995).

Consistent with other findings, levels of dependency revealed a specificity of

effects. Although interaction terms involving high dependency and school grades were

not statistically significant as compared to children low in dependency, highly dependent

youngsters did, however, show higher levels of depression when they felt that others held

a negative opinion of them. These significant associations were seen only in the context

of negative teacher ratings; with peer ratings, a nonsignificant association was found

(Luthar et al., 1995).

The work of Luthar and Blatt ( 1993) has further established that certain aspects of

social and emotional functioning are uniquely associated with dependency as compared

to self-criticism. With respect to directionality, the pattern of results was consistent with

previous findings. Dependent teenagers showed greater increases in excessive and

chronic worry as well as an acute awareness of cues from others. Among dependent

individuals, a sense of self is derived from the intensity and characteristics of their

relationships. They are overly concerned about offending others and experience great fear

and apprehension about the possibilities of social rejection. These individuals are sharply

attuned to the behaviour of those around them. In contrast, self-criticism was more

strongly associated with depression and with chronic fears of k ing criticized and the loss

of approval of significant others (Luthar et al.. 1993).

The variables social control and the ability to express one's thoughts and feelings

were not equally related to the two types of depressive tendencies. However,

physiological anxiety and locus of control were found to be equally related to both

dependency and self-criticism, a cornplaint considered typical of dependent individuals.

Self-critical individuals may dso experience physiological difficulties such as

sieeplessness, extreme fatigue and exhaustion. Support for self-critical individuals

characteristicaIIy experiencing considerable guilt and self-blarne has been seen in

previous research, it was assumed that in addition these individuals would experience a

strong sense of attribution in response to negative life events as well. However, Luthar et

ai., 1993) found that self-criticism was highly correlated with an extemal locus of control.

Further, the extent of this association between dependency and externality did not differ

significantly, suggesting that, individuals high on both dependency and self-criticism

experience feelings of insecurity and defenselessness to extemal forces.

Within another body of literature, it has k e n shown that the children of mothers

who have a history of unipolar depression reported significantly lower perceived self-

esteem and a more depressogenic attributional style than children of medically il1 or well

mothers (Goodman, Adamson, Riniti, & Cole, 1994). The goal of Garber and Robinson's

( 1997) study was to replicate and extend this research by testing whether children of

parents with a history of mood disorders differ from children of parents who have never

experienced mental health problems. Results of their study were consistent with previous

findings in several respects. As expected, the children of mothers with a history of

depressive syndrome reported experiencing a wide range of psychopathology. These

individuals reported feelings of unimportance, lower perceived scholastic

accomplishments and abilities, a more intemal attribution of causality for negative life

events, greater seIf-loathing, and more recurrent negative thoughts than offspring of

mothers who had no history of mood disorders. It is possible that the observed

differences between the high- and low-risk children's cognitive differences could have

been due, in part, to their current level of depression. Further anaiyses were conducted to

circumvent this issue. Results indicated that even when depression was controlled for,

high-risk children still reported feelings of worthlessness, academic and behaviourai

inhibitions, and increased self-rejection. This specificity of differences between the high-

risk and Iow-risk children was basically unchanged even when data was reanalyzed

controlling for children with a history of a mood disorder. Essentiaily, the recurrent

negative thoughts reported by high-risk children were not primarily a result of their

existent disposition or a permanent effect left from a previous depressive episode. This

suggests that children of mothers with a history of mood disorders who repcrted greater

self-criticism and feelings of inferiority may indicate a cognitive vulnerability to

depression (Garber et al., 1997).

Particularly in this study, cognitive vulnerability was associated with children of

mothers with a more chronic history of depression. Data analysis revealed that even after

control ling for their current level of depressive symptoms, children who had a longer

exposure to depressed mothers -- that is mothers who reported long bouts of depression

lasting four years o r longer -- were more likely to report having a negative attributional

style, greater self-criticism, poor self-image, Iower academic readiness and greater

hopelessness than children of mothers less chronically depressed o r well mothers. The

recurrent negative thoughts that characterized some children of chronicall y depressed

mothers emphasize the dissirnilarity of such chiidren. Potentially, therefore, these

findings might heIp to account for the development of and transmission of increased

negative cognitive style arnong children of chronically depressed mothers. A number of

broad explanations for this have k e n advanced. The first suggests that perhaps children

deveIop a negative self-perception and a negative cognition of the causality of events in

response to their daily interactions with their depressed mothers. Consistent with

expectations and prior research, it has k e n revealed that the relationship between the

depressed mother and child are characterised by conflict, feelings of unimportance,

disapproval, and excessive authority. Once estabhshed, this negative form of interaction

between mother and child is perpetuating and these individuals are more likely to develop

a negative cognitive style (Garber et al., 1997).

Second, it aiso is possible that there may be a heredity component involved;

chronicall y depressed mothers rnay have a greater genetic and biological vulnerability

that is inherited by their children (Garber et al., 1997).

Third, there is the likelihood that the hardships of life may result in mothers

experiencing depression and children developing a negative self and social perception.

Clearly, future research needs to explore the importance of hereditary. intrapersonal and

interpersonal factors in the developrnent of negative cognitions and depression (Garber et

al., 1997).

As noted earlier, many researchers suggest that there is a link between depressive

concerns and dysfunctional early family relationships (Arieti & Bemporad, 1980;

Bowlby, 1980). The work of Frank, Poorman, Van Egeren, and Field (1997) has extended

the empirical work on adolescent-parent relationships. Their findings are consistent with

a cognitively mediated model of depression that is cyclic in nature. This model links

adolescents' difficulties with their parents to their self-representation, sel f-schema and to

their depressed moods. As children, self-critical and interpersonally consumed

individuals learn to accommodate and adjust to varying parenting styles by adopting

contrasting but similarly unstable means of maintaining closeness to and distance from

their parents. Essentidly, self-critical individuals rely on withdrawal. and avoidant

behaviours to pa rd themselves against parents who are demanding and controlling,

while dependent children are more likely to be accommodating, unassuming, and quick to

avoid any dissension (Blatt et al., 19924). The findings in this context highlight the

unique role of self-representation, which includes a constant battle to maintain a positive

and competent self-image and the fear of estrangement, k ing disapproved by others and

the withdrawal of love.

Adolescents high in self-criticism reported high levels of counterdependency and

alienation from their parents, whereas those describing themselves as highly dependent

and intensely close to their parents reported more interpersonal concems. Additionally,

adolescents indicating separation difficulties with their parents reported more of both

types of concerns, while individuals reporting more depressive concems revealed greater

ievels of depression (Frank et al., 1997). A parent-child reiationship that darnages the

dependant's ability to regulate proximity needs with separation and autonomy needs

predetermines an internalized depressive self-schema (Blatt et al., 1992a).

Generally, adolescents' depressive concems explained most of the variance in

adolescent depression, which was initially accounted for by perceived difficulties with

parents. The one exception was a statistically significant, albeit weak, relationship

between lack of parental involvement and rejection in relation to mother and adolescents'

syrnptoms of depression. The authors suggest that the impact of parental behaviour

occurs as an integral effect that involves not only the sex of the child but also the sex of

the parent. Given the primary feelings of interpersonal alienation, separateness, and

seclusion associated with adolescent depression and the uniqueness of the mzternal

relationship in providing their offspring with a caring and dependable relationship, the

above results are not surprising.

Separation difficulties with parents led to depression only via their relationship to

negative cognitive self-schema. Frank et al. ( 1997) suggests that at this point, it may be

beneficial to identify the subtle, theoretical characterization of adolescents' separation

conflicts. In essence, self-criticism seemed to be heightened by parents who attempted to

discourage the adolescent's effort at assertion and autonomy. Relationship concerns,

however, were central for those adolescents admitting that they had persona1 fears of

estrangement and that they yearned for a less separate relationship with their parents. The

authors note that although the size of these relations was quite small, the overall results

are largely supportive of prior descriptions of cornpositional differences in the degree of

separation difficulties experienced by self-critical individuals as compared to adolescents

wi th interpersonal concerns (Blatt et al., l992d).

Comorbiditv

Over the past decade, a striking feature of depressive phenornena in children and

adolescents is the relatively high degree of comorbidity to which these experiences are

associated with other conditions, emotions, syndromes, and disorders (Haggerty et al.,

1 994). Research now indicates that a vast majority of other ps ychiatric disorders are more

likely to be found among youngsters with depressive disorders. With regard to

depression, Compas, Grant, and Ey (1994) believe that it is safe to Say that comorbidity is

the ruIe rather than the exception during childhood and adolescence. This phenomenon

has been implicated in anxiety disorders (Alessi, Robbins, & Dilsaver, 1987), conduct

problems (Alessi & Magen, l988), attention-deficit disorder (Anderson, Williams,

McGee. & Silva, 1987), eating disorders (Rastarn, 1992; Smith & Steiner, l992), and

substance-abuse disorders (Bukstein, Glancy, & Kaminer, 1992), among other disorders.

Current perceptions of depression in children and adolescents suggests that depression in

these individuals, as in adults, is quite a common psychological problem that is usuaily

linked to other forms of psychopathology (Reynolds et al., 1994). While it is uncornmon

for parents :O report that their children are depressed, they will frequently describe

behaviours such as those mentioned above. This misunderstanding results in infrequent

referrals for care and treatment.

Sex Differences and De~ression

The possibility of gender differences has important implications for the current

research. Clearly, it is necessary to examine whether males and females differ in levels of

depression and related phenornena, and it is also necessary to separately examine

correlational results for males versus females. Previous research on gender differences is

discussed beiow.

Most of the literature on adolescent depression proposes that adolescents are

considerably more depressed than children (Angold, 1988) and that they may be

substantially more depressed than adults (Shoenbach et al ., 1984). Sex differences also

have been observed in adolescent samples (Nolen-Hoeksema, 1990).

Nolen-Hoeksema ( 1987) found that among adults, females were twice as likely as

males to show depression. These sex differences were observed in both major depressive

disorders and in Iess serious levels of depression. Interestingly, Pearce ( 1978) found that

among prepubescent children there was a slight tendency for males to display more

depression than femdes. It seems that this shift in the sex differences takes place some

time in mid- to late adolescence. This is a general assumption and the precise timing

remains unctear (Nolen-Hoeksema, I W O ) .

It has been suggested that two resources are significant in the management and

modification of change when dealing with depression: social support and interna1 coping

resources. Social support is a concept that has gained a great deal of attention in the

examination of stressful life events and its impact on mental health among adults. Whik

there is growing evidence that parental support is critical for adolescent mental health,

less is known about the influences of peers.

Intemal coping resources are usually referred to as coping styles (e.g., Nolen-

Hoeksema, 1987) and have been linked to both the appearance and amelioration of

depression in adults. Clearly, Nolen-Hoeksema's theory is appropriate for the study of

depression in adolescence. Not only is coping style linked to the socialization process of

males and females, it is also believed to change during adolescence. This change is

known as gender intensification. According to the gender intensification theory, the

propensity for the acceptance of feminine and masculine gender rotes during adolescence

may, in girls, increase the reliance on relationships with others for self-esteem as well as

characteristics of dependence and unassertiveness. In boys, it may decrease reliance on

relationships with others for self-esteem resulting in a higher level of self-assurance and

assertiveness. These differences in the way girIs and boys identify with their environment

may influence the development of gender differences in depression (Nolen-Hoeksema &

Girgus, 1994). Although, Nolen-Hoeksema ( 1987, 1990) suggests gender differences in

depression, it is important to note that rumination as discussed below is not assessed in

the current research. However, this literature illustrates the need to consider possible

gender differences and ruminative responses in depressive phenomena.

The duration of a depressed mood is directly related to how individuals react to it.

Ruminating and agonizing will augment and perpetuate the mood, while self-imposed

distractions will relieve the depressed mood. The Iatter response is referred to as

nonsymptom-focusing behaviour. (Nolen-Hoeksema, Morrow, & Fredrickson, 1993).

Men are more prone to distracting behaviours that are incompatible with their present

mood state. Distracting responses take the individual's mind off his or her symptoms of

depression and allow the individual to focus on more enjoyable and pleasing activities

(Nolen-Hoeksema, 1987, 199 1 ). Clearf y, some distracting responses may be intrinsically

counterproductive because they c m lead to fatal or life-threatening consequences,

Examples include engaging in violent behaviour or the use of narcotics. Even though

these actions may in fact divert the individual's attention from his or her unhappy feelings

and allow the individual some relief from the depressed mood, the relief is short-lived

because their negative actions will ultimately lead to more depression. However, not al1

distracting responses are intrinsically hazardous to the individual (Nolen-Hoeksema,

1987, 1991).

In contrast, women are more likely to ruminate, augmenting their depressed mood

by deliberating at Iength about it and its possible causes. Ruminative responses are

thoughts and behaviours that direct the depressed individual's attention to his o r her

symptoms (Nolen-Hoeksema, 1987, 199 1 ). These behaviours and thoughts tend to be

self-focused and deliberative. Ruminating individuals tend to be very distressed about the

reasons and significance of their depression. Though they are very concerned, they d o not

take any action to alter their condition, and they spend a great deal of time thinking about

how unhappy and sad they feel.

Current literature on adolescent coping styles suggests that sex-typed adult coping

patterns may begin in adolescence (Siddique & D'Arcy, 1984). In a study conducted b y

Nolen-Hoeksema, Girgus, and Seligman ( 199 1 ), they found that boys consistently

recounted more depressive symptoms than girls did. Additionally, they fourid that boys

and girls were equally likely to report sad moods, feelings of worthlessness, and

physiological complaints, but boys were more likely than girls to report behaviour

disturbances symptoms and Ioss of pleasure in previously valued activities.

An exphnation for these results is that boys were more prone to select internai,

fixed and global explanations for negative occurrences than girls were. According to this

principle. individuals seem to have fixed styles of justifying good and bad events which

are Iabelled "explanatory style" (Abramson, Seligman, Teasdale, 1978). When

considering the explanatory style theory, it seems that individuals who have such a style

are inciined to expect negative events and they d o not expect positive events to recur.

Also. these individuals tend not to take credit for those positive events that may occur.

Abramson and her colleagues ( 1978) maintain that the hopelessness and dismal

expectations as weIl as feelings of worthlessness which are a consequence of the

maladaptive explanatory style, put the individual at risk for the impulsive, influential, a n d

self-esteem deficits of depression. Studies have revealed that generaily adolescent girls

tend to feel an increasing pressure from others to comply with the prescribed ferninine

sex role and they report an increasing concem about the resulting social consequences of

challenging their sex role (Nolen-Hoeksema et al., 1991). For example, Rosen and

Aneshensel ( 1976) questioned 3,049 seventh- through twelfth-grade children about the

consequences of challenging their sex role. Girls, more than the boys, reported that they

would be disliked by a member of the opposite sex if they were aggressive, aspired to

their own interests or defeated a boy in a competition. Additionally, girls reported that

they atternpted to hide their ability and forcefulness more and behaved in defenceiess and

submissive ways. They also revealed worrying about the reactions of others to their

appearance and behaviour.

Nolen-Hoeksema and her colleagues ( 199 1 ) have proposed that perhaps the

increasing pressure for females to behave nonassertively and to conceal their ability may

cause at least some females to experience feeIings of helplessness about their ability to

bring about desired results. As a result they may develop a maladaptive explanatory style,

making them more susceptible to depression. Further study in this area is needed, as there

are few relevant and supportive studies that exist.

When coping styles were examined, fernales coped with depressive symptoms by

discussing their problems with a friend or by seeking professional help. However, male

depressives coped by neglecting the problem, using narcotics, or drinking alcohol

(Vredenburg, Krames, & Flett, 1986).

Further, Vredenburg et al. revealed that persons of the opposite sex more

frequently rejected depressed individuals than nondepressed individuais. This strong

negative reaction was consistently seen in ratings of interest in future contact, self-

rejection, and perceived impairment of individual functioning. Additionally, regardless of

sex, a greater number of feminine traits were attributed to depressives than

nondepressives. Extensively, the findings suggest that males are more likely to encounter

negative social experiences for revealing emotive aspects of depression and for seeking

help. It is conceivable that the prevalence of depression in women is higher because men

are more likely to experience greater social rejection and retribution for disclosing

feelings of depression and therefore seek alternative ways to deal with it.

Work conducted by Hammen and Padesky ( 1977) established that sex differences

do not exist with respect to the intensity of depressive symptoms. These findings are

consistent with results from past investigations (Bedrosian, 198 1; Teri, 1982). They

revealed, however, that different patterns for male and female adolescents in their

expression of depression do exist. Specifically, males showed symptomatology

characterized by oversensitivity, work inhibition, social isolation and disturbed sleep

patterns. Females, on the other hand, presented symptoms characterized by body image

distonion, eating problems, weight loss, feelings of sadness, and dissatisfaction.

Baron and Joly (1988) specifically looked at the patterns of depressive responses

of adolescents on the Beck Depression Inventory (BDI; Beck, Ward. Mendelson, Mock,

& Erbaugh, 196 1). Although the results revealed that there were no sex differences in the

severity of depressive symptoms --- which is consistent with findings from previous

investigations looking at both clinical (e-g., Strober, Green, & Carlson, 198 1 ) and

nonclinical adolescent samples (e.g., Kaplan, Nussbaum, Skomorowsky, Shenker, &

Ramsey, 1980; Siegel & Griffin, 1984) --- they did, however, ciearly reveal that different

patterns for male and female adolescents in their expression of depression were

widespread. Male adolescents tended to show a symptomatology characterized by

oversensitiveness, reduced productivity, decreased interest in pleasurable activities, and

sleeping problems, while females' contributing symptoms were characterized by concerns

with body image, feelings of unattractiveness, eating problems, weight loss, irritable

moods. and lack of satisfaction. There seems to be an important relationship between

physical self-concept and depression for femde adolescents. That is, femde extemal

focus is characterized by bodily concems while male extemal focus is characterized by

proficiency concerns such as an inability to perform satisfactorily at work. Overall, what

this shows is that gender differences in mean levels of depression must be examined, and

related personality factors and separate correlations must be done for males and females.

The rnost frequently used taxonomy system for the clinicai characterization of

depressive disorders in North Arnerican is the Diagnostic and Statistical Manual of

Mental Disorders (DSM), which, with the publication of the 3rd edition and its

subsequent revision (DSM-III and DSM-III-R; Amencan Psychiatric Association, 1980,

1987), estabtished the standard for the categorization of depressive disorders in children

and adolescents. DSM is currently in its 4th edition (DSM-N; American Psychiatric

Association 1994).

Research has spawned a number of viewpoints and systems for the classification

and identification of depressive phenomena in children and adolescents. The three levels

of categorization are depressive mood, depressive syndromes, and depressive disorders-

Whiie there is considerable overlap among the three concepts, they each reflect different

underlying assumptions about the evaluation and classification of depressive phenomena

(Haggerty et al., 1994). The purpose of this section is to provide background on the

nature of depression in adolescents.

Depressive Disorders

This discussion of depressive disorders will highIight the three major types:

depressive mood, depressive syndromes, and major depressive disorders as identified by

DSM-W. The discussion will outline the relationship between symptom and syndrome in

the delineation of these disorders.

De~ressive mood. We have al1 experienced periods of sadness or unhappy moods

at some point in our lives. Depressed mood is a universal human experience. Varying life

experiences are known to bring about these depressed periods; these phases of depressed

mood rnay be a result of such negative environmental incidents as the break up of a long-

time relationship or k ing unsuccessful at an important task. These feelings of sadness

rnay iast momentarily or they may remain for an extended period of time. Further, these

feelings rnay occur in response to one particular problem or they rnay be a consequence

of many different problems (Petersen? Compas, Brooks-Gunn, Stemmler, Ey, & Grant,

1993).

