MINISTRY OF EDUCATION AND TRAINING HANOI NATIONAL UNIVERSITY OF EDUCATION
PHAN DIEU MAI
Depression in high school students
Major: Specialized Psychology Code: 9.31.04.01
SUMMARY OF DOCTORAL THESIS IN PSYCHOLOGY
HANOI - 2020
The thesis is completed in: FACULTY OF PSYCHOLOGY AND EDUCATION STUDIES - HANOI NATIONAL UNIVERSITY OF EDUCATION
Scientific instructor:
1. Assoc. Prof. PhD. Do Thi Hanh Phuc 2. Assoc. Prof. PhD. Tran Thi My Luong
Critic 1: Assoc. Prof. PhD. TRAN THU HUONG
University Of Social Sciences And Humanities
Critic 2: Assoc. Prof. PhD. LA THI THU THUY
Institute Of Psychhology
Critic 3: Assoc. Prof. PhD. NGUYEN THI MAI LAN
Vietnam Academmy Of Social Sciences
The dissertation will be defended in front of the grassroots-level
Judging Council at Faculty of Psychology and Education Studies, Hanoi National University of Education. at ….. hour......, day…. month….. 2020
The thesis can be found at Hanoi National Library or Library of
Hanoi National University of Education
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PREAMBLE
1. Reason to choose a topic
Depression is one of the most common emotional disorders among mental health conditions. People with depression exhibit reduced mood, sad emotions, inhibiting thinking, language and slow movement. Depression is known for its consequences to patients, typically reduced labor productivity, loss of interest in all activities, a mood of pessimism, feeling bored, the creative ability seeming to completely disappear, even suicidal behavior if it is severe. According to the World Health Organization, around 200 million people in the world, accounting for nearly 5.0% of the population, have typical depressive symptoms. In Vietnam alone, the proportion of people with depression is 2.8% (WHO, 2000). More than half of depressed patients are hospitalized with recurrences at least 1-2 times per year. If untreated, the number of occurrences of the disease as well as the severity of symptoms tend to increase over time. The suicide rate because of depression is serious: depression accounts for two thirds of suicide deaths. Depression care costs are huge and increasing. In terms of burden of disease, depression ranks 5th in women and 7th in men (World Bank, 1990); anxiety and depression rank first in both adult men and women in the world aged 15-34 (WHO, 2012). Depression will become the second leading cause of working capacity loss in the world by 2020 (WHO). Severe or mild depression can all affect the quality of life of an individual, affecting the family, community and society. Psychologists believe that detecting signs early in life can make treatment more effective and less expensive.
The upper secondary school age is a transitional development period from child to adult: they are no longer children but not yet adults. This is a period of special development with a series of physical, psychological and social changes, in order to meet the requirements and tasks of the age group. They often have difficulty making life plans, choosing careers and vocational schools. This is also the period that is most likely to cause psychological disturbances compared to other ages. According to the study “Psychological disorders - diagnosis and treatment with high school students in Hanoi” by the Institute of Psychology, in 2000, it showed that at the age of 17, there were 19.5% of students with avoidant personality disorder; 40% often complain about their bodies; 22.5% were worried about depression; 29.3% had social problems such as dropping out of school, running away from home, fighting, using drugs, etc. (Nguyen Ba Dat, 2003). A cross-sectional study of 972 high school students, aged 13 to 16, in northern Vietnam found a high rate of poor mental health, with 17.6% feeling sad and hopeless every day for two weeks for the past 12 months (Tran B.P., 2007). Adolescent depression and anxiety form significant public health concerns. Anxiety and depression symptoms often increase during adolescence, leading to an estimated 20% of adolescents meeting diagnostic criteria for depression and an estimated 32% of adolescents. Adolescents meet the criteria for anxiety disorders at the age of 18 (Hankin et al. 1998; Merikangas et al. 2010). Depression and anxiety can affect adolescents' development and are at risk of dropping out of school, suicide and substance abuse (Swan and Kendall 2016; Vander Stoep et al.
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2000). Early detection and treatment of depression in young people can reduce morbidity, mortality, and the risk of inappropriate behavior. Appropriate goals to prevent depression in high school students are the initial prevention programs. Treatment strategies include psychological education, such as parenting skills in caring for children, bringing health care programs into school, psychotherapy and drug therapy as well as family psychotherapy. Risk factors for depression in high school students include socio-economic deprivation, parental death, living only with mothers and depressed parents. Children of depressed parents are a high-risk group and have received much attention in recent years. The risk for this group of students increased significantly due to genetic factors as well as psychological factors. Early detection and aggressive treatment in the early stages of depression in this group is important in reducing the onset, cost and associated conditions of depression.
In Vietnam, now the protection and health care for students has come a big step. While the prevention of diseases has reduced the rate of malnourished children, deaths and other bacterial infections, the mental health protection and care have not been paid enough attention. Psychological studies on depression in students and adolescents are few and far less concerned with the impact and burden it has on students, families, schools and society. For depressed students, if we take measures for early detection, correct diagnosis, timely intervention, it is possible to avoid negative consequences left in the development of their psychology, helping them avoid difficulties and failures in adolescence, reducing the impact it can have on families, schools and society.
Stemming from the above reasons, we chose to research the topic “Depression
in high school students”. 2. Research purposes
Researching the theoretical basis and examining the manifestation of depression and depression related factors in high school students, how to cope with difficulties of high school students. On that basis, some preventive and intervention measures will be proposed and experimented for high school students. 3. Research subject and objects 3.1. Research subject
Manifestations of depression, factors related to depression, coping with
depression of high school students. 3.2. Research objects 3.2.1. Research objects
- 708 students at 6 schools, including Nho Quan A High School, Ethnic Boarding High School, Binh Minh High School, Tran Hung Dao High School in Ninh Binh province, Hong Thai High School, Nguyen Binh Khiem High School in Hanoi.
- 5 homeroom teachers and 5 parents of students.
3.2.2. Objects of experimental research
The impact program will be experimented to raise the awareness of high school students about themselves, the world, the future and ways to cope with difficulties for over 60 high school students at Binh Minh High School, Kim Son District, Ninh Binh Province.
