An interview with Anna Viduani, a Brazilian researcher in adolescents’ depression.
“If you ask closed-ended questions, you are only going to get the answers to these questions,” says Anna, the research psychologist from Brazil who is interested in depression in adolescence, in particular adolescents’ perspectives on what it means, and feels like, to be depressed.
Anna is conducting her research in Brazil, and she recently published two scientific articles – one focusing on adolescents’ experiences of depression, and the other on their experiences of receiving the diagnosis of depression.
Having worked together with Anna on a research project in the past, Identifying Depression Early in Adolescence (IDEA), I was lucky to get a chance to talk to her about her recent work in qualitative research, which is the kind of research that asks open-ended questions in an interview-like format to explore and understand the depth and breadth of the topic – in this case, adolescents’ perspectives on depression.
Similarly to Anna, I am a mental health scientist with a background in Psychology and I was always fascinated by this kind of scientific approach, because it integrates diverse perspectives, and is a great indicator of which way to go in research. And who is a better guide to understanding depression than those who have experienced it?
“We were really interested in exploring in greater detail how Brazilian adolescents perceived and experienced depression”, Anna explains, “we interviewed adolescents with open-ended questions, trying to truly understand their experiences, perceptions, thoughts, and behaviours about depression.”
She emphasises the power of giving a voice to those with lived experience if we want to understand “what is important and what really matters to those affected by depression”. Knowing this can point us in the right direction in terms of research, clinical practice, school interventions, and generally, in society to help open a dialogue and reduce stigma.
“What did you learn from your group of adolescents”? I am curious.
“One of the first things that we learnt was that many of the adolescents never had a chance to speak about their experiences before, and being part of our study, gave them this space to talk and think about it. We felt like they were using the space to make sense of something that they did not have the opportunity to express before, and to make sense of their symptoms.” When talking to Anna, I felt that this alone seemed like reason enough to conduct this study, it was offering something important to these kids.
And whilst this space for open conversation was available, Anna learnt something new about how youth experienced depression, what was important to them, and where to go from there in terms of helping create an environment fostering well-being.
“Adolescents felt like their voices were often not heard, especially by adults or other people in their lives, and they felt like they were not treated as experts of their own experiences”. This was an important piece of information as it showed the need to create spaces where adolescents could share how they felt. This was also something that was reflected in the interviews with parents who reciprocated the feeling that there was a lack of communication and understanding for them about what their children were going through. “I know what sadness means for me, but I have no idea what sadness means for my child”, one of the parents said. This statement really struck me as it was saying something powerful – you can really miss the point if you are not curious about the other. I wanted to know if Anna found the answer to this question – what did sadness and depression mean to adolescents in her study?
The central theme that emerged was social isolation. When exploring it further, she found that two aspects were contributing to how adolescents experienced depression – an internal sense of loneliness and how it was reflected in the quality of relationships with others.
Anna and her colleagues called it a relational model of depression. According to this model, isolating and withdrawing from social interactions also serves as a coping strategy for internal discomfort and difficulties relating. “We proposed this model because we felt like social isolation was at the core of the experience”, Anna says, and adds, “I feel like this is not an experience that is limited to Brazil and might be applicable to adolescents in different parts of the world”.
Anna talked about opening a dialogue which really helped to normalise experiences where participants could understand and name what was happening to them. For example, adolescents who received a diagnosis of depression were able to think about it. However, adolescents who were not familiar with what depression was, and did not know anyone who had depression, found it more difficult to accept and understand the nature of it. There was a sense of confusion. For example, how can the condition that is rooted in biological changes be manifested in mood changes – “How can emotions be a disease?” This also meant that they felt more worried when they received a diagnosis and there was a sense of stigma associated with it - “Some adolescents really struggled to come to terms with having a diagnosis, feeling like it would bring up a lot of stigma because they had this idea of depression as something negative”.
Listening to Anna, I felt like I learnt a fair bit about adolescents’ experiences, and I wondered, what’s next – how can we use this information to help address the gaps?
“I feel like the biggest message that we wanted to convey to everyone is listening to adolescents, it's always a good measure when trying to identify what the main difficulties are and which direction to go next in terms of interventions. For example, based on what we learnt, we could start thinking about interventions that would focus on social connectedness, interpersonal relationships, opening spaces for communication between not only peers, but also different generations, reducing stigma and so on.” I couldn’t agree more. I think it is incredibly important that we create spaces and listen to those with lived experience and integrate this knowledge with that of researchers and health professionals. This way we can think together what is relevant and how we can make it work.
And we are on the right track with new research projects emerging, such as CELEBRATE, which looks at co-producing a framework of guidelines for engaging young people in biological research in mental health. I hope more projects like this will follow and conversations will open.
As, supposedly (although not scientifically confirmed), Fyodor Dostoyevsky said, “Much unhappiness has come into the world because of bewilderment and things left unsaid.” Let’s talk.