Work in the field of depressed mood has particularly focused on depression as a

symptom. In this sense, the term depression refers to the presence of a sad mood,

unhappiness, or blue feelings, which rnay last for an unspecified length of time (Petersen

et al.. 1993). At this level, no assumptions are made about any existing or nonexisting

additional symptoms. The process by which depressed mood is described and validated

are through adolescents' self-reports on their emotions and feelings obtained through

measures specifically designed to assess mood levels or through responses made on items

found in checklists of depressive symptoms (Petersen et al., 1993). Sad or depressed

mood is usually experienced with various negative emotions, such as feelings of guilt and

self-reproach, feu, anger, contempt, and self-loathing (Cantwell & Baker, 199 1 ) and is

relativeiy common during the stage of adolescence when al1 or some of these other

negative emotions rnay be present (Saylor, Finch, Spirito, & Bennett, 1984).

Depressed mood is also likely to regularly cooccur with other problems. In

particuiar. the depressed mood has k e n associated with such emotions as anxiety and

social withdrawal. While it is true that anxiety and depressed rnood frequently cooccur,

anxiety may or may not be associated with positive moods. Conversely, when one is

experiencing depressed mood it is not possible for the individual to experience happiness

or self-pleasure; these two emotions do not occur at the same time. Similady, when one is

feeling happiness, depressed mood does not consii tute a part of this emotion (Watson &

Clark, 1984; Watson & Kendall, 1989). Parental referral, indicating the presence of

depressed mood, has k e n the most signifiant factor in differentiating clinically referred

and nonreferred youth (Achenbach, 199 1 b, 199 Id).

Depressive svndromes. The prevailing viewpoint in Our understanding of

depression in children and adolescents suggests that depression in young people is a

fairly common mental health problem that typically displays itself along with a wide

range of other forms of psychopathology (Reynolds et al.. 1994). At this level, the terni

depression is used to refer to a syndrome that refers to a group of behaviours and

eniotions that have been found to regularly occur together in a determined pattern that are

not associated with chance. However. it cannot be inferred that a particular modei exists

for the nature or cause of these identified symptoms (Petersen et al., 1993). The

depressive syndrome has generally been recognized as consisting of not only complaints

that include both anxiety and depression, but also complaints about feelings of loneliness

and isolation: crying speils; feelings of guilt about displaying unacceptable behaviours;

feelings of a strong need to be perfect; feelings of rejection; fears of persecution and

mistreatment from others; feelings of unimportance, agitation, fear, shame, and self-

loathing (Achenbach, 199 la, 199 1 b, 199 1 c). Our understanding of these groups of

symptoms has been greatly enhanced by two foms of assessment methodologies:

adolescent self-reports and reports from parents and teachers.

Maior demessive disorder. Grounds for a depressive disorder diagnosis include

signs of a depressive disorder episode. The depressive disorder has generally been

recognized as consisting of changes in mood plus changes in at least five of nine primary

symptom clusters within a 2-week period that distinguishes a change from one's former

functioning. These five symptoms must consist of either ( I ) a depressed or irritable mood

evident for most of the day or (2) loss of interest in usual activities and a loss of pleasure

that is normally derived from performing these activities. These symptoms are essential if

the diagnosis is to be considered. The following qualifying symptoms are necessary to

characterize the existence of a depressive disorder: changes in appetite and in weight,

changes in the individual's sleep pattern, psychomotor agitation or psychomotor

retardation. fatigue or loss of energy, feelings of worthlessness or feelings of guilt,

decreased ability to think or concentrate, and recurrent thoughts of death or suicide

(Petersen et al., 1993).

Once it has been established that there is evidence for a depressive disorder, it is

essential to further mle out ( 1 ) any accompanying natural factors that may have provoked

or caused the disorder, (2) the presentation of the syndrome as a product of an

environmental factor such as the grief reaction resulting after a significant loss, (3) the

preexistence of delusions or hallucinations in the absence of mood symptoms, and (4) the

manifestation of underlying thought disorders (Poznanski & Mokros, 1994).

Once the occurrence of a major depressive episode has been established the next

step is to define the occurrence of the major depressive disorder as a single episode. This

is true if the individual's history does not reveal any indication of a prior happening. If

there is evidence of more than one episode then it is defined as recurrent (Poznanski et

al., 1994).

Dvsthvmia

While major depressive episodes characterize episodic mood disturbances,

Dysthyrnia describes a slightly milder chronic course. A dysthymic disorder is diagnosed

when an individuai has had a period of depressed or irritable mood, which is prominent

and present rnost days for a duration of at least 1-year. in addition, dysthymic disorder

requires at least two of six qualifying symptoms, which must occur in conjunction with

the essential symptom. These syn-iptoms include changes in appeti te, sleep disturbance,

reduced energy, low self-esteem, diminished ability to concentrate, and feelings of

hopelessness (Petersen et al., 1993). Further: ( 1 ) A decrease in the symptom presentation

cannot have continued for more than 2 months during the episode and there (2) cannot be

any evidence of major depression during the episode, (3) there cannot be any evidence of

a history of manic or hypomanic disorder, (4) or any indication of an underlying thought

disorder, and (5) no evidence of an organic basis for the episode can be established

(Poznanski et al., 1994).

Although the distinction between dysthymia and major depression is clearly

ambiguous in children and adolescents, Kovacs, Feinberg, Crouse-Novack, Paulauskas,

& Finkelstein (1984), has established that a distinction can indeed be made, and that it is

not unusual for children to be diagnosed with double depressions in which the occurrence

of an episode of major depression concomitantly occurs with preexistîng dysthyrnia.

Help-Seekinp Behaviour

Most individuals suffering from distress and persona1 problems do not seek help.

A large number of reasons have been noted in the clinical and theoretical Iiterature for

this reluctance. Initially, individuals may be hesitant to ask for support because their

problems are difficult to acknowledge or their existence is denied (Amato & Bradshaw,

1985). Acosta ( 1980) believes that extemal constraints may aIso p h y a role in an

individual's unwillingness to seek help. The perception of restraints such as financial

concerns. transportation, and not being able to afford the time have also been found to

prevent help-seeking. in addition, if the actual help source is perceived as being inept,

incapable of helping, or inaccessible. help-seeking is unlikely to occur (Saunders,

Resnick, Hoberman, & Blum, 1994).

Additionally, factors which are more psychological in nature have also been

suggested. Some have argued, based on the reasoning of an equity theory, that an

assumption of obligation with respect to the helper may be aversive enough in various

circumstances to delay or inhibit help-seeking (Greenberg, 1980). Other studies have also

shown that help-seeking is affected by feelings of obligation. Greenberg and Frisch

( 1972) found that feelings of indebtedness intensify as the amount of help rendered

increases. Further to this, experiments have indicated that when an individual feels that

the help received cannot be reciprocated, then help-seeking is less likely to occur (Moms

& Rosen, 1973). Also, it has also been found that individuals who regarded the cause of

the probkm to be a result of their own actions were more likely to report fear of help-

seeking. This overall framework is consistent with research that suggest sceking

professional help is a threat to self-esteem, which indicates that problems that cannot be

attributed to external factors are more likely to make the recipient appear and feel

helpless, powerless, and incornpetent (Schonert-Reichl & Muller, 1996). Other findings,

which confirm this position, suggest that individuals with more personal problems were

also more prone to be apprehensive. Consistent with this, problems that are more intimate

tend to be more centrai to an individual's self-perception, and consequently, more likely

to be ego-threatening (Amato et al., 1985). Fisher, Nadler, and Whitcher-Alagna (1982)

advanced a slightly different theoretical overview, contending that help-seeking is

ultimately threatening to the recipient's self-esteem. Consistent with this threat to self-

esteem rnodel is the fact that people have k e n found to be reluctant to seek help or

utilize heaith services based on privacy concems, distress about self-reliance, and

personal inadequacy (Newacheck, 1989). Thus, it appears that this reluctance to seek help

exemplifies rneaningful psychological obstacles, which stands between the perception of

a disturbing problem and the motive behind searching for help which might improve the

situation. It seems that the attitudes surrounding an individual's reason for k ing reluctant

to seek help are related to the overall nature of the situation, the perceived severity of the

problem, and the personality and attitude of the individual. In this context, the

characteristics and intensity of these reluctance motives influence the decision as well as

one's attitude toward or actual use of the help source (Amato et al., 1985). Brown (1982),

in his study of the social and psychological correlates of help-seeking among urban

adults, found that individuals who did not obtain help for emotional problems reported a

greater reluctance to discuss problems with others while those individuals who did obtain

help reported little difficulty discussing their problems.

Robbins and Greenley ( 1 983) propose a similar theoretical framework. They

suggest that the attribution and definition of problems are more likely to influence help-

seeking decisions. Specifically, the more the individual concludes that the problems they

are experiencing are crippling, bothersome, or threatening to his or her emotional

stabitity, the greater the proclivity towards seeking professional assistance. Also, if the

individual believes the taxonomy of their problems is a resuIt of interna1 factors as

opposed to the environment or other external factors, and if they assume that their

problems will be long-term as opposed to self-restricting and limiting, then the individual

is more inclined to self-refer. The greater the tendency to interpret one's problems as the

result of personal failure or inadequacy as opposed to king extemally attributed. the

greater the tendency of professional help-seeking. Problems feared to be of long duration

are more iike1y to influence one to search for help. Conversely, if problems are thought to

be short-lived and likely to go away by themselves, then the individuai is less likely to

search for help.

The results obtained from Robbins et al.'s (1983) study revealed that college

students who defined their personal or emotional problem as incapacitating, long-term,

and due to interna1 factors, were more likely to obtain professional help. In addition,

students who considered their problems to be frightening, interfering with their daily

activities. and emotionally threatening, were more likely to have sought professional

help. In contrast, those who perceived their problems to be less severe, restricting, or

threatening were Iess likely to obtain formal help. Further, it was also established that

students were twice as likely to seek help if they accepted persona1 responsibility for

causing their problems than if they believed their problems were caused by external

factors. A number of broad explanations for this difference have been advanced. The first

suggest that perhaps internals who believe that their own behaviour can bring about

valuable changes are more likely to view help-seeking as appropriate. A second

explanation has to do with one's level of education. Highly educated persons are inclined

to consider psychiatrists and psychologists more often than those with less education

(Robbins et al., 1983).

Bomstein, Krukonis, Manning, Mastrosimone, and Rossner (1993) put forth a

concept that, in the present context, implies a positive relationship between interpersonal

dependency and health service utilization. Specificafiy, the authors investigated the

relationship of college undergraduates' level of dependency to their decision to seek

professional help. The difference with this study is that the methodological problems that

have characterized previous studies in this area have been addressed: The participants'

level of interpersonal dependency was measured beforehand, and repeated measures of

utilization of professional services were then collected over a three-month period,

Further, monthly self-reports of health status from each participant were collected. The

authors hypothesized that dependent participants would demonstrate an overutilization of

professional services such as a greater number of visits to the college health center, to

private physicians and to hospitals than nondependent participants, after controlling for

health status.

In the research, the dependent person is described as a helpfd, insecure individual

who relies upon another for attention and affection, for protection, and emotional support,

electing to seek the opinions and direction of others rather than acting on their own ideas

and beliefs (Bornstein et al., 1993)

The resuhs of the study conducted by Bornstein et al. ( 1993) supported the

hypothesis that Ievel of interpersonal dependency predicts levels of untilization of

professional help in both men and women. The present study increases Our understanding

about mental health needs, professional help-seeking, and other elements associated with

the decision to seek help in dependent persondity types across a variety of settings such

as medical personnel, school- based sources and social support. The advantages of these

findings are twofold. First, the results suggest that dependent person's help-seeking

behaviour is manifested in many situations. Taken together, help-seeking behaviour is the

innermost feature of dependent personality types. Second, rather than fitting extant

findings, the results are not in line with previous research that suggests that dependency

is uniquely associated with negative personality traits. While the results did establish that

high levels of dependency correlated with increased use of health services, this frequency

actuaIly reveals an active rather than a passive individual taking action to ensure that their

health concems are taken care of. Given that increased dependency was associated with

high utilization of professional services in their sample of undergraduates, the current

resuIts suggest that in certain situations, interpersonai dependency can be a strength

rather than a handicap. To date, recent studies have begun to focus on the positive

qualities of dependency such as awareness of interna1 cues, cooperativeness, and a

readiness to corne to the aid of others.

These results have clear clinical implications in that it is important to understand

an individual's cause for seeking help before a medical or psychoIogical intervention

strategy is implemented. Indeed, an understanding of an individual's Ievel of dependency

may help rnedical, school personnel, psychologists, and other health care professionals to

recognise help-seeking behaviour that is based on general problems from help-seeking

that is fundarnentally based on an individual's need for guidance and nurturing. Although

this may not be feasible in every case, it does provide an overall frarnework. Other

findings revealed that women obtained significantiy higher interpersonal dependency

scores than did men. These results are consistent with the results of previous studies- One

reason for this may be that women are often more willing than men to acknowledge their

dependency needs even though their needs may be comparable (Bornstein et al., 1993).

Sex Differences and Hel~-Seekin~ Behaviour

Several speculations in the help-seeking literature are consistent wi th the findings

of Kessler. Brown, and Broman (198 1 ) who contend that women more readily than men,

tend to translate their psychological symptoms into conscious problem recognition. That

is. women seem to be more willing to translate emotionai anguish into a conscious

recognition that they have psychological problems. It is clear, however, that once

personal problems are identified, both men and women are equally likely to seek

professional help (Kessler et al., 198 1).

Some findings revealed that women generally hold a more positive attitude

toward help-seeking than do men (Paykel, 199 1 ). Others did not find a difference in help-

seeking orientation between the sexes. In a study conducted by Tijhuis, Peters, and Foets

( 1 WO), little difference in attitude and inclination toward help-seeking between the sexes

was found. Further research in this area is needed.

Developmental progressions have been conceptualized as a period in life

consisting of significant change. Adolescence is a period of social, emotional, and

psychological transition. For an adolescent not experiencing any significant hedth

problems this period of transition is typicaily stressful. For those adolescents who have or

have been diagnosed with a mental health problem, this penod of transition can be

particularly difficult. In a study conducted by Barker and Adelman (1994) they

considered the following questions: Where do young adolescent people go for help when

they experience difficulty coping with mental or psychological problems? What actually

influences their decisions to seek help? Robbins et al. (1983) suggest that generally, the

evidence indicates that adolescents tend to underutilize professional services based on

their related negative attitudes toward mental health professionals and preference for

informa1 sources of help such as family members and friends which tend to influence

their future help-seeking behaviour. Despite the obvious need for help, the utilization of

services may also be associated with the inability or unwillingness of adolescents to

identify themselves as experiencing a problem. Fears about autonomy, stigma and social

rejection may aiso be concems.

Seeking help, which is considered to be intemally caused is likely to suggest

greater personai inadequacy, hence posing a threat to self-esteem and increasing the costs

of help-seeking. This implies that people foreseeing embarrassrnent or reproach for

internally attributed problems, are particulariy guarded about the selection of an

appropriate help source.

Saunders et al. (1994) found that informai help-seeking behaviour was unrelated

to identifying a need for help, but was associated with obtaining help. Particularly,

adolescents who reported that they discussed their concems and problems with others

indicated that they would also be inclined to obtain formal help from a trained

professional. Adolescents who did not talk about their problems were less likely to seek

professionai help. However, despite this, both groups were equally likely to recognize the

need for help. One way to understand these results is to note that talking with others

encouraged the help-seeker to seek more formal and intensive medicd services by

establishing an environment where reassurance, support, and encouragement were

forthcoming.

Saunders et al. (1994) established in their study that adolescents were generally

more likely to turn to friends for specific problems such as depression and family issues.

However. they also reported that they would tum to family members for help.

Interestingly, it was further established that to whom adolescents tumed to help was not

associated with the Iikelihood of identifying the need for help, but was associated with

whether help was actually obtained. Adolescents who would go to a family member were

more likely to seek help which they believed was needed, whiie adolescents who would

not turn to a family member were the least likely to seek help. Other results found in their

study showed that those who experienced a relationship with their parents and who felt

loved and cared for by their parents and other adults were more inclined to seek help. It

seems that seeking informal support for problems is an important component of actually

obtaining forma1 help. However, there are other contributing factors that suggest that the

influence of social support is quite cornplex.

The ramifications of both intervention and prevention with respect to the help-

seeking behaviour of adolescents experiencing emotional problems are quite evident.

While only 50 percent of the adolescents who identified themselves as in need of help

actuaIIy obtained it; it is clear that educational and outreach programs designed to

facilitate the process and improve attitudes toward the use of medical services are clearly

needed. The strength behind these intervention establishments may be further facilitated

by the increased awareness of existing bamers that youth face when seeking treatment.

Prevention programs should focus not only on the advancement of resistance to the

progression of disorders or reducing behaviours that place adolescents at great risk for

such dysfunctions, but should also highlight the importance of self-awareness with regard

to clinical need and the relevance and benefit of help-seeking (Saunders et al., 1994).

Despite findings that show that adolescents experience great stress in their lives,

only recently have researchers begun to explore how adolescents cope (Srebnik, Cauce,

& Baydar, 1996; Hennan-Stahl, Stemmler, & Petersen, 1995). One area of investigation

that is receiving increased research attention is the investigation of the help-seeking

behaviours that adolescents utilize to cope with stress. anxiety and depression (Baker et

al., 1994; Dubow et al., 1990).

Compas, Malcarne, & Fondacaro (1988), has found that those who seek help and

advice from individuals in their social support network tend to be better adjusted, as this

serves as one type of problem-focused coping strategy. Certainly, a fundamental aspect

that may be important when distinguishing between those individuais who successfidly

traverse the course of childhood to adulthood versus those who do not, may be a result of

their ability to utilize varying sources of support from parental and peer relationships as

weII as school personnel, teachers, psychologists, psychiatrists and the like. The benefit

of such support has been shown to diminish the effects of stress and provide an

environment of understanding, support and concern (Cauce, Mason, Gonzales, Hiraga, &

Liu. f 994). Although earlier research has indicated that adults have more success deaiing

with stressful events when they are able to turn to farniiy and friends for advice and

guidance. scarce data exist regarding adolescents' use of support and their attitudes

towards help-seeking. As welt, tittle research has k e n conducted to understand the

underlying personality factors that may be linked to depression and seeking help during

adolescence.

Researchers have recently begun to document the help-seeking behaviours of

adolescents from individuals in their social networks (Nelson-Le Gall, 1981). While these

investigations have contributed significantly towards our understanding about the

properties and intent of adolescents' help-seeking behaviours, several issues need to be

addressed.

While previous research indicates a Iink between personality variables and social

support, relatively few studies have explored this correlation among adolescents. This

study will investigate the effects of personality variables such as perfectionism as they

are related to depression and attitudes toward help-seeking.

Research on self-worth and self-esteem in adolescents suggests that these factors

may determine the use of helping resources as well as in the preference for advice from

aduIts as opposed to their peers (DuBois, Felner, Sherman, & Bull, 1994; Wintre &

Crowley, 1993). A number of studies have suggested that an individual's sociai support

network may heighten self-esteem as well as defend against decreases in self-worth under

stressful conditions. A number of studies. regarding self-worth and social support have

indicated that children with enhanced self-worth were those who also reported having a

supportive network to turn to for help (Harter, 1989). Less obvious at this point, however,

is the association of self-worth to help-seeking. Nadler, Mayseless, Peri, & Chemerinski

( 1985) conducted a study of help-seeking behaviour involving an academic task and

found that individuals with high self-esteem were more reiuctant to seek help than those

individuals with low self-esteem. Other research conducted by Schonert-Reich1, Offer, &

Howard ( 1995), on adolescent help-seeking found that a positive self-concept was

correlated with seeking help and advice from parents, while a negative self-concept was

correlated with the utilization of support from mental health professionals.

A number of studies have suggested that self-consciousness may limit one's

ability to disclose persona1 problems in a help-seeking context. Self-consciousness is also

one mental factor that may impede or facilitate one's ability to seek help when dealing

with a crisis or a stressful event. Both those prone to socially prescribed perfectionism

and perfectionism sel f-presentation are more ii kel y to experience greater social reticence

as a fear of appearing inadequate and incompetent.