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4. Scientific hypothesis
High school students have relatively high levels of depression and mild and cognitive aspects are most evident. There are many factors related to depression in high school students, of which learning is the most related factor for depressive expression in them. If there are effective measures to raise the awareness of high school students about themselves, the world, the future and ways to cope with difficulties, it will contribute to preventing depression in high school students. 5. Research mission 5.1. Building the basic theoretical issues about depression: an overview of the study history of depression, depression, depression in high school students (concepts, manifestations and related factors, coping with depression). 5.2. Surveying and evaluating the manifestations of depression in high school students, factors related to depression in high school students and how to cope with difficulties to prevent depression in high school students. 5.3. Proposing measures and conducting experimental measures to raise the awareness of high school students about themselves, the world, the future and ways to cope with difficulties to prevent depression in high school students. 6. Limiting subjects, objects and scope of the research 6.1. Limiting research subjects
This topic only approaches the problem, focusing on research on depression
manifestations and related factors for high school students in psychology. 6.2. Objective and scope of the research
The research is conducted at 6 high schools in the province of Ninh Binh and Hanoi.
7. Approach methodology and research methods 7.1. Research methodology 7.1.1. Principles of operation 7.1.2. Principles of systematic approach 7.1.3. Principles of educational goal approach 7.1.4. Interdisciplinary principles 7.2. Research methods 7.2.1. Document research method 7.2.2 Multiple choice method 7.2.3. Survey method by questionnaire 7.2.4. Interview method 7 2.5. Case study method 7.2.6. Experimental method 7.2.7. Mathematical statistical methods 8. Contribution of the thesis 8.1. Theoretical contribution
The thesis has summarized and pointed out research directions on depression and depression in high school students, research directions on epidemiology, research directions on depression intervention therapies, research directions on coping with depression.
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The thesis has built a theoretical basis for depression in high school students, specifically: depression concept, criteria for diagnosing depression according to ICD - 10, DSM-V, the concept of depression in high school students. The thesis has also identified the symptoms of depression in high school students, and clarified the factors related to depression in high school students, how to cope with depression in high school students. 8.2. Practical contribution
The thesis shows that the rate of depressive expression in high school students is relatively high, mainly in the degree of mild depressive manifestations, and in the cognitive aspect is most pronounced. A group of male students, 12th grade and average - weak performers show more depression.
For high school students, the factors most concerned with anxiety are problems with the learning environment (relationship with peers and teachers, academic results and examination pressure). For those students with depression, the factors that are most related to anxiety are problems with personality characteristics (emotionally unstable, afraid to communicate, etc.).
High school students, especially those with depression, have a way of coping
with the problem in a negative way.
The thesis shows the positive correlation between negative perceptions about
self, the world and the future; stress factors and coping with negative thoughts.
The research also points out the effectiveness and appropriateness of impact measures to raise awareness among high school students about themselves, the world, the future and the ways to cope with difficulties are effective measures to prevent depression in high school students. 9. Thesis structure
The thesis includes the following sections: Introduction; Chapter 1: Rationale for depression in high school students, Chapter 2: Organization and research methods; Chapter 3: Research results of depression situation in high school students; conclusions and recommendations; list of published works; list of references; appendix.
Chapter 1 RATIONALE FOR DEPRESSION IN HIGH SCHOOL STUDENTS
1.1. Overview of depression research in high school students
So far, the studies on depression are quite diverse and plentiful, generalized into many different research directions. The overview of the topic is presented in three main research directions: (1) epidemiological research on depression; (2) research on depression interventions; (3) research on coping with depression. 1.2. Depression 1.2.1. Depression concept
Depression is a state of prolonged decline in physiological function, causing negative effects on life and is manifested in the cognitive, emotional, behavioral and physiological aspects of the individual
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1.2.2. Depression according to approach points of view
* Theory of distraction * Cognitive theory * Cognitive theory - behavior * Interpersonal theory * Existential humanist theory * Biological approach
1.2.3. Diagnostic criteria for depression according to ICD-10 1.2.4. Diagnostic criteria for depression according to DSM - V 1.3. Depression in high school students 1.3.1. Psychological development characteristics of high school students
According to developmental psychology, the age of high school students is in the early stage of adolescence and is often referred to as student youth. This period is from 15 to 18 years old. 1.3.2. Depression in high school students
Depression in high school students is a state of prolonged decline in psychophysiological functions, causing negative effects on life and is manifested in the cognitive, emotional, behavioral and physiological aspects of high school students.
Depression in high school students has the same symptoms as general
depression in adults and even other manifestations than adults.
* Depression in high school students expressed through cognition - Negative thoughts - Inhibition of thinking * Depression in high school students expressed through emotions - Negative emotions - Reduced interest * Depression in high school students expressed through behavior - Cowering and being isolated - Sluggishness in thinking, words and body movements - Negative behaviors: using addictive substances, having disturbing behaviors,
harassing, etc. - Suicide * Depression in high school students manifested through physiology - Sleep disorders - Eating disorder - Losing energy, reducing energy - Other manifestations accompanying: headache, back pain, nausea, etc.
1.4. Factors related to depression in high school students
- Physiological characteristics - Personality characteristics - Family and relationships in the family - Learning environment
1.5. How high school students cope with depression
Coping is the way in which individuals express their interactions with their
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respective circumstances with their own logic, meaning in people's lives and their psychic abilities.
In this research, we divide into 3 methods to cope with depression among high school students: emotional-focused coping method, thought-focused coping method, and action-focused coping method. The emotional-focused coping group of high school students has three ways of expression: internal feelings, emotional outward appearance, and emotional support. The thought-focused coping group of high school students focuses on thinking with five ways of expression: denying, accepting, explaining in a positive way, blaming situations, and evading. The action-focused coping group of high school students has 6 ways of expression: restraining themselves, replacing with negative behaviors, replacing with positive behaviors, seeking advice, planning, and coping proactively.
