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The Self-Efficacy Questionnaire for Depression in Adolescents (SEQ-DA)

Article  in  European Child & Adolescent Psychiatry · November 2005

DOI: 10.1007/s00787-005-0462-y · Source: PubMed

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Eur Child Adolesc Psychiatry (2005)

14:357–363 DOI 10.1007/s00787-005-0462-y ORIGINAL CONTRIBUTION

Bruce Tonge The Self-Efficacy Questionnaire for

Neville King
Ester Klimkeit Depression in Adolescents (SEQ-DA)
Glenn Melvin
David Heyne Development and psychometric evaluation
Michael Gordon

Accepted: 3 December 2004 N. King retest reliability. Results indicated

Monash University that higher SEQ-DA scores were
Faculty of Education
B. Tonge · Dr. E. Klimkeit (
) · G. Melvin · Clayton, Victoria 3800, Australia associated with lower self-rated
M. Gordon depression scores (Reynolds Ado-
Monash University Centre lescent Depression Scale), which is
for Developmental Psychiatry evidence of good construct valid-
and Psychology
School of Psychology, Psychiatry ■ Abstract The 12-item clinician ity. Further, higher SEQ-DA scores
and Psychological Medicine or self-administered Self-Efficacy prior to treatment predicted better
Monash Medical Centre Questionnaire for Depression in outcome at the end of the 3
246 Clayton Road Adolescents (SEQ-DA) was devel- months of treatment and at 6
Clayton, Victoria 3168, Australia
Tel.: +61-3/9594-1300 oped as a measure of perceived months post-treatment. Therefore,
Fax: +61-3/9594-6333 ability to cope with depressive the SEQ-DA has a potentially use-
E-Mail: symptomatology. This study exam- ful role in clinical work and re-
[email protected] ined the reliability and validity of search with depressed young peo-
D. Heyne the SEQ-DA in a clinical popula- ple.
Developmental and Educational Psychology tion of 130 adolescents that were
Faculty of Social and Behavioural Sciences
Leiden University
receiving treatment for depression. ■ Key words self-efficacy –
PO Box 9555 Psychometric evaluation revealed adolescents – depression –
2300 RB Leiden, The Netherlands good internal consistency and test- psychometric properties

of disease burden for Australian adolescents in 1996

Introduction [21].
Bandura [4] proposed that when individuals have
According to Bandura [6], in order to competently carry high outcome expectancy, but relative to others they
out and maintain a particular behaviour, one needs have low self-efficacy expectancy, the result is a lack of
both the belief that a given behaviour will lead to the behavioural initiative and persistence, self-devaluation
desired outcome (high outcome expectancy) and the and depressed mood. Under conditions of low outcome
belief that one can successfully execute the behaviour to expectancy, individuals may experience lack of behav-
produce the outcome (high self-efficacy expectancy). ioural initiative and persistence, but not depressive
High self-efficacy has been found to be a good predic- symptoms such as self-devaluation and despondency,
tor of health promotion behaviours, such as smoking because they do not view themselves as flawed relative
cessation [15, 30, 32], weight reduction [10, 11, 31] and to others. Bandura et al. [7] suggested that a low sense of
pain management [3, 8, 20]. Perceived self-efficacy is efficacy to exercise control in one’s life can lead to de-
also crucial to perceived personal control and success- pression through unfulfilled aspirations. Furthermore,
ful adaptation to life events [5]. Further, it has been sug- the authors posited that a low sense of social efficacy
gested that it may act as an important buffer against de- may impair the gain of social supports that could act as
ECAP 462

pression [5]. Depression is a disabling condition that a buffer against depression, and that a low sense of effi-
has been estimated to have been the third highest cause cacy to control depressing ruminative thoughts may
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358 European Child & Adolescent Psychiatry (2005) Vol. 14, No. 7
© Steinkopff Verlag 2005

