Taking control of mental health

Adolescence can be a highly turbulent period and is associated with a rise in mental health issues. Depression is a particularly common problem in teens, affecting over 21% of the population (Auerbach et al., 2018). Various theories have attempted to account for the upsurge in mental health issues during adolescence, but often neglect the importance of 'control'. 

Since the late 1950s, psychologists such as Robert White have advocated the importance of perceived control (PC), referring to one's sense of autonomy, in both mental and physical welfare. Numerous theories of depression are rooted in the assumption that the absence of PC results in diminished perceptions of self-efficacy and a state of 'hopelessness' (Abramson et al., 1989).

Seminal evidence for Hopelessness Theory comes from a study in 1972 by Glass and Singer, in which participants were exposed to noxious tones. They either had access to a button which would terminate the tone (high PC) or no access to the button (low PC). The group with the button reported lower psychological distress than the group without the button, indicating that PC has a protective function from psychological distress. 

An avalanche of research followed, finding extensive support for Hopelessness Theory. Subsequent literature has demonstrated that individuals with depression report lower PC than non-depressed individuals in both adulthood (Volz et al., 2018) and adolescence (Crandall et al., 2018). Moreover, reductions in PC often precede depression (Bjørkløf et al., 2018), whereas elevations are associated with remission (Hamilton & Abramson, 1983). These results suggest that PC entails a causal role in the manifestation of depression.

Despite the abundant evidence for the influence of PC on depression, research on the role of desire for control (DFC) is sparse. Desire for control refers to the extent to which one tries to exert control over their daily lives. Evidence from my own research indicates that DFC possesses an inverse relationship with depression, such that individuals with low DFC exhibit greater depressive symptomology than individuals with high DFC (Myles, unpublished data). 

However, the picture may not be so clear. One study reported that the risk of depression is greater when DFC is elevated relative PC, compared to when PC is greater than DFC (Amoura et al., 2014). These preliminary results indicate that one might experience an increased risk of depression if their DFC is not matched by a correspondingly high level of PC. 

The influence of PC and DFC on mental health may be particularly relevant in adolescence. Adolescence reflects a period of growing freedom, as teens attempt to exert increasing independence. The motivation to exercise freedom represents a form of DFC, whereas the independence afforded by parents reflects an aspect of PC. Indeed, this effort to exercise greater independence is often met with increasingly large amounts of freedom granted by parents/carers. 

But what if this rise in DFC is not appropriately matched by corresponding elevations in PC? Overly controlling parental behaviour has been linked with the development of internalising difficulties in teens (Gecas & Seff, 1990), with reductions in controlling behaviour associated with improved psychological welfare (Conger et al., 1997). Perhaps the rise in mental health issues during adolescence partially stems from a discrepancy between PC and DFC, whereby increases in DFC exceed increments in PC.

Anecdotally, this theory makes a lot of sense. How often have you heard teenagers complain about the restrictions placed on them by their parents/carers? Unfortunately, data on the topic is largely absent and it is currently unclear whether PC and DFC have a particularly significant impact on teenage psychological welfare. I would be interested to know whether others believe that incongruous levels of PC and DFC may underlie the upsurge in mental health issues during adolescence. 

Liam Myles
Assistant Psychologist
Surrey and Borders Partnership NHS Foundation Trust 

References

Abramson, L. Y., Metalsky, G. I., & Alloy, L. B. (1989). Hopelessness depression: A theory-based subtype of depression. Psychological review, 96(2), 358.

Amoura, C., Berjot, S., Gillet, N., & Altintas, E. (2014). Desire for control, perception of control: their impact on autonomous motivation and psychological adjustment. Motivation and Emotion, 38(3), 323-335.

Auerbach, R. P., Mortier, P., Bruffaerts, R., Alonso, J., Benjet, C., Cuijpers, P., ... & Murray, E. (2018). WHO World Mental Health Surveys International College Student Project: prevalence and distribution of mental disorders. Journal of abnormal psychology, 127(7), 623.

Bjørkløf, G. H., Engedal, K., Selbæk, G., Maia, D. B., Borza, T., Benth, J. Š., & Helvik, A. S. (2018). Can depression in psychogeriatric inpatients at one year follow-up be explained by locus of control and coping strategies? Aging & mental health, 22(3), 379-388. 

Conger, K. J., Conger, R. D., & Scaramella, L. V. (1997). Parents, siblings, psychological control, and adolescent adjustment. Journal of Adolescent Research, 12(1), 113-138.

Crandall, A., Allsop, Y., & Hanson, C. L. (2018). The longitudinal association between cognitive control capacities, suicidality, and depression during late adolescence and young adulthood. Journal of adolescence, 65, 167-176.

Gecas, V., & Seff, M. A. (1990). Families and adolescents: A review of the 1980s. Journal of Marriage and family, 52(4), 941.

Glass, D. C., & Singer, J. E. (1972). Behavioral Aftereffects of Unpredictable and Uncontrollable Aversive Events: Although subjects were able to adapt to loud noise and other stressors in laboratory experiments, they clearly demonstrated adverse aftereffects. American Scientist, 60(4), 457-465.

Hamilton, E. W., & Abramson, L. Y. (1983). Cognitive patterns and major depressive disorder: A longitudinal study in a hospital setting. Journal of Abnormal Psychology, 92(2), 173.

Volz, M., Voelkle, M. C., & Werheid, K. (2019). General self-efficacy as a driving factor of post-stroke depression: A longitudinal study. Neuropsychological rehabilitation, 29(9), 1426-1438.

White, R. W. (1959). Motivation reconsidered: The concept of competence. Psychological review, 66(5), 297.