Incidence and Teachers' Perceived Causation of Depression in Primary School Children in Greece

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2006 27: 296School Psychology InternationalGeorge Kleftaras and Eleni Didaskalou

Children in GreeceIncidence and Teachers' Perceived Causation of Depression in Primary School

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Incidence and Teachers’ Perceived Causation ofDepression in Primary School Children in Greece

GEORGE KLEFTARAS and ELENI DIDASKALOUUniversity of Thessaly, Department of Special Education, Greece

ABSTRACT Emotional difficulties, and especially depressive sym-ptomatology, constitute a serious and relatively frequent childhoodproblem which are often overlooked. Teachers’ responses to pupils’depression seem to be related to their understanding concerning thecauses of this problem. Thus, the aims of the present research are: (a) to estimate the proportion of pupils displaying depressive sympto-matology; (b) to examine teachers’ readiness and ability to identifythose pupils; (c) to search for teachers’ perceptions concerning the causation of pupils’ behavioural-emotional problems includingdepression and (d) to explore the differences between younger andolder teachers’ causal attributions. The sample consisted of 323 pupilsfrom the fifth to sixth grades and their teachers, in the area of Volos,Greece. Pupils completed the Children’s Depression Inventory, whiletheir teachers completed a questionnaire concerning their perceptionsof the incidence and causes of their students’ emotional-behaviouralproblems and depressive symptoms. The results indicate that approxi-mately 30 percent of the students indicated a high level of depressivesymptoms, while their teachers seemed to lack readiness and skills foridentifying this; they reported more often behaviour problems andtended to attribute students’ difficulties to factors lying outside theschool context. Implications are discussed in terms of developments inteachers’ training and policies leading to greater support for pupilsexperiencing depressive symptoms.

KEY WORDS: childhood depression; teacher’s perceived causes; teachers’ views

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Please address correspondence to: George Kleftaras, University of Thessaly,Department of Special Education, Argonafton and Fillelinon, 38221 Volos,Greece. Tel.: 210-9882075, 210-9885026, 24210-74738. Fax: 24210-74799. E-mail: [email protected], [email protected]

School Psychology International Copyright © 2006 SAGE Publications (London,Thousand Oaks, CA and New Delhi), Vol. 27(3): 296–314.DOI: 10.1177/0143034306067284

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IntroductionIn the course of the 1990s, many educational systems in the westernworld reported an increase in the number of pupils presenting emo-tional and behavioural problems (Artinopoulou, 2001; Castle andParsons, 1997; Didaskalou and Millward, 2001; Kakavoulis, 1998;Sanders and Hendry, 1997; Slee, 1995). Teachers also pointed out therising complexity of pupils’ emotional difficulties and the higherdemands placed upon them in terms of their management. Amongthese, depressive symptomatology constitutes a serious and relativelyfrequent childhood problem, and it has been estimated that approxi-mately 10–15 percent of primary school children present significantdepressive symptoms (Bibou-Nakou and Kioseoglou, 2001; Hammenand Rudolph, 1996; Kleftaras, 2004b; Liu et al., 1999; Ollson et al.,1999).

However, differences among studies in terms of case definitions, timeintervals assessed, assessment techniques, sample composition andsize make comparison of prevalence rates across studies difficult. Thus,in some other studies, prevalence rates for depression in children,based on the Diagnostic and Statistical Manual of Mental Disorders(DSM-IV; American Psychiatric Association, 1994) criteria and includ-ing both Major Depressive Disorder and Dysthymic Disorder, rangedfrom 0.3 percent to 6.4 percent (Bird et al., 1988; Cohen et al., 1993;Costelo et al., 1996a, 1996b; Fleming and Offord, 1990; Polaino-Lorente and Domenech, 1993; Puura et al., 1997). It appears that thenumber of children experiencing significant depressive symptomat-ology may be considerably higher than the suggested by the typicalepidemiological studies employing DSM or the International Classifi-cation of Diseases (ICD; World Health Organization, 1992) criteria. Forinstance, in an adolescent study the prevalence rate of clinically signifi-cant levels of depressive symptomatology was estimated as high as23.6 percent (Steinhausen and Metzke, 1999). Finally, the commonlyfound 2:1 female-to-male sex ratio in adults has not been reported con-sistently in children. In pre-adolescents the rate of depression has beenfound to be about equal in boys and girls, and in some cases higheramong boys (Anderson et al., 1987; Angold and Rutter, 1992; Fleminget al., 1989).

