Depressive symptoms among children and adolescents in Iran: a confirmatory factor analytic study of the centre for epidemiological studies depression scale for children

This study investigated the psychometric properties of the Iranian translation of the Centre for Epidemiological Studies Depression Scale for Children (CES-DC) in school children and adolescents in Iran. The CES-DC is a 20-item self-report scale designed to measure depressive symptoms in children and adolescents. A total of 1,984 children and adolescents, aged 12-17 years, participated in this research. In addition to the CES-DC, all participants completed the Spence Children's Anxiety Scale (SCAS) and the Strength and Difficulties Questionnaire (SDQ). The CES-DC demonstrated high internal consistency (Cronbach Alpha = .87). Confirmatory factor analyses revealed the same four factor structure as proposed by Radloff. Invariance tests showed an equivalent structure among boys and girls and younger and older adolescents. The CES-DC total scores correlated significantly with the SCAS total scores and the SDQ emotional symptoms subscale, providing support of its convergent validity. To conclude, the CES-DC proved to be a reliable and valid measure of depressive symptoms in the Iranian context.

The structure of anxiety symptoms among adolescents in Iran: a confirmatory factor analytic study of the Spence Children's Anxiety Scale

The present study examined the psychometric properties of the Iranian translation of the Spence Children's Anxiety Scale (SCAS) in a large community sample of adolescents (N = 1984), aged 12-17 years, in Ahvaz City, Iran. In addition to the SCAS, all participants completed the Strengths and Difficulties Questionnaire (SDQ), and the Centre for Epidemiological Studies Depression Scale for Children (CES-DC). The internal consistency (Cronbach Alpha = .92) and the validity of the Iranian translation of the SCAS was excellent. The SCAS total scores correlated significantly with the CES-DC, as well as with the emotional, conduct problems, hyperactivity-inattention, and peer problems subscales of the SDQ. However, Steiger's Z test demonstrated that correlations between the SCAS scores and the SDQ conduct problems or hyperactivity-inattention subscales were significantly lower than the correlations between the SCAS scores and the SDQ emotional symptoms subscale. Confirmatory factor analyses revealed the same 6-factor structure as the original SCAS. The SCAS proved to be a reliable and valid measure of anxiety symptoms among adolescents in Iran.

A Japanese form of social anxiety (taijin kyofusho): frequency and correlates in two generations of the same family

BACKGROUND

One specific type of social anxiety, occurring primarily in Japanese culture, is called taijin kyofusho. Taijin kyofusho is characterized by an intense fear that one's body parts or functions displease, embarrass or are offensive to others.

AIM

The main aim of the present study was to compare the frequency and correlates of taijin kyofusho symptoms (TKS) in Japanese adolescents and their parents.

METHOD

The sample included 351 adolescents, aged 12 to 17 years, and one of their parents/guardians. These adolescents were recruited from secondary schools in Miyazaki, Japan. All participants completed a set of questionnaires that were used to measure TKS, DSM-IV anxiety disorder symptoms, general difficulties and positive attributes, self-construals and social support.

RESULTS

Adolescents reported significantly more TKS than their parent/guardians. In each generational sample high TKS was significantly associated with high levels of anxiety symptoms, the strongest correlation being with social phobia. The pattern of the relationship between self-construal and TKS differed across the two generations. Among adolescents, independent self-construal was associated with lower TKS, whereas among parents, interdependent self-construal was associated with lower evaluative concerns from others.

CONCLUSION

The present study illustrates the importance of the diverse roles that self-construals play in TKS across different generations of the same family constellation in contemporary Japanese culture.

Psychometric properties of the Strength and Difficulties Questionnaire from five European countries

The Strength and Difficulties Questionnaire (SDQ) is a brief screening instrument for assessing emotional and behavioural problems in children and adolescents. This study examined the factor structure and validity of the self-report original English version of the SDQ and four of its many translations (German, Cypriot Greek, Swedish, and Italian). A total of 2418 adolescents from five European countries (Germany, Cyprus, England, Sweden, Italy), ages 12 to 17 years, participated. The sample was drawn from general (school) populations. In addition to the SDQ, all participants completed the Spence Children's Anxiety Scale (SCAS), a measure of anxiety symptoms. The internal consistency and validity of the SDQ total difficulties were good for most countries. Confirmatory factor analysis showed that both five- and three-factor models provided good fit for the whole sample; however, the three-factor model fit somewhat better than the five-factor model. The factor structure differed across countries, with the three-factor model showing better fit indices in Cyprus, whereas the five-factor model fitted better in Germany. Fit indices for the UK, Sweden, and Italy were poor for both models. When the reversed items were removed, the goodness-of-fit improved significantly for the total sample and in each country. It is therefore recommended that the reversed items be removed or re-worded in future studies.