help to convert depressive mood to a more pervasive de- ing the predictive value of self-efficacy for depression
pressive disorder. indicate that self-efficacy is not simply an effect of de-
This theory of self-efficacy is consistent with other pression because it occurs prior to the depression. How-
prominent cognitive theories of depression such as the ever, this ignores the possibility that the level of self-
learned helplessness theory [1] and Beck’s cognitive the- efficacy has been determined already by prior
ory of depression [9]. Learned helplessness theory ar- (unmeasured) events [16, 17]. However, even the great-
gues that one of the key factors in depression is attribu- est critics acknowledge that self-efficacy has “certain
tional or explanatory style, by which an individual tends utility in terms of predicting behaviour” (p. 252 [17]),
to explain positive and negative life events. Individuals and is of clinical interest in terms of planning and eval-
who tend to explain negative events using internal, sta- uating treatment.As pointed out by Muris [24], the value
ble and global factors are likely to be prone to depression of a self-efficacy instrument may be to provide informa-
following the occurrence of a negative event [1]. Beck [9] tion on the extent to which treatment has been effective
proposed that individuals suffering from depression in the client’s acquisition of effective coping skills for
have negative beliefs about themselves, the world, and negative emotions.
the future. In terms of self-efficacy theory, individuals
who according to Beck [9] generally view themselves as
incompetent and incapable, or according to Abramson ■ Aim
et al. [1] attribute the cause of bad outcomes to stable in-
ternal flaws, are probably expressing low self-efficacy In adults with depressive disorders, it has been found
expectancy. that those with greater self-efficacy regarding their abil-
Thus far, some studies have found a relationship be- ity to cope with their depression had fewer depressive
tween depressive symptoms and perceived self-efficacy. symptoms and were functioning better after treatment
For example, a cross-sectional study of high school stu- [33]. In the light of this finding, it would be of potential
dents revealed a negative correlation between self-effi- value to extend the investigation of self-efficacy of cop-
cacy and depression [13]. The domain of self-efficacy ing with depression to adolescents. The first step in this
expectancy might predict depression because specific process is the development of a reliable and valid in-
measures of self-efficacy, such as academic and emo- strument for assessing self-efficacy expectations about
tional self-efficacy, have been found to be more strongly coping with depressive symptoms in adolescents. The
associated with depression than physical or social self- current study reports the development and psychomet-
efficacy [13, 24, 25]. ric evaluation of such a questionnaire, the self-adminis-
Longitudinal research findings have shown that low tered Self-Efficacy Questionnaire for Depression in
levels of academic and social self-efficacy in a sample of Adolescents (SEQ-DA).
school children were predictive of long-term depression
at 1- and 2-year follow-up [7].A study with clinically de-
pressed adults showed that improvements in depression Subjects and methods
after group cognitive therapy treatment were closely as-
sociated with higher post-treatment levels of self-effi- ■ Sample
cacy regarding control of mood and with self-monitored
levels of negative cognition [18]. Further, remission in The 12-item SEQ-DA was trialled in a sample of 57 ado-
the following year was predicted by initial response to lescents that were treated in the Berriga House [14] and
treatment, shorter duration of the depressive episode 73 adolescents that were treated in the Time for a Future
prior to treatment, and by post-treatment self-efficacy [22] adolescent depression projects. These projects
regarding control of negative cognition. treated 12- to 18-year-old adolescents (mean age = 15.05
Self-efficacy theory has been criticised for failing to years, SD = 1.51) living in the community, that were suf-
acknowledge that self-efficacy may not be an indepen- fering from depression. The adolescents were randomly
dent variable, but rather an epiphenomenon of perfor- assigned to treatment with cognitive behaviour therapy
mance (see [16, 17]). While self-efficacy has been ac- (CBT), supportive therapy, a selective serotonin re-up-
knowledged as having utility in predicting behaviour take inhibitor (sertraline), or a combination of sertra-
such as smoking cessation and management of pain, it line and CBT. Of these adolescents, 68 were diagnosed
has been criticised when referred to as a cause of behav- with DSM-IV criteria [2] major depressive disorder, 30
iour [17]. Kirsch [19] argues that behavioural change with dysthymic disorder, 31 with depression not other-
linked to self-efficacy is not so much a belief in one’s wise specified, and one with an adjustment disorder
ability to accomplish something,but rather a willingness with depressed mood. The ratio of females to males was
to undertake these tasks. Similarly, a low sense of self-ef- nearly 2:1 (85 females and 45 males). The sample com-
ficacy may merely be an epiphenomenon of having a de- prised six 12-year-olds, fourteen 13-year-olds, thirty-
pressive disorder. It could be argued that studies show- two 14-year-olds, twenty-one 15-year-olds, thirty-four
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B. Tonge et al. 359

