Eve Twivy - Thesis submitted in partial fulfilment of the degree of Doctor of Clinical Psychology (DClinPsych)
Keywords: systematic review
cancer
survivorship
quality improvement
social media
depression
meta-aggregation
measure development
qualitative
adolescence

Systematic Review of the Literature
Background: The under-recognition of depression in adolescents suggests that a better understanding of its presentation may be needed. Conceptualisations of adolescent depression are largely the same as adult depression, with minimal consideration of developmental stage. Exploration of first-hand accounts could help to identify any unique features of adolescent depression. Therefore, this review aimed to gain an understanding of the lived experience of adolescents with depression to inform clinical practice.
Method: A systematic review was performed to identify qualitative studies on first-hand experiences of adolescent depression. Methodological quality of included papers was assessed and key data was extracted. Meta-aggregation was the method of synthesis, whereby extracted themes from the papers were grouped according to shared meanings.
Results: Fifteen studies were identified for inclusion. Aggregation of 56 themes resulted in 16 categories and three synthesised findings encompassing key aspects of adolescent depression: causes, symptoms and coping.
Conclusions: Individual differences were evident in adolescents’ perspectives on causes, symptoms and coping in the context of depression, thus detailed assessment by practitioners is indicated. It is noteworthy that adolescents reported some experiences, such as social disconnection and anger, that are not captured by current diagnostic criteria. Practitioners should be aware of the potential differences in presentation of adolescent and adult depression.
Service Improvement Project
Background: Existing literature implies there may be gaps in post-treatment support for young people with cancer. This service improvement project aimed to understand the needs and experiences of young people when ending active cancer treatment in a UK children’s hospital.
Methods: Semi-structured interviews were conducted with nine young people, aged 13 -18 years, who had finished cancer treatment and were receiving follow-up care. The data was analysed using thematic analysis. Results: Four main themes were developed: being in the dark; separation from the hospital; consequences of cancer; and getting back to normal life.
Discussion: Young people faced varying physical, psychological and social challenges when adjusting to life after cancer treatment. There is a need for a consistent approach to assessing young people’s biopsychosocial needs at the end of treatment, with subsequent provision of individualised support.
Theoretically Driven Research Project
Objective: Depression often arises during adolescence. Social media forms a significant part of adolescents’ lives, yet its impact on depression is unclear. We aimed to develop a questionnaire assessing positive and negative ways of using social media in order to understand the potential role of social media in adolescent depression.
Method: 1140 adolescents (including 569 with depression) aged 11-18 (Mage = 16.3 years; 62.2% female; 82.5% White) completed the original item pool. Factor analyses were conducted to derive the Social Media Scale (SMS). SMS scores were compared in adolescents with and without depression.
Results: The 45-item, nine-factor, SMS, had an acceptable model fit and adequate internal consistency (α = .70 to .92). There was no significant difference between groups in factor scores for ‘Pleasure’ and ‘Connecting with others’. However, factor scores were higher (p < .001) in the depressed group with large effect sizes for ‘Social comparison’ and ‘Passing time’, medium effect sizes for ‘Impression management’, ‘Hostility towards others’ and ‘Hostility from others’, and small effect sizes for ‘Fear of social exclusion’ and ‘Seeking support’.
Conclusions: The SMS may be a useful tool to assess motivations, behaviours, thoughts, and experiences related to social media use. Positive aspects of social media use were no less common among adolescents with depression than adolescents without depression. Yet, negative aspects of social media use were more common among adolescents with depression, with the largest differences for social comparison and using social media to pass time. These may be specific targets for future psychological interventions.