Tellura Youth Journal: Issue 3, March 2022

RHEUMATOID ARTHRITIS: PATHOPHYSIOLO AND TREATMENTS TEENAGE DEPRESSION QUALITY OF FAMILY AND PEER RELATION RHEUMATOID ARTHRITIS: PATHOPHYSIOLO AND TREATMENTS TEENAGE DEPRESSION QUALITY OF FAMILY AND PEER RELATION RHEUMATOID ARTHRITIS: PATHOPHYSIOLO AND TREATMENTS TEENAGE DEPRESSION QUALITY OF FAMILY AND PEER RELATION RHEUMATOID ARTHRITIS: PATHOPHYSIOLO AND TREATMENTS TEENAGE DEPRESSION QUALITY OF FAMILY AND PEER RELATION RHEUMATOID ARTHRITIS: PATHOPHYSIOLO AND TREATMENTS TEENAGE DEPRESSION QUALITY OF FAMILY AND PEER RELATION RHEUMATOID ARTHRITIS: PATHOPHYSIOLO

MARCH 2022 • ISSUE 3

tellura YOUTH JOURNAL

Tellura | Youth Journal | Issue 3 March 2022 Cover designed by Ayesha Umair. The articles within this publication are the intellectual property of their respective authors, and must be cited appropriately. They may not be reproduced in any way without prior permission from the authors. Note also that the contents or conclusions derived within these articles represent the viewpoints of their respective authors, not any of the Tellura sta members or editors. The remaining content within this publication is under an MIT License, and supports the Open Source Initiative. More information can be found on

https://tellura-sci.web.app/about

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This document was compiled using L TEX.

Authors, listed alphabetically Heerud Seyedian Jeninaah Hamilton

Tellura Members Involved Rija Khalid, Head of Youth Journal Chelsea Shi, Editor Hadiqa Shaikh, Editor Manvir Chima, Editor Sarah DiMatteo, Editor Owen Zhou, Edtior Jiawen Deng, Editor Phavithraa Sabesan, Editor Grace Goodale, Editor Ridhi Gopalakrishnan, Editor Ayesha Umair, President

Tellura is a student organization a liated with the McMaster Students Union (MSU). Its mission is to provide a set of accessible guides, materials, and opportunities that help high school and middle school students learn about scienti c research. For any questions or concerns, please contact

tellura@mcmaster.ca

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Contents

1 Introduction

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2 Rheumatoid Arthritis: Pathophysiology, Causes, and Treatments

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3 Teenage Depression and the Quality of Family and Peer Relationships

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4 Conclusion

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1

Introduction

Dear Reader, Welcome to Issue 3 of the this Youth Journal! It has been organized by Tellura, which is an MSU-a liated student club at McMaster University. Tellura provides guidance and resources for students in grades 7 to 12 on science research. The youth journal articles are written by secondary school students who are paired up with undergraduate editors and receive guidance and feedback from them.

This journal aims to give

secondary school students a chance to practice science writing and improve their skills through receiving and applying feedback.

In this issue, we explore a variety of topics including rheumatoid arthritis and teenage depression.

We are grateful for the hard work and dedication of the youth journal department and all the authors, to provide you with high-quality student work.

We hope that you will enjoy the second issue of our youth journal and will nd the articles valuable and insightful.

All the best, Rija Khalid Head of Youth Journal

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2

Rheumatoid Arthritis: Pathophysiology, Causes, and Treatments

Heerud Seyedian, edited by Chelsea Shi, Owen Zhou, Jiawen Deng, and Hadiqa Shaikh I. Introduction

i. Anatomy of Synovial Joints Bones provide support for the human body and work with muscles to enable the freedom of movement. The place where two or more bones meet is known as a joint. are known as synovial joints.

The most common type of joints in the body

These joints are freely mobile, meaning that they allow for movement and

exibility. They are encapsulated by a synovial membrane that contains synovial uid and has lymphatics and blood vessels running through it. This viscous uid lubricates and nourishes articular cartilage, a smooth connective tissue that covers the ends of the bones and allows joint movement with minimal friction. The synovial membrane is surrounded by a brous joint capsule (or articular capsule) which protects the synovial uid and helps keep it in place (Alomar et al., 2007).

Arthritis is a term given to disorders that cause in ammation in the joints. The term, rheumatoid, comes from the word, rheumatism, which refers to a musculoskeletal illness (Parish, 2005).

Figure 1: A synovial joint.

ii Rheumatoid Arthritis Rheumatoid Arthritis (RA) is an autoimmune disease, meaning that a patient's immune system mistakenly attacks their body.

