Testing a Model of Depression Among Thai Adolescents Duangjai Vatanasin, RN, PhD (Candidate), Darawan Thapinta, RN, PhD, Elaine Adams Thompson, RN, PhD, and Petsunee Thungjaroenkul, RN, PhD Duangjai Vatanasin, RN, is PhD Candidate, The Graduate School, Chiang Mai University, Muang, Chiang Mai, Thailand; Darawan Thapinta, RN, PhD, is Associate Professor, Faculty of Nursing, Psychiatric Nursing, Chiang Mai University, Muang, Chiang Mai, Thailand. Elaine Adams Thompson, RN, PhD, is Professor, Department of Psychosocial and Community Health, School of Nursing, University of Washington, Seattle, WA, USA. Petsunee Thungjaroenkul, RN, PhD, is Assistant Professor, Faculty of Nursing, Nursing Administration, Chiang Mai University, Muang, Chiang Mai, Thailand Search terms: Adolescent, depression, negative automatic thought, social problem solving, rumination Author contact: duangjaivat@yahoo.com; duangjaivat@hotmail.com, with a copy to the Editor: poster@uta.edu doi: 10.1111/jcap.12012 PROBLEM: This predictive correlational study was designed to test a comprehen- sive model of depression for Thai adolescents. METHODS: This sample included 800 high school students in Chiang Mai, Thai- land. Data were collected using self-reported measures of depression, negative auto- matic thoughts, effective social problem solving, ineffective social problem solving, rumination, parental care, parental overprotection, and negative life events. FINDINGS: Structural equation modeling revealed that negative automatic thoughts, effective and ineffective social problem solving mediated the effects of rumination, negative life events, and parental care and overprotection on adolescent depression. CONCLUSION: These findings provide new knowledge about identified factors and the mechanisms of their influence on depression among Thai adolescents, which are appropriate for targeting preventive interventions. Depression in adolescents is a worldwide mental health problem (Sheeber, Hops, & Davis, 2001).Adolescents are con- sidered a high-risk group for depression because they are con- fronted with multiple stressors in rapidly changing societies (Romeo, 2010). Approximately 19% to 30% of Thai adoles- cents studying in grades 10 to 12 experience depression (Borriruklert, 2007; Charoensuk, 2007; Ruangkanchanasetr, Plitponkarnpim, Hetrakul, & Kongsakon, 2005). Recognizing the severity and extensiveness of the impact of depression raises the priority for prevention efforts in Thailand. To develop effective depression prevention programs requires a clear understanding of the broad range of influencing factors and the processes or mechanisms by which depression emerges in adolescence (Garber, Webb, & Horowitz, 2009); however, there is a lack of integration of multiple factors that are guided by theories as well as its interaction with other variables in Thailand. Thus, multiple factors influencing depression among Thai adolescents should be clearly defined and examined simultaneously. Purpose This study was designed to test the effects of adolescent per- ceptions of contextual factors (parental care, parental over- protection, and negative life events) and cognitive factors (effective problem solving, ineffective problem solving, rumi- nation, and negative automatic thoughts) on adolescent depression in an effort to build a theoretical framework to support the design of appropriate depression prevention programs for Thai adolescents. Background Generally, adolescents experience transient elevations of depressed mood resulting from diverse factors such as stress- ful life experiences, problematic interpersonal situations, and hormonal fluctuations (Kolvin & Sadowski, 2001).According to a comprehensive literature review based on adolescent self- report, the prevalence of adolescent depression is high glo- bally (Huang, Sousa, Tu, & Hwang, 2005; Perera, Torabi, Jayawardana, & Pallethanna, 2006). Thai late adolescence, generally encompassing the high school years, is the highest risk group to develop adolescent depression (Ruangkancha- nasetr et al., 2005). They also manifest with multiple stressors that come from their circumstances. Many demands and rapid changes in the high school years, including increasing amounts of schoolwork, assignment deadlines, and exams, can make them one of the most stressful times of life (Tasai, Reuchutakul, & Thummaporn, 2008). Thus, adolescents who fail to cope well with their growth and development as well as fail to accomplish their development may have intense emo- tional and behavioral problems. Journal of Child and Adolescent Psychiatric Nursing ISSN 1073-6077 195 Journal of Child and Adolescent Psychiatric Nursing 25 (2012) 195–206 © 2012 Wiley Periodicals, Inc.