With the criteria of reducing stress on an individual level, the coping methods can be divided into positive methods (proactive action, positive emotions and thinking to get rid of a problem) and negative methods (negative emotions, negative thoughts and actions). Conclusion of Chapter 1
Chapter 2 RESEARCH ORGANIZATION AND METHOD
2.1. Research organization The thesis implementation takes place with the following process: 2.1.1. Phase 1: Theoretical research 2.1.2. Phase 2: Building a research toolkit 2.1.3. Phase 3: Trial survey and official survey 2.1.4. Phase 4: Assessing the results of practical surveys, writing a thesis. 2.2. Research objects and methods 2.2.1. Research area and objects
The research is conducted on 775 students and 708 valid votes are collected. The sample of the sample includes students of grades 10, 11 and 12 at 6 high schools in Ninh Binh province and Hanoi. 2.2.2. Research methods 2.2.2.1. Methods of theoretical research
Using methods of analyzing, synthesizing and systematizing the materials on
depression in high school students. 2.2.2.2. Multiple choice method
- Studying the rate, severity and expression of depression in high school
students by Beck's depression test
- Studying awareness of high school students about themselves, the world and
the future using a CTI triad scale. 2.2.2.3. Survey method by questionnaire
- Studying factors affecting depression in high school students
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- Studying ways to cope with difficulties of high school students
2.2.2.4. Interview method
Interview students, homeroom teachers and their parents about the symptoms of depression in high school students, factors related to their depression, ways to cope with their difficulties, etc. 2.2.2.5. Case study method 2.2.2.6. Experimental method
The impact program is implemented to raise awareness of high school students about themselves, the world, the future and ways to cope with difficulties in preventing depression in high school students with 3 main topics: (1) Self-awareness; (2) Career orientation; (3) Coping with difficulties. 2.2.2.7. Mathematical statistical method
In this project, we have used SPSS for Windows version 22.0 to process and
analyze research data.
Chapter 3 RESEARCH RESULTS ON THE REAL SITUATION OF DEPRESSION IN HIGH SCHOOL STUDENTS
3.1. Situation of depressive expression in high school students in the research area 3.1.1. Depression prevalence in high school students on the Beck depression scale Table 3.1. Prevalence and severity of depressive symptoms of high school
students
Expressions
No. 1 2 3 4
Quantity 566 94 41 7 708 Percentage 79,9 13,3 5,8 1,0 100 No depression Mild depression Moderate depression Severe depression Total
Table 3.1 shows that the majority (79.9%) of students participating in the research topic show no signs of depression. About 20.1% of the students show self- expression of depression at different rates. Among the students with depressive symptoms, the majority of them show mild depression, the rate of severe depression is about 1% of the total research population.
Table 3.2. Depression manifestations of high school students according to demographic and social criteria
Demographic and social groups Depression severity Moderate depression Mild depression
Gender Male Female Severe No depression depression Q’ty % Q’ty % Q’ty % Q’ty % 1,7 223 76,6 41 14,1 22 0,5 343 82,3 53 12,7 19 7,6 4,6 5 2
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Grade
6,2 4,6 6,6 7,6 193 74,8 48 18,6 16 192 80,3 32 13,4 11 14 181 85,8 14 6,6 8 83 79,0 13 12,4 1 4 2 1 0,4 1,7 0,9 1,0
4 4,8 68 81,9 10 12,0 1 1,2
School
79 66,9 26 22,0 11 7 8 9,3 6,8 4,0 2 1 2 1,7 1,0 1,0
91 91,0 6,0 3,0 6 3 0 0,0
Region
People
Learning outcomes Grade 10 Grade 11 Grade 12 Nho quan A School Ethnic Boarding High School Binh Minh School Tran Hung Dao School 80 77,7 15 14,6 Hong Thai School 165 82,9 24 12,1 Nguyen Binh Khiem School Rural areas Urban areas Kinh people Other peoples Very good Good Average/ weak 230 75,2 49 16,0 23 7,5 336 83,6 45 11,2 18 4,5 491 80,1 82 13,4 34 5,5 7 75 78,9 12 12,6 7,4 3 124 76,1 36 22,1 1,8 6,1 26 8,9 359 84,1 38 83 70,3 20 16,9 12 10,2 4 3 6 1 0 4 3 1,3 0,7 1,0 1,1 0,0 0,9 2,5
For each specific group, it can be seen that the group of male students has a higher level of depressive expression than girls (Average point = 2.07, compared to 1.30). The average point for male students is also the highest among all groups considered and presented in this table. In our opinion, it comes from the specific psychological development of students according to gender. Girls in high school age are generally more mature than boys in terms of psychology and social skills. Folk experience has summarized the “females become mature at the age of thirteen, males become mature at the age of sixteen” to refer to the development of puberty among students. It is also because of the slower growth and psychosocial maturity of boys in this age group, so they may find themselves clumsy and have less social skills than other girls. That more or less created tension, psychological disorder in the male students.
According to the school year criteria, we can see that the average level of depressive expression increases with the school year, the highest is grade 12 with the average score of depressive expression is 1.6. The cause of this situation may be related to the learning process of high school students. Grade 12 is a school year for students to worry, prepare for the final exam, the most important thing in everyone's life. Some students may be worried about stress and depression more. The academic pressure to pass the exam is also clearly shown in the average point which indicates depression according to the learning criteria.
It can be seen that students with moderate and weak academic results clearly reflect depression. It is entirely understandable that for students, learning is the most important task, academic achievement is sometimes the pride of the family. Failing to achieve high results in study is a great pressure. These not yet includes concerns about future exam results and other things.
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By location criteria, students in rural areas have higher levels of depressive expression than students in urban areas. This result is similar to previous research by Dang Hoang Minh and colleagues that the rural group has higher average scores than the urban groups and the ones living near urban areas on the anxiety/depression scale, which may be a risk factor for anxiety/depression. Also according to this study, there is a significant interaction between family income and anxiety/depression, the higher the family income, the less anxiety/depression the child has. The income of rural families is less than that of the cities, they have to spend more time making a living, so they are less interested in their children and do not create good conditions for their children as families in urban areas. Therefore, rural students are at higher risk of depression than students in urban areas. On the other hand, when interviewing teachers of Binh Minh School, it is known that many families of students of the school have low income, parents have to work far away from home, do not come home often; as a result, they do not have much time to care for their children. This is also one of the reasons for the high rate of depressive expression at this school. 3.1.2. Manifestations of depression in high school students 3.1.2.1. Expression of depression in high school students according to results of Beck scale Table 3.3. Beck depression results according to the expression
Expressions DLC
Average score of the group with depression (N=142) 1,16 0,84 0,80 0,71 0,65 0,63 0,72 0,30
Average general point of awareness Average general point of emotions Average general point of behavior Average general point of physiological characterisitcs
Of the total of 21 manifestations, self-criticism has the highest average point, followed by Past Failures and Feeling Guilty. All three manifestations are in the cognitive group.