As the second-most common type of arthritis, RA is estimated to have a worldwide

prevalence of approximately 0.24%. However, some countries such as Canada and the United States have a much higher prevalence of up to 1% (Cross et al., 2014). RA most commonly a ects the synovial joints

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of the body, causing acute in ammation which is accompanied by an abundance of pain and swelling. The most commonly a ected joints in RA are the wrists, hands, knees, ankles, and feet. Generally, doctors can distinguish RA from other types of Arthritis due to its symmetrical aspect as the disease typically a ects both sides of the body equally. Other organs in the body can be a ected as well, such as the eyes, lungs, heart, skin, and the digestive tract (Johns Hopkins Arthritis Center).

One of the more unpredictable and bothersome qualities of RA are the ares that patients frequently experience throughout the course of their disease. A are is identi ed as a period of increased disease activity or worsening symptoms; a time when the medications patients normally rely on to control their disease does not seem to work. Due to variability across individuals, ares can vary in intensity, duration, and frequency.

Although ares often seem to occur with no conspicuous cause, their initiation can commonly be attributed to an observable trigger.

For most patients, the risk of ares increase when treatments are tapered or

stopped. Other triggers include overexertion, stress, infection, or lack of sleep (Arthritis Foundation).

iii. Disease Onset Early signs of RA often include fatigue, weight loss, and joint sti ness, before eventually progressing to major joint pain and tenderness.

After experiencing such symptoms, patients visit their physicians who

perform multiple blood tests to detect the presence of rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) antibodies that indicate the presence of autoimmune disease (Lin et al., 2020). Further, physicians may order erythrocyte sedimentation rate (ESR) and/or C-reactive protein (CRP) tests to detect the presence of in ammation.

RA symptoms present themselves in varying forms in di erent individuals. In most patients, symptoms develop gradually over several years, though others may experience a more rapid progression of symptoms.

Patients rarely contract the disease for a limited period of time before going into remission (a time with no symptoms) for the rest of their life.

Although RA itself is not generally considered a lethal disease, deaths in patients with RA are often attributed to complications of the disease and its treatment.

In Canada, all-cause mortality rates are

elevated in RA patients with a 40-50% greater mortality risk compared to the general population. Leading causes of death in RA patients are identi ed as infectious diseases, respiratory diseases, and gastrointestinal diseases in the order presented. In general, RA patients can see a possible decrease in life expectancy by around 10 to 15 years. However, with recent advances in methods of treatment, many patients continue to live with their disease past the age of 80 or even 90 years (Widdi ld et al., 2018).

II. Pathophysiology

In RA, T-helper cells and B-cells enter the circulation and reach the joints.

Here, T-helper cells release

chemicals known as cytokines, B-cells release and autoimmune antibodies into cells of the synovial membrane.

A healthy synovial membrane is a delicate lining with a thickness of only 1-3 cells. However, due to the release of cytokines, this lining is greatly hypertrophied in RA and can develop to be up to 8-10 cells thick (Johns Hopkins Arthritis Center). This increase in cellularity of the synovial membrane is called the pannus. The pannus invades and erodes cartilage and bone, causing acute pain and swelling in the joints. If left untreated, the pannus releases uids and chemicals that eat away bone and cartilage tissues, causing destruction of the joint. As the pannus grows, in ammation in the joint increases and causes a build-up of uid that leads to swelling (Weyand & Goronzy, 2017).

Over time, space between the bones, previously lled with synovial uid, narrows which may cause the joint to gradually grow and fuse together. This process is referred to as ankylosis. Ankylosis causes a loss in

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Figure 2: Growth of Pannus.

the patient's ability to move the joint in addition to extreme pain. As in ammation in the joint increases, angiogenesis occurs, which is the excess formation of new blood vessels around the joint. This further allows T-helper cells and autoimmune antibodies produced from B-cells to enter the joint through lymph vessels and release more cytokines, speeding up the process of RA (Cooles & Isaacs, 2011).

Figure 3: Stages of RA. Although the majority of RA symptoms present themselves in the joints, in ammatory cytokines that are released in the joints often escape through the bloodstream and reach multiple organ systems across the body.

These cytokines cause a variety of additional symptoms that most frequently appear during ares. These symptoms include, but are not limited to, fever, vasculitis, and muscle weakness. Furthermore, cytokines cause scar tissue in the lungs, making gas exchange more di cult. The pleural cavity surrounding the lungs also can become in amed and cause the lungs to ll up with uids (Cojocaru et al., 2010). This process is known as pleural e usion and can often be dangerous if left untreated.

III. Causes

Typically, a combination of both genetic and environmental factors contribute to the development of RA." (Deane et al., 2017). Genetic risk factors are de ned as properties in the genetics of an individual that lead to an increased susceptibility to certain conditions or diseases.

