Personality correlations with depressiveness among adolescents

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1 186 ersonality correlations with depressiveness among adolescents Aurelija Markevičiūtė 1, Antanas Goštautas 1,2, Ina ilkauskienė 1,2 1 Institute of Cardiology, Kaunas University of Medicine 2 University of Vytautas Magnus, Lithuania Key words: adolescents, depressiveness, personality, psychological adjustment. Summary. Objective. The aim of the study was to assess personality correlates of depressiveness as well as their relationships with the level of depressiveness. Material and methods. The data on the depressiveness of 954 (452 boys and 502 girls) of ninth grade schoolchildren from 26 secondary schools of one administrative region of Lithuania were analyzed. The methods used in the study were Minnesota Multiphasic ersonality Inventory for Adolescents, and Composite International Diagnostic Interview. Results. Twenty two schoolchildren (5 boys and 17 girls) with extremely high scores on Minnesota Multiphasic ersonality Inventory Depression scale were found to have depression or dysthymia. It was found that depressive boys and girls (high scores on scores Minnesota Multiphasic ersonality Inventory Depression scale) had higher scores on Minnesota Multiphasic ersonality Inventory clinical scales (except Mania scale, which was lower) as compared to the non-depressive ones. Girls with depressiveness, which corresponded to the level of depression or clinical dysthymia by Composite International Diagnostic Interview had higher scores on Minnesota Multiphasic ersonality Inventory clinical scales (except Mania scale, which was lower), as compared to the other girls (both depressive and non-depressive, as measured by Minnesota Multiphasic ersonality Inventory Depression scale). Girls with depressiveness, which corresponded to the level of clinical depression or clinical dysthymia, also had worse psychological adjustment. Conclusion. Depressive adolescents, boys and girls, differ from non-depressive ones by worse psychological adjustment. The level of depression did not differ from depressive girls (having high scores on Minnesota Multiphasic ersonality Inventory Depression scale) in their non-adaptive personality characteristics, but markedly differed from that of other girls irrespective of theirs Minnesota Multiphasic ersonality Inventory Depression scale scores. Introduction Investigations into affective disorders among children and adolescents have gained an increased interest within the last decade. rofound research studies allowed to accumulate a considerable amount of data about the prevalence, etiopathogenesis, variations in clinical course, peculiarities of treatment and its effectiveness (1-3). Nevertheless, depressive disorders among adolescents (major depression, psychogenic depression, dysthymia) cause diagnostic problems due to diversity of symptoms and high comorbidity with other mental disorders (1, 2). Cicchetti D. and Toth SL. point out that even per cent of depressive adolescents do not receive timely help (4). Despite the difference in viewpoints on manifestation of the symptoms of depressive disorders the majority of authors regard depressive disorders as one of the main suicide causes in adolescence (5-7). Besides, the studies confirm the relationship between consumption of legal and illegal drugs and depressive disorders among adolescents (1, 7, 8). Depressive adolescents have poorer academic performance (9, 10), often have problems with their behavior (1, 2, 7). They are less active in out-of-class activities, they become more self-isolated (3, 9, 10). They, particularly girls, tend to have more somatic complaints (1, 11-14) and assess their health status more negatively (11, 12). Both depressed girls and boys evaluated their health worse than non-depressed adolescents (11, 12). Correspondence to A. Markevičiūtė, Institute of Cardiology, Kaunas University of Medicine, Sukilėlių 17, 3007 Kaunas, Lithuania