Depression in adults is characterized by depressed mood (sad affect),lack of interest or pleasure in activities, feelings of worthlessness and changes in appetite, weight, activity level and sleep patterns (Kleftaras, 2004a). For children from preschool through adolescence,the same criteria outlined for adults in DSM-IV are used to definedepressive disorders regardless of developmental level, with the excep-tion that for children and adolescents, irritability is considered amanifestation of depressed mood, and the duration of dysthymia is one

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rather than two years (Lewinsohn et al., 1998; see Luby et al., 2002;Ryan et al., 1987). In addition, dysphoric (depressed) mood might bemanifest by excessive crying in very young children, nonverbal sadnessin school-age children and irritability in adolescents (Garber andHorowitz, 2002; Kleftaras, 2004b; Weiss and Garber, 2003). Although acore set of depressive symptoms might exist that are common across all ages, it has been demonstrated that, concerning neurobiological correlates of depression, the differences between depressed children,adolescents and adults far outweigh the similarities, suggesting thereis still much to understand in the developmental nature of depression(Kaufman et al., 2001; Seligman et al., 2004).

A combination of three main factors that are applicable not only tothe Greek but also to the wider European context, seems to account forthe fact that depression in children has gone unnoticed for so long.Firstly, being influenced by the psychoanalytical model, it was believeduntil recently that depression could not emerge until adolescence, aperiod when the superego is more fully developed. Secondly, manydepressed children are often the ‘ nicest’ boys and girls in the block andthe most well behaved children in school. They are often well manneredand, unlike pupils displaying disruptive behaviour, they neither annoyor bother the teacher and classmates nor disrupt the educationalprocess (Cytryn and McKnew, 1996; Harrington, 2002; Kazdin andMarciano, 1998; Kendall, 1999; Kleftaras, 2004b). Thirdly, the sociallyapproved way that children experiencing depression behave in theclassroom, in conjunction with the recent escalation of misbehaviour inschools, often leads teachers to focus too narrowly on the needs ofpupils with the most obvious and pressing behavioural difficulties atthe expense of those with emotional problems, and especially depres-sive symptoms.

In fact, the recently perceived escalation of behaviour problems has caused considerable anxiety in all those involved either directly orindirectly in the educational process. In order to combat increasing con-cerns in the media as well as from within the educational system itself,governments have sought to intervene directly by developing a range of responses and policy initiatives aimed at eliminating difficult behaviour in schools and classrooms. Under these conditions, the needsof those with emotional problems, including depressive symptomat-ology, are in danger of being overlooked, as the focus becomes one ofaddressing the increase in behavioural difficulties. By focusing heavilyon the needs of those pupils with the most obvious and pressing behav-ioural difficulties, the needs of those with emotional problems andespecially depression are often ignored (Cooper, 1998; Didaskalou andKleftaras, in press; Didaskalou and Millward, 2001, 2002; Maras,1996).

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One factor that may influence teachers’ substantial readiness toaddress and respond to pupils with emotional problems, includingdepressive symptoms, relates to their perceptions concerning the causation of these problems. Usually teachers tend to attribute thecausation of pupils’ emotional problems almost exclusively to factorsthat reside outside the school context, including deficits within thechild and/or adverse family circumstances (Bibou-Nakou, 2003; Mavro-poulou and Padeliadu, 2000; Poulou and Norwich, 2002; Thacker et al.,2002; Vlachou et al., 2004).

Within this trend there is, however, a view that teachers’ attributionof pupils’ problems to external factors may well reflect their denialand/or lack of skills to respond effectively to pupils’ needs. Additionally,such a perspective underestimates the crucial impact that the schoolecology and educational practices are likely to exercise on the genesisand development of pupils’ emotional problems (Mortimore et al., 1988;Reynolds, 1995; Reynolds and Cuttance, 1992; Rutter et al., 1979). Furthermore, previous studies have examined the relationshipbetween teachers’ reports of the incidence of emotional and behaviouralproblems, and their years of age (Borg and Falzon, 1990; Didaskalouand Millward 2001; Papatheodorou and Ramasut, 1993). Age may be animportant factor in differentiating teachers regarding their causalattributions of pupils’ problems, especially when variables such as parenthood, teaching experience and traditional-conservative viewsconcerning child-rearing practices are involved.