Existing beliefs and research indicate that adolescence is a highly disturbed and

tumultuous period in the life cycle which tends to be characterized by increased self-

consciousness (Saunders et al., 1994), with adolescent fernales indicating a higher level

of self-consciousness compared to their male counterparts. Currently, little data exist

investigating the relationship between self-consciousness and help-seeking behaviours

among adolescents.

Perfectionisrn

Perfectionism is a personality factor that is believed to be associated with

increased vulnerability to depression and reiated forms of dysfunction. It is a widely held

belief that the motivation for perfection is a significant influence on people's behaviour.

Typically. perfectionism is identified as the propensity to maintain and aspire to

extraordinarily high goals (Hewitt, 1989). Perfectionists frantically and obsessively strive

toward impossible goals and measure their own worth entirely in terms of productivity

and proficiency (Burns, 1980b). This type of perfectionist sets exceedingly high

standards. This is in sharp contrast to the normal pursuit of excellence where an

individual's worth is measured not by productivity, but by realistic, attainable steps

toward a desired goal.

To be perfect would require that the individud's actions be automatic and

mechanical in the absence of charm, without logic. and practically without any fulfilling

attributes (Pacht, 1984). Pacht has argued that perfection is not only an unacceptable

aspiration, but a crippling one as well. In reality the final goal of perfection is

nonexistent, but it is the striving toward this impossible goal that creates an environment

of discontent and turrnoil and is identified with a number of psychological and medical

complaints.

Most previous research is limited because perfectionism was considered to be a

unidimensional cognitive constmct (Burns, 1983). That is, perfectionism has been

conceptualized and evaluated as if it is a unidimensional personality trait with a belief

system based entirely on high personal standards. But current evidence suggests that the

perfectionism constmct should be viewed from a multidimensional perspective, which

has both personai and social aspects (Frost, Marten, Lahart. & Rosenblate, 1990b; Hewitt

et al., 1991 b).

Trait Dimensions of Perfectionism

The persona1 aspects of perfectionism have been identified as self-oriented

perfectionism (Hewitt & Flett, 1990, 199 1 b), which tdvpically has an intrapersonal

dimension. Self-oriented perfectionism is distinguished by a strong motivation to be

perfect, obsessive striving, a proclivity to engage in all-or-none thinking whereby only

total success or total failure exist as a final outcome, and generalization of idealistic self-

standards across behavioural domains. The self-oriented perfectionist establishes and

maintains unrealistic self-standards and focuses on his or her own imperfections and

failures. These characteristics reportedl y contribute to a depressive-prone personaiity by

heightening faiIure and influencing information processing associated with the inability

to achieve standads (e-g., Burns & Beck, 1978; Hewitt & Genest, 1990). Both cognitive

and self-control theorists (e.g., Beck, 1967; Kanfer & Hagerrnan, 198 1 ) believe that the

joint tendency to expect perfection from oneself and the motivation tc attain unrealistic

standards creates a susceptibility to depression by exposing failures, increasing self-

punitive behaviours and decreasing contentment and self-reinforcement (Hewitt et al.,

1993a).

While most believe that punitive self-standards are the foundational Iink between

self-oriented perfectionism and depression, socially prescribed perfectionism, it is held,

renders a person prone to depression because it involves the perceptions of one's inability

to fulfil the ideals and expectations of significant others. This theory assumes that others

have unrealistic principles and perfectionistic motives for personal behaviours and that

others will be pleased only when these standards are attained. This perfectionism

dimension involves numerous social interaction variables such as fear of negative social

evaluation, belief of external control of reinforcement, and a strong need for the approval

of others (Hewitt e t al., 199 1 b). Although it is believed that the standards in socially

prescribed perfectionism originate outside the self, it should be emphasized that

attributing control to external forces can result in depressive symptoms of self-blame

(Kranz & Rude, 1984). Interpersonal sensitivity in socially prescribed perfectionists, may

stem from a perceived inability to meet the imposed standards (Flett, Hewitt, Blankstein,

& Pickering, in press) and may be further intensified by the individual's need t o gain

approval from others and his or her sensitivity to criticism.

Other-oriented perfectionism (this dimension is not assessed in this study) is

identified with an unrealistic expectation of others. Other-oriented perfectionists are

prone to be extremely critical of others, dominating and unyielding. Consequently, this

dimension should be unrelated to depression because it involves an external focus on

other individuals' shortcomings rather than shortcomings of the self. However, it may

have secondary implications in that it can cause distress by creating difficult relationships

(Hewitt et al., 199 1 b).

Dimensions of Perfectionism Self-Presentation

In addition to the characteristic dimensions of perfectionism, Hewitt, Flett, and

Fairlie (1994) have also provided a framework for social facets of perfectionism, which

involve self-presentational styles that include a striving to create an image of flawlessness

to others. Research on the development of the Perfectionism Self-Presentation Scale

(PSPS; Hewitt et al., 1994) has shown that individual differences in perfectionism self-

presentarion can be measured and that the dimension encompasses three major

components: the need to appear perfect, the need to avoid appearing imperfect, and the

need to avoid disclosure of imperfection (Hewitt, Flett, & Ediger, 1995).

Al though researc h tends to indicate that the perfectionisrn sel f-presentation

dimensions are intercorrelated. there are some important conceptual and empirical

distinctions among the dimensions. One element of perfectionism self-presentation (i-e.,

the need to appear perfect) involves claiming a desired identity, while two elements of

perfectionism self-presentation (i-e., avoiding the appearance of imperfection and the

nondisclosure of imperfection) involve avoiding and undesired identity. A further

distinction involves the nondisclosure of imperfection dimension, which is more directly

associated with interpersonal communication than the other two perfectionistic

dimensions.

Work on the Perfectionism Self-Presentation Scale (PSPS) is stil1 in its

preliminary stages. However, initiai evidence supports the usefulness of this measure

when administered to a variety of sarnples. For instance, Hewitt et al., (1994)

administered the PSPS, the Multidimensional Perfectionism Scale and various measures

of self-esteem, depression, and anxiety to a sample of 169 undergraduates from York

University. Correlational analyses showed that the PSPS dimensions assessing the

avoidance of imperfection and the nondisclosure of imperfection were associated broadly

with the indices of depression, anxiety, and low self-esteem, and there were fewer

significant associations involving the need to appear perfect. In addition, regression

analyses were conducted to test whether the PSPS predicted unique variance in measures

of maladjustment, over and above the predictiveness of trait MPS dimensions. The

pattern of results indicated that the PSPS dimensions did indeed predict significant levels

of unique variance in distress scores, over and above the MPS. These data illustrate the

need to consider both trait dimensions and elements of PSP when seeking to predict

levels of psychological distress in university students.

The prirnary focus of Hewitt, Flett and Ediger's (1995) study was to assess the

relationship between personal, social, and self-presentational dimensions of perfectionisrn

and eating disorder behaviours in a sample of female coIlege students. A secondary

interest was to rneasure other characteristics associated with eating disordered behaviour,

namely body image avoidance, and global self-esteem. The results of the study indicated

that self-oriented perfectionism was related specifically to eirtreme loss of appetite and

aversion to food. Essentially, this dimension was concemed only with restricting food

intake and with being slender and lithe and did not seem to be involved in other aspects

of eating disordered behaviour. Social dimensions of perfectionism, however, were

related more to eating disorder behaviours as well as self-esteem issues.

Hewitt et al. (1995) also revealed that some perfectionistic striving seen in eating

disordered behaviour involved the strong need to accede to an archetype or mode1 of

perfection that was perceived as a demand by others. This suggests that the primary drive

behind this perception is that in order to be acceptable to others one must meet their

perceived perfectionistic requirements.

Another finding, aibeit unexpected. was a positive relationship between other-

oriented perfectionism and increased body image avoidance. One explanation for this

finding may be that, in a nonclinical sample, a preoccupation with body image avoidance

may be much the same as needing others to be perfect (Hewitt et al., 1995).

The findings of the study also suggest that two major components of the construct

perfectionism self-presentation: the need to appear perfect and the need to avoid

appearing imperfect were related to both anorexic and bulirnic tendencies and to a

preoccupation with public appraisal and responses to one's appearance. Taken together, it

seems that the social aspects of perfectionism are uniquely related to appearance and

global self-esteem. Overall, the findings speak to the relevance of identifying the

different dimensions of perfectionism as they relate to the various symptoms and

characteristics of eating disorders (Hewitt et al., 1995).

A recent study by Habke, Hewitt. & Flett (1999) examined the extent to which the

dimensions assessed by the perfectionism self-presentation scale are associated with

marital difficulties, especially in the form of sexual problems. A sampie of 74 married or

CO-habiting couples completed measures of trait perfectionism, perfectionism self-

presentation, depression, dyadic adjustment, and sexual satisfaction. Correlational

analyses confirmed the presence of a general association between perfectionism self-

presentation and problems in sexual satisfaction. Stronger findings where obtained for

women than men; perfectionism self-presentation in women was associated with self-

reports of low satisfaction with there partners.

However, research has not investigated perfectionism self-presentation in

adolescents. For instance, the association between perfectionism self-presentation and

psychological distress in adolescents has not been exarnined. Moreover, there are no data

available regarding adolescent's heip-seeking attitudes as they relate to the three

dimensions of perfectionism self-presentation. When exarnining the different dimensions

of perfectionism, the perfectionism self-presentation type variables would seem to be the

most relevant if the focus is on help-seeking attitudes. Clearly, when conducting a study

on help-seeking attitudes it would be very important CO have perfectionism self-

presentation dimensions included over and above socially prescribed perfectionism.

Perfectionism and Depression

Perfectionisrn and ûe~ression in Adults

The research literature on perfectionism has evolved significantly in the last 10

years. As previously stated, numerous empirical investigations using developed scales,

have provided convincing evidence that perfectionism is a multidimensional construct

that seems to play an important role in adaptive and maladaptive functioning, including a

broad range of disorders such as depression and suicide (Blatt, 1995). Based on the

findings that socially prescribed perfectionism is the belief that others have unrealistic

and exaggerated expectations that are difficult, if not impossible, to meet, and in order to

receive their approval and acceptance the individual must meet these standards (Frost et

al.. 1990b; Hewitt et al., 199 1 a, 199 1 b), it has been revealed that these unrealistic

standards are experienced as externali y imposed and uncontrollable. As a result, these

individuais often have feelings of failure, apprehension. anger, powerlessness, and

pessimism and these feelings are often associated with depression and suicida1 thoughts.

Al though sel f-oriented perfection ism interacts primaril y wi th achievement stressors to

predict depression, socially prescribed perfectionism interacts with both interpersonal and

achievement stress to predict depression (Hewitt & Flett, 1993b). Self-oriented and

socially prescribed perfectionism define the intrapersonal and interpersonal dimensions

of perfectionism (Flett, Hewitt, Blankstein, & O'Brien. 199 1 a), both of which are related

to mental stress and anxiety.

Hamachek ( 1978) suggested that neurotic perfectionism, one who is extremely

preoccupied with making mistakes and is fearfùl of negative judgements from othen,

may be the result of an unhappy childhood with rejecting or inconsistently accepting

parents whose admiration and praise was consistently dependent on the child's

performance. Parents with perfectionistic standards are extremely criticai, unyieiding, and

usually less understanding (Hamacheck, 1978). Perfectionistic parents are not only

indifferent about their own achievements, but also find it difficult to acknowledge and

recognize the efforts of their children. These parents rarely approve and appreciate their

children's accomplishments; they constantly push them to do better. As a result, the child

never feels fulfilled because his or her behaviour is never quite good enough to meet

parental standards and expectations (Missildine, 1963). Further, perfectionistic parents

tend to impan disapproval in more indirect ways by continually suggesting that they are

dissatisfied, but will be satisfied when the chi Id's performance irnproves. Consequentl y,

these children, similar to their parents. never recognize their own triumphs and come to

feel that they have never completely realised their parent's expectations (Missildine,

1963). Research indicates that perfectionistic parents use detachment and disapproval as

retribution, and their children come to react to mistakes with frustration, dread, and

apprehension. They view mistakes and failure as something that must be avoided. Once

established, this form of self-measure can become self-perpetuating and foster extreme

pressures for perfectionisrn (Burns 1 %Oa, 1 %Ob).

In summary, on the bais of these findings, perfectionistic individuals experience

depression that is primarily focused on issues of self-importance and self-disapproval;

they reprove, evaluate, and criticize themselves and have feelings of extreme regret,

humiliation, failure, and unimportance. They are highly motivated by the danger of

faiIing in order to meet severe and harshly voiced parental expectations and desires.

Research conducted by Blatt ( 1974) found that generally, children tend to believe that

their parent's praise was conditional upon meeting their strict and unreasonable standards,

and lived in fear of losing their parents' love and admiration. Consequently, their self-

crïticism appears to be a facsimile of their relationship with their parents, who intensely

watch their behaviour and strive to prevent their attempts at individuation and self-

growth. As a result, their profound self-loathing and need for perfection seem to emerge

from a relationship with parents who were invading, restricting and austere (McCranie et

al., 1984).

As compared to cl inical observations, recent longitudinal research i ndicates that

an individuai's recolIections about his or her parents, and correlational analyses or

Iongitudinal anecdotal reports and correlational findings reveal important causal links. It

seems that most of the formulations about the correlation of parental behaviour to the

development of perfectionism in children have been based on the former method which

limits the conclusions about a possible causal relationship between early childhood

experiences and the resulting development of perfectionism (Lewinsohn & Rosenbaum,

1987). Longitudinal studies demonstrate that parents that are controlling and rejecting

duri ng earl y childhood before the age of 8 is predictive of the child's level of self-

criticism in early adolescence (ages 12- 13) and of the level of depression when the child

reaches late adolescent and young adulthood (Koestner, Zuroff, & Powers, 1991 1. Also,

the level of self-criticism in early adolescence is predictive of lower education, lower

socio-economic occupational status, and a higher occurrence of maladjustment,

depression. discontent with farnily, penonal relationships and employment in later

adui thood (Zuroff, Koestner, & Powers, 1994). Consequently, perfectionistic individuals,

who are highly self-critical, intensely scrutinize and judge themselves in the same strict

punitive manner. as they believe that their parents have judged them. They constantly

strive to meet the harsh parental standards and also identify with them. They direct these

attitudes toward themselves so that whatever they achieve is never fully enjoyed or

acknowledged (Meissner, 1986).

On the basis of these developmental and clinical findings, certain perfectionism

dimensions may be associated with adaptive forms of coping, whereas other dimensions

may be associated with maladaptive forms of coping. Several studies have shown for

example, that self-oriented and other-oriented perfectionism were both related to a

positive problem-solving orientation. In contrat, socially prescribed perfectionism was

related to a negative problem-solving orientation. Specifically, Flett, Hewitt, Blankstein,

& Van Brunschot. (199 1 b) administered the Social Problem-Solving Inventory (D'Zurilla

& Nezu, 1990) and the Multidimensional Perfectionism Scale (MPS; Hewitt et al.,

199 1 b) to a sample of college students. Based on their findings, Flett et al. ( 199 1 b)

concluded that important causal links between socially prescribed perfectionism and a

negative problem-solving orientation may be due, in part, to feelings of unimportance and

learned helplessness that accompany the belief that others are setting and imposing very

high standards for them.

Similarly, in a related study, Flett et aI. (199 la) administered the MPS and the

Self-Control Schedule (SCS; Rosenbaum, 1980), a measure of learned resourcefulness or

coping ability, and measures of depression and self-esteem to another sample of students.

The research results showed that both self-oriented perfectionism and other-oriented

perfectionism were associated with greater forms of learned resourcefulness. This study

in particular showed no significant correlation between learned resourcefulness and

socially prescribed perfectionism, although learned resourcefulness was controlled by a

positive association between socially prescribed perfectionism and depression. Those

who reported experiencing the greatest depression were socially prescribed perfectionists

and those individuals with counteractive and low defenses.

Research findings, which examined the possibility of depression as a joint

function between levels of perfectionism and coping styles, indicated that self-oriented

perfectionism and emotion-oriented coping, combined to produce greater levels of

depressive symptomatology. That is, the association between emotion-oriented coping

and depression was greater for those individuals who tend to be perfectionistic and highly

self-critical in terms of their own goals and aspirations (Hewitt, Fiett, & Endler, 1995).

This finding was important for two reasons. First, it provided an expianation as to

why, in some studies, self-oriented perfectionism is associated as a main effect with

depression. (e.g., Hewitt et al., 1991b) and in other studies it is not (e.g., Fiett et al.,

199 1 a). It seems that self-oriented perfectionism and depression will be related to the

degree that perfectionists react to failure and stress by reflecting on their negative

ernotional States. Second, this finding is important because it further supports the need for

the examination of possible personality moderators and the association between coping

and depression. The interaction revealed in this study gives support to the outlook of self-

regdation models predicting the 1 ikelihood of more depression experienced by an

i ndividual c haracterized by simul taneousl y high personal standards and a maladaptive

fom of coping such as projection and wish fulfilment. The current findings add to a

growing number of studies that indicate the need for the opportunity to explore factors

that may be related to high levels of personal standards or feelings of imposed standards

to increase depression (Flett et al., 199 1 a, Hewitt & Dyck, 1986; Hewitt et al., 1993a;

Hewitt et al.. 1990).

In summary, research findings indicate that self-oriented perfectionism is relevant

to the study of coping for several reasons. As previously mentioned. self-oriented

perfectionism was identified with emotion-oriented coping. Second, sel f-oriented

perfectionism was a personality factor that has an intense investment in issues of self-

definition and self-worth, which is related to a certain amount of stress or failure because

these individuals have exceedingly high standards. Accordingly, self-oriented

perfectionism may be a stress-promoting factor that heightens the importance of effective

coping defences.

Past research has shown that socially prescribed perfectionists often have feelings

of failure, powerlessness, and pessimism and these feelings are often associated with

depression and suicida1 thoughts. As mentioned previousiy, research has also shown that

while sel f-oriented perfectionism interacis mainly with achievement stressors to predict

depression. socially prescribed perfectionism interacts with both interpersonal and

achievement stress to predict depression (Hewitt et al., 1993).

Consistent with past findings Fiett et al., ( 1991a) found that sociaily prescribed

perfectionism was the perfectionism dimension most strongly associated with depression

in college students. More precisely, students that had the belief that others upheld

perfectionistic expectations of them were strongly prone to increased severity of

depression. As expected, results were largely supportive of theoretical predictions with

self-esteem as the adjustment measure. It was found that higher levels of socially

prescri bed perfectionism were signi ficantl y associated with decreased sel f-esteem (Flett

et al.. 199 1 a).

The analyses aIso reveaied that the interaction of social1 y prescribed

perfectionism and self-control accounted for a significant amount of the variance in

depression and self-esteem scores, with greater socially prescribed perfectionism and

reduced self-control k ing more strongl y related to poorer adjustment. In addition,

consistent with expectations, it was found that the two main effects of self-control and

socially prescribed perfectionism interacted to account for a unique variance in

depression scores, such that socially prescribed perfectionistic individuals reported

significantly greater levels of depression but reported lower levels of learned

resourcefulness. These findings are interesting because of their implications. Once it is

perceived that externally imposed perfectionistic social standards exist, individuals who

possess and initiate effective instrumental coping strategies will respond in a relatively

adaptive rnanner to stressful life events. In contrast, individuals reporting significant

levels of depression are those who believe that external perfectionistic standards exist but

lack a basic adaptive response style, either in terms of responding to or controlling for

negative life events, behaviours or cognitions (Flett et al., 199 la).