Self-efficacy questionnaire for depressed adolescents

16-year-olds, eighteen 17-year-olds, and five 18-year- shown to have good reliability and validity, with an in-
olds. Over 60 % of the sample was also diagnosed with ternal consistency reliability of 0.91 and test-retest reli-
other comorbid disorders. The most frequently diag- ability of 0.87 [29]. The RADS has also been found to
nosed comorbid problems were generalised anxiety dis- correlate highly (r > 0.72) with other measures of de-
order (11 %), dysthymic disorder (5.4 %), oppositional pression including the Hamilton Depression Rating
defiant disorder (3.8 %), post-traumatic stress disorder Scale [29] and the Children’s Depression Inventory [28],
(3.1 %), and DSM-IV [2] v-coded family relational prob- indicating good construct validity.
lems (23.8 %). Participants were excluded from these
projects if they suffered from bipolar disorder, psy-
chosis, chronic illness, intellectual disability precluding ■ Procedure
participation in CBT, or if they were actively suicidal re-
quiring hospitalisation. The SEQ-DA and the RADS were included as part of the
The stability of the scale over time was tested in 35 of assessment process for Berriga House and Time for a Fu-
these adolescents, first at the initial assessment session, ture study participants [14]. The SEQ-DA data from
then 1–2 weeks later, prior to the start of treatment. those adolescents that were diagnosed with a depressive
While this interval is somewhat short and, thus, a disorder and undertook treatment in these projects
methodological limitation, this procedure ensured that were included in this study. Of those participants, 35
participants did not have altered self-efficacy at retest were retested 1–2 weeks after the first assessment ses-
due to treatment effects. The test-retest sample com- sion, prior to starting treatment.
prised 13 males and 22 females ranging from 12 to 17
years of age (mean age = 15.3 years, SD = 1.4). One par-
ticipant was 12 years old, three were 13, nine were 14, Results
three were 15, ten were 16 and nine were 17 years old.
■ Scale analysis

■ Instruments Exploratory factor analyses provide insight as to the un-

derlying factor structure of a scale. Testing the factor
The 12 items of the SEQ-DA were developed by the au- structure of the SEQ-DA aims to examine the integrity
thors to measure specific self-efficacy expectancies re- of the instrument for use in evaluating adolescents’ per-
lated to coping with depressive symptomatology. Scale ceived ability to cope with depressive symptomatology.
item selection was informed by DSM-IV [2] diagnostic Exploratory factor analysis using principal components
criteria for depressive disorders, a review of the adoles- with varimax rotation was performed on the 12 items of
cent depression literature, the clinical experience of the the SEQ-DA for 123 participants who did not have any
authors, and consideration of age-related developmen- missing data from a total of 130. A two-factor solution
tal features of depression. The items measured the abil- (with loadings of 0.4 or more) and a three-factor solu-
ity to cope with managing activities, sad mood, over- or tion (with loadings of 0.5 or more) emerged that ex-
under-eating, sleep difficulties, tiredness, concentration plained 39 % and 48 % of the variance, respectively. The
difficulties, irritability and anger, a difficult day, negative two-factor solution depicted in Table 1 indicated that the
thoughts, holding a conversation with unfamiliar peo-
ple, life events and self-harm impulses. While many
Table 1 Factor loading of items from the SEQ-DA for the two-factor solution
items pertain to diagnostic criteria for a depressive
episode, no items refer to psychomotor changes, because Item Factor loading
these are relatively uncommon in adolescent depression
[27]. Perceived coping is evaluated on a five-point scale, Factor 1
ranging from “really sure I couldn’t (1)”, “probably Coping with sad mood 0.67
Managing doing favourite activity 0.65
couldn’t (2)”,“maybe (3)”,“probably could (4)”, and “re- Coping with sleep difficulties 0.63
ally sure I could (5)”. Scoring is conducted by summing Coping with stopping negative thoughts 0.57
the responses, yielding a possible total score between 12 Coping with over- or under-eating 0.57
and 60. Higher scores reflect greater self-efficacy expec- Coping with concentration difficulties 0.52
tations. Coping with a difficult day 0.50
The 30-item Reynolds Adolescent Depression Scale Coping with tiredness 0.44
(RADS) [28] was chosen as a test of concurrent validity Factor 2
for the SEQ-DA. The RADS is also self-administered and Coping with a future big life event 0.70
takes 5–10 min to complete. Scores on this scale range Cope with self-harming impulses 0.68
Coping with irritable/angry mood 0.54
from 30 to 120, and a score above 76 is considered to in- Coping with having a conversation with unfamiliar people 0.48
dicate clinical levels of depression. The scale has been
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360 European Child & Adolescent Psychiatry (2005) Vol. 14, No. 7
© Steinkopff Verlag 2005