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Environmental risk factors are de ned as

factors in an individual's environment and lifestyle that make them more vulnerable to certain conditions or diseases.

i. Genetic Factors Heritability analysis of multiple studies suggests that about 60% of a population's predisposition to RA can be accounted for by genetic factors (Lee & Weinblatt, 2001). In general, females are associated with an increased risk of the disease, as 66% to 86% of global RA patients are female (Ngo et al., 2014). Numerous femalespeci c risk factors of RA have been recognized such as estrogen de ciency, early menopause, polycystic ovary syndrome, and pre-eclampsia (Deane et al., 2017).

Early menopause in women is widely accepted

as a risk factor and predictor of RA. The reason for this falls behind the hypothalamic-pituitary-adrenal (HPA) axis: a complex set of direct in uences and feedback interactions among three components. An HPA axis with a sluggish response to stress can uctuate a woman's endocrine hormone levels and lead to a higher frequency of early menopause. Women who experience early menopause as a result of an insu cient HPA axis are more likely to contract RA due to unnatural levels of endocrine (Pikwer et al., 2012).

As

another recognized RA risk factor, estrogen de ciency (predominantly in postmenopausal women) causes various immune dysregulations. An abnormal distribution of T helper-cell subsets and enhanced reactivity of T helper-17 (Th17) cells is among these dysregulations observed in women with estrogen de ciency. This results in elevated levels of in ammatory cytokines which stimulate articular cartilage to secrete enzymes that lead to tissue destruction (Sapir-Koren & Livshits, 2017).

Some genetic factors that lead to an increased chance of contracting RA are pre-existing in an individual's genetic coding.

The strongest of the genetic risk factors is a set of alleles known as shared epitope (SE)

alleles which are thought to contribute up to 40% of the genetic risk of RA (Deane et al., 2017). Another identi ed genetic risk factor for RA is in the proteins of our cells. Human Leukocyte Antigens (HLA) are hereditary proteins found in most cells of our bodies. Those with speci c subsets of HLA proteins such as HLA-DR1 and HLA-DR4 are more susceptible to RA, especially when exposed to environmental risk factors (Auger & Roudier, 1997).

ii. Environmental Factors Fortunately, many of the environmental risk factors for RA are within our control. The strongest of these factors is cigarette smoke. A Japanese study determined that the risk of developing RA was approximately twice as high for smokers than for non-smokers in men, and 1.3-times higher in women (Chang et al., 2014).

Systemic low-grade in ammation caused by smoking leads to changes within the joints themselves which cause severe pain and in ammation in RA patients. Furthermore, exposure to silica dust, which often occurs for those in jobs such as construction laborers and drywallers, is associated with the development of RA among other autoimmune diseases. Once silica particles are inhaled, they travel through the trachea and into the lungs and through the bronchus and bronchioles.

In the lungs, they come into contact with the

alveoli where their ingestion by macrophages initiates an in ammatory response that stimulates broblasts to produce collagen. Silica particles are encased by collagen which leads to brosis and silicosis. Silicosis has been linked to the development of autoimmune diseases (Pollard, 2016). Breastfeeding in women has also been shown to increase the risk of RA due to elevated levels of the lactation hormone, prolactin, which increases in ammation in synovial and periodontal tissues (El-Wakeel et al., 2021).

An individual's diet plays a major role in the risk of RA. While some foods have bene ts in preventing the disease, speci c dietary intakes have proin ammatory e ects on the joints, making them risk factors for RA. Such diets include red meat, sodium, and ber. Excessive consumption of red meat has been associated with an increased risk of RA. This is due to increased in ammation derived by meat fats and nitrites (Pattison et al., 2004). A high dietary sodium intake, common in Western countries, has also been associated with an increased risk of RA. High levels of sodium intake amplify the detrimental e ects of other environmental

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factors.

Smoking is the strongest of these factors, as a high sodium intake in smokers increases the risk

of anti-citrullinated protein antibodies (ACPA) positivity which is an in ammatory marker associated with joint destruction (Salgado et al., 2015). Lastly, carbohydrate absorption is decreased by diets with a high intake of ber.

Carbohydrate absorption presents a negative relationship with C-reactive protein (CRP),

interleukin-6 (IL-6), and tumor necrosis factor alpha (TNF-α), mediators of in ammation (Gioia et al., 2020).

iii. Other Factors In addition, age is known as a major factor in an individual's risk of RA. According to a study in the USA, the prevalence of RA in individuals over the age of 60 was found to be 2%, showing an increase when compared to rates of those below the age of 60 (0.5-1%) (Kobak & Bes, 2018).