In light of the above, the aims of the present study are to: (a) estimatethe proportion of primary school age children in one area of Greece dis-playing depressive symptomatology; (b) examine teachers’ readinessand ability to identify and report those pupils presenting depressivesymptoms; (c) investigate Greek primary school teachers’ perceptionsconcerning the causation of pupils’ behavioural and emotional prob-lems including depression and (d) explore the group differencesbetween younger and older teachers’ causal attributions of pupils’problematic behaviour.

Methods

SubjectsThree hundred and twenty-three students, mostly Greek in nation-ality, attending the fifth and sixth grade of primary school (155 boysand 169 girls), ranging from 10 to 13 years of age, and their 35 class-room teachers (16 males and 19 females) constitute the sample of thestudy. The students’ sample was drawn from ten schools located in theextended area of the city of Volos in Thessaly, in central Greece. All


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pupils had siblings and the vast majority of their parents (92 percent)were married, with only 4.9 percent of them reporting that their parents were divorced or separated. In general, the children reportedhaving a good or a very good relationship with their parents and siblings, got relatively good grades at school and claimed to be satisfiedin class. Some of the students’ socio-demographic characteristics areillustrated in Table 1.

Table 1 Students’ sociodemographic characteristics (n = 333)

n Percent

SexBoys 155 47.8Girls 169 52.2

Age10 15 4.611 161 49.712 138 42.613 9 2.8

NationalityGreek 300 92.6Other 24 7.4

Parents situationMarried 298 92Divorced/separated 16 4.9Mother or father deceased 9 2.8

Relationship to parentsGood or very good 313 96.6Fair 6 1.8Poor or very poor 5 1.5

Number of siblingsOne 43 13.3Two 187 57.7Three 64 19.8Four 22 6.8Five+ 7 2.2

Friends in schoolMany good friends 210 64.8Some friends 81 25A few friends 29 9No friends at all 3 0.9

Materials and procedureThe young participants were administered the Children’s DepressionInventory (CDI) in groups during out-of-class sessions that lasted for approximately half an hour. The CDI is a 27-item-self-reportedsymptom-oriented scale suitable for school-age youngsters and adoles-


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cents, aged 7 to 17 years. It quantifies several dimensions of depressionincluding disturbed mood, hedonic capacity, negative functions, self-evaluation and interpersonal problems. Several items relate to theconsequences of depression in contexts that are specifically relevant tochildren, such as the school context. This instrument has been con-structed, revised and validated in the US by Kovacs (1985; 1992)possesses a good internal consistency (Cronbach’s alpha = 0.71 to 0.89)and test–retest reliability. It was translated into Greek and revisedthrough back-translations by a team of four bilingual psychologists andgeneral education teachers. Since the CDI has not been validated inGreece, we studied its factorial structure based on our sample. Accord-ing to the principal-components factor analysis the factorial structureof this instrument, as it was found in our sample, is satisfactory andconfirms the results of previous studies. It contains a general factorand the Varmax rotations have given the expected factors.

Teachers’ perceptions concerning the incidence of students’ behav-ioural and emotional problems including depressive symptomatologywere elicited by responding to a questionnaire constructed by theauthors for the purposes of the present study. This questionnaire consisted of 14 behaviours, half of which presented emotional problemsand the other half behavioural ones. The teachers in our study had toreport the precise number of pupils in their classroom who, according totheir personal judgement, displayed problematic behaviour or behav-iour that caused them concern and rate the frequency of occurrence ofeach item-behaviour on a weekly basis, using a three-point scale.

Finally, teachers were asked to number and describe the perceivedcauses of the problems that were being displayed by those particularstudents in the classroom whom they identified as exhibiting problem-atic behaviour or behaviour that raised concern for them. Teachers’responses were classified by three raters, according to their content,into five categories: (a) family dysfunction/adverse family background;(b) inappropriate and inconsistent parenting skills and rearing prac-tices; (c) psychological and biological deficits in children; (d) schoolcontext and educational practices and (e) unknown causes.