first factor comprised eight items, which measured per- inclusion of item 7 (coping with irritable or angry
ceived confidence in coping with somatic and psycho- mood) was questionable. The weight for item 7 was not
logical symptoms of depression. The remaining four significant, suggesting that the fit may be improved
items that constituted factor 2 did not appear to measure with removal of this item. However, results were incon-
a common underlying construct. The items on factor 2 clusive, with CFI scores improving (0.80) with deletion
consisted of both confidence in coping with external of item 7 and RMSEA scores deteriorating (0.091). Cron-
events (such as life events and holding a conversation bach’s α improved from 0.73 to 0.75 with the removal of
with unfamiliar people), and coping with irritable or an- item 7.
gry mood and self-harm impulses.
The three-factor solution depicted in Table 2 also did
not suggest three meaningful constructs. Although the ■ Reliability analysis
first factor appeared to measure perceived confidence in
coping with somatic and psychological symptoms of de- Test-retest reliability for the SEQ-DA was established by
pression, the second and third factors did not appear to comparing initial scores of 33 adolescents (2 adolescents
reflect any clear underlying constructs. The second fac- were excluded due to missing data) with scores obtained
tor measured perceived ability to cope with negative 1–2 weeks after the first assessment, prior to start of
thoughts, hold a conversation with unfamiliar people treatment. The instrument was found to have very good
and to cope with self-harm impulses. The third factor stability with both Pearson’s r and intra-class correla-
measured the perceived ability to cope with irritability tions equalling 0.85. The SEQ-DA also has good internal
or anger, future life events and sleep difficulties. In view consistency with a Cronbach’s α reliability coefficient of
of the lack of meaningful constructs evident in both the 0.73.
two- and three-factor solutions, it was concluded that
the SEQ-DA best reflects a single dimension, although a
single-factor solution explains only 28 % of the total ■ Validity
variance.A single-factor solution is conceptually consis-
tent with the aim of designing an instrument to measure Construct validity was determined by examining the as-
the construct of perceived ability to cope with depres- sociation of SEQ-DA total scores and total depression
sive symptomatology. scores measured by the RADS. As higher scores on the
The high internal consistency of the instrument SEQ-DA reflect better functioning, and higher scores on
(Cronbach’s α = 0.73) further supports the decision to the RADS indicate poorer functioning, an inverse rela-
regard the SEQ-DA as reflecting one single dimension. tionship was expected. The SEQ-DA scores were signifi-
In addition, confirmatory factor analysis was conducted cantly negatively correlated with total RADS scores
to determine how well a single factor fits the data. Re- (Pearson’s r = –0.67, p < 0.001).
sults indicated that there was a reasonable fit [compara-
tive fit index (CFI) = 0.78, root mean square error ap-
proximation (RMSEA) = 0.086]. Out of the 12 items, only ■ Relationship between SEQ-DA and post-treatment
depression scores