2 ersonality correlations with depressiveness among adolescents 187 Some authors indicate, that depression, as well as other disorders, may be understood as a continuum (15), and that subclinical forms of depression may serve as a serious risk factor for depressive disorders in adolescence and later (1-3). Subclinical depression, or depressiveness, significantly hampers psychosocial adjustment of the adolescent, his or her cognitive capacities, negatively affect his or her somatic health (1, 3, 9, 11, 12). While analyzing literature data on the relationship between depressive disorders and personality characteristics in adolescents, one may come across several viewpoints on the matter. The first one states, that personality traits and predispositions are related to the development of depressive disorders. There are studies of adult and adolescent populations on the relationship between personality and depression investigating personality characteristics, based on neuroticism, extraversion, openness to new experience, consciousness, agreeableness, affective temperaments and other dimensions (16-21). The results revealed, that neuroticism and high self-criticism increased risk for depression, and that the variety of depressive states within the continuum might be partially explained by the peculiarities of the temperament of the individual (16-21). Goodyer I. et al. (1993), analyzing differences of temperament in depressive and non-depressive adolescents found only one difference, i. e. that depressive adolescents, irrespective of their gender, were inclined to express negative emotions more intensely than non-depressive ones, and that depressive girls tend to express their negative emotions more intensely as compared to boys (7). Another viewpoint states that depression influences personality development and personality peculiarities. Long-lasting depressive disorders affect individual configuration of personality (18). robably the mostly widespread opinion suggests that there is a mutual relationship between depression and personality characteristics. In other words, certain personality traits are related to the development of depressive disorders, and, on the other hand, depressive disorders, through an impact on a person s socialization and emotional life, may induce the pathologisation of one s character (22). It was found that depressive disorders were more likely to occur among passive, humble, withdrawing, prone to criticizing themselves without serious reason adolescents, or among unstable, impulsive, hypersensitive ones (1, 2, 7, 23). On the other hand, defective regulation of mood during depression disorders may have an unfavorable impact upon the growing individual (22). Negative cognitive or attribution style, forming in early adolescence, is also thought to be an important factor in the genesis of depressive disorders (1-2, 24). Some literature findings indicate that this style is related to personality (22, 24); others state that it is not clear whether negative cognitive style is a personality trait or a characteristic of depressive state (1, 2). Adolescents with negative cognitive style are more likely to develop depression. Besides, depressive adolescents are characterized by increased disturbances of cognitive process, greater despair, sense of guilt due to uncontrolled outer effects, social deficit, and low selfworth (1, 9, 22). Morm N. and Winquist J. add (2002), that fixation to negative aspect of the self is closely related to a marked negative affect (25). Gasquet I. Found (1998) that approximately 60 per cent of depressive adolescents also suffer from personality disorders (7). These personality disorders are borderline ones, and often disappear when depression is cured (1, 7). Our study analyses relationships between depressiveness and personality traits within a non-clinical adolescent group. Depressiveness was regarded as a state being between the absence of depressive symptoms on one side and manifestation of clinical depression (26) on the other side of the continuum. This is a new approach in Lithuania, because previous studies analyzed only clinical depression among adolescents using ICD-10 criteria. Objective. The objective of the study was to assess personality correlates of depressiveness as well as their relationships with the degree of depressiveness. The hypothesis was tested as follow: Depressiveness in adolescents is related to a lover level of general psychological adjustment. Material and methods The subjects of the study were yearold schoolchildren (519 boys and 507 girls) of 26 secondary schools (ninth grade pupils) of one administrative region of Lithuania. Sixty eight (6.22 per cent) schoolchildren did not participate in the study due to various reasons, thus the study analyses the data of 954 (87.37 per cent of the total amount of pupils in these grades) schoolchildren (452 boys and 502 girls), who filled in the administered questionnaires. The study was carried out from October, 2000 through January, In January, 2001 a deeper investigation of depressiveness was performed with 120 schoolchildren (60 boys and 60 girls), having the highest and the lowest scores of MMI-A D scale. The data of 59 boys and 60 girls was analyzed.

