STRESS, BULLYING, CORTISOL, AND DEPRESSIVE SYMPTOMS IN 9 GRADE ADOLESCENTS ...

388 Pages·2015·2.38 MB·English

by  Windows User

STRESS, BULLYING, CORTISOL, AND DEPRESSIVE SYMPTOMS
IN 9TH GRADE ADOLESCENTS

by

SUSAN G. WILLIAMS

ANNE TURNER-HENSON, COMMITTEE CHAIR
ANDRES AZUERO
LUCRECIA COLLINS
TEENA MCGUINNESS
JENNIFER LANGHINRICHSEN-ROHLING

A DISSERTATION
Submitted to the graduate faculty of the University of Alabama at Birmingham
in partial fulfillment of the requirements for the degree of
Doctor of Philosophy

BIRMINGHAM, Alabama

2015
Copyright by
Susan G. Williams
2015
STRESS, BULLYING, CORTISOL, AND DEPRESSIVE SYMPTOMS
IN 9TH GRADE ADOLESCENTS

SUSAN G. WILLIAMS

UNIVERSITY OF ALABAMA AT BIRMINGHAM
SCHOOL OF NURSING PHD PROGRAM

ABSTRACT
Stress and bullying are known contributors to depressive symptoms in
adolescents. Prevalence of depressive symptoms in adolescents is estimated to range from
13% to 34% in recent studies. Ninth graders are in a transitional period developmentally,
biologically, physically, and psychosocially. Few studies have examined the relationship
between stress, bullying, and depressive symptoms from a biobehavioral perspective in
9th graders. The purpose of this study was to examine stress, bullying, and depressive
symptoms including a biomarker of stress, salivary cortisol diurnal rhythm, to determine
if there is mediation between the individual variables of stressful life events, perceived
stress, bullying, and depressive symptoms. The theoretical framework was McEwen’s
Theory of Allostatic Load.
A convenience sample of 9th graders (n = 143), was recruited from two high
schools in a Southern state. Saliva specimens for cortisol were collected in the morning
and afternoon. After collection of the morning saliva sample, adolescents completed
online surveys, including the Center for Epidemiologic Studies Depression Survey-10,
Perceived Stress Scale-10, Personal Experiences Checklist, and Self Rating Scale for
Pubertal Development. An afternoon saliva sample was collected, and adolescents’
completed the Coddington Life Event Scale-Adolescents by paper and pencil.
iii
Adolescents scoring > 9 on the depression survey (clinically significant depressive
symptoms) were referred to the school nurse.
Approximately 40% of adolescents scored 10-30 or clinically meaningful
depressive symptoms. Stressful life events ranged from 0-79 events in one year. Life
change unit scores ranged from 0-1691 with 80% of participants scoring above the
normative score of 170. Perceived stress scores revealed that 84% of adolescents scored
10-30 out of a 40-point scale. Bullying scores revealed an average score of 15.14 out of
128 total score. Significant correlations with depressive symptoms were noted with
stressful life events, life change units, perceived stress, verbal/relational bullying, and
gender identity. Two variables (PSS-10, PECK) and one covariate (gender identity) were
significant predictors of depressive symptoms. These findings should help to guide
school nurses, teachers, counselors, or other professional working with this population.
Future research is warranted with 9th graders experiencing a transition to high school.

Keywords: stressful life events, life change units, perceived stress, bullying,
cortisol diurnal rhythm, depressive symptoms, and 9th grade adolescents

iv
DEDICATION
I dedicate this work to my husband Andy and my two sons, Drew and JP. Thank
you for your understanding, encouragement, support, and unconditional love during my
pursuit of this “mountain climb.” I have many other family and dear friends who have
supported and encouraged me on this journey including my mom, Nanny and Papa,
Sandra and Kevin McKenzie, and the fellows of the Leadership and Education in Child
Health Nursing fellowship group. I am blessed to have had this opportunity and will
always be grateful for my family, friends, and those who educated me in this process.