The current study extends the literature by examining the link between

perfectionism self-presentation and depression, which has not been evident. The work of

Hewitt et ai. ( 1995) has established a link between a perfectionistic style of self-

presentation and low self-esteem. The authors (Hewitt et al., I993b) believe that the

endless need to appear accomplished is an attempt to offset their feelings of low self-

esteem. Others have suggested that low self-esteem involves self-presentation based

partially on a need to avoid attracting attention to oneself (Baumeister. Tice, & Hutton,

1989). Essentially, it seems that social aspects of perfectionism self-presentation are

uniquely associated with outward appearance and general self-esteem. As extreme

standards and self-appraisals are unrealistic, perceived failures and a poor self-concept

are common among these individuals (Hewitt et al.. I99l b). These individuals have a

marked aversion to public scrutiny. Their strong need to avoid exposure of their flaws

and inadequacies may characterize their efforts to escape from constant rerninders of

persona1 faiiures as well as to avoid private and public admission of their inability to

meet expectations of perfection (Hewitt et al., 1995). One of the primary goals of this

study is to test whether experiences of depression are evident among individuals high on

this dimension.

Perfectionism and De~ression in Adolescents

There is growing literature on suicide and suicide atternpts in adolescents

(Holinger & Offer, 198 1). Some authors believe that suicide among adolescents has

increased to epidemic proportions (Woznica et al., 1990). It has been suggested that

suicide among adolescents has tripled in recent years. This increase in suicide has given

rise to the need to further understand the nature and manifestations of the risk factors

involved (Hewitt et al., 1997). While there have been rnany trait related investigations of

adolescent suicide, there has been far less theoretical focus on intrapersonal and cognitive

factors. Goldsmith et al., (1990) have identified adolescence as an especially important

period of development for understanding perfectionistic behaviour and increased suicidal

behaviour.

A number of studies have provided evidence that two dimensions of

perfectionism are closely related to youth suicide. These dimensions involve self-

imposed expectations of perfection (Delisle, 1990) and socially imposed expectations

which involve the perception that others are impressing perfection on oneself

(Baumeister, 1990).

The work of Hewitt et al. (1997) has established that there is an association

between levek of perfectionism dimensions and suicide ideation in an adolescent

psychiatrie sample. A positive relationship between socially prescribed perfectionism and

higher ievels of suicide ideation in adolescents was established. Indeed, sociaily

prescribed perfectionism may be especially relevant in adolescent suicide ideation, in that

it may be a function of the preoçcupation many adolescents have with an increased

identification with peers and acceptance, as well as fears of public failure (Hewitt et al.,

1 997).

Taken together, these findings have obvious clinical implications. For example,

the importance of assessing perfectionistic behaviour has been emphasized when

considering suicide risk, given the current thinking that suggest social dimensions of

perfectionism may be the most important to assess (Maltsberger, 1986). Second, Hewitt

et al. (1993a) have argueci that perfectionists are more inclined to interpret events as

failures. Consequently, it is important to assess how individuals perceive and ascribe

existent stressors and life events. Third. the authors have begun developing a treatment

approach for the various aspects and consequences of perfectionism, and this treatment

may be significant in reducing suicide threats by adolescents (Hewitt et al., 1997).

The work of sorne researchers has attempted to develop distinguishing

characteristics between depression and anxiety based on their fundamental cognitive

structures. Consistent with this notion, self-discrepancy ttieory has proven to be an

essential theoretical framework (Higgins. 1987).

Research in the development of the self-discrepancy theory has established that

specific types of self-standards are invariably associated with obvious foms of emotional

distress, particularly depression and anxiety. The theory encompasses three integral parts

of the self that effect a person's emotional experience: the actual self (the belief system

one holds of the attributes he or she actually believes to currently possess), the ideal self

(the belief system one holds of the attributes that he or she would ideally like to possess),

and the ought self (the belief system one holds of the attributes that he or she ought to

process: Hankin et al., 1997). Wylie (1979) explains that the ideal and ought selves are

thought of as self-guides, whereas the actual self represents our understanding of the

terrn, sel f-concept.

Essentially, the self-discrepancy model posits that an individual's vulnerability

and increased negative emotion such as feelings of depression and anxiety result as

discrepancies emerge between the actual self and the self-guides (i.e., the ideal and ought

selves). Increased negative emotions emerge when a greater discrepancy between the

actual self and self-guides exist (Hankin et al., 1997).

The same theoretical frarnework as proposed by the self-discrepancy theory has

been put forth by Hewitt e t al. ( 199 1 a, 199 1 b). Their mode1 of perfectionism also

suggests a relationship between a person's vulnerability to experience negative emotions

and particular types of high standards. The sirnilarity continues in that self-oriented

perfectionism appears to be related to ideal self-guides, as this dimension involves the

setting and maintaining of high standards for the self. Hence, those who demand

perfection may experience more events as stressful, because of an uncompromising

standard for success that permits only absolute success o r complete failure as outcornes

(Han kin et al.. 1997). Likewise, socialIy prescribed perfectionism appears to have the

same properties as the ought self. as this construct involves how they perceive themselves

from the standpoint of others. Both actual self and ought self discrepancies and socially

prescribed perfectionism entai1 a form of social failure were one has not met the

standards and expectations of others, and this results in high Ievels of stress (Hankin et

al.. 1997).

Taken together, given the overall similarity between the two constructs of

perfectionism and self-discrepancy theory, one might correctly predict that self-oriented

perfectionism would be associated with higher levels of depressive symptoms, while

socially prescribed perfectionism would reveal a higher evidence of anxious syrnptoms

(Hankin et al., 1997).

The findings of Hankin et al. ( 1997) support this general hypothesis that extreme

self-standards are uniquely associated with particular kinds of emotional distress during

adolescence. Specifically, ideal standards were related to depressive moods and

symptoms, and not to overall negative emotional States. Further, actual self and ought self

discrepancies were significant predictors of anxious symptoms, as opposed to general

dysphoric ernotion, whereas socially prescribed perfectionism seemed to be associated

with various types of maladjustment (Hewitt et al., 199 la) rather than to any specific type

of distress. However, self-oriented perfectionism and depression were not linked in this

sample. These results were not consistent with previous findings with adult samples

(Hewitt et al., 199 la, i 99 1 b) where self-oriented perfectionism was correlated positively

with depressive symptoms. As noted above, the Hankin et al. (1997) study suggests that

socially prescribed perfectionism is a better predictor of depression in adolescents than is

self-oriented perfectionism. This conclusion is also supported by the results of a recent

study conducted by Boergers, Spirito, & Donaldson (1998) who investigated suicidal

tendencies in a sample of 120 adolescent suicide attempters. The participants in this

research completed a battery of measures that included the Child-Adolescent

Perfectionism Scale, and scales assessing hopelessness, depression, motivation for self-

harm, and family functioning. Correlational analyses showed that socially prescribed

perfectionism but not self-oriented perfectionism was associated with suicidal tendencies.

Moreover, a discriminant function analysis found that depression and socially prescribed

perfectionism were robust predictors that were associated with the adolescents' stated

desire to die. These data combine with the findings reported by Hankin et al. ( 1997) to

suggest that socially prescribed perfectionism is a more relevant predictor than self-

oriented perfectionism.

Perfectionism and Helo-Seekine Behaviour

Although help-seeking attitudes for mental distress has not yet been studied in

adolescents, there are two studies (Onwuegbuzie & Daley, 1999; Frost Trepanier, Brown,

Heimberg, Juster, Makris, & Leung, 1997) that indirectly suggest that perfectionism

should have a negative orientation towards help-seeking. Specifically, Onwuegbuzie et

ai. ( 1999) found that socially prescribed perfectionism was associated with a fear of

asking for help. They investigated perfectionism and statistic anxiety in graduate

students. Results revealed that socially prescribed perfectionism was correlated with

higher statistic anxiety and a greater feu of asking for help. What this suggests, is that

similar tendencies may be associated with this construct and fear of asking for help in a

therapeutic context. Essentiall y, although in a very di fferent context, one could

hypothesize that this dimension would be related to a negative help-seeking attitude,

given that it was associated with fear of asking for help in a graduate-level research - methodology course.

To date, there has been little research on perfectionism and trait self-concealment

using the self-conceaiment scale. However, Frost et al. (1997) in a daily monitoring study

found that perfectionists who had a high concern over mistakes reported a greater desire

to keep their mistakes a secret from other people. Suggesting that if you look at trait

measures the more defensive forms of perfectionisrn, like socially prescribed

perfectionism or perfectionism self-presentation, they would be associated with trait

levels of self-concealment.

Self-Concealment

In this study, to investigate the impact of self-concealment and help seeking in

adolescents, students were asked both to indicate their willingness to seek help for

psychological problems and whether they had self-concealed It was hypothesized that

socially prescribed perfectionism and perfectionism self-presentation would be associated

with high self-concealment and negative attitudes toward help-seeking.

Larson and Chastain ( 1 990) suggest that sel f-concealment is a widespread inner

personal experience. Self-concealment is defined as a predisposition to actively hide

distressing and potentially painful intimate information. Work in this specific area has

caused the need to distinguish between self-disclosure and self-concealment. Borrowing

from Larson et al. self-disclosure is described as the act of revealing personal information

to others and self-concealment, as outlined above, is described as the act of concealing

personal information from others. Differentiating between these two concepts is thought

to be an important conceptual and research issue. Some researchers argue that self-

concealment and self-disclosure are two distinct. yet related constructs. One possible

relationship is that they share an inverse association. Essentially, high self-concealing

individuals do not disclose and Iow-disclosing individuals do not self-conceal.

Nonetheless, it is hoped that the self-concealment Iiterature will help to further extend the

lines within the sel f-disclosure research tradition.

Most people have negative thoughts and self-information that they have not

shared with others. This intimate and private information can include highly sensitive and

traumatic experiences or simple everyday embarrassments. These factors may shape and

influence an individual's propensity to share these secrets, which may be told to a select

few or to no one at d l . Clinical observation, practice, and research indicate that some

individuals are more inciined to self-conceal than others, and the inability or reluctance to

discuss major concems with others is attributed to circumstance or individual differences

(Larson et al., 1990). By not confiding and discussing personal problems, especially those

threatening to self-esteem, high self-concealing individuals are denied the health benefits

of a social support network. The psychological and physical health significance of self-

concealment has been further underscored by recent evidence that not expressing and

revealing traumatic events leads to long-terrn negative effects. For instance, one example,

is that self-concealment has been found to be positively correlated with symptoms of

depression (Kelly and Achter, 1995).

Kelly et al. found that high levels of self-concealment was associated with less

favorable attitudes towards psychotherapy but that both favorable attitudes toward

psychotherapy and high levels of self-concealment were a greater predictor of perceived

likelihood of seeking help. Also, high self-concealers were more IikeIy to have sought

counselling as compared to low self-concealers. These authors further hypothesized that

seIf-concealers' negative attitudes toward psychotherapy could be attributed to their

intense fear of having to reveal their most private thoughts, emotions, and behaviours to a

therapist. They speculated that despite high self-concealers' apprehension towards

psychotherapy, they were more Iikely to actively seek professional help due to their

limited access to a socid support network. The authors also hypothesized that self-

concealment would better predict intentions to seek professional help than would

depression. Conversely, some chaiienged this proposal with findings showing that high

self-concealers were three times more likely than low self-concealers to report needing,

but not seeking professional help. Further, it was found that self-concealment actually

attenuated the advantageous effect of low social support on perceived likelihood of

service utilization. AIso, it was reveaied that self-concealment was not a better predictor

of the intentions of seeking help than was depression. In fact, data suggested that types of

distress experienced was a better predictor of the intentions to seek-help depending on the

nature of problems help was sought for (Cepeda-Benito & Short, 1998; Cohen & Wills,

1985, Cohen & Hoberman, 1983).

In this context, understanding this construct is highiy relevant for counselIors,

because the core of psychotherapy often involves the client's revelation of their most

traumatic and private experiences. Chicians have long beheld this construct as

extrerneiy important in the etiology and treatrnent of mental disorders.

Adolescents who sought help from professionals reported having lower feelings

of self-worth while those adolescents who did not seek help from professionals did not

make such a claim. Schonert-Reichl et al. (1996) suggest that perhaps adolescents who

possess an overall healthy sense of self-worth do not feel the need to seek the help of a

professional because of their prevailing sense of self-assurance and confidence. It may be

that seeking the help of a professional is seen as a threat to the individual's self-esteem. A

number of studies have provided evidence that individuais in need of help are often

reluctant to use the available resources because it represents an open acknowledgement of

failure (Nadler. Fisher, DePauIo, 1983). Similarly. Schonert-Reichl et al. (1996) found

that adolescents who do not utilize the services offered by professionals were more self-

conscious than adolescents who were users of professional services. It seems that the

need for ptivacy is an important aspect for adolescents. Research indicates that an

adolescents' reports of perceived obstacles to seeking help include: concems that family

and ftiends may find out and the belief that their problem was too intimate to discuss with

anyone (Dubow, Lovko, Kausch, 1990). it is clear that these findings suggest that self-

consciousness plays a compromising role in the utilization of help-seeking from mental

heai th professionals.

Summary of Goals and Main Hypotheses

4t present, there are a number of issues involving depression and help-seeking in

adolescents that still need to be addressed. The present study sought to determine the

extent to which personality variables such as perfectionism, seIf-criticism, dependency.

and self-concealment related to depressive symptoms and help-seeking attitudes in

female and male adolescents.

The first goal of this study was to assess overall levels of depressive symptoms

and overall help-seeking attitudes in adolescents. Consistent with other recent studies of

adolescents (Garland & Zigler, 1994; Allgood-Merten et al., t 990) it was expected that

overall levels of psychological distress would be relatively high in this sample.

The second goal of this study was to examine the extent to which the various

dimensions of trait perfectionism and perfectionism self-presentation are associated with

depression. Regarding the trait dimensions of perfectionism (i.e., self-orïented and

socially prescribed perfectionism) it was hypothesized that sociaily prescribed

perfectionism would be the dimension more closely linked with depression. This would

be in keeping with the findings reported by Hewitt et al. (1997) and by Boergers et al.

( 19%). One explanation for socially prescribed perfectionism k i n g linked more strongly

with adolescent depression involves the heightened concems that many adolescents

struggie with, d o n g with their excessive concerns with socid approval, acceptance, and

public failure (see Hewitt et al., 1997).

A related hypothesis was that perfectionism self-presentation would aiso be

associated with eIevated levels of depression among female and male adolescents.

Although this issue has not been investigated directly in an adolescent sample, a link

between perfectionism self-presentation and depression would be consistent with the

findings of research with university students which suggest that perfectionism self-

presentation is associated with psychological distress (see Hewitt et al., 1995).

Another purpose of this research is to examine the extent to which the constmcts

of dependency and self-criticism are associated with depression in adolescents. Past

research testing Blatt's model of depression has tended to show that both self-criticism

and dependency are associated with depression in adolescents (e.g., Fichman, Koestner,

& Zuroff, 1994), with self-criticism k i n g the more robust predictor. Similady, it was

hypothesized in the current research that self-criticism and dependency would be

correiated with depression in female and male adolescents.

Another prediction was that self-concealment would be correlated significantly

with depression in adolescents. Larson et al. (1990) confirmed that self-concealment in

university students was associated with increased depression, higher anxiety, and health

problems. A high level of self-concealment reflects a defensive orientation toward the

self and deficits in self-esteem which may be expressed in the fonn of depressive

symptoms.

Although the main focus of the current work is on the link between personality

factors and maladjustment, it is important to note that the current study also provides an

opportunity to examine the correlations arnong the personality variables. Several

associations were expected to be present. For instance, in terms of perfectionism, it was

anticipated that trait components of perfectionism would be associated with self-

criticism. Blatt (1995) has posited that there is a iink between perfectionism and self-

criticism in adults, so it is quite possible that socially prescribed perfectionism and self-

oriented perfectionism are associated with self-criticism in the current sample. Given that

perfectionism self-presentation and self-concealment both focus on not displaying or

revealing negative aspects of the self, it was aiso expected that self-concealment would

be associated with the various dimensions of perfectionism self-presentation.

The next series of hypotheses focuses on the correlates of help-seeking attitudes.

The first main hypothesis was that socially prescribed perfectionism and perfectionism

self-presentation would be associated with negative help-seeking attitudes, with

perfectionism sel f-presentation suggested as the best predictor of a negative attitude

toward help-seeking. Given what we know about the construct of perfectionism setf-

presentation, it was predicted that the nondisclosure factor should be the one that is most

relevant since the act of help-seeking would entail communication and disclosing of

one's shortcomings.

A second issue addressed in the present investigation concerned the relationship

between dependency and help-seeking behaviours. It was predicted that dependency

would be linked with positive help-seeking attitudes. Research on this interpersonal

inclination revealed that dependency predicted higher hedth service utilization in both

male and females (Bomstein et al., 1993). They also found that there is clear and

consistent evidence that help-seeking represents the essence of interpersonal dependency

(Bomstein et ai., 1993).

A third issue also addressed in this investigation concerns the examination of

depression and i ts link to negative help-seeking attitudes. It is predicted that depressed

adolescents are more likely to have negative attitudes toward seeking help. Garland et al.

( 1994) reported that mental health services are drasticalIy underutilized by children and

adolescents. One possible explanation put forth for this underutilization was that

generally. young people in need of psychological support have negative attitudes toward

seeking help. The central focus of Garland et al.3 (1994) study was based on an

underlying question as to how likely was a depressed individual, when confronted with a

stressful event, prepared to avail themselves of opportunities to seek help? The

characteristics of depression --- feelings of helplessness, hopelessness, and indifference

suggest that a depressed individual would be Iess likely to take the initiative towards

getting help. As expected, the findings spoke to the importance of identifying those who

reported more depressive symptoms and demonstrated depressive characteristics, as they

were more likely to have negative attitudes about seeking help (Garland et al., 1994).

The final set of issues tested in this research focused on whether the perfectionism

trait and self-presentation dimensions were unique predictors of levels of depression,

63

help-seeking attitudes, and self-concealment, over and above other personaii ty factors.

The issue is tested in a series of hierarchicai regression analyses. The main hypothesis

was that perfectionism self-presentation would prove to be a unique predictor of negative

help-seeking attitudes because of the presumed relevance of the unwillingness to disclose

personal imperfections in the help-seeking process.

Method

The participants in the present study were adolescents in grades 10 through 13 (5 1

males and 8 1 females) at three schools in the Toronto Catholic District School Board.

Participants' ages ranged from 15.0 years to 20.0 years, with a mcan age of 18.0 years.

The participants were individuaily tested. Of this sarnple, specifically for males, 0.76%

were 20 years old, 12.9% were 19 years old, 18.2% were 18 years old, and 6.8% were 17

years old. For females, 0.76% were 20 years old, 17.4% were 19 years old, 28% were 18

years old. 9.8% were 17 years old, 1.5% were 16 years old, and 3.9% were 15 years old.

Questionnaires were administered in the same order to al1 students. A letter describing the

study and informing parents of the persona1 and social benefits of participation were

given to al1 students (Appendix A). S~dents became participants in the study through

parental (Appendix B) and student consent procedures (Appendix C).

Procedure

After students had been recruited, informed consent statements were distrïbuted at

the time of data collection, and those 18 years and older wanting to participate were

instructed to sign the statement form and return it before receiving test materials. For

those younger than 18, parental consent was obtained. Of the 132 students, five did not

participate. Al1 of the non-participants were male students who did not retum their

parent/guardian consent form.

Once students had completed the questionnaires, they were given the opportunity

to ask questions before leaving the classroom.

