A health promotion strategy for adolescents: effects of values therapy and relaxation exercises on depressed adolescents
Masked depression and its maladaptive behavioral equivalents are damaging the health of today's adolescent. This experimental study of promoting health in 122 nonclinically depressed junior and senior high school adolescents, ages 12 to 19, was conducted to test the effectiveness of two nursing interventions: values therapy and relaxation exercises combined (T1) and relaxation -exercises only (T2). Academic underachievement, personal values incongruence and tension were measured as behavioral equivalents of depression. A Solomon four group design was used to test four null hypotheses. The theoretical framework combined Adaptation-Level Theory with the Health Promotion Model and addendumed values-attitude schema with a proposed health behaviors continuum. In Part I, 259 subjects were pretested using the Center for Epidemiologic Studies of Depression, FombyHealth/Health Promotion Values, and Relaxation SelfAssessment scales. A sample of 122 randomly selected subjects, scoring >16 on CES-D and stratified by school, gender, and grade average, was randomly assigned to T1, T2, or no treatment groups. In Part 2, once a week for four weeks, 33 subjects, guided by the nurse investigator, discussed pressing problems, examined their pretested values, and performed taped relaxation exercises; 28 performed taped relaxation exercises only. Sixty-one subjects received no treatment. All 259 subjects were posttested. Findings were (1) on pretest 89% of the population were above the CES-D >16 (possible range Oto 60) indicative of depression (range 16 to 46); (2) on posttest 91% were depressed (range 16 to 57); (3) on posttest a decrease to 79% occurred in the sample of 122 subjects (range 14 to 28); (4) T1 was superior to T2 and no treatment for all ages; (5) a -11 point difference in CES-D scores and +10 point difference in grade averages occurred between T1 and no treatment groups in senior high subjects; (6) on posttest the value health for juniors and health, health promotion, happiness, and helpful for seniors were significant; and (7) for all ages health (being healthy) is valued high but health promotion (acting to become healthier) low. Confirmation of the preva lence of depression and the positive effects of values therapy and relaxation exercises deserves attention by nurses, school personnel, parents, and others. Incongruence in the value placed on health and health promotion has implications for health planners. Health promotion constitutes the outcome of nursing intervention s on depressed adolescents.