Table 1 Table presenting characteristics and quality appraisal of included studies

Al-Khattab et al. 2016 [41]

Aged 18–21. African-American (AA) adolescents having

a) depressive symptoms during adolescence (aged 13–17). 22 participants in total

or

b) currently aged 13–17 and receiving treatment for depression. 5 participants in total

USA

How AA adolescents describe symptoms of depression through relationships with people in their lives.

Semi-structured interviews

Thematic analysis

1) keeping others at bay

2) striking out at others

3) seeking help from others

4) joining in with others

5) having others reach out

7/10

Validity

✓ Clear aims

✓ Appropriate qualitative methodology

✓ Appropriate research design

x Appropriate recruitment strategy

x Appropriate data collection

✓ Considered reflexivity appropriately

Results

x Ethical considerations addressed

✓ Rigorous data analysis

✓ Clear statement of findings

Utility of results

✓ Value of research

Anttila et al.

2015 [42]

Aged 15–17 diagnosed with depression (outpatient) without SMI taking part in RCT for internet-based support system

Finland

Adolescent concerns and hopes when referred to outpatient treatment

Written text/essay before intervention

Thematic analysis

1) Relationships

2) Daily actions

3) Identity

4) Well-being

7/10

Validity

✓ Clear aims

✓ Appropriate qualitative methodology

x Appropriate research design

✓ Appropriate recruitment strategy

x Appropriate data collection

x Considered reflexivity appropriately

Results

✓ Ethical considerations addressed

✓ Rigorous data analysis

✓ Clear statement of findings

Utility of results

✓ Value of research

De Mol et al. 2018 [24]

Hospitalized (> 4 months) adolescents (aged 15–18) diagnosed with depression by psychiatrist after receiving outpatient psychotherapy

Belgium

The role of social representations in adolescents’ construction of major depression

Semi-structured interviews

Interpretative Phenomenological Analysis

1) Depression means personal failure

2) Feeling bad is not allowed and is not normal: in fact, depression doesn’t really exist

3) You are obliged to have an intimate relationship, otherwise you are not normal;

4) It is important to have future projects for personal and social well-being

5) Being socially well integrated is normality.

10/10

Validity

✓ Clear aims

✓ Appropriate qualitative methodology

✓ Appropriate research design

✓ Appropriate recruitment strategy

✓ Appropriate data collection

✓ Considered reflexivity appropriately

Results

✓ Ethical considerations addressed

✓ Rigorous data analysis

✓ Clear statement of findings

Utility of results

✓ Value of research

Dundon 2006 [43]

(metasynthesis)

Aged 13–22. 72 diagnosed or self-reported as depression.

6 studies in total, 2 of which unpublished

USA/

Canada

Contribute to the theoretic base of the experience of adolescent depression, affect future research, and guide clinical practice.

Self-reports, semi-structured interviews

TA, Descriptive, narrative, Participatory action, discourse analysis, grounded research

1) Beyond the blues

2) Spiraling down and within

3) Breaking points

4) Seeing and being seen

5) Seeking solutions

6) Taking control.

5/10

Validity

✓ Clear aims

✓ Appropriate qualitative methodology

✓ Appropriate research design

x Appropriate recruitment strategy

x Appropriate data collection

x Considered reflexivity appropriately

Results

✓ Ethical considerations addressed

x Rigorous data analysis

x Clear statement of findings

Utility of results

✓ Value of research

Farmer 2002 [44]

5 adolescents (aged 13–18) diagnosed with depression by therapist.

USA

Experience of major depression from the adolescent’s perspective to provide a more comprehensive description of the disorder.