Table 2 Factor loading of items from the SEQ-DA for the three-factor solution The possibility that pre-treatment self-efficacy might be
a predictor of response to treatment was investigated by
Item Factor loading testing the relationship between pre-treatment SEQ-DA
scores and post-treatment RADS scores, and with 6-
Factor 1
months post-treatment RADS scores. Missing post-
Coping with concentration difficulties 0.67
Coping with sad mood 0.67 treatment data were analysed using an intent-to-treat
Coping with tiredness 0.61 procedure, which is designed to avoid any possible over-
Managing doing favourite activity 0.60 estimation of treatment outcomes due to the non-inclu-
Coping with over- or under-eating 0.55 sion of participants who discontinued treatment. Nel-
Coping with a difficult day 0.51 son’s [26] ‘last observation carried forward’ technique
Factor 2 was used. This involved substituting outcome measures
Coping with having a conversation with unfamiliar people 0.73 from the previous assessment for missing post treat-
Coping with stopping negative thoughts 0.70 ment or 6-months post-treatment assessment data. This
Cope with self-harming impulses 0.64 technique thus assumes that the outcome does not
Factor 3 change with time, and provides a conservative estimate
Coping with irritable/angry mood 0.70 of outcome. Partial correlations controlling for treat-
Coping with a future big life event 0.56
ment type revealed a significant inverse relationship be-
Coping with sleep difficulties –0.51
tween pre-treatment SEQ-DA scores and post-treatment
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B. Tonge et al. 361

Self-efficacy questionnaire for depressed adolescents

RADS scores (r = –0.37, p = 0.001), and between pre- symptoms of depression, children have been found to
treatment SEQ-DA scores and 6-months post-treatment be better informants than their parents [23]. It is possi-
RADS scores (r = –0.43, p < 0.001). ble that questionnaire scores might reflect an overall
negative response style, which may be an epiphenome-
non of the depression (as mentioned in the Introduc-
Discussion tion) rather than the intensity of the depression or per-
ceived ability to cope per se. Further validation of the
The results confirm that the SEQ-DA has satisfactory SEQ-DA could include an investigation of the effects of
reliability and validity. Analyses suggested that a single- comorbid disorders and assessment of the SEQ-DA’s
factor solution best explains the SEQ-DA, which is psychometric properties in a normal population, where
consistent with the aim of designing an instrument to its predictive ability to discriminate depressed and non-
measure the construct of perceived ability to cope with depressed adolescents could be established. It could also
depressive symptomatology. While one item pertaining be useful to determine whether self-efficacy relating to
to coping with irritable or angry mood did not load perceived ability to cope with depressive symptoms is
on the single-factor solution, removal of this item did more strongly associated with depression and more
not reveal conclusive evidence for improved fit. In predictive of treatment outcome than other self-efficacy
addition, irritability is an alternate marker of adolescent scales that measure, for example, academic and social
depression and is, therefore, of upmost clinical impor- self-efficacy.
tance. Thus, while results cast some doubt on the inclu-
sion of this item, its clinical utility suggests that, until ■ Acknowledgements We thank Dr John Taffe for statistical advice
and one anonymous reviewer for his/her insightful comments on this
further validity data are available, this item should be manuscript. The Berriga House and Time for a Future adolescent de-
retained. pression projects were funded by: National Health and Medical Re-
Both test-retest reliability and internal consistency of search Council (project number 990154); Department of Human Ser-
the instrument were satisfactory. Higher pre-treatment vices Victoria Mental Health Branch; Australian Rotary Health
RADS depression scores were associated with lower Research Fund; Commonwealth Government Department of Health;
and the Financial Markets Foundation for Children.
SEQ-DA scores, providing evidence of construct valid-
ity. Further, lower pre-treatment SEQ-DA scores were
also associated with higher RADS depression scores af-
ter completion of treatment and 6 months post-treat-
Appendix
ment. This is consistent with findings from a study of de- ■ SEQ-DA
pressed adults, where higher self-efficacy regarding the
ability to cope with depressive symptoms was related to Name: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Date: . . . . . . . . . . . . . . . . . . .
fewer depressive symptoms and better functioning at
1. If you were feeling depressed, how sure are you that you could
the completion of treatment [33]. manage doing your favourite activity or hobby?
Overall, the SEQ-DA is brief and easy for clinicians
1 2 3 4 5
and researchers to administer. With only 12 items, this
instrument is short enough to use as a self-report as- Really sure Probably Maybe Probably Really sure
I couldn’t couldn’t could I could
sessment tool in depressed adolescents, where reduced
attention span may pose difficulties in assessment. The 2. If you were feeling sad, how sure are you that you could help your-
SEQ-DA may be used to identify an adolescent’s self- self feel less sad?
efficacy before beginning treatment to inform decisions 1 2 3 4 5
regarding the type of cognitive-behavioural coping Really sure Probably Maybe Probably Really sure
strategies the young person may need to develop. Dur- I couldn’t couldn’t could I could
ing treatment it may also be of use to determine the
3. If you couldn’t be bothered eating or if you wanted to eat too
progress of therapy. Finally, the SEQ-DA has potential much, how sure are you of being able to eat a healthy amount (i. e.
as a research tool. For example, it may be used to not too much and not too little)?
establish whether coping with depression self-efficacy is
1 2 3 4 5
a predictor of relapse. This study indicates that higher
Really sure Probably Maybe Probably Really sure
self-efficacy prior to treatment predicts better outcome I couldn’t couldn’t could I could
at the conclusion of 3 months of treatment, and 6
months post-treatment, regardless of the type of treat- 4. If you had difficulty sleeping (i. e. too much or too little), how sure
ment. are you that you could bring this under control?
The reliance on the exclusive use of self-report mea- 1 2 3 4 5
sures to establish validity is a possible limitation of this Really sure Probably Maybe Probably Really sure
study. However, reliability of child reports have been I couldn’t couldn’t could I could
found to increase with age [12], and, with regard to
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362 European Child & Adolescent Psychiatry (2005) Vol. 14, No. 7
© Steinkopff Verlag 2005

