In the therapy room, it can be challenging to pinpoint the actual causes of depression. Nonetheless, it’s intriguing and relevant to explore what young people themselves believe are the root causes of their depression. Equally valuable is considering parents' perspectives, as adolescents and their parents often have differing views on the origins of the adolescent's depression.

At Leiden University, my colleagues and I interviewed 34 adolescents (aged 12–18) diagnosed with clinical depression and their 60 parents—26 of whom were fathers. Families spent a day in our research facilities participating in the RE-PAIR study. At the end of the day, we conducted one-on-one interviews, during which we asked what both the adolescents and their parents perceived as the causes of the young person’s depression.

I remain deeply impressed by the commitment of these young people. Their depression manifested in various symptoms, including mood swings, sleep issues, and concentration difficulties, making participation in research particularly challenging. Despite this, most were able to articulate their insights openly and thoughtfully. For some, this proved more difficult, so after posing an open-ended question, we used a "causes card," a tool listing risk factors for depression based on prior research. Adolescents who initially struggled to identify causes became more engaged with the help of this card.

The discussions with parents were equally enlightening. Their child’s depression was a sensitive subject, often bringing tears to the surface. Many parents expressed feelings of despair and seemed to appreciate that someone was listening to their experiences with genuine curiosity. Parents were generally quite capable of articulating their thoughts on the matter.

A wide range of causes

Among the top five most frequently mentioned themes by both adolescents and parents were social factors (such as bullying), characteristics of the child (such as worry or sensitivity), and stressful experiences (such as parental divorce or social distancing during COVID-19). While the most commonly cited themes aligned between the two groups, this did not necessarily mean that adolescents and parents in the same family shared the same views. For instance, 13 adolescents mentioned a single traumatic event (such as sexual assault) as a cause of their depression, but in half of these cases, the parents did not raise this issue.

Parents’ insights into their child's perspective

We also asked parents during the interview, "What do you think your child identifies as the causes of their depression?" We compared the themes parents mentioned with those cited by their child. Parents had a moderate understanding of their child’s beliefs, meaning that when a parent mentioned a particular theme, their child often cited the same one. However, it was also common for adolescents to name a theme that their parents had not anticipated, suggesting that parents might not always be fully aware of certain issues or their impact.

The most frequently mentioned theme by adolescents was social factors, such as a lack of friends or being bullied. This was also the theme where we saw the greatest overlap and accuracy within families, meaning both adolescents and parents raised this issue, and parents accurately predicted that their child would mention it. These social experiences appear to be something adolescents already discuss with their parents, and parents recognise the impact these factors have on their child’s well-being. However, there is room for improvement in communication about other themes.

Implications for clinical practice

Our research has yielded three practical implications for clinical practice:

1. Each adolescent holds a personal set of beliefs about the causes of their depression, which may differ significantly from those of their parents. It is valuable to explore the beliefs of both the young person and their parents to gain more insight into the factors at play in the adolescent’s life and to assess family dynamics.
2. Many causal beliefs revolve around stressful experiences. Around a quarter of the adolescents reported feeling overwhelmed by an accumulation of such experiences. These young people may benefit from professional support in processing these events. Parents could also play a supportive role in this process.
3. A structured approach to exploring thoughts about the causes of depression can provide additional insights. We recommend interviewing adolescents and parents separately, starting with an open question on the subject, then using a "causes card" to guide the discussion, and finally asking which factors are viewed as causes and which are seen as perpetuating factors.

About the study

This research is part of the NWO Vici project RE-PAIR: Unravelling the Impact of Emotional Maltreatment on the Developing Brain, conducted by the Department of Clinical Psychology at Leiden University, led by Professor Bernet Elzinga. The full, peer-reviewed paper A qualitative, multi-perspective study on causal beliefs about adolescent depression is open access. For more information and publications from RE-PAIR, please visit our website.