Semi-structured interviews

Phenomenological approach

1) Dispirited weariness

2) Emotional homelessness (sense of aloneness)

3) Emotional homelessness

(no safety where expected)

4) Unrelenting anger

5) Parental break-up: caught in the middle

6) Spectrum of escape from pain

7) Perspectives on friendship

8) Gaining a sense of getting well

9/10

Validity

✓ Clear aims

✓ Appropriate qualitative methodology

✓ Appropriate research design

✓ Appropriate recruitment strategy

✓ Appropriate data collection

✓ Considered reflexivity appropriately

Results

✓ Ethical considerations addressed

x Rigorous data analysis

✓ Clear statement of findings

Utility of results

X Value of research

Granek 2006 [45]

Students (aged 25–30) gone through an episode of clinical depression (meeting DSM 4 criteria) referring to that period. Didn’t meet criteria for current depression.

Canada

Depressive experience from a subjective perspective

Open ended interviews

Grounded theory/hermeneutic approach

1) Self in relation

2) Self-criticism and self-loathing

3) Loneliness and disconnection

6/10

Validity

✓ Clear aims

✓ Appropriate qualitative methodology

✓ Appropriate research design

x Appropriate recruitment strategy

✓ Appropriate data collection

✓ Considered reflexivity appropriately

Results

x Ethical considerations addressed

x Rigorous data analysis

✓ Clear statement of findings

Utility of results

xValue of research

Kuwabara et al.

2007 [46]

Community sample (18–25) currently experiencing depression determined by physician interviewers (severe depression with suicidality was excluded)

USA

Obtain a relatively unconstrained description of the ways in which depression is construed and experienced among a sample of emerging adults.

Semi-structured interviews

Thematic Analysis

1) Identification as an individual with depression

2) Interactions with the healthcare system

3) Relationships with friends and family

4) Role transitions from childhood to adulthood

9/10

Validity

✓ Clear aims

✓ Appropriate qualitative methodology

✓ Appropriate research design

✓ Appropriate recruitment strategy

✓ Appropriate data collection

✓ Considered reflexivity appropriately

Results

x Ethical considerations addressed

✓ Rigorous data analysis

✓ Clear statement of findings

Utility of results

✓ Value of research

Lachal et al.

2012 [47]

Aged 14–17. Receiving therapy for past depressive episode, 4 participants use medication. Selected after consultation in psychiatry department. Episode was over at the time of interviewing (reflection).

France

How a qualitative method, using in-depth interviews with patients and clinicians, can help building a specific tool to measure depression in adolescents.

Semi-structured interviews

Thematic Analysis

1) Emotional state

2) Non-emotional manifestations

3) Manifestations in social interactions

6/10

Validity

✓ Clear aims

✓ Appropriate qualitative methodology

x Appropriate research design

✓ Appropriate recruitment strategy

x Appropriate data collection

x Considered reflexivity appropriately

Results

✓ Ethical considerations addressed

x Rigorous data analysis

✓ Clear statement of findings

Utility of results

✓ Value of research

McCann et al.

2012 [48]

Aged 16–25. Purposeful sampling at Headspace via clinicians 1) depression as primary diagnose 2). Excluding psychosis and suicidality. 13 had double diagnose depression + anxiety

Australia

Examine the lived experience

of young people diagnosed with depression

Semi-structured interviews

Interpretative Phenomenological Analysis

1) Struggling to make sense of their situation

2) Spiralling down

3) Withdrawing

4) Contemplating self-harm or suicide

8/10

Validity

✓ Clear aims

✓ Appropriate qualitative methodology

✓ Appropriate research design

x Appropriate recruitment strategy

✓ Appropriate data collection

x Considered reflexivity appropriately

Results

✓ Ethical considerations addressed

✓ Rigorous data analysis

✓ Clear statement of findings

Utility of results

✓ Value of research

Meadus 2007 [49]

Aged 15–18 diagnosed with mood disorder (7 depression, 2 bipolar). Treated by psychiatrist or GP. Receiving medication. Both inpatient and outpatient.