5. If you were feeling really tired for most of the day, how sure are 9. If you were thinking sad or negative thoughts about yourself, how
you that you could help yourself get through the day? sure are you of being able to stop thinking that way?
1 2 3 4 5 1 2 3 4 5
Really sure Probably Maybe Probably Really sure Really sure Probably Maybe Probably Really sure
I couldn’t couldn’t could I could I couldn’t couldn’t could I could

6. If you found you were having difficulty concentrating on some- 10. If you were with a group of people you didn’t know very well, how
thing you really wanted to do (e. g. reading a book or doing school sure are you that you could get involved in a conversation with
work), how sure are you that you could keep at it? them?
1 2 3 4 5 1 2 3 4 5
Really sure Probably Maybe Probably Really sure Really sure Probably Maybe Probably Really sure
I couldn’t couldn’t could I could I couldn’t couldn’t could I could

7. If you were feeling irritable or angry, how sure are you that you 11. If you were faced with a big life event in the future (e. g. finishing
could control your temper? school, getting a job or getting married), how sure are you that
you could cope with that event?
1 2 3 4 5
Really sure Probably Maybe Probably Really sure 1 2 3 4 5
I couldn’t couldn’t could I could Really sure Probably Maybe Probably Really sure
I couldn’t couldn’t could I could
8. If you were having a difficult day (e. g. slept through your alarm,
rejected by your friends, got in trouble from your boss or a 12. If you were feeling really sad, how sure are you that you could cope
teacher), how sure are you that you could cope with the rest of the with those feelings without hurting yourself?
day?
1 2 3 4 5
1 2 3 4 5 Really sure Probably Maybe Probably Really sure
Really sure Probably Maybe Probably Really sure I couldn’t couldn’t could I could
I couldn’t couldn’t could I could

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