3 188 Aurelija Markevičiūtė, Antanas Goštautas, Ina ilkauskienė The methods of the study were as follows: 1) Minnesota Multiphasic ersonality Inventory for Adolescents (MMI-A) consisting of 478 items was used to assess personality characteristics. The questionnaire was adapted in 1994 based on the previous adaptation (27). The scales used were as follow: three data evaluation scales (falsehood), F (validity), K (correction); nine major MMI test scales Hs (hypochondria), D (depression), Hy (hysteria), d (psychopathia), a (rigidity), t (psychasthenia), Sc (schizophrenia), Ma (mania), and Si (social introversion). Depressiveness, determined by MMI-A D scale, in the present study will be called depressiveness. Higher level of depressiveness was assessed by WHO Clinical Semi-structured Depression Interview (30). It consisted of 59 items with two answer categories for diagnosing either depression or dysthymia according to ICD-10. Lithuanian version of CIDI approved by WHO (A. Goštautas, 1998). Depressiveness, determined by CIDI, in the present study will be called depression or dysthymia. Inner consistency of the scales of MMI-A was tested using Chronbach alpha coefficient. Statistical methods were Student s criterion (t) and correlation analysis performed using SSS 10 for Windows. Results and discussion. In order to test the hypothesis, boys and girls were divided into two groups according to average values of MMI-A depression scale (D). Adolescents with individual score higher than the average was regarded as depressive (D+), and with the scores lower than the average were regarded as non-depressive (D-). Thus, the group of depressive adolescents consisted of 191 boy and 224 girls, and the non-depressive adolescents were 261 boy and 278 girls. MMI-A scale scores were compared in these two groups of adolescents in order to determine the peculiarities of their psychological adjustment (see Table 1). We found that depressive boys had statistically significantly higher values of all scales (except Ma) as compared to non-depressive boys. Ma scale was statistically significantly higher among non-depressive boys: they were more active and their behavior was more inconsistent. Depressive boys were more defensive during the test (F scale), were more concerned about their health (Hs scale), had an increased need for attention from others and were less emotionally mature (Hy scale). Their behavior slightly deviated from acceptable norms (d scale), their dispositions were more rigid (a scale). They were inclined to withdraw from others, were more reserved (Sc scale), more suspicious (a scale), inclined to avoid social relations (Si scale), their way of thinking and behavior are more singular (Sc scale). They exhibited more lack of self-confidence (t scale). Statistically significantly higher values of all scales (except K and Ma scales) were also found among depressive girls. Scores on Ma scale were higher among non-depressive girls (as it was in the case with boys). Thus, depressive boys as well as depressive girls had higher personality profile as measured by MMI-A, with the exception of Ma scale, the scores of which decreased as the scores on D scale increased. To obtain more data in order to test the hypothesis, we performed correlation analysis of MMI-A scales in the groups of boys and girls. In the group of boys D scale correlated with Hs (0.5), Si (0.5) and Hy (0.49) Table 1. Comparison of personality characteristics as measured by MMI-A scales in the groups of depressive and non-depressive adolescents (boys and girls) Scales Boys Girls D+ (N=191) D (N=261) D+ (N=224) D (N=278) L 4.350± ±1.96 < ± ±1.75 < F 16.92± ±7.82 < ± ±5.60 < K 14.05± ± ± ± Hs 10.10± ±3.54 < ± ±3.87 < Hy 24.45± ±4.60 < ± ±4.78 < d 22.59± ±4.36 < ± ±4.52 < a 14.90± ±4.33 < ± ±4.09 < t 20.95± ±7.49 < ± ±7.13 < Sc 27.78± ±9.65 < ± ±8.31 < Ma 19.21± ±4.41 < ± ± Si 30.68± ±6.20 < ± ±6.58 <0.0001