On the other hand, the items with the lowest scores are in physiological and behavioral categories. Manifestations of Loss of sexual interest and Feeling difficult to focus on something are the manifestations with lowest average point. Suicide is also a sign of low average point. In general, this is a positive point and shows that dangerous manifestations such as self-harm or suicide are not high.
Regarding the expression groups, we can see that the group with average point is much higher than the remaining groups. This is reflected in the depressive manifestations of students participating in this research topic, the cognitive side is the most “problematic” in the given aspects. The results also confirm that the subject continues to use the CTI scale of the three cognitive sets. 3.1.2.2. Depression manifestations in high school students according to the results of the CTI cognitive scale
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Table 3.4. Perceptions of self, the world, and the future in students with depression
Content Indicators DLC Average point Average general point
3.15
Perceptions of self
4.34
2.75 3.23 3.57 4.15 5.06 3.91 4.12 4.23 4.02 4.93 3.26 3.59 3.91 1.63 1.47 1.36 1.25 1.37 1.46 1.15 1.27 1.39 1.30 1.31 1.26 1.46
3.54 3.86 1.64
3.10 1.51
Opinions about the world
3.97 4.35 3.32 1.53 1.38 1.43 4.18
4.47 1.51
4.79 1.45
3.31 1.41
3.83 1.49
3.34 1.35 3.23
2.93 1.28
2.76 1.44
Opinions about the future 3.14 1.29
4.86 1.42
3.80
3.69 3.77 1.42 1.30
3.54 1.31 17. I feel I have full things like other people 25. I can do many things well 33. I like myself 31. I am a person of no worth 5. I am a failure 10. I have messed up my important relationships 13. I cannot do anything right 21. I hate myself 29. I feel guilty about many things 35. I have many weaknesses in my personality 3. Almost everyone is friendly and helpful 8. Acquaintances often help me when I need them 12. My daily activities are fun and rewarding 20. People who are important to me often help and support me 24. I have friends or relatives who always help and support me. 18. The world is a place full of hostility 23. Too many bad things happen to me 27. My family does not care what happens to me 30. Other people often make it difficult for me to do anything 34. I have to face so many difficulties 6. I like to think about the good things that await me 9. I expect everything to be going well for me in the next few years 11. The future for me is full of interesting things 28. There are good things to come to me in the future 36. I hope that I will be as satisfied and comfortable as the last time 15. My life has nothing to look forward to 16. Problems and worries always happen to me. one way or another 19. There is no reason for me to hope for the future 26. My future is simply all bad 32. There is nothing for me to look forward to in the future
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Table 3.4 shows that in all 3 aspects, the positive and positive manifestations have overall GPA lower than the negative and negative manifestations. Comparing the three manifestations sides (themselves, the world and the future) in the CTI scale of 142 students mentioned above, it can be seen that the concept of self-esteem of the students is the most negative expression. That reflects that they have relatively negative self-esteem. Among the positive items of the opinion group, the item with the lowest score is 17 “I feel I have full things like other people” (Average Point = 2.75, at the level of “disagree”). This shows that students feel self-centered and self- disadvantaged compared to those around them. Similarly, item number 25 “I can do many things well” has the Average Point of 3.23. This low point shows that the students underestimate their abilities, not believing they can do their job well. From this result, it can be seen that in negative items about yourself, the high average point is understandable. The item with the highest score on the whole CTI scale also falls into the group of views about self and in the negative direction, item number 5 “I am a failure” (Average Point = 5.06).
Their views on the future are also important because high school students are in the future. A table of results from a perspective of the future of 142 students showed that neither positive nor negative views about the future had high results. Positive items, showing a positive view of the future, do not have a high average point (Average Point = 3.23); on the contrary, the items show a pessimistic attitude, not confident in the future of themselves nor expressing a negative attitude as clearly as the two perspectives on themselves and the world (Average Point = 3.8). In our opinion, this may be related to the fact that students are all young with bright future, they still expect positive results, assert themselves more clearly.
In order to provide a clearer view, we calculate both positive and negative results in both study groups including the non-depressed group (566 students) and the depressed group (142 students). The table of data is as follows:
Group
Table 3.5. The average score of both positive and negative sides in both groups Negative No. average point 2.59 Positive average point 5.79 1
The above summary table shows a clearer view of views about self, the world and the future in two groups of students. If the non-depressed group all agree with positive, optimistic views and disagree with negative and pessimistic expressions, the depressed group on the Beck scale tends to disagree with positive statements and more agree with negative statements. On the other hand, in the Beck Depression scale, the signs of depression in students are not too clear. In other words, the depressive symptoms of students are not serious. Maybe it comes from the excessive anxiety, the embarrassment, the difficulties in the pressure of study, the life of adolescence but not the pathological level, which makes students can have extreme behaviors such as suicidal intentions or views, a completely false view of yourself, the world and the future.
2 3.30 4.10 Non-depressed group (N = 566) Group with depression on the Beck scale (N = 142)
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Table 3.6. Awareness of self, the world and the future of students with
depression according to the levels
Depression manifestations (Beck) Content Indicators
Mild Moderate Severe
17. I feel I have full things like other people 3.14 2.17 2.04
25. I can do many things well 3.62 2.65 2.62
33. I like myself 4.15 2.81 2.83
31. I am a person of no worth 3.84 4.52 4.64
5. I am a failure 3.69 5.54 5.78
Perceptions of self 10. I have messed up my important relationships 3.71 4.23 4.30
13. I cannot do anything right 3.39 4.85 4.91
21. I hate myself 3.05 5.57 5.87
29. I feel guilty about many things 3.82 4.30 4.40
35. I have many weaknesses in my personality 4.34 5.83 5.89
2.24 2.19
2.94 2.80
3.83 3.62
3.02 2.90
4.51 2.42 2.40
3. Almost everyone is friendly and helpful 4.02 8. Acquaintances often help me when I need them 4.24 12. My daily activities are fun and rewarding 3.96 20. People who are important to me often 4.54 help and support me 24. I have friends or relatives who always help and support me. 18. The world is a place full of hostility Opinions about the world 3.84 4.23 4.37
23. Too many bad things happen to me 3.79 4.93 5.04
27. My family does not care what happens to me 3.05 381 3.88
3.44 5.64 5.89
30. Other people often make it difficult for me to do anything 34. I have to face so many difficulties 4.35 5.87 5.92
4.22 2.92 2.80
4.46 3.05 2.91
4.22 2.15 2.11
Opinions about the future 3.98 1.96 2.05
3.75 1.73 1.62 6. I like to think about the good things that await me 9. I expect everything to be going well for me in the next few years 11. The future for me is full of interesting things 28. There are good things to come to me in the future 36. I hope that I will be as satisfied and comfortable as the last time
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Depression manifestations (Beck) Content Indicators
Mild Moderate Severe
15. My life has nothing to look forward to 2.75 3.57 3.71
4.34 5.29 5.38
3.32 3.97 4.15
16. Problems and worries always happen to me. one way or another 19. There is no reason for me to hope for the future 26. My future is simply all bad 2.84 4.25 4.48
2.79 4.52 4.69 32. There is nothing for me to look forward to in the future
The aforementioned table shows a clear trend that the greater the degree of depression, the more negative the awareness about yourself, the world and the future is. From another perspective, one can also say that negative perceptions about oneself, the world, and the future exacerbate the depression of students. 3.2. Factors related to depression in high school students
Table 3.7. Assessment of students with anxiety-related factors (N=566)
Factors
Learning environment Family environment Physiological characteristics Personality characteristics Average point 2.53 2.30 2.38 2.47
Table 3.7 shows that learning environment is the most influential factors for students' stress and anxiety (N = 566) with an average point of 2.53, followed by personality characteristics 2.47; physiological characteristics 2.38 and family environment 2.30.