Prevention of anxiety symptoms in children: results from a universal school-based trial

The present study evaluated the effectiveness of a universal school-based cognitive behavior prevention program (the FRIENDS program) for childhood anxiety. Participants were 638 children, ages 9 to 12 years, from 14 schools in North Rhine-Westphalia, Germany. All the children completed standardized measures of anxiety and depression, social and adaptive functioning, coping strategies, social skills, and perfectionism before and after the 10-week FRIENDS program and at two follow-up assessments (6 and 12 months) or wait period. Children who participated in the FRIENDS program exhibited significantly fewer anxiety and depressive symptoms, and lower perfectionism scores than children in the control group at 12-month follow-up. Younger children (9-10-year-olds) displayed treatment gains immediately after the intervention, whereas older children (11-12-year-olds) showed anxiety reduction only at 6- and 12-month follow-up. Perfectionism and avoidant coping acted as mediators of pre- to postintervention changes in anxiety scores. This study provides empirical evidence for the utility of the FRIENDS program in reducing anxiety and depressive symptoms among German children.

Anxiety symptoms among adolescents in Japan and England: their relationship with self-construals and social support

BACKGROUND

Most of our knowledge about anxiety in adolescents has come from studies conducted in Western countries. Little is known about the extent to which these results can be generalized to those who live in other cultures. The main aim of this study was to compare the frequency and correlates of anxiety symptoms among adolescents in Japan and England.

METHOD

A total of 689 adolescents (338 from England and 351 from Japan), aged 12-17 years, took part in this research. They completed a set of questionnaires which were used to measure DSM-IV anxiety disorder symptoms, general difficulties and positive attributes, self-construals, and social support.

RESULTS

Adolescents in England reported significantly higher levels of anxiety symptoms than adolescents in Japan. In both countries, independent self-construal was negatively associated with anxiety symptoms, while interdependent self-construal was positively associated with anxiety. However, the magnitude of this relationship was stronger for independent self-construal than the interdependent self-construal. Path analysis showed that the effect of interdependent self-construal seemed to be weaker in Japan than in England.

CONCLUSION

Future studies need to explore the effects of cultural context and environmental experiences such as the role of parenting styles that account for the higher levels of anxiety in English compared with Japanese adolescents.

Comorbidity of substance use disorders among community-based and high-risk adolescents

The aim of this article was to examine the frequency and comorbidity of substance use disorders (SUD) among community-based adolescents and high-risk adolescents, using the same methodology. Adolescents from the community (N=1035) were recruited from 36 schools. High-risk adolescents (N=374) comprised those whose parent(s) have the diagnosis of SUD and who were undergoing a treatment for their SUD. Adolescents were interviewed using the computerized Munich version of the Composite International Diagnostic Interview to access the presence of SUD and other major DSM-IV psychiatric disorders. The lifetime rate of SUD was significantly lower in the community-based (12.3%) than the high-risk (38.3%) groups of adolescents. In both settings, SUD co-occurred highly with other psychiatric disorders. About 52.7% and 62.2% of the community-based and high-risk adolescents with SUD, respectively, had at least one additional disorder. Adolescents with SUD and comorbid disorders were significantly more psychologically distressed, compared to adolescents with SUD only. Adolescents with SUD had significantly lower perceived attachment to parents, but significantly higher attachment to peers compared to adolescents without any psychiatric disorders. The implications of the present findings were discussed in terms of the need to design prevention program especially for high-risk children, and also stressed the importance of conducting comprehensive assessment among adolescents referred for the treatment of SUD.