IV. Treatments

In active RA, rapid achievement of tight control of disease activity is required as earlier treatment often leads to better results. The start of treatment in the early stages of the disease while symptoms are still minor often leads to prevention of major joint damage. Frequently monitoring the patient and modifying the treatment accordingly is crucial for the proper treatment of RA. Until the 1990s, treatment of RA was similar throughout most patients. Since then, numerous new methods have been discovered and individual treatment plans are unique to patients depending on the course of their disease (Ruyssen-Witrand & Constantin, 2018).

i. Medication As the primary method of treatment for RA, numerous medications have been shown to help prevent and reduce symptoms of the disease.

Some popular medications used by doctors to treat RA include non-

steroidal anti-in ammatory drugs (NSAIDs), glucocorticoids, and synthetic disease-modifying antirheumatic drugs (DMARDs) (Burmester & Pope, 2017).

The three most frequently used DMARDs for RA fall un-

der the conventional synthetic DMARDs subdivision: methotrexate, hydroxychloroquine, and sulfadiazine.

Methotrexate is the suggested rst-line therapy for RA, as 30% 50% of early RA patients are able to reach a state of either remission or low disease activity through this treatment.

Further, hydroxychloroquine

displays anti-in ammatory and immunomodulatory properties, and sulfadiazine displays anti-in ammatory, immune-modulatory, and antibiotic properties, all of which can be e cacious in the treatment of RA (Lin et al., 2020). The administration of glucocorticoids is particularly controversial due to their severe side e ects in long-term use which range from minor acne to Cushing syndrome which may result in diabetes mellitus or potentially life-threatening heart disease if left untreated (Oray et al., 2016). However, glucocorticoids have been used as an e ective treatment method for over 70 years in 30% to 50% of all RA cases globally and will continue to be used despite their side e ects (Ruyssen-Witrand & Constantin, 2018). The administration of estrogen to female RA patients through Hormone Replacement Therapy (HRT) is also a particularly e ective and popular method of treatment. It has been proven to result in improvements in joint pain, decreased bone loss, and a reduction in the patient's risk of developing RA (Holroyd & Edwards, 2009). Bromocriptine (BRC) is another form of medication shown to help relieve RA patients of their symptoms by decreasing prolactin (PRL) levels. female RA patients.

PRL is a lactation hormone associated with increased pain and in ammation in

BRC decreases PRL levels in patients which improves numerous symptoms such as

morning sti ness and joint tenderness (Tang et al., 2019).

Unfortunately, most of the medication used for RA treatment has various side e ects that can be detrimental to the patient's health and well-being; in particular, DMARDs. Side e ects of methotrexate include hair loss, stomatitis, nausea, and hepatotoxicity caused by its disruption of folate metabolism. Fortunately

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these can be prevented by the prophylactic supplementation of folate (mainly as folic acid). Although with low frequency (4.4%-19%), ophthalmic toxicity and retinal degeneration are known side e ects of hydroxychloroquine. Sulfadiazine also displays side-e ects, including fatigue, nausea, abdominal pain (dyspepsia), and diarrhea (Lin et al., 2020). Doctors often refrain from prescribing DMARDs for this particular reason as they may assess that their patient would not be able to tolerate the side e ects (Burmester & Pope, 2017).

ii. Diet & Supplementation In addition to medications, various forms of nutrients and dietary intakes have proven to be bene cial in RA. Patients are frequently advised by doctors to go on a Mediterranean diet as it includes a multitude of foods and nutrients which are associated with improvements in symptoms and disease progression.

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Mediterranean diet is categorized by being rich in fruits, vegetables, legumes, nuts, beans, cereals, grains, sh, and unsaturated fats. A study showed signi cant improvements in the Disease Activity Score for RA (DAS28) when comparing a Mediterranean diet to a habitual diet.

Patients reported a notable decrease

in joint tenderness in addition to lower levels of hip, knee, and ankle pain (Skldstam et al., 2003). Other dietary intakes that contribute to major improvements in RA include fruits and vegetables, extra virgin olive oil, tomato juice, black tea, red wine, ginger powder, cinnamon powder, and sa ron. These foods have antiin ammatory e ects by decreasing levels of a variety of in ammatory markers such as CRP, IL-6, TNF-α, thromboxane 2 (TXB2), and leukotriene B4 (LTB4) (Gioia et al., 2020). Intake of these foods throughout the course of the disease is often recommended by doctors in order to decrease the severity of symptoms and slow down disease progression.

Furthermore, doctors often pursue supplementation as a method of treatment for RA. Consistent supplementation of N-3 fatty acids shows signi cant improvements in DAS28 along with a reduction in joint swelling and tenderness. Additionally, intake of antioxidants through supplementation shows improvements in the general health of RA patients (Nelson et al., 2020).