It can be said that the issues related to learning are the most influential factors for the anxiety and stress of students. This is indispensable because during the period of sitting on the school chair, the main activity of students is studying. That regulates the social relationships, anxiety or satisfaction of students in general. Whether other people judge whether they are positive or not, or whether they are confident or optimistic depends much on their learning.
The group with the second highest average point is the students' personality factor. The items in this group are quite similar in terms of average point, ranging from 2.3 to 2.6. These items are their personalities, but they are also placed in relationships with other people such as “afraid to communicate”, “lack of confidence, timidity”. Thus we see the relevance in evaluating the factors that make students nervous. Because of this, physiological characteristics such as “body development” or “appearance of inferiority” are also factors that make students feel anxious.
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Table 3.8. Assessment of students with depression on anxiety-related factors (N=142)
Factors
Learning environment Family environment Physiological characteristics Personality characteristics Average point 2,74 2,60 2,70 2,91
From the above data table, it can be commented that: The average point of the study, family, physiology and personality in the group showing depression is higher than the group without depression. It is entirely understandable that this data sheet is from students who show depression on the Beck scale.
Throught the comparison between 04 groups of factors, it can be seen that if in the non-depressed group, learning is the factor that causes students the most stresssed, the group with depressive expression and personality is what makes them worried and stressful. Among items belonging to personality characteristics group, “unstable emotion” is the item with the highest anxiety score (Average point = 3.14). This shows that besides the objective factors such as learning, family, student's personality is also an important factor that makes them worried, stressed and depressed. The second most important factor is learning. This we have analyzed in the previous sections. From these two factors, we can see the same difficulties and pressures in learning, but it is possible that their personalities, their excessive anxiety are the factors that put them under stress, more or less.
Table 3.9. Assessment of students with depression about anxiety related factors according to levels (N = 142)
Factors Indicators
Learning environment
Depression Mild Moderate Severe 2.42 2.07 2.35 2.11 2.63 2.27 2.57 2.13 2.39 2.01 3.22 2.89 2.72 3.27 2.65 3.17 2.68 3.18 2.79 3.43 2.69 3.28 2.14 2.02 2.34 2.29 2.16 2.67 3.30 3.35 3.34 3.52 3.40
Too much homework Academic results are not as expected Learning time is overloaded Pressure of examination Pressure for future career orientation Pressure to pass a university entrance exam Conflict with peers Isolated by peers Conflict with teachers or scare teachers No friends or very few friends Difficulties in relations with the opposite sex Difficult in love 2.70 3.12 3.13
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Factors Indicators
Family
Physiological characteristics
Personality characteristics
Depression Mild Moderate Severe Their parents are divorced. separated 2.30 2.45 Family discord. conflict 2.48 2.72 Relatives in family lost 1.73 1.82 Family economy is difficult 2.11 2.14 Parents have too much expectation on them 3.18 2.63 Parents do not understand them 2.73 3.35 2.74 3.47 Parents often compare them with others The family's accommodation is not stable 2.06 2.38 2.65 3.31 Parents do not care about them 2.88 3.47 Conflicts with parents 2.59 2.75 Body fatigue. inability to function 2.66 2.87 Body development 2.40 2.57 The health is not good 2.50 3.73 Easy to be impulsive. hard to control myself 2.59 2.81 Not confident about appearance 2.88 3.69 Emotions are not stable 2.77 3.24 Lack of confidence. shyness. or shyness 2.81 3.29 Stupid communication 2.46 3.35 See life in a negative way 2.58 3.52 Vulnerable 2.36 2.81 1.69 1.60 2.60 3.41 3.51 2.24 3.47 3.29 2.86 2.91 2.43 3.69 2.77 3.84 3.19 3.27 3.57 3.64
The aforementioned table further clarifies stress-causing factors in 142 students according to depression levels. The results point out that the overall trend is that the higher the score on the Beck scale (the tendency to exacerbate depression), the higher the score on the factors that cause them anxiety.
Looking at the stress groups and depression levels on the Beck scale, we can see that the group of students with mild and moderate depression has higher results in factors such as learning, exams; meanwhile, the group with severe depression has higher scores in personality and physiological characteristics. This result does not mean that we blame the students but only to point out the factors that affect them and point out the way for them as well as the school and family to support them to cope with difficulties and adjust themselves in work and life. In fact, as we have previously analyzed, with the same stressful factors as learning or friendships, some students are less stressed, even solve problems well. 3.3. Ways to cope with difficulties for high school students
In order to best compare the coping ability of the two groups of depressed and non-depressed students, we handle the average points of these two groups separately by using the “select case” function in the SPSS software.