64

Measures

AI1 Participants were administered the following measures (Appendix D):

The Child-Adolescent Perfectionism Scale (CAPS)

The CAPS (Flett, Hewitt, Boucher, Davidson, & Munro, 1997) is a 22-item

measure of perfectionism founded on the multidimensiond conceptualization of

perfectionism (Hewitt et al., 1990. 199 la) (see Appendix E). The CAPS provides

subscale measures of self-oriented perfectionism ( e g , "1 try to be perfect in everything 1

do") and socially prescribed perfectionism (e.g., "There are people in my life who expect

me to be perfect"). Participants provide 5-point ratings of the extent of their agreement

with each item. The scale was developed using the construction validation approach and

is closely modeled after its adult equivalent, the Mukidimensional Perfectionism Scale

(Hewitt, 1989; Hewitt et al., 1991a). Adequate levels of reliability and validity have k e n

established. The test-retest correlation was 1 = .74, p < -01, for self-oriented perfectionism

and the test-retest correlation was = .66. p < -01. for socially prescribed perfectionism

(Flett et al.. 1997). The internal consistency of each scale was assessed, and it was

established that the scales had adequate internai consistency. The alpha coefficient for the

self-oriented scale was -85. The item-total correlations ranged from -36 to -76. The alpha

coefficient for the socially prescribed perfectionism scale was -8 1. The item total

correlations ranged from .28 io -59.

A previous study with 13 1 high school students exarnined the correlations

between the CAPS and the Eating Disorder Inventory Perfectionism Subscale (EDI). The

analyses confirmed that there were strong, significant correlations between the CAPS

measures and the EDI perfectionism subscale. The correlations between self-oriented

perfectionism and the EDI rneasure were -4 1, pl < .O 1 for girls and -72, < .O 1 for boys.

The correlations between socially prescribed perfectionism and the EDI rneasure were

-45, < .O 1 for girls and -55, E < .O 1 for boys. Also, the correlations between the two

CAPS dimensions for boys versus girls was 1 = -32, < -05, and = -50, E < -01,

respectively.

Perfectionism Self-Presentation Scale (PSPS)

The PSPS (Hewitt, Flett, & Farlie, 1994) is a 27-item measure of three

dimensions of perfectionism self-presentation (Appendix F). The Need to Appear Perfect

subscale measures the desire to present oneself as perfect to others (e.g., "It is very

important that I always appear to be on top of things"). The Avoid Appearing Imperfect

subscale measures the desire not to appear less than perfect to others (e.g., "1 do not want

people to see me do something unless 1 am very good at it"). The Avoid Disclosure of

Imperfection subscale measures the need to avoid public admissions of imperfection or

failures le-g., "1 try to keep my faults to myself"). Participants rate their agreement with

items on a 7-point scale with higher scores indicating greater perfectionism self-

presentation. As indicated earlier, data supporting the reliability and validity of the PSPS

can be found in Hewitt et al. (1994). In a study conducted by Hewitt et al. (1995), it was

found in a sample of female university students that higher levels of perfectionism self-

presentation were associated wi th lower self-esteem in ternis of global self-esteem and

appearance self-esteem. To date, however, there is no psychometric information available

on the use of the PSPS with adolescents.

The Adolescent Demessive Exwriences Ouestionnaire (DEO-A)

The Depressive Experiences Questionnaire (DEQ) was devejoped based on the

notion of a continuity between norrnality and pathology (Blatt. 1974) (Appendix G). The

items included assess everyday life experiences generally associated with depression, but

are not necessarily symptoms of depression in their own right. Specifically, life

experiences were assessed in two broad dornains: Factor 1, Dependency, involves

interpersonal relationship items concerned with abandonment, loneliness, helplessness

and feelings of rejection by others. Items on Factor 2, Self-Criticism, involve criticism

toward the self for failing to meet expectations and standards, which result in an

unsatisfied sense of self. Here. the terrn dysphoric experiences describe a personality

ges ta1 t reflecting day-to-day concems in l i fe situations. Normal levels of concerns

reflected in these configurations cm denote a good investment in persona1 relations or

achievernent. while, an unhealthy investment can be extremely detrimental resulting in

high levels of depression.

The DEQ consists of 66 items rateci on a 7-point scale that provide scores on two

types of dysphoric tendencies --- Dependency and Self-Criticism --- along with a third

factor called Efficacy, which depicts a sense of well-being. An example of an item on the

Dependency factor is "1 often think about the danger of losing someone who is close to

me." An example of a SeIf-Criticism item is, ''1 often find that 1 don? live up to my own

standards or ideals." The third factor, Efficacy, is reflected in the item, "1 set my goals

and standards as high as possible" (Blatt & Luthar, 1995). Test-retest reliabilities of the

scale are high (Zuroff, Moskowitz, Wielgus, Powers. & Franko, 1983), interna1

consistency and discriminant vaiidity have been demonstrated (e-g., Blatt et al.. 1982)-

The reduced version, a 20-item scaie (Fichman et al., 1994) of the DEQ-A was

designed for use with children and adolescents. The wording was simplified and the items

were changed to make it more directly relevant to the concems of adolescents (Blatt,

Schaffer, Bers, & Quinlan, 1992). The participants respond on a 5-point scaie. Adequate

levels of validity for the three scales have been documented with adolescent samples

(Blatt et al., 1992~).

Ten-day test-retest reliability coefficients for the Adolescent DEQ-A (44-i tem)

have been found to be -86, -79, and -65 for Dependency. Self-Criticism, and Efficacy

respectively (Blatt et al., 1992~). However, less is known about the 20-item version.

Self Concealment Scale ( S C S )

The Self-Concealment Scale (SCS) was developed to mesure the inclination for

actively concealing personal information frorn others, specifically information that is

perceived as distressing or negative (Appendix I)- Self-concealment is related to, but

theoretically and empirically distinct from, self-disclosure (Larson & Chastain, 1990).

The SCS contains I O items that refer to (a) a self-reported inclination to keep things to

oneself (e-g., "There are lots of things about me that 1 keep to myself '); (b) information

of a highly distressing secret or negative thoughts about themselves that have been shared

with one or two persons or no one at al1 (e-g., "1 have negative thoughts about myself that

1 never share with anyone"); and (c) uneasiness about the disclosure of concealed private

information (e-,o., "If 1 shared al1 my secrets with my friends, they'd like me less")

(Larson et al., 1990).

The interna1 consistency estimate of Cronbach's alpha showed a = .83 (N = 306).

Test-retest reliability, as was assessed in an independent sample of female graduate

counseling psychology students (n = 43) with a 4-week interval between testing revealed

r = .8 1 (Larson et al., 1990).

The Center for E~idemioiogic Studies ïk~ression Scale (CES-Dl

The Center for Epidemiologic Studies Depression Scale (CES-D; Radloff, 1977)

scale is a short, 20-item self-report scale created to measure current level, of depressive

symptomatology in the generai population and asks respondents to rate the frequency of

each symptom during the past week (Appendix H). The fundamental elements of

depressive symptornatology were identified from the clinical literature and factor analysis

studies. These components included: depressed mood; feelings of shame and

worthlessness; feeIings of helplessness and hopelessness; psychomotor agitation; changes

in appetite; and sleep disturbance. Only a few items were chosen to represent each

component (Radloff, 1977) The possible range of scores is zero to 60, with higher scores

revealing more symptomatology in individuals. Measures of intemal consistency

(coefficient alpha and the Spearman-Brown split-halves method) were high in the general

population (approximately -85) and even higher in the patient sample (approximately .90)

(RadIoff, 1977). This measure has been widely used and has demonstrated its usefulness

as a screen instrument with adolescents (Allgood-Merten et al., 1990; Ganïson,

Shoenbach, & Kaplan, 1985; Schoenbach. Kaplan, Grimson, & Wagner, 1982).

Heip-Seekine Scale

This 22-item instrument was designed to measure children's and adolescents'

wil lingness to seek help for psychological problems from adutts in the school setting.

Items include "Teachers andor counsellors can help when you're upset about a personal

probiem" and "There should be an adult at school who talks to kids about personal

problems and family problems" (see Appendix J). Items are rated on 4-point scaie that

ranges from "strongl y agree" to "strongly disagree." In a recent study with 1 8 1 students

ages 15- 16, the mean score was 35.3 (SD = 9.6) for males and 60.2 (SD = 9.3) for

fernales. Correlation coefficients for the help-seeking score and the following variables

are listed below (al1 were significant at the .O1 level): Hopelessness (Kazdin scale) (-.37);

Total Behaviour Problem Score on the YSR (Achen bach) (-.38); Depression (Kovacs

CDI) (-.45); Satisfaction with SociaI Support (Samson) (-22); Social Competence on the

YSR ( - 2 1 ). In a multiple regression analysis, the strongest independent predictor of

negative heIp-seeking attitudes was depression scores (Garland, 1995).

Results

The extant research design permits assessrnent of the contribution of personality

factors to depression and response styles, specifically help-seeking and self-concealment.

The analyses of these relations included correlations, analysis of variance (ANOVA),

multivariate analysis of variance (MANOVA). and hierarchical multiple regression. Al1

data was anaiysed separately for males and females given the issue of gender differences

in adolescent depression.

Upon exploration of the variables, it was discovered that the Center for

Epidemiologic Studies Depression Scale (CES-D) was not normally distributed. There

was significant positive skew (t(13 1 ) = 3.96, p < -05). To transform the data to normality.

a log transformation of depression was taken and the resulting variable was not skewed

(A( 13 1 ) = 1 -05, P > -05). While the mean and standard deviaticn of the untransformed

variable is reported, subsequent statistical analyses involving the CES-D scale were done

with the transfomed variable. Also, it should be noted that the residuals from the

regression analysis of the transfomed data will be discussed later in the multiple

regression section.

Descriptive Analvses

The means and standard deviations for al1 the measures, as well as interna1

consistency values (Cronbach, 195 1 ) are displayed in Table 1 : Help-seeking (a = -8 1 ),

Dependency (a = .72), Self-criticism (a = .64), Efficacy (a = .46), Self-concealment (a =

.84), Depression (a = .86), The need to appear perfect (a = .80), The need to avoid

appearing imperfect (a = .8 1 ), The need to avoid disclosure of imperfection (a = .72),

7 1

Self-oriented perfectionism (a = 32). and Socially prescribed perfectionism (a = -87).

Although the alphas for some measures were considerably lower than those obtained in

other research (e-g., Blatt et al.. 1992c), this is likely due to the use of the 20-item version

of the scale rather than the full 66-item version. Given the relatively low alphas obtained

for self-criticism and efficacy, the results involving these measures should be interpreted

with a degree of caution.

Table 1

Reliabilities using the Total Sample

Total Smple

M SD ALPHA

~elp-Seekinga 6 1.52 7.54 0.8 1

~ e ~ e n d e n c ~ ~ 27.32 5.26 0.72

self-criticismb 22.52 4.83 0.64

Efficacyb 14.64 2.47 0.46

self-Concealment' 27.10 8.40 0.84

Appeard 39.9 1 9.87 0.80

Avoidd 41.15 9.94 0.8 1

on-~isclosure~ 22.55 6.90 0.72

Sei? 35.90 7.64 0.82

Social' 29.92 8.14 0.87

~epression' 17.69 9.56 0.86

Note.

" Adolescent version of the Help-Seeking Scale Adolescent Depressive Experiences Questionnaire ' Sel f-Concealment Scale "erfectionistic Self-Presentation Scale ' Multidimensional Perfectionism Scale ' The Center for Epidemiologic Studies Depression Scale

As for the means obtained in this study, statistical tests were not computed to

determine whether these means differed significantly from the means from other samples,

and this decision was based on the lack of established norrns for some of the key

measures. However, it appeared in general that the means were quite comparable to those

obtained from other samples, with the exception of the scores obtained for the measure of

help-seeking attitudes. An overall mean of 6 1.52 was obtained in the current study, while

Garland et al. (1994) reponed a mean of 66.50 for their subsample of older adolescents.

This outcome suggests that help-seeking attitudes were more negative in the current

sampie.

The means obtained for the perfectionism measures were in keeping with the

means obtained with previous samples. Regarding the Child-Adolescent Perfectionism

Scale. Hewitt et al. (1997) reported means of 34.03 for self-oriented perfectionism and

27.20 for socially prescribed perfectionism when the scale was adrninistered to their

sample of inpatient adolescents. The respective means for self-oriented and socially

prescribed perfectionism in the current study were 35.90 and 29.92. Thus, levels of

socially prescribed perfectionism were slightly higher in the current sample. As for the

Perfect ionism Sei f-Presentation Scale, there are no publications in the literature that

describe previous research with this measure in an adolescent sarnple. However, the

means shown in Table 1 are consistent with the values reported in other research (see

Habke et al., 1999; Hewitt et al., 1995). For instance, Hewitt et al. ( 1995) reported

respective PSPS means of 41.38,44.68, and 22.98 for the subscale measures of the need

to appear perfect, the need to avoid appearing imperfect, and the need to avoid disclosing

imperfections when these measures were assessed in their study of appearance-related

concerns in university women. The respective means for these three subscales in the

current study were 39.9 1,4 1.15, and 22.55. These values are very similar to the means

reported by Habke et al. ( 1999).

Unfortunately, Fichrnan et al. (1994) did not report the means for each of their

subscale measures of dependency, self-criticism, and efficacy so it was not possible to

conduct meaningful comparisons. The level of self-concealment reported in the present

study was slightly higher (M = 27.10) than the mean reported of 25.02 obtained for

Larson et al., (1990) university student sample.

Finaily, and perhaps most irnportantly, the CES-D mean of 17.69 in the current

study is noteworthy in that the mean score for the current sample exceeds the

recommended cut-off of 16 that has been used in the past to establish the existence of a

case of at least rnild depression. The current result is in keeping with reports that levels of

depressive symptoms are substantidly elevated in adolescent samples. This issue will be

addressed at length in the subsequent discussion section.

MANOVA of Scales bv Gender

A multivariate analysis of variance (MANOVA) using Hotelling's Trace statistic

was performed to see if gender differences existed on al1 measures. The results were

significant (F( 1 1,120) = 2.02, p < -05). Univariate results showed (refer to Table 2) that

there were statistically significant differences for Help-Seeking (F(1,130) = 6.15, <

-05); the need to appear perfect (F( 1,130) = 4.86, p < -05) and the need to avoid

disclosure of imperfection (F( 1,130) = 10.52, p < .O 1 ). As predicted, females reported

that they were more likely to engage in heIp-seeking behaviour = 62.82, SD = 6.48)

than males (M = 59.57, SD = 8.58). The need to appear perfect was higher in maIes &f =

31.19, SD = 8.98) than in females (M = 38.38, SD = 10.19). The need to avoid disclosure

of imperfection was also higher in males (M = 21.85, SD = 7.16) than in females (M =

21-01, SD = 6.3 1).

Table 2

Analyses of Variance and Mean Scores for Males and Females

,Males Females

M SD M SD F-value

Help-Seeking'

13ependencyb

self-criticismb

~ f f i c a c ~ ~

seIf-Concealmentc

~ p p e a r ~

~ v o i d ~

c on-~isclosure~ SelF

Social"

~ e ~ r e s s i o n '

Note.

" Adolescent version of the Help-Seeking Scale b Adolescent Depressive Experiences Questionnaire ' Self-Concealment Scale

Perfectionistic Self-Presentation Scale " Multidimensional Perfectionism Scale f The Center for Epidemiologic Studies Depression Scale

Correlational Analvses

Next, the interrelations arnong the variables utilized in this study were examined.

Pearson correlations were computed to determine the extent to which perfectionism,

dependency, self-criticism, self-concealment, and depression were associated. These

correlations were also examined separately by sex. The correlations that emerged are

discussed below. A test looking at the largest difference in correlations for males and

females was also conducted; significant results were not found, therefore no further tests

were performed.

Correlations with Self-Oriented Perfectionism

Pearson product-moment correlations were computed among the numerous

measures. These results are shown in Table 3 for the total sample. It can be seen that self-

oriented perfectionisrn was significantly correlated with the following variables: self-

oriented perfectionism was associated with higher levels of efficacy (r(I30) = .25, g <

.O 1 ), self- concealrnent (~(130) = - 1 9 , ~ < .Os), the need to appear perfect (r(130) = .6C,

< .O I ), the need to avoid appearing imperfect (r( 130) = .46, p < .O 1 ), and the need to

avoid disclosure of imperfection (r(l30) = -38, p < -01).

Table 3

Correlational Analyses Usine the Total Sarnple

Variables 1 2 3 4 5 6 7 8 9 10 1 1

1 Hclp-Secking" --

2 Dcpcndencyb 0.32** -- 3 ~clf-criticisrnb -0.11 0.27**--

3 ~ f f i ç a c ~ ~ 0.06 O. 15 -0.28** --

5 Self-Concealment' -0.07 0,30** 0.45** O. 12 -- 6 ~ ~ ~ c a r ~ -0.02 0.23** 0.17* 0.14 0.32** - 7 ~ v o i d ~ 0.00 0.42** 0.35** 0.15 0.50** 0.64** -- S ~on-Disclosurcd -0.36** 0.05 0.27** 0.07 0.50** 0.42** 0.49** --

9 Self 0.10 O. 14 0.03 0.25** 0.19* 0.61 ** 0.46** 0.38** -- 10 Social' -0.10 0.17 0.31** OZ** 0.38** 0.34** 0.40** 0.42** 0.48** -- 1 1 ~eprcss ion~ -0.03 0.28** 0.39**-0.10 0.30** 0.09 0.20* 0.22* 0.10 0.30** --

Note. - " Adolescent version of the Help-Seeking Scalc b Adolescent Dcprcssive Experiences Questionnaire ' Sel f-Concealment Scale

Pcrfcctionistic Self-Presentation Scale ' Multidimcnsional Perfcctionism Scalc f The Center for EpidemioIogic Studies Depression Scalc

Tables 4 and 5 present the analyses conducted separately for mates and fernales. It

can be seen that particularly for males, self-oriented perfectionism was correlated

significantl y with efficacy b(5 1 ) = -34, E < .05), the need to appear perfect ( r (5 1 ) = .6 1.2

< .O 1 ). and the need to avoid disclosure of imperfection (r(5 1 ) = -4 1, p < .O 1).

Table 4

Correlational Analyses for Males

Variables 1 2 3 4 5 6 7 8 9 10 1 1

1 Help-Sceking" -- 2 ~ e ~ e n d e n c ~ ~ 0.24 - 3 self-~riticism~ -0.14 0.29* -- 3 t3fficacyb 0.00 O. 1 1 -0.28* -- 5 Self-Concealmentc -0.07 0.34* 0.38** -0.08 --

6 ~ ~ p u ~ 0.08 0.19 0-1 1 0.22 0.40** -- 7 ~ v o i d ~ -0.05 0.31* 0.24 0.10 0.54** O-51** -- 8 ~on-~ i sc losu rc~ -0.3 I* -0.01 0.16 0.13 0.53** 0.37** 0.45** --

9 Self 0.07 -0.09 -0.19 0.34* 0.18 O-61** 0.25 0.41** -- 1 O Social' -0.14 0.08 0.59** 0.05 0.39** 0.28* 0.29* 0.41** 0.22 -- 1 1 ~e~ress ion ' -0.05 0.29* 0.55**-0.14 0.36** 0.08 0.17 0.13 0.01 0.26 --

Note.

' Adolescent version of the Help-Seeking Scale Adolcsccnt Depressive Experiences Questionnaire ' Sclf-Concealment Scale d Pcrfcctionistic Self-Presentation Scalc " Multidirncnsiond Perfectionism Scale ' ~ h c Center for Epidemiologic Studies Depression Scale

With females it was shown that self-oriented perfectionism was correlated with

dependency (r(77) = - 2 9 , ~ < .Ol), and with al1 three major components of perfectionism

self-presentation: the need to appear perfect (r(77) = .60, p < .01), the need to avoid

appearing impei-fect (1(77) = - 5 8 , ~ < .O 1 ), and the need to avoid disclosure of

imperfection ( ~ ( 7 7 ) = -34, p c .O 1 ).