ResultsAccording to the data collected during the course of this study, a con-siderable number of these primary school students displayed eithermild or severe depressive symptomatology corresponding to CDI cut-offpoints of 10 and 19 respectively, as indicated by the constructors of theinstrument and the relevant literature related to general screening.Twenty-eight (8.6 percent) students displayed definite (severe) symp-toms of depression (19–28 CDI score), 71 (21.9 percent) exhibited mild


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depressive symptomatology (10-18 CDI score), while 224 (69.3 percent)did not present any significant symptoms of depression (0–9 CDIscore). Thus, 99 (30.5 percent) of the total sample of 323 pupils exhib-ited significant depressive symptoms (Table 2).

Table 2 Distribution of frequency of students’ self-reported depressive symptomatology (CDI)

Depressivesymptomatology Frequency (n) Percent

Absence (0–9 CDI score) 224 69.3Mild (10–18 CDI score) 71 21.9Severe (19–28 CDI score) 28 8.6Mild and severe (10–28 CDI score) 99 30.5Total 323 100

As far as teachers’ ability to identify those pupils displaying prob-lematic behaviour was concerned, the data indicate that teachers,based on their personal judgement, reported that only 34 out of thetotal number of 323 students who completed the CDI test, exhibitedemotional and behavioural difficulties (Table 3). Therefore, only 11 per-cent approximately of the students were perceived as experiencingdifficulties by their teachers. However, among those 34 students, iden-tified by their teachers as presenting problematic behaviour, 20reported no depressive symptoms, while only three reported severedepressive symptomatology (Table 3).

Table 3 Comparative presentation of students’ self-reports and teachers’ perceptions on depressive symptomatology (CDI)

Depressive symptomatology(CDI)

Mild andAbsence Mild Severe severe

n n n n(%) (%) (%) (%)

Students’ self-reported 224 71 28 99depression (n = 323) (69.3) (21.9) (8.6) (30.5) Students displaying 20 11 3 14problematic behaviour, as (6.2) (3.4) (0.9) (4.3) reported by teachers (n = 34) Students displaying depression, 60 25 85but not identified by teachers (60.6) (25.2) (85.8) (n = 85)


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Thus, from the total number of 99 students who reported mild andsevere depressive symptomatology, teachers were able to identify only 14 (14.1 percent). They did not identify the remaining 85 pupils,corresponding to 85.8 percent of the students displaying depressivesymptomatology. In relation to the types of students’ problematicbehaviour, as perceived by teachers, a further analysis indicated a tendency for teachers to report a higher incidence of behavioural prob-lems compared to emotional ones, though this tendency was not sogreat as to reach a level of statistical significance.

The major causes to which teachers attribute students’ problematicbehaviour are related, in terms of reported frequency to: (a) problemswithin families such as family dysfunction and adverse family back-ground; (b) inappropriate parenting skills, inconsistent modellingand/or indulgent rearing practices; (c) biological and/or psychologicaldeficits in children; (d) factors related to the school context includingdominant educational practices and the kind of relationships devel-oped within it. However, it is important to mention that the frequencyof reporting school related factors was extremely low. In fact, causesrelated to problems within families were reported 35 times, followed by22 references to inappropriate parenting skills including inconsistentmodelling and indulgent rearing practices, 13 mentions of biologicaland/or psychological problems in children and only five references tothe school context (Table 4).

Table 4 Teachers’ causal attributions of students’ emotional andbehavioural problems

Reported causes Frequency (n) Percent

Problems within families such as family 35 45.45dysfunction and/or adverse family background Inappropriate parenting skills, inconsistent 22 28.57modelling and/or indulgent rearing practices Biological and psychological deficits in children 13 16.88School context, including dominant educational 5 6.49practices and relationships developed within it. Unknown causes 2 2.59

Finally, as suggested in the literature, age constitutes a factor that islikely to impact on teachers’ causal attributions. Thus, we decided toexplore any differences that might exist in teachers’ causal attributionsof pupils’ problems, in relation to teachers’ years of age. The sample ofteachers (n = 35) was subdivided into three groups, according to age.The first group consisted of ten teachers, aged 25 to 35 years, the second group of 19 teachers, aged 36 to 46 years and the third group of


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six teachers, aged 47 or above. Consequently, teachers’ references (77in total) with regard to perceived causes of students’ difficulties werealso classified into three groups according to the age of the teacher whoreported them. Due to the small sample size, the Kruskal-Wallis One-way Analysis of Variance (nonparametric test) was used for analysingthe data. Similar significant results were, however, obtained by usingthe One-Way Analysis of Variance (ANOVA).