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Table 3.10. Average point about the coping ability of high school students
Coping group
Coping with the focus on emotions
Coping with the focus on thinking
Coping with the focus on behavior Average point of students without depression (N=566) 2.38 2.48 1.94 2.44 2.04 2.67 Average point of students with depression (N142) 2.17 2.52 2.02 2.57 2.03 2.84 Positive Negative Positive Negative Positive Negative
In general, students with no signs of depression on the Beck scale have better coping strategies than students with depression. It shows how to deal with stress as both a manifestation of anxiety and depression, but at the same time it can also cause students to fall into a state of psychological crisis or depression.
Between positive and negative coping ways, in general, both groups of students show a clearer negative coping way with the higher average point compared to than a positive coping way. Obviously, between the ages of 16 and 18, life skills, maturity in thinking, actions, life experiences are not many. Students’ ways to cope with difficulties are limited. From this perspective, it is possible to see the important role of training, forming students with coping skills in life, not letting them fall into difficulties, anxious to look for applications. A negative coping way makes the anxiety unresolved but sometimes the consequences are even greater.
Emotion-focused coping ways among high school students with depression: their negative coping ways are most pronounced on the inner surfaces with high agreement on items that no longer believe in themselves (3.21) and the world seems to collapse (3.24). This shows that for students with depression lack the sharing, positive emotional support (positive coping items have low results) and they face difficulties in expressing themselves, are pessimistic about the future and have low self-esteem. We calculated the correlation coefficient between item 3 (I no longer believe in myself and life) in the question about coping with problems with item 5 (I am a failure), item 21 (I hate myself) and item 35 (I have many weaknesses in my personality) on the question of the CTI cognitive trio and the correlation coefficient results of these items are as follows:
Table 3.11. Correlation between emotional items about self
Item 3, coping
Pearson Correlation Sig. (2-tailed) N Item 3, coping 1 142 Item 5, CTI Item 21, CTI Item 35, CTI ,524** ,000 142 ,655** ,002 142 ,561** ,000 142
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The results in the table above show that the questions are all strongly correlated with each other. It reflects the unity in negative self-esteem as well as how to cope with depression negatively emotionally. This result also shows the need to help students have a positive self-esteem, helping them to discover their potentials so that they can confidently develop in their lives in the future.
Thingking-focused coping ways among high school students with depression: the group of items with the highest average point is the response to blame on objective circumstances. When faced with difficulties and worries, if there is a positive outlook, students can see it as an experience to be more stable in life, accepting their abilities. There are things that can be done or cannot be done. Blaming on the situation will prevent students from seeing themselves clearly and drawing experiences in life to continue training themselves. Among the items of this coping group, item No. 27 (no one wants to help me) obtains the highest approval from students with depression. While in the emotion-focused coping ways, students show a lack of confidence in themselves, have negative feelings about themselves, they seem to be inclined to isolate themselves and consider themselves abandoned. Here, once again, we see the support and assistance for disadvantaged and depressed students who need the participation of many people and many social groups so that they can feel the sincere care and support from people around.
Table 3.12. Coping manifestations of students based on levels of depressive expression
Coping group
Negative Mild depression 2.65 Moderate depression 2.76 Severe depression 2.75
Negative 2.34 2.43 2.47
2.31 1.71 1.74 Feeling inside Showing affection outside Search for emotional support Positive
Negative Positive 2.43 2.29 2.87 2.18 2.95 2.13
Positive 1.91 1.46 1.42
Negative 2.75 2.87 2.90
2.28 2.11 2.65 2.34 2.59 2.41
Negative 3.39 3.63 3.51
Coping with the focus on emotions Coping with the focus on thinking Coping with the focus on behavior Coping with the focus on emotions Coping with the focus on thinking Positive 1.82 1.61 1.57
Positive Positive 2.58 1.99 2.19 1.83 2.10 1.80
Positive 1.94 1.87 1.86 Deny Accept Explain in a positive way Blame on the situation Negative Evade Control themselves Negative Replace with negative behaviors Replace with positive behaviors Seek advice Make plans Cope with difficulties actively
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The table compares the coping ways of the three groups according to the level of depressive showing that students with milder levels of depression express better coping ways. This is reflected in the higher point with more positive and less negative coping ways in studnets with mild depression than those in severe depression. This trend is almost evident in all items.
In addition, in order to have a better insight into the response of depressed students on the Beck scale, we continue to analyze the correlation between the following contents:
- Stress factors (item C1-HT4 (test pressure, examinations), C1 - GDD9 (Parents
do not care) and C1 - NC4 (Look at life negatively)
- Coping with negative thoughts, including item 27 (no one wants to help you)
and item 28 (due to circumstances like that)
- Perception of the future and the world on the CTI scale, including: item 16 (the trouble that always happens to me), item 23 (too many bad things happen to me) and item 27 (my family doesn't care about what happened to me).
The correlation coefficient results of these contents are as follows:
Table 3.13. Correlation between factors causing anxiety, coping with negative thoughts and negative perceptions about the world and the future
Correlations
World
Future - 16 World -23 -27 C2_27 C2_28 C1_HT4 C1_GĐ9 C1_NC4
1 .716** .588** .464** .552** .475** .538** .785***
Future -16
142 .000 142 .028 142 .033 .003 142 142 .037 142 .001 142 .027 142
.716** 1 .569** .449** .630** .694** .696** .724**
World -23
.000 142 142 .006 142 .005 .003 142 142 .026 142 .020 142 .041 142
.588** .569** 1 .773** .509** -.029** .517** .571**
World -27
.028 142 .006 142 142 .001 .008 142 142 .032 142 .041 142 .040 142
.464** .449** .773** 1 .534** .652** .781** .431**
C2_27
.033 142 .003 142 .001 142 .000 142 142 .001 142 .040 142 .016 142
.552** .630** .509** .534** 1 -.242 .544** .624**
C2_28
Pearson Correlation Sig. (2-tailed) N Pearson Correlation Sig. (2-tailed) N Pearson Correlation Sig. (2-tailed) N Pearson Correlation Sig. (2-tailed) N Pearson Correlation Sig. (2-tailed) N .003 142 .005 142 .008 142 .000 142 142 .117 142 .027 142 .034 142
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The above table shows the positive and relatively strong relationship between items. In other words, with 142 students with depression, stress factors related to school pressures, disinterested parents and personality characteristics, views on the world and the future are still negative when students find it difficult or stuck.
The results show us the need to help students firstly realize the advantages and disadvantages in life so that they have no superficial view of life in general and do not blame on the situation, recognize themselves, analyze their abilities and requirements of life, work to know how to handle difficulties in the best way. Only on the basis of their own awareness can they help "cut off" difficulties that they are facing.