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Arthritis care & research, 70 (12),

3

Teenage Depression and the Quality of Family and Peer Relationships

Jeninaah Hamilton, edited by Manvir Chima, Sarah DiMatteo, Phavithraa Sabesan, Grace Goodale, and Ridhi Gopalakrishnan Abstract

This study examined the quality of family and peer relationships and its impact on depression in teenagers.

The main objective is to demonstrate a correlation between the quality of these relationships and depression in teens. 100 adolescents ranging in age from 14 to 17 across Ontario and the United States were surveyed on social media platforms. The results showed a negative correlation between participants' rankings of the quality of family and peer relationships and ratings of feelings of depression.

The higher the quality of

relationship ranking, whether family or peer, the lower the rating for feeling depressed and vice versa. A neutral ranking for the quality of these relationships does not support the hypothesis but comparisons to other studies may account for these di erences.

Teenage Relationships and Depression

Many individuals associate adolescence, the years between the onset of puberty and the beginning of adulthood (Walinga & Stangor, 2014), with mood swings, bad attitudes, and behavioural problems. While these issues may be a reality for some teens, it is not the case for all. In fact, approximately 5% of male youth and 12% of female youth between the ages of 12-19 have experienced at least one episode of major depression, making this age group one of the highest across Canada for developing depression with approximately 3.2 million at risk (Canadian Mental Health Association 2020). Studies have shown that relationships have a major impact on teenagers and the quality of their mental health (Canadian Mental Health Association 2020). The more favourable a teenager rates a relationship, whether familial, social, or romantic, the less likely he or she is to be depressed. On the contrary, teens reporting con ict or tension in relation to others demonstrated the highest rates of depression (Canadian Mental Health Association 2020).

One source of depression in teens is family relationships with a particular emphasis on the parent-child relationship. A study conducted by Chen & Harris (2019) looking at parent-child relationships, especially during adolescence, showed that healthy relationships can help prevent depression in teens. The researchers investigated how individuals with strong parent-child relationships have signi cantly low levels of depressive symptoms in their young adolescence to adult lives compared to other individuals with poor family relationships. The researchers concluded that parent-child relationships must be positive to reduce symptoms of depression in the teenage years and establish good mental health in the future (Chen & Harris, 2019).

Conversely, research by Nelemans et al. (2016) examined how problems in parent-teen relationships can be connected to depressive symptoms. A study was performed where teens and their parents were given a questionnaire investigating their relationship. Results of the survey showed that the adolescents who reported depressive symptoms also had a negative relationship with their parents (Nelemans et al, 2016).

A potential reason for a negative relationship between parents and teenagers is o ered by By (2003) who discusses how teenagers' parents struggle to understand mental illness and its impact on a young adult's life. A study conducted by Kansas State University monitored 13,257 teenagers frequently for mental health problems. The study concluded that the most common mental illnesses reported were anxiety and depression; mostly attributed to poor family relationships in teen's lives on account of parents being too busy with other commitments in life to take notice, or feeling embarrassed and ashamed about their teenager's condition to o er the necessary support (By, 2003).

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To further illustrate this nding, Freed (2016) also studied the link between family relationships and adolescent depressive symptoms. A two-year study investigated the major impact of family functioning on a teen's emotional well-being and depressive symptoms. It was found that family relationships are connected to a teenager's emotional control along with the ability to understand and communicate feelings.

Poor

family bonds due to a lack of communication can lead to emotional instability which can, in turn, lead to depressive symptoms (Freed, 2016). Therefore, the research clearly establishes a strong association between dysfunctional parent-child relationships and depression in teenagers.

Other potential sources of depression in teenage relationships are peers and romantic signi cant others.

Nalin (2017) describes how a teenager's relationship with their friends can positively impact their own mental health. In this study, researchers explored the relationship between a teen's mental health and that of their friends. The results demonstrated a positive correlation between an individual's mental health status and that of their friends (Nalin, 2017). Furthermore, the study also showed how healthy friendships decrease the probability of teenage depression by fty percent and can even support the recovery process from mental illness (Nalin, 2017). Therefore, a teenager is more likely to show signs of psychological well-being if their friends demonstrate psychological well-being as well.

Furthermore, research by Buck and Dix (2012) examined how a lack of self-con dence among peer relationships can increase depressive symptoms in teenagers. It has been highly supported by research that peer groups become important and can impact teens' mental and emotional health during early adolescence. As such, Buck and Dix (2012) conducted a longitudinal study of youth when in the sixth and ninth grades to rate both the quality of peer relationships and popularity. It was concluded that youth with poor quality peer relationships demonstrated an increased inhibition , or self-consciousness, which translated to lower popularity ratings and an increase of depressive symptoms (Buck & Dix, 2012).