As Table 5 shows, the differences observed among the three age-groups of teachers, in terms of perceived causes of students’ emotionaland behavioural problems, were significant only with regard to inap-propriate parenting skills, inconsistent modelling and/or indulgentrearing practices (χ2 = 6.35, p < 0.05). No significant differences werefound among teachers causal attributions of pupils’ difficulties withrespect to: (a) problems within families such as family dysfunctionand/or adverse family background (χ2 = 0.02, p > 0.05) and (b) psycho-logical and/or biological deficits in children (χ2 = 0.57, p > 0.05). Finally,no comparisons could be computed among teachers’ different agegroups and perceived causes of students’ problems related to school factors, including educational practices and/or relationships developedwithin the school context, due to the small number of teachers’ refer-ences (only five) to these particular causes.

Table 5 Comparisons (Kruskal-Wallis Test) among teachers’ agegroups on perceived causes of students’ emotional and behaviouralproblems

Teachers’ age groups

Teachers’ reported 25–35 years 36–46 years 47+ yearscausation Mean Rank Mean Rank Mean Rank χ2(df)

Problems within families 17.70 18.00 18.50 0.02 (2)such as family dysfunction and/or adverse family background (35 references) Inappropriate parenting 13.25 9.46 20.50 6.35* (2)skills, inconsistent modelling and/or indulgent rearing practices(22 references) Biological and psychological 5.25 7.32 — 0.57 (1) deficits in children (13 references)

*p < 0.05.


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Discussion

The incidence of depressive symptomatology in Greek primary schoolage childrenIn the context of the current research it can be inferred with some con-fidence that approximately 30 percent of primary school age children inthe extended area of Volos in Thessaly, in central Greece, and probablyall over the country, display significant symptoms of depression at anygiven time. This exceeds by two or three times the percentage emanat-ing from epidemiological surveys undertaken elsewhere using thesame or similar instruments, suggesting that approximately 10–15percent of the child population report significant depressive symptoms(e.g. Bibou-Nakou and Kioseoglou, 2001; Gotlib and Hammen, 1992;Liu et al., 1999; Ollson et al., 1999; Rutter, 1986).

The considerable number of primary school-age children who displaymild and severe depressive symptomatology in conjunction with theadverse prognosis of the condition in pre-adolescence and adolescence,clearly implies that we face a reality that calls for action on the part ofschool policy makers, especially in terms of developments in teachertraining programs and policies leading to greater levels of support forpupils experiencing depressive symptoms. The need to support thosestudents who experience emotional problems, including depression,becomes even more urgent in the light of the limited effectiveness thatcharacterizes most of the dominant support practices within the Greekordinary schooling system. In particular, teachers very often reportthat they feel ill-equipped in dealing with the great complexity andrange of problems students display within an under-resourced school-ing system (Didaskalou, 2002; Gavrilidou et al., 1994; Nikolopoulou,1986; Vlachou et al., 2004). Despite teachers’ repeated calls for supportfrom child psychological and support services that are located outsidethe school context, as well as from child mental health community services, the current dominant practices continue to be characterizedby ineffective co-operative and support mechanisms between the schooland most of the relevant services available (Bezevegis and Giannitsas,2000; Paraskevopoulos, 2002).

Teachers’ readiness and ability to identify pupils displaying depressionGreek primary school teachers seem to be lacking in readiness and efficient skills for identifying and reporting those pupils presentingdepressive symptoms. A number of hypotheses may account for teachers’ low reporting. It could be possible that Greek teachers, liketeachers everywhere, are more concerned about identifying and elimi-nating students’ increasing behaviour problems than emotionaldifficulties and especially depressive symptoms. However, a more


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plausible hypothesis is that Greek teachers neither are aware of norwell informed about the phenomenology and symptomatology ofdepression in childhood and its adverse impact on students’ cognitive,academic and social functioning. It could be suggested that althoughteachers might be concerned about the behaviour of some of their students, they lack the necessary skills and training to identify depres-sive symptoms and to respond to them effectively. This hypothesis isfurther supported by the fact that primary school teachers report thatthey experience the greatest difficulty in dealing with those studentsdisplaying emotional problems such as ‘appear unhappy, depressed, ordistressed in the class’, or ‘seem unusually timid, lack confidence withtheir work, do not speak without the teacher’s indication’ (Didaskalouand Millward, 2002).