Psychometric properties of the Spence Child Anxiety Scale with adolescents from five European countries

This study examined the factor structure, reliability, and validity of the original Spence Child Anxiety Scale (SCAS) and its four translations (German, Cypriot Greek, Swedish, Italian). A total of 2558 adolescents from five European countries (Germany = 495; Cyprus = 611; UK = 469; Sweden = 484; Italy = 499), ages 12-17 years, participated in the study. In addition to the SCAS, all participants completed the Strengths and Difficulties Questionnaire, a measure of general difficulties and positive attributes. The internal consistency and validity (convergent and discriminant) of the SCAS were excellent. Multiple group confirmatory factor analysis provided strong support for the generalizability of a 6-factor inter-correlated model across five European countries. Adolescents in the UK had significantly higher anxiety levels than adolescents in four other European countries. Our findings suggest that the SCAS is suitable for assessing anxiety disorder symptoms in adolescents in Germany, the UK, Cyprus, Sweden, and in Italy.

Taijin Kyofusho and Social Phobia Symptoms in Young Adults in England and in Japan

The main aims of the present study were to compare the frequency of social phobia and taijin kyofusho symptoms among young adults in Japan and in England and to examine the role of family environment in the development of these two conditions. A total of 927 young adults (462 in England and 465 in Japan) between the ages of 19 and 24 were investigated. They completed a set of questionnaires that were used to measure social phobia and taijin kyofusho symptoms, as well as family background. Results showed that young adults in Japan reported significantly higher levels of taijin kyofusho and social phobia symptoms than young adults in England. Family sociability had a consistent effect on both social phobia and taijin kyofusho symptoms across the two cultures, but parental rearing attitudes showed distinct patterns between the two countries. This finding suggests that cross-cultural models need to consider familial factors that may be predictive across cultures and others that may be more culturally specific.

Gender differences in the developmental course of depression

BACKGROUND

There is ample evidence for female preponderance of major depressive disorder (MDD) in adolescence and adulthood. This study examined gender differences in the developmental course (i.e., incidence, duration, number of depressive episodes, and recovery rates) of MDD in non-referred adolescents and young adults.

METHODS

Data from the Oregon Adolescent Depression Project were used to examine gender differences in the developmental course of MDD. Gender differences in the onset, duration, number of depressive episode and rate of recovery from MDD were examined in a population-based sample of the same individuals (participants: N=773) during adolescence (age 14 to 17) and at age 30.

RESULTS

Compared to males, females have higher incidence rates of MDD and had a more chronic course. Difference in duration of depressive episodes is marginally significant between male and female, with females having longer episodes. Lower onset age correlates significantly with more number of episodes in both genders; however, lower onset age predicts a worse course of depression only in females.

LIMITATIONS

The sample was from a single region of the country and consisted mostly of White adolescents.

CONCLUSIONS

Childhood depression may be a more serious risk factor for girls than for boys.

The facets of anxiety sensitivity in adolescents

This study examined the factor structure, reliability, and validity of the German translation of the Childhood Anxiety Sensitivity Index (CASI). A total of 1292 adolescents participated in the study. Analyses using the Schmid-Leiman solution showed the CASI to have one higher order factor and three orthogonal lower order factors. CASI scores correlated significantly with anxiety symptoms and with general difficulties. Hierarchical multiple regression showed CASI to make a significant contribution in predicting anxiety even after controlling for variance due to general difficulties, thus giving further support to the incremental validity of the CASI. The CASI is a potentially useful measure to include in longitudinal studies that examine the development of childhood and adolescent anxiety disorders.

Anxiety symptoms in Chinese and German adolescents: their relationship with early learning experiences, perfectionism, and learning motivation

The main aim of this study was to compare the frequency and correlates of DSM-IV anxiety disorder symptoms among non-referred adolescents in Germany and in Hong Kong. A total of 1,022 adolescents (594 from Germany and 428 from Hong Kong) between the ages of 12 and 17 years were investigated. Results showed that adolescents in Hong Kong reported significantly higher levels of anxiety symptoms than adolescents in Germany. Anxiety symptoms showed different correlates in different cultures. Specifically, academic motivational goals to compete to get good grades and to be rewarded for their performance correlated significantly with anxiety symptoms in Hong Kong. In Germany, anxiety symptoms correlated significantly with reinforcement received for anxiety-related problems (i.e., instrumental learning) and with parental verbal transmission about the danger of anxiety (i.e., informational learning). The findings underscore the importance of cultural factors on adolescent's anxiety.