If on the Beck scale we see 142 students showing signs of depression and the cognitive side is what they clearly show their difficulties and stress, then in the questionnaire about coping with difficulties as mentioned above continue to show their thoughts about the world, the future with many "problems". They tend to blame the situation, feel lonely, etc. That may stem from the psychological characteristics of their age: they are young and their perception of themselves, perceptions gender and the situation in general are not really profound. The results of this research also once again show us which facial expressions are the weakest when they have to cope with difficulties and stress.
Behavior-focused coping ways in groups with depression: The results of the above-mentioned depressive students indicate that when they are worried or stressed, they are less likely to have positive behaviors such as interacting with friends, reading books, playing sports but focus much on negative behaviors. From the perspective of specific items, the item with the highest average point is item 39 (I run away from home; I am not at my home often; I often sleep at other people's homes -Average point is 3.81). In their teenage years, students may leave their houses for a short time and then then return out of self-esteem. However at high school age when their social friendships have become wider, leaving home can last for days and be accompanied by risks and draws of bad achievements. Obviously, when happy or sad, everyone needs to share. The fact that students with different levels of depression choose to leave their homes shows their relationship with family members may not be good. 3.4. Case study analysis 3.5. Experimental results
Table 3.14. Depression expression of high school students participating in experiments in two groups on the Beck scale Control group
No. Depression Experimental group After Before experiment experiment After experiment
1 Not depressed 2 Mild 3 Moderate 4 Severe
Before experiment Q’ty % Q’ty % Q’ty % Q’ty % 56,6 15 26,6 10 13,3 4 3,3 1 100 30 50 33,3 13,3 3,3 100 50 36,6 10,0 3,3 100 50 33,3 13,3 3,3 100 15 10 4 1 30 15 11 3 1 30 17 8 4 1 30 Total
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though
Table 3.14 shows that there is not much difference in depression level on the two measurements by the Beck scale. There are some positive changes, such as a decrease in the number of moderate depression (control group) and a decrease in the number of mild depression (experimental group) but this is a change in both groups. In our opinion, that comes from the fact that depression is a state of prolonged decline, so some experiments are conducted even teachers and experimenters have really tried to organize and convey the positive but not yet effective psychological content with the group of depressed students. However, compared to the first meeting session, the students participating in the experiment are more open, more comfortable, the signs of pressure in learning, family, friends, life in general seem less.
Below are the results of evaluation of perceptions of self, opinions about the
world and the future in two experimental groups on the CTI scale.
Table 3.15. Perceptions of self, opinions about the world and the future in two experimental groups on a CTI scale
Experimental group (N=30)
Item After experiment
Perceptions of self Opinions about the world Opinions about the future Control group (N=30) Before After Before experiment experiment experiment Average point Average point Average point Average point 4.37 4.32 3.71 3.67 4.31 4.33 3.72 3.48 5.46 5.39 2.80 2.77 4.83 3.08 5.00 3.21 5.54 2.32 4.37 3.61 4.31 3.44 5.32 2.86
Table 3.15 confirms the clear difference in the group of 30 students participating in the experiment. If the previous data sheet showed that the difference in the rate of depressed students was not much (reducing 02 students with mild depression, other levels did not change), this data table shows that after participating In the course of experiments, the students had a more positive view of themselves, the world and the future. This is reflected in the fact that the positive item groups all have a higher average point and negative items about themselves, the world and the future have a decreased average point. This is also evident in the empirical sessions, from appreciating your weaknesses and downplaying your strengths to being more appreciative of yourself, focusing on positive things and promote their strengths.
On the other hand, 20/36 items on the CTI scale show t - test p ≤ 0.05, confirming the statistically significant difference between the two before and after experiments. For specific figures, please see the appendix. The results show the positive effects of the content that we conduct experiments on students.
Besides perceptions of self, opinions about the world and the future, the way to cope with difficulties of high school students is also an important content that we are interested in in the experiment process. The comparison results before and after the experiment of the two groups on this issue showed better response to the difficulties
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of the experimental group than the control group. This is reflected in the fact that most of the positive response items have higher scores in the experimental group and the items that show negative responses in the experimental group have the results decreased. The results reflect the positive effect of the experimental program for students of the 39/56 item response group in the above data table with the test results of t-test p ≤ 0.05 proving the difference. There are significant differences in the response before and after the students' experimental participation.
Comparing the group of response items, it can be seen that the group of items related to the actual response behavior has the most positive results, showing the clearest change in the students after participating in the experiment. For example, item 37 (using addictive substances such as alcohol, tobacco, sedatives, etc.) shows the average point decreased from 3.85 to 2.83; item 38 (fighting) shows the average point decreased from 3.29 to 2.53; item 39 (running away from home) shows the average point decreased from 3.97 to 3.13. In the opposite direction, items that exhibit positive coping behaviors have an average increase of points, typically as item 42 (said to feel more comfortable), 1.50 - 2.53; item 46 (talk to someone who can do something for you), 2.00 - 2.86. The results show that the positive response behaviors and the sharing of difficulties were used more by the experimental students.
In addition, the table of experimental results also shows a few results contrary to the general trend. For example, the negative behavior group shows self-restraint (item 33 - 36) whose average score does not change significantly, even the negative behavior in this group has the following higher results, such as item 33 (try not to be too sad) with the average score of 1.62 - 2.03, p = 0.003. In our opinion, this does not show negative results but shows that students have more control over their emotions and behaviors. This shows students have more control over their problems. The fact that they try to control their emotions, avoid outrageous behaviors and wait for the right time to explain to people is clearly behaviors showing maturity, "choosing words" in behaviors as well as show their feelings.
CONCLUSION AND RECOMMENDATIONS
1. Conclusion
Through studying the depression topic in high school students, we draw the
following conclusions: 1.1. Theory
Depression in high school students is a state of prolonged decline, causing negative effects on life and is manifested in the cognitive, emotional, behavioral and physiological aspects of high school students.