A number of researchers also argue that the dominance of a psycho-medical perspective in the Greek context has until recently reinforcedteachers’ reliance on external experts, such as psychologists and men-tal health practitioners, in dealing with pupils’ emotional problems(Didaskalou and Millward, 2002; Gavrilidou, et al., 1994; Nikolopoulouand Oakland, 1990). Such a consideration was especially evident inteacher training colleges in the 1970s and early 1980s, which offered atwo-year program of studies. It was anticipated that the revision ofundergraduate training programs from two to four years provided byuniversities, would encourage the use of different perspectives in train-ing programs, that are compatible with the current trends in the fieldwhich emphasize the impact that dominant educational practices arelikely to have on the development and elimination of pupils’ emotionalproblems.

However, as yet only a small number of teachers who were trainedfor four years have been appointed in schools, and it is therefore toosoon to ascertain whether there has been a noticeable impact on theperceptions and professional skills of teachers. In fact, the vast majority of the participants in the present study had graduated fromteacher training colleges, and only three out of the total number of 35teachers sampled had completed a four-year program of study. In spiteof the absence of significant courses on classroom behaviour manage-ment in their initial training programmes, primary school teachersappear to be more perplexed by pupils’ emotional rather than behav-ioural problems. Given the impact that depression may have onindividual students’ social and emotional development as well as ontheir learning and participation in classroom activities, the manage-ment of students’ emotional problems clearly remains a concern forthose teachers already in position.


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Greek primary school teachers’ causal attributions of pupils’ emotionaland behavioural problemsThe findings from this study confirm previous evidence gathered inGreece (Mavropoulou and Padeliadu, 2000; Poulou and Norwich, 2002;Vlachou et al., 2004) and elsewhere (Cooper et al., 1994; Gray andNoakes, 1994; Hanko, 1995; Lloyd-Smith and Davies, 1995), indicatingthat teachers tend to attribute the causes of pupils’ emotional andbehavioural problems to factors that reside outside the school context(family dysfunction and ineffective rearing practices). This may wellreflect their denial and/or lack of appropriate skills to respond effec-tively to pupils’ needs. In fact, teachers’ responses suggest that themajority operate within a model of causation premised on individualpathology (Bibou-Nakou, 2003; Clark et al., 1998; Croll and Moses,2000; Reybekill, 1998; Slee, 1995. Vlachou-Balafouti, 2001; Vlachou-Balafouti and Zoniou-Sideris, 2000 ; Zafiropoulou, 2002).

The dominance of the medical perspective encourages many teachersto assume that responses to students’ emotional needs are beyond theirprofessional skills and responsibilities and that the most appropriatepractice is to refer students to external specialists. This attitude prevents them from taking into account those school factors that may contribute to or exacerbate students’ emotional and behaviouraldifficulties and it is probably the greatest obstacle towards the develop-ment of school-based approaches in Greek schools (Cooper, 1999;Didaskalou, 2002; Gavrilidou et al., 1994; Paraskevopoulos, 2002;Stasinos, 1991; Vlachou-Balafouti, 1999).

Furthermore, it is noteworthy that the recent increased interest inthe role that school is expected to play in students’ psychological well-being is likely to be related to important changes in the internaldynamics of the Greek family and the way these dynamics are influ-enced by broader societal developments. As more Greek women becomefinancially independent, patterns of interaction within the familychange, challenging traditional roles and providing a potential sourceof conflict between spouses, which in turn is often responsible for psychological difficulties and problems in children. In addition, theincreased frequency and social acceptance of divorce has also con-tributed to greater instability within the family (Hatzichristou, 1998;1999). These changes have loosened many of the traditional supportsavailable to children, emphasizing the role that schools are increas-ingly expected to play in the socialization and psychological health oftheir students (Gavrilidou et al., 1994; Georgas, 1989; Ierodiakonou,1988; Nikolopoulou and Oakland, 1990; Stefanis and Madianos, 1981).