v
ACKNOWLEDGEMENTS
I am sincerely grateful for my advisor and chairperson, Dr. Anne Turner-Henson
for guiding me throughout my dissertation. Dr. Marti Rice was also instrumental in my
completion this PhD program within the Leadership and Education in Child Health
Nursing (LECHN) Traineeship. I am grateful for the countless hours they have both
spent in seminars with me and all of the other trainees working to develop our skills as
leaders and nurse researchers knowledgeable in biobehavioral research.
I am grateful to Dr. Lucrecia Collins for writing and publishing her work on
cyberbullying, as that is how I discovered this talented educator who was graciously
willing to meet with me and to participate on my committee. Dr. Collins was a great
support to me spiritually, mentally, and academically. Thank you to Dr. Teena
McGuinness, for providing me with guidance related to the mental health of adolescents.
Thank you to Dr. Andres Azuero who had immense patience with my developing
knowledge and understanding of statistics. I am grateful to Dr. Jennifer Langhinrichsen-
Rohling for writing an article on sensitive issues in adolescents, for this is how I found
her at the University of South Alabama. I appreciate your mentoring, encouragement,
and your ability to work with someone outside of your Department of Psychology when
conducting research, writing, publishing, and presenting our work. Lastly, I would like to
thank Dr. Barbara Broome and Dr. Todd Harlan for their advice and encouragement
throughout this PhD education as my previous Chair and current Chair and supervisor at
the University of South Alabama College of Nursing.
vi
The completed coursework and dissertation study were supported from the
Leadership Education in Child-health Nursing (LECHN) – Maternal Child Health Bureau
(grant number T80MC09653, PI: A. Turner-Henson); Sigma Theta Tau Zeta Gamma
Chapter – Mobile, AL; Alabama State Nurses Association, and the Louder Dissertation
Scholarship. The contents of this dissertation are solely the responsibility of the author
and do not necessarily represent the official views of the above-mentioned funding
sources.

vii
TABLE OF CONTENTS
PAGE
ABSTRACT…………………………………………………………………..... iii
DEDICATION………………………………………………………………...... v
ACKNOWLEDGEMENTS…………………………………………………..…vi
TABLE OF CONTENTS………………………………………………………viii
LIST OF TABLES ………………………………………………………….…xiii
LIST OF FIGURES ……………………………………………………….......xvi
CHAPTER 1: INTRODUCTION……………………………………...………...1
Purpose of the Study………………………………………………....….22
Statement of the Problem……………………………………………......22
Significance of the Problem…………………………………………......25
Research Questions and Hypotheses………………………………........26
Theoretical Framework………………………………………………….28
Conceptual Framework……………………………………….…..……..33
Definition of Terms………………………………………………...……34
Assumptions………………………………………….……………….…35
Summary………………………………………………………………...36
CHAPTER 2- LITERATURE REVIEW………….…………………………....37
Depression in the United States……………………………………...… 38
Depressive Symptoms in Adolescents…………………..….….. 40
Depressive Symptoms among 9th graders……………….…..…..45
Stress in the United States……………………………............................48
viii
Stress in Adolescents……………………………………...….....50
Stressful Life events……………………………………...….….50
Perceived Stress…………………………………………………53
Stress in 9th graders……………………………………….…….56
Cortisol……………………………………………………………….....60
Measurement of Cortisol……………………………………......64
Cortisol and Depressive Symptoms…………………………….67
Bullying and Adolescence……………………………………….….….71
Bullying and 9th graders……………………………….…….….73
Potential Confounding Variables…………………………….…………78
Gender………………………..………………………..…….....78
Race……………………………………………………..……....81
Socioeconomic Status……………………………………..…....85
Gender Identity…………………………………………..……..86
Pubertal Status………………………………………………......88
Limitations………………………………………………………….…...89
Summary……………………………………………………………..….92
CHAPTER 3 – METHODOLOGY…………………………………………..….……..94
Research Design…………………………………………….…………………..94
Setting and Sample…...........................................................................................95
Characteristics of Sample…………………………….………………....95
Inclusion and Exclusion Criteria…………………….…………….…....96
Characteristics of the Setting…………………………..……….………97
ix
Sample Size and Justification of Sample Size…………………..……....97
Power Analysis…………………………………………………….....…99
Protection of Human Subjects……………………………….………….…..…..99
Pilot Study……………………………………………………………….…….103
Instrumentation………………………………………………………………...112
Demographic Questionnaire……………………………………..…….113
Center for Epidemiological Studies Depression Survey – 10……........115
Coddington Life Event Survey………………………………….….….116
Perceived Stress Scale………………………………………….….…..118
Personal Experiences Checklist………………………………….…….119
Self-Rating Scale for Pubertal Development...……………..…….........120
Cortisol Sampling and Analysis…………………………………..…….….....122
Procedures for Data Collection…………………………………………...…....127
Data Management and Statistical Analysis Plan.………..…………………….132
Summary………………………………………………….………….……..….136
CHAPTER 4 – FINDINGS…………………………………………....……………...138
Instrument Reliability……………………………………………………..…...139
Sample, Setting, and Characteristics…………………………………………..140
Socio-demographic Characteristics of the Sample……………………….……141
Health Variables: Pubertal Status and Smoking Status……………….…..…..143
Descriptive Statistics…………………………………………………….…….144
Cortisol (AM, PM, and Cortisol Diurnal Rhythm)………………...…..144
Stressful Day………………………………………………….………..147
x