Comorbidity of depressive disorders among adolescents in community and clinical settings

The aim of this article was to examine the comorbidity rates and clinical characteristics of depressive disorders among adolescents in community and clinical settings, using the same methodology. One thousand and thirty-five adolescents from the community setting and 200 adolescents from the clinical setting were interviewed using the computerized Munich version of the Composite International Diagnostic Interview. In both settings, the comorbidity of depressive disorders with other psychiatric disorders was high. About 58% of the depressed adolescents in the community setting had at least one additional disorder, compared with 63.5% in the clinical setting. The most common comorbid pattern was that of depressive and anxiety disorders. Among adolescents with anxiety and depression, 72% and 62% of those in the community and clinical settings, respectively, reported the occurrence of anxiety before that of depression. Depressed adolescents with comorbid disorders used significantly more mental health services than adolescents with depression only. The findings suggest the need to design assessment and intervention strategies to deal with adolescents with multiple disorders.

Dimensionality and psychometric invariance of the Youth Self-Report Form of the Child Behavior Checklist in cross-national settings

The Youth Self-Report Form's (YSR's) factor model was derived from traditional exploratory factor analytical procedures. Assuming appropriate model specification, psychometrically invariant items, and that its items provide useful psychometric information across nations omitted from its normative samples, the YSR is widely used in cross-national studies of nonreferred children. Item response theory analytical procedures reveal (a) 2 dimensions partly overlapping with the YSR's Internalizing and Externalizing second-order factors; (b) variance (i.e., differential item functioning) in how well a few items discriminate for nonreferred children across two nations; and (c) variance in estimating severity levels in children with identical psychopathological severity cross-nationally. Addressing psychometric variance, limiting redundancy, and matching children's psychopathological severity levels with items measuring this severity might promote more accurate and economical assessment.

Course and outcome of major depressive disorder in non-referred adolescents

BACKGROUND

Although major depressive disorder (MDD) is one of the most common disorders in adolescence, little is known about its course and outcome in non-referred adolescents. Therefore, the aims of this article were to examine the course and outcome of MDD in non-referred adolescents, and to examine factors related to its stability.

METHODS

Five hundred and twenty-three adolescents were interviewed twice at an interval of about 15 months using the computerized Munich version of the Composite International Diagnostic Interview.

RESULTS

Of the 90 adolescents who met the diagnosis of MDD at T1, 22 (24.4%) still met the same diagnosis at T2. Sixty-eight (75.6%) of them no longer met the diagnosis of MDD at T2, and in some of these cases, their depression was replaced by several other disorders; 44 adolescents received no diagnostic criteria for any DSM-IV disorders. The factors that were significantly associated with the stability of MDD included the presence of substance use disorders and parental alcohol problems, negative life events and negative coping, past suicidal attempt, suicidal thought, and concrete suicidal plan at the T1-interview. Adolescents with "chronic" (T1 and T2) compared to "transient" (only T1) MDD and those without any disorders were significantly more impaired in various life domains.

LIMITATIONS

This study was based on a small number of adolescents with a chronic MDD.

CONCLUSIONS

The course and outcome of MDD in majority of the adolescents seemed to have a favourable course, whereas in some adolescents, it tended to have a heterogeneous pattern.

Callous-unemotional traits in a community sample of adolescents

This study examined the structure, distribution, and correlates of a new measure of self-reported callous-unemotional (CU) traits in 1,443 adolescents (774 boys, 669 girls) between the ages of 13 to 18 years. The Inventory of Callous-Unemotional Traits was subjected to exploratory factor analysis and confirmatory factor analysis. Exploratory factor analysis produced three factors: callousness, uncaring, and unemotional. Fit indexes suggested that the three-factor model, with a single higher-order factor, represented a satisfactory solution for the data. This factor structure fits well for both boys and girls. CU traits correlated significantly with measures of conduct problems and psychosocial impairment. Furthermore, the traits showed predicted associations with sensation seeking and the Big Five personality dimensions, supporting the construct validity of the measure of CU traits.