Finally, teachers’ age constitutes a factor that, according to ourresults, influences their responses over the causation of students’ emotional and behavioural problems. Some interesting significant


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differences are observed in the way teachers’ perceived causes are dis-tributed across the three age teachers’ groups (25–35, 36–46, 47 +). Infact, younger and mainly older teachers but not those of the middle agegroup category attribute the genesis of students’ problems to ineffec-tive parenting skills and indulgent rearing practices. One reason thatmay account for this result relates on the one hand to younger teachers’lack of long experience and skills in parenthood and classroom behav-iour management, and on the other hand to older teachers’ moretraditional and consequently conservative views concerning child rearing practices. However, these reasons do not seem to apply to theteachers of the middle age group category, who are likely at this age tobe parents themselves, have a relatively longer teaching experienceand may not rely heavily on more traditional, conservative and strictchild discipline methods. However, given the small number of teachersin the different age groups, the above accounts, concerning the impactof age on teachers’ causal attributions of students’ emotional andbehavioural problems, remains an issue for further research.

ImplicationsThe implications of this study are limited by the small sample size andthe fact that all subjects were of a specific age-range in a specific area ofGreece (extended area of Volos) and not clinically diagnosed asdepressed. Therefore, the results cannot even as yet be generalized tothe Greek population of children as a whole or to a clinically depressedstudents’ sample, though we consider that Volos is a typical Greek city,and there is no indication to believe that children living in this area differ in any significant way from children in other parts of Greece.Further research work must be done in order to check the validity ofthe findings across ages and different parts of Greece, as well as onclinically depressed schoolchildren population.

Another limitation of this study is that the Children’s DepressionInventory, used for assessing children’s depressive symptomatology,has not been standardized in Greece. In addition, it is a self-reportscale and consequently social desirability factors cannot be totallyruled out. Thus, we suggest that future research should incorporatebehavioural indexes of depression or depressive symptomatology inorder to provide external validation of the present findings, given thatchildren often have difficulty in expressing or recalling informationregarding the symptoms they experience (Emslie and Mayers, 1999).

In spite of these limitations, we consider that some important impli-cations for policy makers result from the findings of the present study,which may constitute a base for examining current practices and plan-ning prospective educational developments. Given the considerablenumber of students displaying depressive symptomatology, the policy


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agenda should gradually begin to emphasize: (a) teachers’ training pro-grams at both pre- and in-service level, aiming to enable teachersfirstly to identify and secondly to respond effectively to students withemotional problems, especially depression; (b) the establishment ofsupport structures and services within the school context aiming atproviding assistance to both classroom teachers and the majority ofstudents and their families, including those who face identified minoror serious difficulties in the academic, social and psychological domainsand (c) the development of effective co-operative schemes and com-munication mechanisms among the school and community-basedmental health and social care provision services (Adelman and Taylor,1998; Callias, 2000; Hatzichristou, 1999; Indoe, 1998; Nastasi, 1998).

Furthermore, given the crucial impact that teachers’ causal attribu-tions of students’ difficulties is likely to exercise on their responses, special emphasis should be placed in prospective training courses onattitudinal issues concerning the positive influence that the widerschool context may have on the reduction of students’ problems.Although evidence indicates that establishing effective school–parentliaison is considered to be an essential requirement for developing effective responses aiming at reducing students’ depressive sym-ptomatology (Bibou-Nakou and Stogiannidou, 2002; Miller, 1994;Paraskevopoulos, 2002), many Greek teachers and parents still sub-scribe to a view that sees the school as entirely the territory of teachers. This implies that developing appropriate skills and effectiveapproaches in working successfully with the parents of students dis-playing behavioural and emotional problems, including depression, areissues that have to be incorporated in future teachers training courses.

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Angold, A. and Rutter, M. (1992) ‘Effects of Age and Pubertal Status on Depres-sion in a Large Clinical Sample’, Development and Psychopathology 4: 5–28.

Artinopoulou, B. (2001) Via sto sxoleio: erevnes kai politikes stin Evropi[Violence in Schools: Research and Policies in Europe]. Athens: Metehmio.

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Documents

Incidence and Teachers' Perceived Causation of Depression in Primary School Children in Greece