Canada

Explore the phenomenon of coping as experienced by adolescents with a mood disorder

Unstructured interviews

Grounded theory, each interview analysed before starting the next interview

1) Feeling different

2) Cutting off connections

3) Facing the challenge /reconnecting

4) Learning from the experience

7/10

Validity

✓ Clear aims

✓ Appropriate qualitative methodology

✓ Appropriate research design

x Appropriate recruitment strategy

✓ Appropriate data collection

x Considered reflexivity appropriately

Results

✓ Ethical considerations addressed

x Rigorous data analysis

✓ Clear statement of findings

Utility of results

✓ Value of research

Midgley et al. 2015 [50]

Aged 11–17. Diagnosed with depression with moderate to severe impairment. Part of larger RCT (IMPACT study) clinically referred to child and adolescent mental health services for treatment for depression, but have yet to receive therapy

UK

Exploring the experience of depression in a sample

of young people aged between 11 and 17

Semi-structured interviews (before intervention, rather brief 4-37 min)

Framework analysis

1) Misery, despair and tears

2) Anger and violence towards self and others

3) A bleak view of everything

4) Isolation and cutting off from the world

5) The impact on education

9/10

Validity

✓ Clear aims

✓ Appropriate qualitative methodology

✓ Appropriate research design

✓ Appropriate recruitment strategy

xAppropriate data collection

✓ Considered reflexivity appropriately

Results

✓ Ethical considerations addressed

✓ Rigorous data analysis

✓ Clear statement of findings

Utility of results

✓ Value of research

Rosales 2008 [51]

(PhD thesis)

Aged 12–15 and diagnosed with bipolar disorder, dysthymia, and major depression. Purposeful sampling through community counsellors and school districts professional counsellors, private therapists, school psychologists.

Students included were required to have a support system in place such as parents and peers.

USA

middle school adolescents their thoughts and perceptions about their experiences with depression

Semi-structured & open-ended

Comparative method analysis

1) Person centred

2) Hopelessness

3) Relationships/ connections

4) isolation

5) Escape/ distractions

7/10

Validity

✓ Clear aims

✓ Appropriate qualitative methodology

✓ Appropriate research design

xAppropriate recruitment strategy

✓ Appropriate data collection

✓ Considered reflexivity appropriately

Results

x Ethical considerations addressed

x Rigorous data analysis

✓ Clear statement of findings

Utility of results

✓ Value of research

Weitkamp et al. 2016 [52]

Aged 14–19. Interviewed after max two sessions with therapist suffering from depressive disorder. Exclusion criteria: cognitively too impaired to participate as rated by therapist/interviewer.

All met criteria depression ICD and some with comorbidity of PTSS, anxiety and bereavement.

Germany

Lived experience of young people diagnosed with depression, and additionally to look at the way these YP accessed therapy in the context of the German mental health system.

Semi-structured interviews

Interpretative Phenomenological analysis

1) Suffering is experienced as overwhelming

2) An experience of loneliness and isolation

3) Struggling to understand the suffering

4) Therapy as a last resort

8/10

Validity

✓ Clear aims

✓ Appropriate qualitative methodology

✓ Appropriate research design

x Appropriate recruitment strategy

✓ Appropriate data collection

✓ Considered reflexivity appropriately

Results

x Ethical considerations addressed

✓ Rigorous data analysis

✓ Clear statement of findings

Utility of results

✓ Value of research

Woodgate et al. 2006 [53]

Aged 13–19. Outpatient diagnosed with depression for > 18 months. 12 other mental health condition as well (e.g. ADHD/substance abuse) but no other severe mental illness.

Canada

Gain an understanding of what it was like to be an adolescent living with depression.

Open-ended interviews

&

Focus groups (same participants in groups of 6)

Hermeneutic phenomenology

1) Containing the shadow of fear

2) Keeping the self alive

3) Maintaining a sense of belonging in the world

4) Feeling valued as a human being

6/10

Validity

✓ Clear aims

✓ Appropriate qualitative methodology

✓ Appropriate research design

x Appropriate recruitment strategy

✓ Appropriate data collection

x Considered reflexivity appropriately

Results

✓ Ethical considerations addressed

x Rigorous data analysis

x Clear statement of findings

Utility of results

✓ Value of research