Moreover, in terms of signi cant others, Beckmeyer, Coleman and Proulx (2018) studied whether adolescents' positive or negative association with romantic relationships have a connection to depressive symptoms and problem behaviors. Data was collected from teens who had been or were currently in romantic relationships to determine whether their positive and negative interactions led to the presentation of depressive symptoms (Beckmeyer et al., 2018). The results demonstrated teens in romantic relationships may be at risk of depressive symptoms and problematic behavior when partner interactions are negative (Beckmeyer et al., 2018). Therefore, the e ect of negative peer and romantic relationships may cause depression in teenagers who at this stage highly value these interactions.

In the present study, the research will seek to determine if family, peer, and romantic relationships lead to the development of depressive symptoms in teenagers.

Several key studies, as mentioned above, have

found a correlation between these relationships and depression in teenagers. This information would provide a better overall understanding of one of the main causes of teen depression. A survey of high school students will be conducted using a questionnaire about the types and quality of their current relationships as well as their thoughts and feelings about these relationships. It is hypothesized that the poor-quality relationships in teens' lives can negatively impact their mental health leading to depression.

Method

Participants 100 adolescents participated in this study on teenage relationships and depression. 80 percent of the participants attended various secondary schools throughout the province of Ontario, and the other 20 percent of participants were students from di erent geographical locations in the United States of America including Manhattan, New York and Herndon, Virginia. Participants ranged in age from 14 to 17 and between grades 9 and 12. 69% of the participants were female, 22% were male. These participants were selected because they were easily accessible via social media and provided a fair representation of diversity in terms of gender,

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age, and race.

Materials/Procedure A copy of the questionnaire that queried about the participant's identity and quality of relationships was created on Surveyplanet. The survey was uploaded onto the researcher's Instagram and Snapchat accounts.

Students with access to these two social media platforms were able to access and respond to the online questionnaire. Once completed, the Surveyplanet website alerted the researcher about the status of completed questionnaires as well as each participant's responses. After 100 students participated, access to the online questionnaire was disabled and the results were measured following the completion of data collection.

Results

The results of this study determined participants' feelings of depression in both family and peer relationships.

In terms of family, participants ranked the quality of their family relationships and rated their feelings of depression in these relationships, as seen in Graph 1. Of signi cance, 92% of adolescents who ranked their family relationships as a 1 out of 5, or not good, often have feelings of depression in these relationships while 8% of adolescents indicated always having feelings of depression. Of the 19 individuals who reported a neutral family relationship, as ranked 3 out of 5, 57% sometimes feel depressed, 32% often feel depressed, and 11% always feel depressed. For those teenagers who ranked their relationship with their family as 5 out of 5, or very good, 49% rarely feel depressed, 35% sometimes feel depressed, and 16% often feel depressed.

Participants also examined the quality of their peer relationships and feelings of depression, as seen in Graph 2. This examination required participants to rank the quality of their relationships with peers and rate their feelings of depression accordingly. For a ranking of 1 out of 5, indicative of poor-quality relationships, 86% of adolescents were often depressed and 14% of adolescents were always depressed. A neutral rating of 3 out of 5 demonstrated a variation in feelings of depression. Thirty six of individuals were sometimes depressed, 41% of individuals were often depressed, and 23% of individuals were always depressed. Moreover, of those participants who reported very good peer relationships, with a ranking of 5 out of 5, 70% were rarely depressed, 25% were sometimes depressed, and 5% were often depressed.

It is important to note that participants ranking either family or peer relationships as 1 out of 5, as seen in Tables 1 and 2, did not report rarely feeling depressed. Moreover, of those participants ranking either family or peer relationships as very good, 5 out of 5, as seen in Tables 1 and 2, no one indicated a rating of always feeling depressed.

Discussion

Some areas of this study support a correlation between family and peer relationships and depression in teenagers.

A careful examination of Graph 1 clearly indicates that teenagers who share close family ties

rarely experience feelings of depression while those who do not are more likely to be depressed. These results support the hypothesis that poor-quality relationships in teens' lives can negatively impact their mental health, leading to depression.

One possible explanation is that good quality family relationships provide

teenagers with a strong support system. This allows for open communication to mitigate negative thoughts and feelings that could potentially trigger the signs and symptoms indicative of teenage depression. This nding closely relates to that of Chen & Harris (2019), demonstrating that positive parent-child relationships are necessary for decreasing the likelihood of teenage depression. Alternatively, for those individuals who report feelings of depression, the poor quality of their family relationships suggests a lack of support. This result is in keeping with Nelemans et al., (2016), By (2003), and Freed (2016) who demonstrated that

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problems in parent-teen relationships can be connected to depressive symptoms on account of ine ective communication as a necessary means of support. This leads to the development of emotional instability and a tendency towards depression in adolescence.