Table 5

Correlational Analyses for Fernales

- -- - - -- - -

Variables 1 2 3 4 5 6 7 8 9 10 1 1

I Help-Seeking" -- 2 ~ c ~ e n d c n c ~ ~ 0.38** --

3 ~ e l f-criticismb -0.1 1 O Z * -- 3 ~ f f i c a c ~ ~ O. 17 O. 19 -0.27* -- 5 Self-Concealmentc -0.05 0.30** 0.49** O. 19 --

6 Appeatd -0.03 0.29**0.23* 0.07 0.26* -- 7 ~ v o i d ~ 0-09 0.50** 0.41 ** O. 15 0.47** 0.70** --

8 ~ o n - ~ i s c l o s u r e ~ -0.33** 0.14 0.38** -0.02 0.48** 0.41 ** 0.51** -- 9 Self 0.17 0.29** 0.15 0.21 0.20 0.60** 0.58** 0.34** -- 1 O Social' -0.07 0.22 0.22* 0.33** 0.37** 0.37** 0.45** 0.46** 0.62** -- 1 1 ~e~rcss ion ' -0.04 0.27* 0.46** -0.07 0.43** 0.1 1 0.22* 0.3 1 ** 0.16 0.32** --

Note.

" Adolescent version of the HeIp-Seeking Scalc Adolcsccnt Deprcssive Experiences Questionnaire ' Sclf-Concealment Scale

Pcrfectionistic Self-Prcsentation Scale ' Mul tidimcnsional Perfectionism Scale f The Ccnter for Epidemiologic Studies Depression Scalc

Correlations with Sociallv Prescribed Perfectionism

As expected, socially prescribed perfectionism in the total sampie was positively

correlated with self-criticism (~(130) = -34, p < .O1 ), self-concealment (~(130) = .38, Q <

.O 1 ). the need to appear perfect (r( 130) = .34, Q c .O t ), the need to avoid appearing

imperfect (r( 130) = -40, < .01), the need to avoid disclosure of imperfection (r(130) =

-42, p < .O 1 ), and depression (r( 130) = .30, p < .O 1 ). Even though these individuais

reported higher levels of depression, they also reported feelings of efficacy (r(130) = .25,

2 < .O 1). This was true for female socially prescribed perfectionists as well (see below).

This anomalistic finding suggests that despite feelings of depression, these individuals

still have feelings of power and effectiveness to bring about change.

Funher correlational analyses were performed to assess the correlates of socially

prescribed perfectionism among males. Specifically, high levels of this variable were

related to greater self-criticism (r(5 1 ) = -59, E < .O 1), self-concealment (r(5 1) = -39, <

.O 1 ), and the three elements of perfectionism self-presentation: the need to appear perfect

( ~ ( 5 1 ) = 2 8 . E < .05), the need to avoid appearing imperfect (r(5 1) = -29, < .05), and the

need to avoid disclosure of imperfection (r(5 1 ) = -4 1, p < .O 1 ).

Analyses conducted for females yielded similar results. Social1 y prescribed

perfectionism was associated with higher levels of self-criticism (r(77) = -22, p < .05),

self-concealment (~(77) = .37, Q < .O 1); and with the three dimensions of perfectionism

self-presentation that is, the need to appear perfect (r(77) = -37, < .O 1 ), the need to

avoid appeanng imperfect (r(77) = .45. p < -01); and the need to avoid disclosure of

imperfection (~(77) = -46, p c .01). Socially prescribed perfectionism was also linked

with higher levels of efficacy (~(77) = -33, < -01) and greater depression (r(77) = -32, p

< .O 1 ).

Correlations with Dependencv

Dependency in the total sample was correlated with help-seeking (r(130) = .32, p

c .O 1 ), self-concealment (r(130) = -30, p < .01), the need to appear perfect (r(130) = -23, p

< .O l ) , the need to avoid appearing imperfect (r(l30) = .42, p < .01) and with depression

(r( 130) = -28, Q < .01).

For males, dependency was also associated with greater self-concealment (r(5 1) =

.34, E < .05), the need to avoid appearing imperfect (r(5 1 ) = -3 1, < .05), and depression

(xi5 1 ) = .29, Q < .OS). For, males this variable was not correlated with help-seeking-

For females, however, dependency was related to help-seeking ('r(77) = -38, p c

-01 ). It was also related to self-concealment (r(77) = .30, < .01), as well as to the two

eIements of perfectionism self-presentation: the need to appear perfect (r(77) = -29, p <

-0 1 ), and the need to avoid appearing imperfect (r(77) = S O , e c .O 1 ) as well as with

depression (r(77) = .27, p < -05).

Correlations with Self-Criticism

Regarding the total sample, high self-criticism was associated with lower efficacy

(x( 1 30) = - 2 8 , < -0 1 ), higher self-concea'ment (r( 130) = - 4 5 , ~ < .O 1 ), the need to

appear perfect (r( 1 30) = - 1 7, e < .05), the need to avoid appearing imperfect (r( I 30) =

-35, E < -0 1 ), the need to avoid disclosure of imperfection (r(l3O) = -26, g < -0 I ) and with

depression (r( 130) = -49, g < .0 1 ).

Males high on self-criticism indicated greater self-concealment (r(5 I ) = -38, <

-0 1 ), and depression (r(5 I ) = -55, p < .O 1 ). Additionally, a significant inverse relationship

with efficacy (r(5 I ) = -28, p < .05), was also revealed.

The data involving females also yielded an inverse relationship between efficacy

and self-criticism (r(77) = -.27, p < .05) and a positive relationship between self-

concealment (~(77) = - 4 9 , ~ < .01), the need to appear perfect (r(77) = -23, c .OS), the

need to avoid appearing imperfect (r(77) = .4I, E c .OI), the need to avoid disclosure of

imperfection (r(77) = -38, g < .01), and depression (r(77) = -46, p < .01).

Correlations with Self-Concealment

High levels of self-concealment were correlated with a strong need to present to

others an image of perfection (r( 130) = -32, p < .O 1 ). It was aiso correlated with those

wanting to avoid presenting as imperfect (r(I30) = -50, < .01), and the disclosing of

imperfections (r( 130) = .50, p < .O 1 ).

For males, similar results were found; higher levels of self-concealment were

correlated with the need to appear perfect (r(5 1 ) = -40' I> < .01), and the need to avoid

disclosure of imperfection (r(5 1) = -53, p < .O 1 ).

Analyses conducted for females also yielded similar results. Self-concealment

was correlated positively with the need to appear perfect (r(77) = - 2 6 , ~ < .OS), the need

to avoid the appearance of imperfection (r(77) = -47, pl < .OI), and the need to avoid

disdosure of imperfection (r(77) = -48, p < .O1 ). Overail, self-concealment was not

correlated with help-seeking.

Correlations with Heh-Seeking

As expected, a negative correlation was found for the need to avoid disclosure of

perfection and help-seeking (r( 130) = -.36, Q < .O 1 ). Help-seeking attitudes reported by

males was associated negatively with the disclosure of imperfections (r(5 1) = -.3 1, p <

.05). They reported having a negative attitude towards help-seeking. Similarly, females

high on this dimension indicated a negative help-seeking orientation (r(77) = -.33, e <

.O 1 ). Clearly, if one were reluctant to reveal imperfections, then seeking help would not

be viewed as a viable option.

Correlations with Depression

It was also revealed in the total sample that depression was experienced by those

possessing a strong need to avoid appearing imperfect (r(130) = 20, c .05), and a

strong need to avoid disclosing imperfections (r(130) = 2 2 , < -05). Further, an

association was found among depression and self-concealment (r(I30) = - 4 0 , ~ < -01).

While higher depression in males was associated with greater self-concealment

(5(5 1 ) = .36, Q < .O 1), depression in females was not only associated with greater self-

concealment (r(77) = .42, e < -01). it was also associated with the need to avoid

appearing imperfect (r(77) = .22, p < -05). as well as the need to avoid disclosure of

imperfection (~(77) = -3 1, E < -01). Overall, it should be noted that there was a lack of

correlation with depression and help-seeking.

Multi~le Repression

A hierarchical regression procedure (Cohen, 1968) was used to test the

incremental contribution of the perfectionism dimension after removing variance

attributable to dependency and self-criticism. A separate regression analysis was

conducted for each of the outcome variables. Self-criticism and dependency were the first

independent variables entered into the regression equations. These two independent

variables were followed by the five main effects (self-oriented perfectionism, the need to

avoid non-disclosure of imperfection, socially prescribed perfectionism, the need to

appear perfect, and the need to avoid appearing imperfect). With each model, a final

bIock tested whether the mode1 was equivalent for males and females. As noted earlier, a

particular goal of this study was to test the incremental predictive utility of perfectionism

over and above measures of self-criticism and dependency in terrns of their relative

ability to predict variance of these outcomes.

The equivalence of the regression model for males and fernales, which can be

called homogeneity of regression models, was tested by adding sex as the main effect and

creating interaction tems as the cross products of sex by each of the other predictors.

These interaction tems were entered as one block after al1 main effects were entered. The

Fchuige test of the entire block is then a test of whether or not the model varies depending -

on sex. For al1 regression models tested, it was not possible to reject the nul1 hypothesis

that the models are equivalent across gender. The eh,, tests are as follows: Help-

seeking, (Fchm,, (7,116) = 0.35, > -90). for Depression, (Fchmge (7,116) = 0.72, Q > .60),

and for Self-concealment (Fchmg, (7,116) = 0.70, > -70). As a result, al1 analyses were

performed without the sex main effect or the sex by other predictors.

Personalitv Predictors of Heb-Seekinp

For the model predicting help-seeking as the dependent measure, dependency and

self-criticism accounted for a significant proportion of the variance. about 14%, (Frhuige

(2,129) = 10.55, E < .001). IndiviciualIy, dependency explained unique variation in help-

seeking (F(1,124) = 14.10, p < .001). Greater dependency was associated with increased

help-seeking. Results are shown in Table 6.

Table 6

Results of Hierarchical Regression Analyses for he Prediction of Help-Seekinp;

Predictors R2change Fchange Sig - Fchange Std. B t Sio - t

Block One DEQ O. 13 10.55 0.001 *** Dcpcndency" 0.33 3.87 0.001*** Self-Criticism" -0.06 -0.75 0.46

B lock Two Perfectionism 0.16 5.78 0.00 1 *** car^ -0.09 -0.82 0.42 ~ v o i d ~ 0.05 0.44 0.66 Non ~ i s c l o s u r e ~ -0.42 -4.5 1 0.001*** Self 0.29 2.73 0.01 ** Socialc -0.08 -0.85 0.40

Nntc.

" Adolcsccnt Deprcssivc Experiences Questionnaire Pcrfcctionistic Self-Presentation Scale Multidimensional Perfectionism Scale

Std. B = Standardized Regression Coefficient Sig t = All single predictor values reported as measured with al1 predictors in the mode1

The five perfectionism predictor variables in the second block were able to

account for about 16% of additional variance in help-seeking, (Fchmge (5,124) = 5.78, Q <

.O0 1 ). As expected, the need to avoid disclosure of imperfection was significant (F(l, 124)

= 20.34.2 < -00 1 ). Individuals high on this perfectionism factor were less likely to

actively seek-help for their problerns. Self-oriented perfectionism was also a significant

predictor (F(1,124) = 7.45, < .05), with greater self-oriented perfectionism k ing related

to active help-seeking. However. it should be noted that the zero-order correlations did

not suggest a positive link between self-oriented perfectionism and help-seeking

attitudes.

Personaiitv Predictors of ih~ression

A test of normality of the residuals using Kolmogorov-Smirnov was performed to

justify the use of the transformed variable for the depression scale. While the residuals of

the transformed variable fit within the bounds of normality, (F( 1 30) = -053, p > 20) those

of the untransformed variable did not (F(130) = -097, p < -004).

The outcome measure in the second anal ysis involved depression symptom report

scores. Results are displayed in Table 7. Acting together, dependency and self-criticism

accounted for 26% of the variation in depression scores (Fch, (2,129) = 22.68. E <

-00 1 ). Acting alone, dependency was significant as a predictor of depression (F( 1,124) =

5 . 2 4 , ~ < . O s ) . Seif-criticism was also significant (F( 1,124) = 22.47, p < -00 1). Higher

levels of dependency and self-criticism were associated with greater depression. Results

for the perfectionism dimensions were not significant with depression as the criterion.

Perfectionism explained no variation in depression scores (Frhmgc (5,124) = 1.19, p < -3 1 ).

Table 7

Results of Hierarchical Regression for the Prediction of Devression

Predictors RZchange Fchanae Sig Fchange - Std. B t Sig; t

BIock One DEQ 0.26 22.68 0.001 *** Dependency" 0.20 2.29 0.05 Self-Criticism" 0.41 4.74 0.001***

Block Two Perfectionism 0.03 1.19 0.3 18 car^ -0.09 -0.79 0.43 ~ v o i d ~ -0.10 -0.91 0.37 Non ~ i s c l o s u r e ~ 0.1 1 1.20 0.23 Sclf 0.06 0.59 0.56 SociaI' O. 12 1.27 0.21

" Adolescent Depressive Experiences Questionnaire h Pcrfectionistic Self-Presentation Scale ' Multidimensional Perfectionism Scale

Std. B = Standardized Rcgression Coefficient Sig t = AI1 single predictor values reported as rneasured with al1 predictors in the model

Personalitv Predictors of Self-Concealment

The final analysis looked specifically at self-concealrnent as the outcome

measure. The results, as seen in Table 8, revealed that the dependency and self-criticism

block was significant. (Fchmgc (2,129) = 19.97, p < -001 ), accounting for 24% of the

variance. Examination of the predictors within the block found that greater self-criticism

was associated with higher levels of seIf-concealment (F(1,124) = 7.62, p < -05). The

perfectionism block was significant, &,,, (5,124) = 8.13, p < .001), accounting for an

additional 19% of the variance. Greater non-disclosure was associated with self-

concealment, (F(1,124) =14.59, E < -001).

Table 8

Results of Hierarchical Re~ession Analvses for the Prediction of Self-Concealment

Predictors R2 change F change Sig Fchanae Std. B t Sig t

Block One DEQ 0.24 19.97 0.00 1 *** Dcpendency" O. 14 1.80 0.07 Sclf-Criticisrn" 0.22 2.76 0.01**

Block Two Perfectionkm 0.19 8.13 0.001 *** ~ ~ ~ e a r ~ 0.01 -0.08 0.94 ~ v o i d ~ 0.20 1.90 0.06 Non ~ isc losure~ 0.32 3.82 0.001*** Sclt" -0.10 -1.08 0.28 Socialc 0.1t 1.33 0.19

Note.

" Adolcscent Depressive Experienccs Questionnaire Pcrfectionistic Self-Prcsentation Scalc ' Multidimensional Perfcctionism Scale

Std. B = Standardized Regression Coefficient Sig t = AII single predictor values reported as measured with al1 predictors in the modcl

Discussion

As indicated earlier, the focus of the current study was to examine the extent to

which personality vulnerability factors are associated with psychological distress and

help-seeking attitudes in a sample of adolescents. Specifically. the current research

investigated the degree to which measures of perfectionism, self-criticism, dependency,

and self-concealment were associated with levels of depressive syrnptoms and negative

orientations towards seelung help. These issues were assessed by conducting a cross-

sectional study with a sample of Catholic high school students from Toronto.

The discussion section is organized according to the main goals of the current

study. First. the discussion focuses on the levels of depression found in the current study.

and how the current findings compared with past findings. This section includes a

discussion of whether males and females differed in levels of depression and related

variables. The next section of the discussion focuses on the results of the correlational

analyses that sought to determine the link between the personality factors and depression.

The third section of the discussion focuses on the personality factors that were associated

with help-seeking attitudes. The discussion concludes with an analysis of the limitations

of the current study as well as possible directions for future research.

De~ression in Adolescents

A key finding that emerged from this research was that the mean level of

depression was found to be quite high. In fact. the mean score for the sample as a whole

was higher than the recommended cut-off point of 16 on the CES-D (Radloff, 1977). This

finding is not unique because a number of studies have found that levels of depression are 89

elevated among adolescents. For instance, a study of 220 students in grades six through

twelve found that 57% of the students reported symptoms of depressed mood with the

CES-D as the depression measure (see Culp, Clyman, & Culp, 1995). Although concems

have been raised about a possible epidemic in adolescent depression and suicide over the

past decade (see Peterson et al., 1993), the current study suggests that the problem may

be even greater than previously recognized. In their review paper, Peterson et ai. (1993)

analyzed the findings of 14 studies and reported that the median level of depression was

35% across samples in research with measures similar to the CES-D. That is, slightly

over one-third of the sample tends to be depressed. However, the results of the current

study indicate that the majority of adolescent students tend to experience at least mild

levels of depression. Clearly, scores on a self-report measure cannot be equated with

diagnosed depression based on diagnostic interviews and clinician ratings (for

discussions, see Coyne, 1994; Flett, Vrenburg, & Krames, 1997). Still, there is some

cause for concern given the growing evidence that the experience of elevated symptoms

of depression is a clear risk factor for the subsequent experience of a major depressive

disorder (see Fiett et al., 1997; Gotlib, Lewinsohn, & Seeley, 1995). In addition, in a

recent study with the CES-D, Gotlib et al. (1995) found that elevated scores on the CES-

D were associated with extensive psychological impairment in adolescents. The current

findings cornbined with previous findings underscore the serious problems associated

with depression in adolescents.

Previous studies of levels of depression in adolescents have typically found that

levels of depression are higher in females than in males and as was discussed in the

introduction section, several studies have sought to identify factors that can account for

these differences (e-g., Sethi & Nolen-Hoeksema, 1997). However, it was found in the

current study that there were no significant gender differences in terms of the Ievels of

depressive symptoms. One possible explanation is that sex differences do not exist when

considering the intensity of symptomatology, but differences do exist in the expression of

depression (Harnmen et al., 1977: Teri, 1982). Males tend to distract themselves. whereas

fcmales ruminate on their depressive mood (Nolen-Hoeksema, 199 1). Also, there is

evidence in university students, regardless of gender, that they share similar life

experiences. This commonality of life experience may help to explain the lack of

significant difference in levels of depression in the current sample (Vredenburg et al.,

1993). Moreover. Coyne (1994) suggest that the results may be artificial based on the

degree of how the adolescents were assessed in this study. Thus, including other

rneasures would be necessary.

Although the gender difference in depression was not evident in the current study,

it was the case that females in the current research had more positive attitudes toward

seeking help. This is a finding that has k e n reponed in numerous studies (e.g.. Feldman.

Hodgson. Corber. & Quinn, 1986; Garland et al.. 1994), including the recent study on

barriers to help-seeking by Kuhl, Jarkon-Horlick. and Momsey (1997). Kuhl et al. found

that adolescent males were much more likely to perceive barriers to seeking help from a

professional. The barriers that were identified included a belief that parents and friends

should be relied upon for help, a belief that help should come from oneself, and a belief

that the help provided by a professional would not be useful.

It is important to jointly examine the possibility of gender differences in

depression and help-seeking attitudes because one reasonable interpretation of the current

findings is that femaie and male adolescents have equivalent levels of depression, but the

more negative attitudes arnong males may result in them k ing less likely to actudly seek

help. Clearly, this issue should be exarnined in further research, but at ieast one thing to

consider is outreach programmes that include a focus on arneiiorating depression in

young males in addition to depression in young females.

In addition to having more negative help-seeking attitudes, males were higher in

two elements of perfectionism self-presentation (the need to appear perfect and the need

to avoid disclosure of imperfection). In this context, the results maybe exptained by

males being less willing to disclose persona1 information. As mentioned above, men tend

to avoid their problems and they are less willing to seek help. They are more likely to

deaf with their problems on their own and disclosing and seeking help is ego threatening.

This self-presentational style may be seen as a possible regulator of helping them deai

with their life problems.

Further, no significant gender differences in mean levels of dependency and self-

criticism were found. This is in contrast to the work by Fichman and colleagues (1994)

whose findings revealed that females indicated higher levels of dependency, while no

gender differences in self-criticism were found. Thus, the present study did not replicate

Fichman et al .' s ( 1 994) gender differences in dependenc y, but did produce similar

findings in a lack of difference in self-criticism.

Personalitv and De~reSsion

The second main goal of this research was to examine the association between

dimensions of perfectionism and depression in adolescents. Resuits with the total sample

showed that self-oriented perfectionism was not correlated significantly with depression.