Depression in high school students is manifested through cognitive, emotional, behavioral and physiological aspects. The cognitive manifestation is that students have negative thoughts and inhibit thinking. The emotional manifestation is that they may have negative emotions, reduce interest, or be irritable. The behavioral manifestation in students is that they make themselves insolated, pay little attention to
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the surrounding activities. There may be behavioral disorders such as harassment, opposition, theft, etc. The physiological manifestations are sleep disorders, eating disorders, fatigue, feeling powerless even though not doing much. Individuals also have a number of accompanying body signs such as headache, back pain, cramps, nausea, vomiting, constipation, rapid breathing, deep breathing, chest pain. With developmental characteristics at high school age, in addition to general expressions, depressive symptoms at this age also have different characteristics compared to adults: Body manifestations (especially pain), mood of depression (especially anger); reduce interest in learning; difficulty in paying attention, difficulty in absorbing the knowledge, bad learning results; paying little attention to the activities around, people around them; behavioral disorders, such as harassment, anti-social, etc. There are often other accompanying manifestations, such as behavioral disorders, anxiety disorders, disorders of social relationships, affected learning results, etc.
There are many factors related to depression in high school students such as learning environment, family, age physiological characteristics, personality characteristics. Coping is the way in which individuals express their interactions with their respective circumstances with their own logic, meaning in people's lives and their psychic abilities. There are 3 ways to cope with difficulties of high school students: focusing on emotions (feelings inside, emotions expressing out and seeking emotional support), responses focusing on thinking (denying, accepting, explaining in a positive way, blaming the situation and evading) and responding to action (restraining yourself, replacing with negative behaviors, replacing with negative behavior, replacing with positive behavior, seeking advice, proactive planning and coping). 1.2. Reality
With using the Beck depressive scale on 708 students in two provinces, Hanoi and Ninh Binh, the results show that 20.1% of the students have depressive symptoms. Most of them have mild depression. The depressive expression on the cognitive aspect is the most obvious. The group of male students, seniors, and students with average and weak grade points show depression more.
The factors related to anxiety and stress of high school students are the learning environment, in which the group of social relationships in the learning environment makes students feel the most worried. For students who exhibit depression, personality characteristics are most related to depression, in which, unstable emotions make them most nervous and stressed.
Students who do not show signs of depression have better ways to cope with difficulties and anxiety than students with depression. Comparing both positive and negative responses, in general, both groups of students showed better negative responses. Emotion-focused coping ways in high school students with depression: their negative coping ways are most pronounced in their internal feelings (no longer believe in themselves and the world seems to collapse). Thinking-focused coping ways in high school students with depression: students who exhibit depression often blame on the most objective situations. Behavior-focused coping ways in high school students with depression: students focus more on negative behaviors. Students with a lower level of depressive expression demonstrate better coping strategies. There is a positive
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correlation between negative perceptions about yourself, the world, and the future; factors causing stress and coping with negative thinking in high school students. 1.3. Experiment
The experimental results have shown that students participating in the experiment have shown more positive results than the control group. This effect is most evident in the group of students with scores close to mild depression and those with mild depression, near non-depression levels. For depressed students, in addition to the psychological support programs like other students, they need to get more support and intervention of psychologists, first of all school psychologists, followed by depression psychologists. 2. Recommendations 2.1. Schools and high school teachers
+ Creating a learning environment, classroom atmosphere, the relationship of teachers with students closer and more friendly; avoiding letting students feel insecure when communicating with teachers and friends.
+ Paying more attention to students not only in terms of academic ability but also anxiety, stress in life and study; organizing counseling rooms/departments, psychological support for students. In fact, this model as we mentioned has shown that schools that have psychological counseling rooms for students, the rate of anxiety and depression in that school decreases.
+ Developing programs, organize career counseling sessions, help students explore their abilities, knowledge about the world of careers, requirements of the career type, labor market. Activities This activity is really useful to help students confidently assess the future and be motivated to strive more in study and practice.
+ When there are students showing signs of depression, teachers should be more interested in sharing, helping them more, advising and referring them to depressive psychologists for effective assistance. 2.2. Student families
+ Family is the first foundation, a home for everyone. Our research results show that parents, especially in students who show signs of psychological disturbance such as anxiety, opposition, and needlessness. It is necessary to have more coordination with schools and parents. They should care more about students, discuss more with students more regularly, be good friends with students to guide students to useful and healthy activities.
+ The expectation of parents to the maturity, study of children is normal. However, it takes dexterity for the interest and expectations that turn into a motivation for the children to study, not into psychological pressure, the burden that makes them lose their confidence and blame themselves.
+ When you see children showing signs of depression, they need to share, confide and care more about them, take them to prestigious psychological centers for the effective support of psychologists specializing in depression. 2.3. Students themselves
+ In terms of awareness, it is necessary to clearly identify students who are the subject of the process of learning, training and participating in social relationships.
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The students are strong both in physical and psychological health, many dreams. Therefore, they need to confidently promote themselves, train themselves to become more and more mature in communication, work and study skills. The confusion that may be present at this stage is perfectly normal, and you may recognize it to further improve yourself.
+ In terms of emotions, attitudes: The optimism of the youth, the attitude towards themselves, the world and their future is the spiritual foundation that determines the direction for their lives in the future. The difficulties and psychological disturbances of students can be shared with teachers, friends, family in an open and sincere way to solve together, not to let themselves fall into a lonely state.
+ Behavioral aspects: In addition to the effort in learning, students need to look forward to behaviors that respond to difficulties in a healthy way such as playing sports, cultural and artistic exchanges. Non-standard behaviors such as drinking, smoking, and violence should be avoided. It can be said that the success of their lives is decided by themselves. Therefore, choosing for yourself how to express, proper attitude in communication and trying to overcome your limitations, train, cultivate the qualities and competencies forte to prepare for the future. Future hybrid is needed.
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LIST OF PUBLISHED WORKS OF THE AUTHOR RELATED TO THE THESIS TOPIC
1.
Tran Thi My Luong, Phan Dieu Mai (2019), "Depression situation in high school students studying in Ninh Binh province and Hanoi city", Journal of Education, Special issue monthly 4/2019, p 146-150.
2.
Phan Dieu Mai (2019), "Coping with difficulties of depressed high school students", Journal of Social Psychology, Number 4 April 2019, pp 137-143.
(2019), "Some theoretical 3.
issues about depression Phan Dieu Mai manifestations in high school students", Journal of Education, No. 454, May 2, 2019, pages 25-29.
4.
Phan Dieu Mai (2019), "Factors affecting depression in high school students", Journal of Social Psychology, No. 5 of May 2019, pp 54-61.
