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Cited by 33Mental Health Treatment and AccessChild and Adolescent Psychosocial and Emotional DevelopmentPsychological Treatments and Disorders

A cross-cultural interpersonal model of adolescent depression: A qualitative study in rural Nepal

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Rose-Clarke, Kelly, Hassan, Eliz, BK, Prakash, Magar, Jananee, Devakumar, Delan, Luitel, Nagendra P., Verdeli, Helen, Kohrt, Brandon A.·2021·Social Science & Medicine
DOI 10.1016/j.socscimed.2020.113623PMC PMC7895817
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Abstract

Most cross-cultural qualitative research on depression has been descriptive, documenting symptoms and explanatory models. There is a lack of qualitative research testing theoretical models of depression. The interpersonal model conceptualises grief, interpersonal disputes, role transitions and social isolation as the context in which depression develops and is the basis of interpersonal therapy (IPT), which is increasingly used in cross-cultural settings to treat depression. We aimed to qualitatively evaluate to what extent the interpersonal model can explain adolescent depression in Nepal. Data were collected between December 2018 and April 2019 and comprised transcripts from 126 participants: 25 semi-structured interviews with depressed adolescents aged 13-18; four focus group discussions with adolescents (N = 38), four with parents/caregivers (N = 39), and two with teachers (N = 17); and seven semi-structured interviews with health and non-governmental organisation workers. We coded data using an analytical framework comprising deductive codes representing key concepts from the interpersonal model of depression and IPT, including principles, techniques and strategies. Participants mainly related depression to interpersonal problem areas of grief, dispute, role transition and social isolation. Interpersonal disputes were common, and for many adolescents this involved parental physical and emotional abuse. Although role transitions were common few adolescents grieved loss of the prior role. Distress related to social isolation was evident despite close physical proximity and extensive social interaction with family and community members. Adolescents described coping strategies that were similar to strategies central to IPT, e.g. identifying helpful and unhelpful relationships and generating options and ways of managing problems. In conclusion, interpersonal problems are relevant to this population and conceptualisations align with core principles of the interpersonal model of depression. The findings highlight the importance of addressing abuse and maltreatment in depression aetiology. They also inform future cultural adaptations of IPT in Nepal and beyond, including the opportunity to integrate local coping strategies.

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  • Depressed adolescents are often primarily irritable and unstable, with frequent anger outbursts, sometimes without significant provocation, which may result in a deterioration of their interpersonal relationships.

    “Indeed, depressed adolescents are often primarily irritable and unstable, with frequent anger outbursts, sometimes without significant provocation, which may result in a deterioration of their interpersonal relationships. 94,95”

    From Time for united action on depression: a Lancet–World Psychiatric Association Commission (2022) · cites this paper as [94]

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  1. World Health Organization mhGAP Intervention Guide - Version 2.0 for Mental, Neurological and Substance Use Disorders in Non-specialised Health Settings 2016 27786430

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Authors
Rose-Clarke, K., Hassan, E., BK, P., Magar, J., Devakumar, D., Luitel, N. P., Verdeli, H., & Kohrt, B. A.
Affiliations
  • King's College London (GB)
  • University College London (GB)
  • Columbia University (US)
  • George Washington University (US)
ORCID
Venue
Social Science & Medicine
Publisher
Elsevier BV
Published
2021-02
Volume
270
Pages
113623
ISSN
0277-9536 (ISSN-L)
DOI
10.1016/j.socscimed.2020.113623
PMC
PMC7895817
OpenAlex
W3112901677
Cited by
33
References
66
Citations by year
2026: 5 · 2025: 4 · 2024: 9 · 2023: 4 · 2022: 7 · 2021: 4
FWCI
4.10
Type
journal article
Language
en
Open access
Licence
Locations
  • Social Science & Medicine (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Research Portal (King's College London) (publishedVersion, cc-by)
  • RePEc: Research Papers in Economics (submittedVersion)
  • UCL Discovery (University College London) (submittedVersion)
Funders
  • National Institute for Health Research
  • Department for International Development
  • Medical Research Council (MR/R020434/1)
Topics
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
  • Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Disorders
Keywords
adolescent depression, interpersonal psychotherapy, cross-cultural adaptation, grief, interpersonal conflict, role transition, social isolation, parental abuse, coping strategies, rural Nepal, etiology of depression
MeSH terms
Adolescent, Cross-Cultural Comparison, Depression, Humans, Interpersonal Relations, Nepal, Rural Population, Qualitative Research

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