When further examining peer relationships and teenage depression, Graph 2 shows that the higher the friendship quality rating the lower the ranking for feeling depressed.

Teenagers who are able to develop

and maintain healthy peer relationships are less likely to experience feelings of depression. This is in direct contrast to teens who do not share close bonds of friendship as these individuals tend to be depressed. Since adolescence is a period of transformation, friendships with peers and signi cant others play a major role in the development of social, mental, and emotional health and well-being (Chen & Harris, 2019). As such, the ndings of this study are consistent with that of Nalin (2017) who demonstrated a positive correlation between an individual's mental health status and that of their friends'. A teen can be helped or hindered by their friends' mental health as when their friends are psychologically healthy or unhealthy, this a ects the mental well-being of the teen as well. Moreover, teenagers who lack a fundamental friendship network also lack access to a social network that can provide a rich source of support in times of need or crisis. Such circumstances o er another possible explanation as to why teens with poor quality friendships are depressed since, at this stage, peer and romantic relationships are highly valued interactions.

Interestingly, neutral ratings of either family or peer relationships resulted in teens ranking their feelings of depression towards the higher end of the scale. In other words, teens who quali ed their relationships as neither good nor bad were more likely to experience feelings of depression.

Moreover, teens tend to

focus on negative aspects of these relationships which may increase the frequency and severity of depressive feelings reported.

Both Freed (2016), who discussed family relationships, and Beckmeyer et al., (2018),

who discussed peer relationships, support this suggestion in that negative relationships were likely to be associated with depressed teens. By's (2003) earlier work attributes negativity to factors that include: the lack of understanding, time, and interest given to the relationship, communication breakdown, or feelings of embarrassment over the individual's mental state. For the purposes of this study, these factors may be applicable but further research is required as they were not examined critically.

Furthermore, it is important to note some limitations with the current study.

First, neutral ratings

from participants in the study may not accurately re ect the quality of their relationships. One explanation is participants may not have been comfortable reporting relationships as not good for various reasons.

In which one of the most important may be the sensitive nature of the quality of the relationship.

If

the relationship is of poor quality, then rating it as such on the questionnaire may have elicited negative thoughts and feelings within the individual; thereby, making him or her depressed.

In this way, it could

potentially be safer for the participant to avoid these consequences altogether by simply reporting family and peer relationships as neutral. Second, what constitutes a good relationship versus a bad relationship is subject to interpretation by individual participants and may not re ect the views of the researcher of this study. Finally, the sample was limited to students with access to social media. Teens who have and make use of social media applications may have di erent views and experiences from those who do not have access or do not choose to express their views online.

Therefore, in order to obtain more accurate results that

can be applied to a larger population of teenagers, it would be necessary to increase the sample size as well as allow for the distribution of questionnaires in secondary schools. By doing so, the scope of the research would be broadened and provide additional information as to the extent to which relationships and their overall quality impact teenage depression. The value of this study for providing valid and reliable research is important for future studies on the quality of relationships and depression in adolescence.

References 1. Beckmeyer, J. J., Coleman, M., & Proulx, C. M. (2018, October 1).

Perceived romantic relation-

ship quality: Associations with adolescents' depressive symptoms and externalizing behavior.

Relations, 67 (4), 539-551. http://doi.org/10.1111/fare.12341

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Family

2. Buck, K. A., & Dix, T. (2012). Can developmental changes in inhibition and peer relationships explain why depressive symptoms increase in early adolescence?

403-13.

http://doi.org/10.1007/s10964-011-9651-9

3. Canadian Mental Health Association.

(2021, July 19).

//cmha.ca/fast-facts-about-mental-illness

Journal of Youth and Adolescence, 41 (4), Fast facts about mental illness.

https:

Strong family ties during teen years can help ward o depression in later years. The Conversation http://theconversation.com/strong-family-ties-d

4. Chen, P., & Harris, K. M. (2019, October, 7).

uring-teen-years-can-help-ward-off-depression-in-later-life-124239

5. Freed, R. D., Rubenstein, L. M., Daryanani, I., Olino, T. M., & Alloy, L. B. (2016). The relationship between family functioning and adolescent depressive symptoms: The role of emotional clarity.

of Youth and Adolescence, 45 (3), 505-519. http://doi.org/10.1007/s10964-016-0429-y

Journal

https://www.google.com /url?q=https://www.healthlinkbc.ca/health-topics/depression-children-and-teens&sa=D& source=docs&ust=1646156742195793&usg=AOvVaw1tcHr0g12gApfEXPg1LF-6

6. HealthLink BC. (2021, September 23). Depression in children and teens.

7. Morgan, E. & Huebner, A. (2019). Adolescent depression. [Review of article Adolescent depression,

Virginia Cooperative Extension, 350-851. https://vtechworks.lib.vt.edu/bitstr eam/handle/10919/92806/350-851(FCS-132P).pdf?sequence1

by N. Ru n].