However. as expected socially prescribed perfectionism was associated with elevated

levels of depression. This finding accords with previous research by Hewitt et al. (1997)

and Hankin et al. (1997), as well as with results linking suicida1 tendencies with socially

prescribed perfectionism (Boergers et al., 1998). Separate analyses for males and females

found that the same general pattern was evident for both individuals, though the

correlation between socially prescribed perfectionism and depression in males did not

reach conventional levels of significance.

The current study also provided an initial assessment of the link between

perfectionism self-presentation and depression in adolescents. The analyses conducted on

the data from the total sample showed that an unwillingness to disclose imperfections and

a need to avoid reveding imperfections were both associated with elevated levels of

depression. Once again, the same general pattern was evident for males and females but

only the correlations for females attained conventional levels of statistical significance.

Thus, these findings for the total sample and female adolescents replicate previous

research which suggests a link between perfectionism self-presentation and psychological

distress in university students (Hewitt et al., 1994).

Additional analyses examined the extent to which dependency and self-criticisrn

were associated with depression. As expected, the analyses revealed that both

dependency and self-criticism were correlated with depression in this sample. This

finding replicated the results reported by Fichman et al. (1994) and was based on the

same version of the DEQ-A used by Fichman et al. (1994). It is noteworthy that the

current findings also replicate a previous study by L u t h et al. (1995) which used an

expanded version of the DEQ-A which is quite different from the one used in this study.

In contrast to the findings obtained with the perfectionism mesures, significant

correlations were obtained for both males and females. It should also be noted that from a

comparative perspective, self-criticism was a more robust predictor than the other

personality variables, including the perfectionism dimensions. Thus, a self-cntical

orientation appears to be central to the experience of depression in adolescents, but the

significant resuits involving dependency and socially prescribed perfectionism still

indicate that interpersonal concems also play a role.

Parenthetically, it should be noted that self-criticism was associated with socially

prescribed perfectionism in both males and females. However, self-criticism was not

associated with self-oriented perfectionism. Other research with adults had pointed to a

closer association between socially prescribed perfectionism and self-criticism than

between self-oriented perfectionism and self-criticism (Hewitt et al., 1993b). Thus, self-

critical forms of perfectionism (see Blatt, 1995) seem to involve a sense of self-criticism

for not having lived up to the pressures to be perfect that are imposed by significant

others or society as a whote.

As stated in the introduction section of this thesis, another goal of this study was

to examine the lin k between self-concealment and depression in adolescents. Indeed, self-

concealment was correlated significantIy with depression for both males and females, and

these associations were arnong the most robust findings in this study. Overall, the

findings suggest that the tendency for depressed adolescents to be self-critical extends to

a related tendency for depressed adolescents to be high in self-concealment. The apparent

tendency for distressed adolescents to try to hide negative aspects of themselves from

others has serious implications in terms of their tendency to avoid seeking available

forms of social support. Self-concealment is associated with an unwillingness to disclose

imperfections to others, and this points to the possibility that certain depressed

adolescents c m become very isolated and withdrawn from the very people who may

provide them some comfort.

Correla tes of HebSeekinp Attitudes

The results of the current snidy did not support the hypothesis that depressed

individuals would indicate negative attitudes toward help-seeking. These findings

contrast with the findings of Garland et al. ( t 994). The replicability of findings using

their measure h a not yet k e n tested, A factor that rnay account for the difference is the

measure used to assess depression. Garland et al. ( 1994) used a different measure of

depression (i.e., The Children's Depression tnventory; CDI), whiie the present study used

the CES-D. which contains more items pertaining to the affective component and

depressed mood. One could speculate then, that the differences were due to this factor. It

is unlikely that the discrepancy in results was due to sample differences. Both studies

investigated an adolescent sample. In fact, in their study, Garland et al. ( 1994) split their

findings for older and younger adolescents. The sample consisted of middle school and

high school students. One could further speculate that the link with help-seeking was not

as strong for this study.

Although help-seeking attitudes and depression were not correlated in the overall

sample, there was an association between depression and self-concealment. This follows

with the findings of Cepeda-Benito et al. (1998). They found a positive association

between distress and self-concealment (-44). They suggest that self-concealment not only

contributes to greater emotional adversity, but also presumably diminishes the possibility

of recovery as a result of the individuals aversion to treatment.

As predicted, it was shown that strong needs to avoid exposing imperfection in

the self was related to negative help-seeking attitudes. This was true for both males and

fernales. Since the act of seeking help would involve imparting one's shortcomings and

flaws. these individuals seem to be less likely to seek solace by confiding in others. For

these individuals, it is important to present and maintain an image of flawlessness to

others (Hewitt et al., 1995).

Unexpectedly, there was the lack of a significant correlation between socially

prescribed perfectionism and negative help-seeking attitudes. Based on previous findings,

one might expect that people high on this dimension would be reluctant to seek help-

Onwuegbuzie et al. (1999) found that a fear of seeking help was correlated with socially

prescribed perfectionism. Indeed, if the adolescent perceives that others hold exceedingly

high expectations of them, then seeking help may be construed as not having lived up to

others' expectations and ideals of perfection.

There is increasing evidence that fear of negative evaluation is a cmcial element

in both perfectionism and statistics anxiety (Onwuegbuzie et ai., 1999). The authors felt

that the study was justified given that at least one research methodology and statistics

course is a degree pre-requisite for most graduate students as well as the fact that most

theses and dissertations involve statistical analyses. The work of Hewitt et al. (199 1 b) has

established that increases in high anxiety for socially prescribed perfectionists are due to

feelings of powerlessness resulting from extemall y imposed standards by significant

others. Consequently, one explanation proposed by Onwuegbuzie et al., (1999) is that the

increase in anxiety level may correspond to the lecture content and assigned tasks given

by the instructor. That is, the socially prescribed perfectionists perceives the expectations

as being unrealistic which results in increases in their anxiety level. Given that the fear of

external negative evaluation is an important component for both socially prescribed

perfectionism and statistics anxiety a relationship between the two is very likely.

Further, it may be that the relationship between socially prescribed perfectionism

and statistics anxiety may stem from the increasing evidence that high levels of socially

prescribed perfectionism leads to low self-effort and expectations resulting from the

discrepancy between the perfectionists' actual functioning and perceived unrealistic

social standards (Hewitt et al., 199 1 b).

Potentiatly, therefore, the association between socially prescribed perfectionism

and fear of asking for help can be explained by the extreme need to avoid social

exposure. Onwuegbuzie et al. ( 1 997) reported that students indicating high levels of

statistics anxiety were more prone to feelings of incornpetence, which is a great source of

embarrassrnent for them and must be actively concealed from others. If is likely then that

l i ke statistics-anxious students' fear of exposure is a driving force for socially prescribed

perfectionists' reluctance to seek help from others given that they do not want to have

their percei ved ignorance exposed.

One explanation for the lack of a correlation between socially prescribed

perfectionism and negative help-seeking attitudes is perhaps, socially prescribed

perfectionism is not as relevant to understanding help-seeking attitudes and mental

distress in adoiescents as first assumed. What may be of more relevance is the

nondisclosure factor of perfectionism self-presentation. Also, perhaps this hypothesis, in

future studies, might receive stronger support if examined among a larger adolescent

sample. This suggests that there is a need for further study.

With respect to having positive attitudes toward help-seeking, the findings

support previous work indicating that individuals high on dependency would be more

likely to have an orientation toward seeking help. However, for males this was not true.

There is extensive literature on help-seeking and dependency in adults, yet the link

between dependency and help-seeking attitudes in adolescents has not received as much

attention. Indeed, previous research indicated that college students exhibited a positive

relationship between interpersonal dependency and medical help-seeking behaviour.

They showed higher rates of health care usage in that they made more trips to the health

center and private clinics than nondependent individuals (Borstein et al., 1993). It may be

there is no association with depression and help-seeking because dependency was also

correlated with depression. There may be a subset of people who are dependent

adolescents who are positively inclined toward help-seeking.

The central focus of Bornstein's (1998) research was to examine the effects of

implicit and self-attributed dependency strivings on laboratory and field measures of help

seeking. McClelland, Koestner, and Weinberger ( 1989) reasoned that while objective and

projective measures are creatzd to measure like constructs, they often assess the many

aspects of an individual's motive and intentional state. They suggest that generally self-

report measures assess self-attributed needs, that is, the motives that are readily

acknowledged as being representative of the persons' mundane functioning and daily

experiences. On the other hand, projective tests assess an implicit need, such as the drive

that governs automatic and unconscious behaviour, often without any awareness by the

individual that these drives or motives influenced their behaviour. In the first study,

college students were pre-screened with commonly used objective and projective

dependency tests. They then endured an information manipulation designed to stress the

salience of dependency-related issues. As expected, the results revealed that dependency

status (low dependency, high dependency, unacknowledged dependency, and dependent

self-presentation) and information manipulation (informed vs. uninformed) did interact

and influenced the frequency of help-seeking behaviour. By altering the individuals'

consciousness of the dependency help-seeking relationship, their willingness to seek and

ask for assistance was affected (Bornstein. 1998).

Study 2 was conducted to examine the interaction of implicit and self-attributed

dependency strivings to help-seeking behaviour in a field setting. It was hypothesized

that implicit and self-attributed dependency needs would differentially predict direct and

indirect help seeking, as both of these types of help-seeking differ in relation to their

perceived rdevance to dependency.

Taken together, the results of these studies are interesting because of their

im~lications regarding the important role the dependency status plays in predicting help- L

see k

seek

ng behaviour across a variety of settings (Bornstein, 1998).

The present results showed that self-criticism was not correlated with help-

ng. One recent study found that adolescents who seek help from professionals have

lower self-worth compared to adolescents who reported not seeking professional help

(Schnort-Reich1 et al., 1996). Additionally, they found that adolescents who did not seek

professional help were more seIf-conscious than adolescents who did seek help. The

authors found that the need for privacy seemed to be an important issue for adolescents.

This fits with the current findings of the apparent unwiilingness of those high on non-

disclosure of imperfection to not want to seek help, as these individuais are very self-

conscious and private. Schonert-Reich1 et al. (1996) suggest that it may be that those

adolescents with high self-worth do not feel the need to seek medicai help because of

their global sense of efficacy and autonomy and medical service utilization may be a

threat to their self-esteem.

Overall, one might predict a link between self-criticism and negative help-seeking

attitudes, given that self-critical individuais are characteristically self-reliant individuais

and they seek autonomy. The factor that rnay account for the difference is that in the

study conducted by Schonert-Reich1 e t al. (1996), they focused on reports of actual help-

seeking behaviour while the present study focused on help-seeking attitudes. This is an

important area to consider in future investigations.

Additional findings confirmed that socially prescribed perfectionism and self-

presentation dimensions were associated with self-concealment. This finding was of

particular interest, as it has never k e n investigated in adolescents before. Self-

concealment has generally been studied in university students. Individuals characterized

by socially prescribed perfectionism and the three dimensions of perfectionism self-

presentation were more likely to hide distressing and potentially embarrassing personal

facts. Thus, the overail pattern of results with adolescents correspo~ded to previous

findings, that people high in perfectionism are high self-concealers.

In a study of undergraduate psychology students, Frost et al. ( 1 997) found that

individuals high in perfectionistic concern over mistakes reported more wony about the

reactions of others to their errors than did students indicating low concern. The

researchers concluded that this concern was not based on the belief that their mistakes

might cause h m to other people, but seemed to stem from the beiief that others would

think poorly of them for their mistakes. Consequently, as a result of this preoccupation

high concem participants reported a greater need of wanting to conceal their errors from

others. Frost and Marten (1990a) suggest that the constant avoidance by perfectionists of

any type of extemal observation or evduation by others may be a key element in

explaining the poor performance of perfectionists compared to nonperfectionists as

demonstrated in a writing task study. Perfectionists' attempt at avoiding disclosure of

their mistakes is achieved by avoiding review and feedback from others on their written

work. Often, the development and improvement of one's writing skills is benefited by

con t i nual practice and feedback and consequentl y, perfectionists writing ability may

remain underdeveloped and limited (Frost et al., 1997). These findings corroborate with a

previous study by Frost, Turcotte, Heimberg, Mattia. Holt, and Hope (1 995) showing that

individuals high in concern-over-mistakes reacted more negatively to mistakes than did

their lower counterparts. High-perfectionistic-concern-over-mistake individuals displayed

a more negative affect, lowered confidence regarding their proficiency to do a task, and

they believed that others would judge them more harshly and view them as less

intelligent. They were also less willing to share their results and they reported being more

l i kel y to conceal their performance outcorne.

Intuitively, it was predicted that the perfectionkm self-presentation factors would

predict negative help-seeking attitudes over and above other personality factors. As

expected, a significant result was found for the non-disclosure dimension of

perfectionism self-presentation. These individuals are less likely to seek professional help

and their decision to seek help is guided by their inability and unwillingness to share

persona1 information. This facet of perfectionism is driven by their intense need to

present an ideal image of the self. This may be due, in part, to their reluctance to privately

or publicly acknowledge and admit to any persona1 shortcomings or inadequacies (Hewitt

et al.. 1995).

Cepeda-Benito et al. (1998) found that self-concealment was positively associated

with personal distress and a de-emphasis on psychological treatment and intervention.

Specifically, those inclined to keep secrets were more likely to avoid rather than seek

help. In contrast, Kelly et ai. (1995) reported that their study showed that high self-

concealers had a more positive orientation toward seeking help compared to those

indicating Iow levels of self-concealment. In addition, it was also shown that high self-

concealers reported greater service utilization and obtaining some fonn of counseling.

Although results of the current study did not yield a relationship between self-

concealment and help-seeking, future research needs to further clarify the relationship

among self-concealment, perfectionisrn, and help-seeking pathways in adolescents.

Psvchometric Results

The new measure of perfectionism demonstrated excelIent psychometric

properties. Also, the findings in this investigation provide evidence for the reliability of

this rneasure as well as preliminary data regarding its validity, in that the perfectionism

dimensions were correlated with one another. The Perfectionism Self-Presentation Scale

was also correlated with self-concealment, which is also evidence of the validity of the

scale with adolescents. In addition, there was good internal consistency with the Child-

Adolescent Perfectionism and Perfectionism Self-Presentation scales.

In the present sarnple, coefficient alpha was -8 1 for help-seeking, -64 for thc self-

criticisrn scale. -72 for the dependency scale and .46 for the efficacy scale. Help-seeking,

self-criticism (note this item was somewhat lower) and dependency al1 had acceptable

reliability this was not so for the efficacy scale. The efficacy scale yielded a low internal

consistency partiaily due to the low number of items, further examination of the item

content shows that the items tap a number of concerns and some items have tangential

relevance to the effkacy construct and does not directly tap perceptions of capability. For

example, ''1 am a very independent person." " 1 enjoy competing with others."

It is important to mention the limitations of this study. First. the study sampled

adolescents mainly from working and middle socio-demographic categories and therefore

discretion is necessary when generalizing to individuals from other backgrounds. Also,

the issue of representativeness 1s relevant for this study as we relied on a volunteer

sample. The question that arises is, can you apply the current findings to other sectors?

Further. the sample was drawn from a population of adolescents attending a Catholic

secondary school and consequently findings are not generalizable to those adolescents

not attending school or institutionalized. Certainly, additional research should attempt to

recognise the help-seeking attitudes when faced with negative expetiences of those

adolescents not in school andor institutionalized. Another limitation is that a cross-

sectional design was ernployed with a modest sample size to examine patterns in help-

seeking attitudes and depression. As a result, it is impossible to definitively test the causal

direction of the relationships depicted in the mediated rnodel.

-4 second potential limitation includes the sole reliance on adolescents' self-

report, for both the measures of personal and social characteristics and those of help-

seeking attitudes. Funher Hewitt et al. (1997) suggests that there may be some shared

variance among the correlations due to the exclusive use of self-report measures.

Although this may be a particularly serious concern, some believe that an adolescent's

self-perceptions, as assessed through personality instruments, are strongly associated with

their understanding of their help-seeking attitudes (Schonert-Reich1 et ai., 1996). While

there may be inherent problems with the use of self-report measures such as accuracy and

recall, it can, however, be argued that the most accurate source is the adolescents

themseIves --- they have the greatest understanding of their experiences and feelings.

Despite this, future studies would benefit from the inclusion of assessrnents other than

self-report rneasures involving more objective measures such as multiple reporters and

behavioural observations in order to achieve a greater understanding about the nature of

help-seeking attitudes in adolescence.

Interpretations of the present findings are further limited since the study relied on

measures that assessed help-seeking attitudes as opposed to behaviour. There may be

some discrepancy between how the adolescent feels about seeking help and actually

availing themselves of opportunities for help. Assessments of adolescents' reasons for not

seeking help or adolescents' perceptions of the obstacles to seeking help were not

explored in this study. The reliance on depression symptom reports versus the use of

theoretical assumptions of depression presents a simiIar limitation. Measures that tapped

behaviours may have proven more beneficial in understanding depression.

Future research that uses measures reflecting al1 three conceptualizations of

depression is important in broadening our knowledge of the relations among depressed

mood. syndromes, and disorders. It is evident that al1 three of these conceptualizations of

depression are worthy of researchers' attention when concerns about the evolutionai and

psychological processes dunng adolescence aise (Compas, Ey, & Grant, 1993).

Analysis of such information would be of great benefit to the understanding of the

characteristics, construction and execution of outreach efforts targeted to reach those

adokscents most in need who are unidentified and underserved (Schoner-Reich1 et al.,

1996).

Aside from an individual's help-seeking behaviour. another variable that deserves

exploration is the importance of cultural identity and relations and farnily values. Cultural

identification and social network characteristics are likely to play an important role in

influencing a child's perception of the mental health care system and his or her help-

seeking activities. Also, the extent to which an individual identifies with ethnic and

cultural beliefs and values, which are incompatible with help-seeking --- for example,

exposing problems that will embarrass the family- the stigmatization that goes with

having persona1 problems or seeking help --- may delay or deter service utilization

(Gariand et al., 1994). Further, having an orientation towards medical intervention such

as embracing the efficacy of physicians and medical personnel rather than destiny,

religion, or claims of psychotherapeutic methods for curing the individual are also

thought to be related to help-seeking behaviour. In addition, the importance of cultural

context. their birth place, ethnic diversity of their host country, the process of social

adaptation. and cultural identity have also been suggested as influences on help-seeking

attitudes and behaviour. As noted earlier, there are those who suggest that research on

service utilization of mental health systems should include more detailed investigations

of the impact of acceptance and awareness as this may be related to one's prior

experience. Evaluating extemai influences such as accessibility and attractiveness of

services is vital, considering that an adolescent's eagerness to seek help is likely to be

greatly associated with the actual or perceived utility and value of formal mental health

services (Garland et al., 1994).

Garland et al. believe that one of the central goals of this area of research is to

identify variables and disentangle a wide range of factors that facilitate, inhibit or pose a

barrier to help-seeking artitudes and behaviours. Specifically, it is important to foster a

greater understanding of the pathways of support and assistance for adolescents. We need

to determine why some young people who have a clinically identified need are so

reluctant to seek or obtain medical help. Can it be explained simply as refusai to admit to

the existence of persona1 problems? Or is it a perceived lack of service availability?

Underutilization and non-attendance may also be founded on previous negative

experiences with prior help-seeking attempts. Also, is a failure to seek help due to a

fatalistic view in which the child sees little or no hope or change likely to influence help-

seeking? It i s a de fini te challenge for professionals to cncourage help-seeking behaviour

while still recognizing the need for autonomy in this population. More information is

required to map the force and direction of casual factors. Clearly, better attempts at

understanding young people's reluctance and barriers as well as motivation for seeking

help and service selection will help to improve and allow the most accessibility for early

intervention and delivery of appropriate services.

