All ETDs from UAB

Advisory Committee Chair

Anne Turner-Henson

Advisory Committee Members

Andres Azuero

Lucrecia Collins

Jennifer Langhinrichsen-Rohling

Teena McGuinness

Document Type


Date of Award


Degree Name by School

Doctor of Philosophy (PhD) School of Nursing


ABSTRACT Stress and bullying are known contributors to depressive symptoms in adolescents. Prevalence of depressive symptoms in adolescents is estimated to range from13% to 34% in recent studies. Ninth graders are in a transitional period developmentally,biologically, physically, and psychosocially. Few studies have examined the relationship between stress, bullying, and depressive symptoms from a biobehavioral perspective in 9th graders. The purpose of this study was to examine stress, bullying, and depressive symptoms including a biomarker of stress, salivary cortisol diurnal rhythm, to determine if there is mediation between the individual variables of stressful life events, perceivedstress, bullying, and depressive symptoms. The theoretical framework was McEwen’sTheory of Allostatic Load. A convenience sample of 9th graders (n = 143), was recruited from two high schools in a Southern state. Saliva specimens for cortisol were collected in the morning and afternoon. After collection of the morning saliva sample, adolescents completed online surveys, including the Center for Epidemiologic Studies Depression Survey-10, Perceived Stress Scale-10, Personal Experiences Checklist, and Self Rating Scale for Pubertal Development. An afternoon saliva sample was collected, and adolescents’ completed the Coddington Life Event Scale-Adolescents by paper and pencil. Adolescents scoring > 9 on the depression survey (clinically significant depressive symptoms) were referred to the school nurse. Approximately 40% of adolescents scored 10-30 or clinically meaningful depressive symptoms. Stressful life events ranged from 0-79 events in one year. Life change unit scores ranged from 0-1691 with 80% of participants scoring above the normative score of 170. Perceived stress scores revealed that 84% of adolescents scored10-30 out of a 40-point scale. Bullying scores revealed an average score of 15.14 out of 128 total score. Significant correlations with depressive symptoms were noted with stressful life events, life change units, perceived stress, verbal/relational bullying, and gender identity. Two variables (PSS-10, PECK) and one covariate (gender identity) were significant predictors of depressive symptoms. These findings should help to guide school nurses, teachers, counselors, or other professional working with this population. Future research is warranted with 9th graders experiencing a transition to high school.

Included in

Nursing Commons



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