8. Nalin, J. (2017, January, 24).

How the emotional health of your teen's friends impacts your teen.

Paradigm Malibu. https://paradigmmalibu.com/emotional-health-friends-impacts-teen/

9. Nelemans, S. A., Branje, S. J. T., Hale III, W. W., Goossens, L., Koot, H. M., Oldehinkel, A. J., & Meeus, W. H. J. (2016). Discrepancies between perceptions of the parent-adolescent relationship and

JournalofY http://doi.org/10.1007/s10964-016-0503-5

early adolescent depressive symptoms: An illustration of polynomial regression analysis.

outhandAdolescence,45(10),

2049-2063.

10. Shellenbarger, S. (2003, April, 17). Hiding from your teen's depression: Parents struggle over how to cope.

Wall Street Journal, Eastern Edition, D.1.

11. Thomson, J. D. (2018). Depression and suicide in teens today.

Vanguard, 37-42. https://saanys.o

rg/wp-content/uploads/2014/09/Van-online2018.pdf#page=32

12. Truschel, J. (2020, September, 25).

Depression de nition and DSM-5 diagnostic criteria.

https://www.psycom.net/depression-definition-dsm-5-diagnostic-criteria/

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13. Walinga, J., & Stangor, C. (2014). 7.3 Adolescence: Developing independence and identity. In

duction to Psychology - 1st Canadian Edition.

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https://opentextbc.ca/introduction topsychology/chapter/6-3-adolescence-developing-independence-and-identity/ BC Campus.

Appendix

Adolescent Relationships Questionnaire This is a self-administrated questionnaire. Please answer each question honestly and choose the answer that best describes your situation. Please answer the following questions respectfully as it will a ect the result of the survey. All information on this survey will remain con dential. This questionnaire does not include any numbers or codes that can help determine a speci c respondent. Thank you for your time. It is greatly appreciated.

1. What grade are you in?

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(a) 9 (b) 10 (c) 11 (d) 12 2. What is your ethnic background? (a) Black (b) Asian (c) White (d) Hispanic (e) Mixed (f ) Other 3. Do you regularly spend time with your family? (a) Always (b) Often (c) Sometimes (d) Rarely 4. Do you agree or disagree with the statement:, Poor relationships can negatively impact your mental health ? (a) Strongly agree (b) Agree (c) Not sure (d) Disagree (e) Strongly disagree 5. Which of these relationships positively impacts your mental health the most? (PICK ONE) (a) Family (b) Friends (c) Romantic (d) Peer (e) Other 6. Which of these relationships negatively impacts your mental health the most? (PICK ONE) (a) Family (b) Friends (c) Romantic (d) Peer (e) Other 7. Do you ever feel down, depressed, or hopeless due to the relationships in your life? (a) Always (b) Often (c) Sometimes

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(d) Rarely 8. I feel the most lonely... (a) When I am with family (b) When I am with my friends (c) When I am with my signi cant other (d) When I am with my peers (e) When I am by myself (f ) Other 9. How would you describe most of the relationships in your life? (a) Excellent (b) Good (c) Okay (d) Bad (e) Terrible 10. On a scale from 1 (not good) to 5 (really good), how would you rate your relationship with your family?

1 2 3 4 5 11. On a scale from 1 (not good) to 5 (really good), how would you rate your relationship with your peers?

1 2 3 4 5

Tables Ranking of Family Relationships

Always

Often

Sometimes

Rarely

1 (Not Good)

1

12

0

0

2

1

5

3

0

3

2

6

11

0

4

2

4

12

10

5 (Very Good)

0

5

11

15

Table 1: Feelings of Depression in Relationships Ranking of Peer Relationships

Always

Often

Sometimes

Rarely

1 (Not Good)

2

12

0

0

2

2

12

3

0

3

5

9

8

0

4

0

5

9

13

5 (Very Good)

0

1

5

14

Table 2: Feelings of Depression in Relationships

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Figure 4:

Figure 5:

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4

Conclusion

This publication was a culmination of the e orts of our authors, the youth journal department, and the support of all out members. We hope to continue providing youth journals regularly in the future, and we hope that this served well as a learning and teaching tool on how to apply scienti c writing and skills.

Thank you, Reader, for helping further our goal of promoting scienti c communication.

Tellura

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