4 ersonality correlations with depressiveness among adolescents 189 scales, while in the group of girls the correlation was with Si (0.5), t (0.5), Hy (0.47) and Sc (0.47) scales. Correlation between D and the other scales were weaker. Deeper analysis of depressiveness was performed applying the WHO Clinical Semi-structured Depression Interview. Twenty two schoolchildren with extremely high scores on D scale were found to have depression or dysthymia. Depressiveness of four boys corresponded to dysthymia, as diagnosed by the Interview, and depressiveness of one boy to medium depressive episode. Depressiveness of six girls corresponded to medium depressive episode, and depressiveness of nine - to dysthymia. Depressiveness of two girls corresponded to both medium depressive episode and dysthymia. All the boys and the girls with extremely low scores on MMI-A D scale answered negatively to the Depression Interview (had not depression or dysthymia). In order to determine what personality characteristics are common among adolescents with depressiveness (the second hypothesis), we compared average scores of MMI-A scales of boys and girls with depression and those with the highest scores on D scale, but no depression or dysthymia according the Depression Interview. Only Si scale was higher (p<0.005) among the depressed boys. They were more reserved, inclined to self-analysis, and were less inclined towards social contacts. Differences in D scale were not statistically significant. Four boys out of five, having answered positively to the Depression Interview, had dysthymia, and one boy had a depression episode. Dysthymia, according ICD-10 and other literature sources, is characterized by less expressed depressive symptoms (1, 2, 14, 26). Among girls with depression or dysthymia only D scale was statistically significantly higher than that of girls without depression or dysthymia. This indicated, that girls with depression or dysthymia were characterized by lower mood, they felt themselves worse, they viewed future as more pessimistic, and were less satisfied with themselves and their activities. These findings confirm the adequacy of both methods and indicate that MMI-A D scale as well as CIDI, maybe used to diagnose similar manifestations of depressed mood, lover energy and decreased activities. Clinical Interview when applied in a group of adolescents, whose depressiveness was determined by the psychological method. Average scores of MMI-A scales were compared in the groups of boys and girls with and without depression or dysthymia, irrespective of their scores on MMI-A D scale (Table 2). The data show, that boys with depression or dysthymia were more suspicious, rigid, more inclined towards withdrawal and self-analysis (a and Si scales). Among girls statistically significant differences were obtained between all clinical scales (except Ma, p> 0.05). Thus, personality traits of girls were similar to those of boys, besides, girls were more concerned about their health, were inclined towards increased attention from others, less mature emotions, higher anxiety, low self-confidence, higher withdrawal, and lower behavioral control. In order to determine the most expressed personality characteristics we compared scores on MMI-A Table 2. Scores on MMI-A scales in the groups of boys and girls with and without depression or dysthymia Boys Scales Depressed Non depressed Depressed Non depressed (N=5) (N=54) (N=17) (N=43) L 4.40± ± ± ± F 18.40± ± ± ±6.10 < K 15.20± ± ± ± Hs 10.60± ± ± ±4.48 < Hy 26.00± ± ± ± d 20.60± ± ± ± a 16.00± ± ± ± t 19.40± ± ± ±9.06 < Sc 26.40± ± ± ±9.79 < Ma 19.00± ± ± ± Si 34.60± ± ± ±9.01 < Girls

5 190 Aurelija Markevičiūtė, Antanas Goštautas, Ina ilkauskienė Table 3. Comparison of scores on MMI-A scales in the groups of depressed boys and girls, and non-depressive boys and girls without depression or dysthymia Boys Scales Depressed Non depressive, Depressed Non depressive, without depression depresija arba without depression (N=5) or dysthymia (N=30) distimija (N=17) or dysthymia(n=30) L 4.40± ± ± ± F 18.40± ± ± ±4.51 < K 15.20± ± ± ± Hs 10.60± ± ± ±3.77 < Hy 26.00± ± ± ±4.92 < d 20.60± ± ± ±4.77 < a 16.00± ± ± ±4.25 < t 19.40± ± ± ±6.85 < Sc 26.40± ± ± ±7.12 < Ma 19.00± ± ± ± Si 34.60± ± ± ±4.94 < Girls scales in the groups of boys and girls with depression or dysthymia, whose scores on D scale were high, and boys and girls without depression or dysthymia, whose scores on D scale were low (Table 3). Among boys with clinical level of depressiveness, Hs, Hy, a, t and Si scales were statistically significantly higher as compared to that of boys with depression or dysthymia. Boys with the depression or dysthymia were more concerned about their health, were not satisfied with themselves, had less mature emotions, were more impatient, had an increased need for attention, were more suspicious, more rigid, more anxious, inclined towards withdrawal, inclined to self-analysis and restricted social contacts. Girls with clinical level of depressiveness had all MMI-A scores statistically significantly higher (except Ma scale). Thus, girls with the depression or dysthymia were more concerned about their health, were not satisfied with themselves, had less mature emotions, were more impatient, had an increased