Despite the limitations outlined above, the data d o enhance the understanding of

personality factors, depression and help-seeking attitudes. As mentioned previously, the

distinction between self-concedment and self-disclosure has been explored, and some

believe that the two are separate, yet related concepts (Larson e t al., 1990). As such, there

is a clear need to look at non-disclosure in counselIing sessions. It is also important to

specifically examine personality variables and the counselling medium and low levels of

disclosure. As well, this applies to self-concealment in that future research could examine

the effects of concealment as a client variable on the counseling process o r outcome. In

addition, research could explore the issue of early termination from therapy specifically

for low versus high self-concealers. If heightened fears of psychotherapy ensue, as the

reality of seeking treatment becomes imminent, anxiety around treatrnent may culminate

during the initial stages, resulting in decreased motivation to continue with the counseling

process. Similarly, clients entering therapy for an acute problem may abandon treatment

prematurely as they begin to experience relief and feel better. As a result, their motivation

to remain and continue with treatment is likefy to decline. Hence, clients who begin to

feel better, but remain apprehensive and fearful of psychotherapy would likely have a

higher dropout rate compared to clients who experience acute distress or who undermine

their fears. Approaching new clients entenng therapy and assessing their distress levels

and anxiety around treatment could verify this. Another potential area of exploration is to

investigate the extent to v~hich counsellors can reduce premature termination by

goveming the counsellors' Iistening intentions, specifically this would include the

counsellors' ability to Iisten to clients' anxieties while discussing treatment gains and

advancing a continued commitment to treatment (Cepeda-Benito et al., 1 998).

Causal statements cannot fK made based on the analysis used in the current study

and therefore one would need to conduct longitudinal prospective studies. Other

measures such as clinical, peer, school or parentai ratings, and behavioural measures will

help to verify the validity and generalizability of research findings in this area.

Nevertheless. longitudinal studies are needed to further examine the extent of personality

factors on depression and help-seeking behaviours as well as parental influences. Studies

assessing parenting in early childhood are essential in further understanding the subtypes

of depression and other clinical symptoms. Longitudinal studies, albeit a few, have found

that adult depressive tendencies were more strongly associated with parenting attributes

particularly for girls. This was not true for boys. Parenting seems to be an important

factor in the development of depressive tendencies as well as other psychopathologies

(Blatt et al., I992d; Missildine, 1963). This suggests that future studies need to examine

the links arnong biologicai, external forces, and interpersonal factors in the development

of depression.

Also, it may be beneficial not only to utilize interview measures but also utilize

them in the context of other variables such as stress and coping ability (Srebnik, et al.,

1996).

It is important to explore the relationship between perfectionism, depression, and

self-concealment and the treatment process. The development of a better understanding

of the role of these factors in the treatment process is in the best interest of not only the

client but the counsellor as well. There is increasing evidence that the counselling process

has the potential to be an effective means of helping to lessen the psychological and

emotional distress associated with psychiatric probiems (Kushner & Sher. 1991).

Therefore. in this context. it becomes clear that it is important to better understand and

learn more about the causal factors that influence an individual's view of therapy. This

knowiedge would help those in the helping profession to develop prevention programs

that increase the appeal of psychotherapy. creating a proactive use of service at the onset

rather than during the advance stages of psychological distress. Increased screening

efforts to recognize and identify adolescents with intemalized symptoms are needed.

These individuals, aithough troubled, often exhibit socially desirable behaviours and may

appear to be well-adjusted (Garland et al., 1994). Other interventions to improve help-

seeking rnight involve the role of helping to remove shame and dispel unfavourable

attitudes toward treatment.

Although research has focused on perfectionism and self-concealment as a

multifaceted phenomenon, limited research exists on the effects of perfectionism and

self-concealment as a client variable on the treatment process and outcome and further

work is needed (Hewitt et al., 1990; Kelly et al., 1995). Also, the role of depression needs

to be explored. Research has indicated that adolescents are taking extreme rneasures

when they experience difficulty coping with psychiatric and psychologicai problems.

The implications for practice are a better understanding of the reciprocal effect of

personality factors, the family and peer context and fonal service utilization to help with

semice planning. Better understanding of the obstacles to and advancement of certain

types of service areas will help to mark elements for service modification. Predictors and

the paths to particular kinds of services and support are likely to Vary depending on

si tuational determinants (Srebnik et al., 1996).

The implications for policy are a better understanding of the intncacies of the

health care system and the subsequent shortcomings and obstacles to adequate health care

for children and adolescents. Often, service utilization is simply based on available

service options. It can only be argued that given the limited resources available for

mental health services, it is clear that emotional and behaviourai disorders will certainly

outnumber actual services (Srebnik et al., 1996). Delivery of services for children and

adolescents at present depends on a number of factors including, the role of family, the

wider cornrnunity, quality of care. and the politicai environment. Service delivery is also

based on assessed and perceived service need as well as the development of effective

treatment inceptions (Srebnik et al., 1996).

Summary

In summary, a cross-sectional investigation was conducted to examine the extent

to which personality variables were associated with depression and negative help-seeking

attitudes in adolescents. The purpose of this investigation was to add to the existing

literature by exarnining some personality factors (e.g., trait perfectionism, perfectionism

sel f-presentation, and sel f-concealment) that have received relative1 y Iittle empirical

attention. In particular, the current investigation was designed to provide additional

information about personality correIates of negative help-seeking attitudes.

Overall, the results of the present study confirmed that adolescents tend to

experience elevated levels of depressive symptoms. in contrast to previous studies, no

gender difference was detected; females and males did not differ in their reported levels

of depression. Correhtiond results established that several personality factors are

associated with depression in adolescents. These factors include socially prescribed

perfectionism, perfectionism self-presentation, self-criticism, dependency, and setf-

concealment, with self-criticism being the factor with the strongest link with depression.

Analyses w ith the help-seeking measure found that higher levels of dependenc y were

associated with more positive attitudes toward seeking professional help, while more

negative attitudes were associated with an unwillingness to disclose imperfections to

others. Self-criticism was not associated with negative help-seeking attitudes. In contrast

to past research, depression was not associated with help-seeking attitudes. FinalIy,

regession analyses showed that perfectionism dimensions did not predict unique

variance in symptoms of depression, over and above measures of self-criticism and

dependency. However one element of perfectionism self-presentation (Le., an

1 1 1

unwillingness to disclose imperfections) was able to predict unique variance in self-

concealment and negative help-seeking attitudes.

The results were discussed within the context of the limitations of the current

researc h, and directions for future research were outlined. Clearl y, findings such as these

have important implications for the potential role cf perfectionism, self-criticism,

dependency, and self-concealment in personal and social adjustment, and related issues

of personai importance to depressed adolescents. A key challenge for the future will be to

find ways to encourage depressed adolescents to seek help, even though they may have a

personality style that inhibits them from seeking help from adults and mental healfh

services.

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Appendices

Amendix A Descti~tion Letter of the Studv

Dear ParentlGuardian:

We are conducting a research study to investigate personal and social characteristics of adolescents. This research will help us understand the behaviour patterns of adolescents when they encounter negative experiences in their Iives. The more teachers and parents know about these negative experiences the more positive support they cm offer.

We woüld like your adolescent to participate in this study. It will take approximately 30 minutes to complete and is entireiy voluntary. Your adolescent is free to refuse to participate in the study, to refuse to answer any specific question and/or withdraw from the study at any time. If you consent, your adolescent will be given a questionnaire containing a number of sentences in which he/she will be asked to indicate the degree to which the sentence reflects hisher feelings and experiences. There are no apparent risks üssociated with participating in the study and a trained researcher will be present to assist your adolescent if required.

Your adolescent's responses will be completely anonymous and wilI be kept strictly confidential. His or her name will not appear on any documents. Only research personnel will have access to the data. Overall results will focus on group trends rather than indi vidual responses.

Following the termination of the study, a summary of the research findings and a complete explanation of the purpose and results of the study will be available upon request.

This study is being conducted jointly by Dr. Solveiga Miezitis, Professor, Department of Applied Psychology, University of Toronto and Dr. Gordon Flett, Professor, Department of Psychology, York University and myseIf, a Ph.D. candidate at the University of Toronto. Should you require any further information, Dr. Flett can be contacted at (4 16) 736-2 100 Ext. 44575.

Thank you in advance for your willingness to consider our request. If you agree to allow your adolescent to participate, please sign the enclosed consent form and have your adolescent return it to hisher teacher.

S incerel y,

ParentKuardian Consent Forms

1 hereby gant permission for my adolescent, Y

(name of adolescent)

to participate in a study king conducted by Tessa DeRosa under the supervision of Dr. Solveiga Miezitis, Department of Applied Psychology, University of Toronto, and Dr. Gordon Flett, Department of Psychology, York University.

1 understand the purpose of this study is to examine how personality variables are related to individuai differences and attitudes towards seeking help. My adolescent's participation will involve hisher completion of self-report questionnaires.

1 understand that participation is entirely voluntary, that my adolescent's responses will be compIetely anonymous, and that the data collected will be kept strictly confidential. Only research personnel will have access to the data records. Analysis of the data will focus on group trends rather than individuai responses.

1 understand that a more complete explanation of the purposes and the results of the study wiII be given, if 1 request it, following the termination of the study, and that 1 will be able to obtain a summary of the research findings.

1 understand that my adolescent can refuse to participate in the snidy, refuse to answer any specific questions, andor withdraw from the study at any time.

Signature of Parent or Legal Guardian Date

Signature of Adolescent

Please pnnt surname of parentlguardian:

Student Consent Form

1 hereby agree to participate in a research study k i n g conducted by Tessa DeRosa under the supervision of Dr. Solveiga Miezitis, Department of Applied Psychology, University of Toronto, and Dr. Gordon Flett, Department of Psychology, York University.

1 understand the purpose of this study is to examine how persondity variables are related to individuai differences and attitudes towards seeking help. My participation will involve the completion of self-report questionnaires.

1 understand that my participation is entirely voluntary, that my responses will be completely anonymous, and that the data collected will be kept strictly confidentid. No one besides research personnel will have access to the data records. Anaiysis of the data will focus on group trends rather than individual responses.

1 understand that a more complete explanation of the purpose and the results of the study will be given, if I request it, following the completion of the study and that 1 will be able to obtain a summary of the research findings.

1 understand that I can refuse to participate in the study, refuse to answer any specific questions, and/or withdraw from the study at any time.

I am 18 years of age or older.

Signature

PIease print sumarne:

Date

Introduction to the Studv

Thank you for participating in this research study. This is not a test. There are no right o r wrong answers. D o not spend a great deal of time thinking about your answers to individual questions but d o take the time to carefully read the instructions for each part of the questionnaire.

Please d o not write your name on the document. Participation in this study is completely anonyrnous and voiuntary. Although it is hoped that you will answer al1 questions, you may refuse to answer any specific question a n d o r withdraw from the study at anytime. The data will be used to understand group trends and no individual student wiIl be identified.

Before beginning the questionnaire package, please complete the following:

Specify gender: MALE FEMALE (please circle one)

Specify age: years old

Current grade: grade

PIease begin ...

The Child and Adolescent Perfectionism Scale (CAPS)

This is a chance to find out about your self. It is not a test. There are no right answers and everyone will have different answers. Be sure that your answers show how you acnidly are. Please do not talk about your answers with anyone else. We will keep your answers private 2nd not show them to anyone.

When you are ready to begin. read each sentence and pick your answer by circling a number from "1" to "5". The five possible answers for each sentence are listed below:

1. False -- Not at al1 true of me 2. Mostly False 3. Neither True or False 4. Mostly True 5. Very True of me

For example. if you were given the sentence "1 like to read comic books", you would circle a "5" if this is very true of you. If you were given the sentence "1 like to keep my room neat and tidy", you would circle a "1" if this was false and not true of you. You are now ready to begin.

Please be sure to answer al1 of the sentences.

False

1 try to be perfect in everything 1 do. 1 2

1 want to be the best at everything i do. 1 2

My parents don't always expect me to be perfect in everything 1 do. 1 2

1 feel that I have to do my best al1 the time. 1 2

There are people in my Iife who expect me to be perfect. 1 2

1 always try for the top score on a test 1 2

It really bothers me if 1 don't do my best al1 the time. 1 2

My family expects me to be perfect. 1 2

True

4 5

4 5

9.

1 o.

I I .

12.

13.

14.

15.

16.

17.

18.

19.

20.

21.

1 don? al ways try to be the bat .

People expect more from me than 1 am able to give.

1 get mad at myself when 1 make a mistake.

Other people think 1 have failed if 1 do not do my very best al1 the time.

Other people always expect me to be perfect.

1 get upset if there is even one mistake in my work.

People around me expect me to be great at everything.

When 1 do something, it has to be perfect.

My teachers expect my work to be perfect.

1 do not have to be the best at everything 1 do.

1 am always expected to do better than others.

Even when 1 pas , 1 feel that 1 have failed if 1 didn't get one of the highest marks in the cIass.

1 feel that people ask too much of me.

22. 1 can't stand to be less than perfect. 1

138

Tnie

5

5

5

5

5

5

5

5

5

5

5

5

5

5

Amendix F Perfectionism Self-Presentation Scale (PSPS)

Listed below are a group of statements. Please rate your agreement with the statements using the following scale:

DIS AGREE NEUTRAL AGREE STRONGLY STRONGLY

1 . It is okay to show others that 1 am not perfect. f 2 3 4 5 6 7

2. 1 judge myself based on the mistakes I make in front of other people. 1 2 3 4 5 6 7

3. I will do almost anything to cover up a mistake. 1 2 3 4 5 6 7

4. Errors are much worse if they are made in public rather than in private. 1 2 3 4 5 6 7

5. 1 try always to present a picture of perfection. 1 2 3 4 5 6 7

6. It would be awful if 1 made a fool of myself in front of others. 1 2 3 4 5 6 7

7. If 1 seem perfect, others will see me more positively. 1 2 3 4 5 6 7

8. 1 brood over mistakes that 1 have made in front of others. 1 2 3 4 5 6 7

9. I never let others know how hard f work on things. 1 2 3 4 5 6 7

10. 1 would like to appear more competent than 1 really am. 1 2 3 4 5 6 7

1 1. It doesn't matter if there is a flaw in my looks. 1 2 3 4 5 6 7

DIS AGREE STRONGLY

AGREE STRONGLY

12.1 do not want people to see me do something unless 1 am very good at it. I 2

13.1 should always keep my problems to myself. i 2

14. 1 should soive my own problems rather than admit them to others. 1 2

15. 1 must appear to be in control of my actions at al1 times. 1 2

16. It is okay to admit mistakes to others. I 2

17. It is important to act perfectly in social situations. 1 2

18. 1 don? really care about king perfectly groomed.

19. Admitting failure to others is the worst possible thing. 1 2

20. 1 hate to make errors in public. 1 2

2 1 . 1 try to keep my faults to myself. 1 - 3

22.1 do not care about making mistakes in public. 1 2

23.1 need to be seen as perfectly capable in everything I do.

24. Failing at something is awful if other people know about it. 1 2

35. It is very important that 1 always appear to be "on top of things". 1 2

26. 1 rnust always appear to be perfect. 1 2

27.1 to look perfect to others. 1 2

The Adolescent De~ressive ExDeriences Ouestionnaire (DEQ-A)

Listed below are a group of statements. Please rate your agreement with the statements using the following scale:

DIS AGREE AGREE STRONGLY STRONGLY

1. 1 set my goals at a very high level.

2. Sometimes 1 feel very big, and other times 1 feel very small.

3. 1 often find that 1 fail short of what 1 expect of myself.

4. 1 feel 1 am always making full use of my abiiities.

5. It bothers me that relationships with people change.

6. There is a big difference between how 1 am and how 1 wish 1 were.

7. 1 enjoy competing with others.

8. Usually 1 am not satisfied with what 1 have.

9. 1 have difficulty breaking off a friendship that is making me unhappy.

10. Often, 1 feel 1 have disappointed others.

1 1. I very often go out of my way to please or help people 1 am close to.

1 2. 1 never reaily feel safe in a close relationship with a parent or a friend.

13. 1 generally watch carefully to see how other people are affected by what 1 say or do.

14. 1 worry a lot about upsetting or hurting someone who is close to me.

15.1 am a very independent person.

16. Anger frightens me.

17. If someone 1 cared about became angry with me, 1 would feel frightened that he or she might leave me.

18. What 1 do and Say has a very strong impact on those around me.

19. The people in my family are very close to each other.

10. 1 am very satisfied with myself and the things 1 have achieved.

DISAGREE STRONGLY

AGREE STRONGLY

AmendUr H The Center for E~idemioloeic Studies De~ression Scales (CES-Dl

Below is a list of the ways you might have felt or behaved. Please indicate by choosing the number which best describes how ofien you have felt this way dunng the past week.

O = Rarely or none of the time (Less than 1 day) 1 = Some or a little of the time ( 1-2 days) 2 = Occasionally or a moderate amount of time (3-4 days) 3 = Most o r al1 of the time (5-7days)

During the past week:

I was bothered by things that usually don t bother me. 1 did not feel like eating: rny appetite was poor. I felt that 1 could not shake off the blues even with help from my family or friends. 1 felt that 1 was just as good as other people. 1 had trouble keeping my mind on what was going on. 1 felt depressed. 1 felt that everything 1 did was an effort. 1 felt hopeful about the future. 1 thought my life had been a failure. 1 felt fearful. My sleep was restless. 1 was happy. 1 talked less than usual. 1 felt lonely. People were unfriendly. 1 enjoyed life. 1 had crying spells. 1 felt sad. 1 felt that people disliked me. 1 could not get "going."

Appendix 1 Self-Concealmen t Scale (SCS)

Listed below are a group of statements. Please rate your agreement with the statements using the following scale:

I have an important secret that I havent shared with anyone.

If I shared al1 my secrets with my friends, they'd like me less.

There are Iots of things about me that 1 keep to myself.

DIS AGREE STRONGLY

Some of my secrets have reaily tonnented me. 1

When something bad happens to me, 1 tend to keep it to myself. 1

I'm often afraid i'll reveal something I dont want to. 1

TelIing a secret often backfires and I wish I hadn't told it. 1

1 have a secret that is so private 1 would lie if anybody asked me about it. 1

My secrets are too embarrassing to share with others. 1

10.1 have negative thoughts about myseIf that 1 never share with anyone. 1

4 5

AGREE STRONGLY

Chose the answers that best describe how you feel.

S trongl y Agree

Adults are good at helping kids with personal or emotional problems.

The best way to d e d with personal problems is to keep them to yourself.

Just talking with someone about things that bother you c m be helpful.

School is not the right place to taik about persona1 or farnily problems.

1 would tell a friend to talk to a teacher or counsellor if he/she were very upset about a family problem.

If you are really sad, it is usuaily a good idea to keep these feelings to yourself.

1 would be willing to talk to someone who helps people with their problems, if 1 felt sad.

1 don't think teachers or counsellors know about how students feel.

If 1 were womed that a friend rnight hurt himself/herself, 1 would talk to another adult about it.

10. Talking with an adult about your problems might help you solve them.

1 1.1 can only talk to someone my own age about my problems.

Agree

2

2

2

2

Disagree

3

3

3

3

Strongl y Disagree

4

4

4

4

S trongl y Agree

12. 1 woutd talk to an adu!t at school about problems in my family. 1

13. Teachers and/or counsellors c m help when you're upset about a persona1 problem. 1

14. There should be an adult at school who talks to kids about personal problems and family problems. 1

15. 1 don't like to talk to any adults about my problems. 1

Agree

2

2

2

2

Disagree

3

3

3

3

146

S trongl y Disagree

4

4

4

4

Try to imagine that you had each of the follo~ing experiences, would you talk to an adult about these things?

Definitely Probably Probably Definitely Yes Not No

16. You felt extremely sad and couldn't concentrate on school.

17. You had a fight with a friend

18. You were scared of things other people aren't usually scared of.

19. You were very upset because your hest friend moved away.

20. You felt very lonely and wanted more friends.

2 1. You were very womed about a friend who was using drugs.

22. You were very sad because someone in your family was sick.