need for attention from others, were more suspicious, more rigid, more anxious, inclined towards withdrawal, and tended to restricted social contacts. Besides, their behavior was much more unstable, inconsistent, difficult to control. ersonality characteristics of depressive (MMI- A D scale) and depressed (Clinical Interview) adolescents are reflected in Table 4. Depressed boys differed by scores on D and Si scales, which indicates their increased depressiveness, withdrawal, the tendency to avoid social contacts. Depressed girls had statistically significantly higher scores on Hs, D, t, Sc, Si scales, showing more psychological problems manifesting as increased anxiety, increased concern about their health, and withdrawal. They also thought badly about themselves, were in a depressed mood, reserved, inclined to self-analysis, and tried to avoid social contacts. Table 5 reflects personality peculiarities of adolescents with depression or dysthymia as compared to the rest schoolchildren. Depressed boys had statistically significantly higher D, a and Si scales pointing to their increased suspiciousness, rigidity. They were also inclined to self-analysis, limited social relations. Depressed girls had higher scores on all clinical scale (except Ma, p> 0.05), indicating an increased concern about their health, need for attention from others, less mature emotions, increased anxiety, lower self-confidence, withdrawal, and poorer control of their behavior. Depressed girls, as well as the depressed boys, were inclined to self-analysis and limited social relations as compared to other (depressive and non-depressive according to MMI-A scales) girls. The results of our study showed that personality characteristics of depressive boys and girls as measured by MMI-A scales, were more expressed than those of non-depressive adolescents. It was also found that adolescents with depression had higher average scores on MMI-A clinical scales. This may be related to subjective assessment among adolescents, which is usually more negative among the depressed ones (1, 2, 21, 31), and that negative emotions among depressed adolescents tend to be stronger (7). Our data confirm the relationship of depressiveness and personality: depressiveness is accompanied by more expressed features of personality, which may have a negative impact

6 ersonality correlations with depressiveness among adolescents 191 Table 4. ersonality characteristics of depressive and depressed adolescents Boys Girls Scales Depressed Depressive Depressed Depressive (N=5) (N=186) (N=17) (N=207) L 4.40± ± ± ± F 18.40± ± ± ± K 15.20± ± ± ± Hs 10.60± ± ± ± D 31.00± ± ± ±2.60 < Hy 26.00± ± ± ± d 20.60± ± ± ± a 16.00± ± ± ± t 19.40± ± ± ±7.23 < Sc 26.40± ± ± ± Ma 19.00± ± ± ± Si 34.60± ± ± ± Table 5. ersonality characteristics of depressed adolescents as compared to the schoolchildren irrespective of their depressiveness according to MMI-A D scale Boys Girls Scales Depressed Others Depressed Others (N=5) (N=447) (N=5) (N=485) L 4.40± ± ± ± F 18.40± ± ± ±7.15 < K 15.20± ± ± ± Hs 10.60± ± ± ±4.59 < Hy 26.00± ± ± ±5.52 < d 20.60± ± ± ±5.21 < a 16.00± ± ± ± t 19.40± ± ± ±7.89 < Sc 26.40± ± ± ±9.98 < Ma 19.00± ± ± ± Si 34.60± ± ± ±7.11 < upon the formation of personality (1-3, 7, 10, 20, 21). Depressiveness in adolescents is related to a lower level of general psychological adjustment. These features were more prominent among depressed girls as compared to depressed boys. This may be due to deeper depressiveness among the studied girls, and higher prevalence of depressed girls. Our findings coincide in this respect with the data of other studies, which indicate, that adolescent girls differ form boys by deeper depressiveness and larger prevalence of depression among girls as compared to boys (1-3, 7). Conclusions: 1. Depressive adolescents, boys and girls, differ from non-depressive ones by worse psychological adjustment. They were more reserved, more anxious, less capable of controlling their behavior, less self-confident, and inclined to having worse communicative habits. 2. The level of depression did not differ from depressive girls (having high scores on MMI-A D scale) in their non-adaptive personality characteristics, but markedly differed from that of other girls irrespective of MMI-A D scale scores.

7 192 Aurelija Markevičiūtė, Antanas Goštautas, Ina ilkauskienė aauglių depresiškumo ir kitų asmenybės bruožų sąsaja Aurelija Markevičiūtė 1, Antanas Goštautas 1,2, Ina ilkauskienė 1,2 1 Kauno medicinos universiteto Kardiologijos institutas, 2 Vytauto Didžiojo universitetas Raktažodžiai: paauglystė, depresiškumas, asmenybė, psichologinis adaptavimasis. Santrauka. Darbo tikslas. Nustatyti paauglių depresiškumo ir kitų asmenybės bruožų sąsajas. Analizuojami 954 (452 berniukų, 502 mergaičių) devintųjų klasių moksleivių, kurie mokėsi 26-iose vieno Lietuvos rajono bendrojo lavinimo mokyklose, depresiškumas ir kiti asmenybės bruožai. aauglių asmenybės bei psichologiniam adaptavimuisi nustatyti naudotas Minesotos daugiaprofilinis asmenybės klausimynas, skirtas paaugliams. Depresijai nustatyti naudotas asaulio sveikatos organizacijos klinikinis pusiau struktūrizuotas depresijos interviu. Rezultatai. 22 paauglių, kuriems pagal Minesotos daugiaprofilinio asmenybės klausimyno depresijos skalės reikšmes (penki berniukai ir septyniolika mergaičių) asaulio sveikatos organizacijos klinikiniu pusiau struktūrizuotu depresijos interviu nustatytas aukščiausias depresiškumas, atitiko klinikinę depresiją arba distimiją. Depresiškų berniukų ir mergaičių Minesotos daugiaprofilinio asmenybės klausimyno klinikinių skalių vidutiniai įverčiai buvo aukštesni, išskyrus manijos skalę, kurios vidutiniai įverčiai buvo žemesni, palyginti su nedepresiškais berniukais ir mergaitėmis. Mergaičių, kurių depresiškumas atitiko klinikinę depresiją ar distimiją, buvo aukštesni Minesotos daugiaprofilinio asmenybės klausimyno klinikinių skalių vidutiniai įverčiai, išskyrus manijos skalės vidutinį įvertį, kuris jų buvo žemesnis. Išvados. Depresiški berniukai ir mergaitės iš kitų paauglių skiriasi blogesniu psichologiniu adaptavimusi. depresiškos mergaitės, kurių depresiškumas atitiko klinikinę depresiją ar distimiją, nesiskyrė neadaptyviais asmenybės bruožais nuo mergaičių, kurioms Minesotos daugiaprofilinio asmenybės klausimyno depresijos skale buvo nustatytas aukštas depresiškumas, tačiau skyrėsi nuo kitų mergaičių (kurių aukštesnis arba žemesnis depresiškumas pagal Minesotos daugiaprofilinio asmenybės klausimyno depresijos skalę) neadaptyviais asmenybės bruožais. Adresas susirašinėjimui: A. Markevičiūtė, KMU Kardiologijos institutas, Sukilėlių 17, 3007 Kaunas References 1. Birmaher B, Ryan ND, Williamson DE, Brent DA, Kaufman J, Dahl RE, et al. Childhood and adolescent depression: a review of the past 10 years. art I. J Am Acad Child Adolesc sychiatry 1996;35(11): Birmaher B, Brent DE, Bernet W, Duune JE, Adair M, Arnold V, et al. ractice parameters for the assessment and treatment of children and adolescents with depressive disorders. J Am Acad Child Adolesc sychiatry 1998;37(Suppl. 10):63S-83S. 3. Kessler RC, Avenevoly S, Merikangas KR. Mood disorders in children and adolescents: an epidemiologic perspective. Biological sychiatry 2001;49(12): Cicchetti D, Toth SL. The development of depression in children and adolescents. Am sychologist 1998;53(2): Leskauskas D, Burba B. Depresijos sindromas tarp bandžiusių nusižudyti vaikų ir paauglių. (Depression syndrome among children and adolescent with suicidal attempts.) Medicina (Kaunas) 1999;35: Gailienė D. Jie neturėjo mirti. Savižudybės Lietuvoje. (They did not have to die. Suicide in Lithuania.) Vilnius; Sous la direction de Lemperiere T. La Depression avant 20 ans. aris: Masson; Nacionalinės sveikatos tarybos metinis pranešimas, (Report of the National Board of Health.) 2000:31-33; Segrin C. Social skills deficits associated with depression. Clinical sychology Review 2002;20(3): Shaw RB. The relationship of academic performance to depression and perceived home environment among gifted high school students [dissertation]. New York; Markevičiūtė A, Goštautas A, ilkauskienė I. aauglių savo sveikatos vertinimo ir depresiškumo sąsaja. (Self-assessment of adolescents health and depressiveness.) Lithuanian Journal of Cardiology 2000;7(4): Bomba J. La Depression chez l adolescent. Etude psychologique et epidemiologique. Confrontations sychiatriques 1987;29: Nixon MK. Mood disorders in children and adolescents: coming of age. J sychiatry Neurosc 1999;24(3): Keller MB. Dysthymia in clinical practice: course, outcome and impact on the community. Rewiew. Acta sychiatrica Scandinavica, Supplementum 1994;383: Available from: URL: dysthymia.html. 15. Clarke GN, Hawkins W, Murphy M, Sheeber L, Lewinsohn M., Seeley JR. Targeted prevention of unipolar depressive disorder in an at-risk sample of high school adolescents: randomized trial of a group cognitive intervention. J Am Acad Child Adolesc sychiatry 1995;34(3): Bagby RM, Rector NA. Self-criticism, dependency and the five factor model of personality in depression: assessing construct overlap. erson Individ Diff 1998;24(6):895-7.

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