Frequency and patterns of mental health services utilization among adolescents with anxiety and depressive disorders

The main aim of this study was to examine the frequency and patterns of mental health services utilization among 12- to 17-year-old adolescents with anxiety and depressive disorders. Another aim was to examine the factors associated with the use of mental health services. The study population comprised 1,035 adolescents randomly recruited from 36 schools. Anxiety and depressive disorders were coded based on DSM-IV criteria using the computerized Munich version of the Composite International Diagnostic Interview. Only 18.2% of the adolescents who met DSM-IV criteria for anxiety disorders, and 23% of those with depressive disorders, used mental health services. Among adolescents with anxiety disorders, mental health services utilization was associated with past suicide attempt, older age, the presence of comorbid disorders, as well as parental anxiety and depression. The only factor that predicts the use of mental health service among adolescents with depressive disorder was a history of suicide attempt. The implication of the results in terms of tailoring services for children and adolescents with anxiety and depressive disorders are discussed.

[Anxiety prevention among schoolchildren]

The FRIENDS programme is a prevention and early intervention programme, which teaches children strategies to cope with anxiety and challenging situations. This paper examines the social validity of the German version of the FRIENDS programme using data from a large-scale study on the prevention of anxiety disorders in schoolchildren, which is funded by the Dr. Karl-Wilder Stiftung. In this paper, data of 208 schoolchildren (aged 9 to 12 years) are used. Results show that the children and their parents were highly satisfied with the FRIENDS programme. Childrens attendance and completion of their homework assignments were very high. Both the children and their parents rated relaxation exercises and thinking helpful thoughts as being more useful for the children than other skills. Treatment acceptability correlated significantly with the childrens clinical outcome. The implications of our findings for future research are discussed.

Anxiety symptoms in Japanese and in German children

The purpose of this study was to compare the frequency of anxiety symptoms and their association with gender and age in Japanese and German children using the Spence Children's Anxiety Scale (SCAS). A total of 1837 children (862 from Germany and 975 from Japan) between the age of 8 and 12 years were investigated. Results revealed that German children reported significantly higher symptoms of separation anxiety, social phobia, obsessive compulsive disorder, and generalized anxiety disorder than Japanese children. Conversely, Japanese children reported significantly higher scores on symptoms related to physical injury fear. In both countries, girls scored higher than boys on all the scales of the SCAS. Symptoms of separation anxiety and panic decreased with age, whereas social phobia increased with age. The findings underscore the impact of culture on children's anxiety.

Comorbidity of anxiety disorders in adolescents

We examined the comorbidity of anxiety disorders and their clinical consequences in adolescents. The 1,035 adolescents, aged 12 to 17 years old, were randomly selected from 36 schools in the province of Bremen, Germany. Anxiety disorders and other psychiatric disorders were coded based on DSM-IV criteria using the computerized Munich version of the Composite International Diagnostic Interview. The comorbidity rate within the anxiety disorders was relatively low (14.1%). However, the comorbidity of anxiety disorders with other psychiatric disorders was high. Approximately half (51%) of the anxious adolescents had other psychiatric disorders. The most common comorbid pattern was that of anxiety and depressive disorders. Among those with both anxiety and depressive disorders, a majority of them (72%) had anxiety before that of depression. Anxious adolescents with comorbid disorders were significantly more psychologically distressed, as assessed using the SCL-90-R, and used more mental health services than adolescents with anxiety disorders only. The effect of comorbidity on mental health services utilization was stronger in males than females. The findings suggest the need to design intervention strategies to deal with cases with multiple disorders.

Course and outcome of anxiety disorders in adolescents

The aim of this article was to examine the course and outcome of anxiety disorders in German adolescents. Anxiety and other psychiatric disorders were coded based on DSM-IV criteria using the computerized Munich version of the Composite International Diagnostic Interview. About 22.6% of the adolescents who fulfilled DSM-IV criteria of any current anxiety disorders at the index investigation (T1) continued to have anxiety at the follow-up investigation (T2), 17.7% had depression, 27.4% somatoform, 6.5% substance use disorders, and 41.9% had no disorders. The factors that were significantly associated with the persistence of anxiety disorders included older age, presence of somatoform and substance use disorders, as well as a high number of negative life events at the T1-interview. Adolescents with "chronic" compared to "transient" anxiety disorders and those without any disorders were significantly more impaired in various life domains. Despite these high levels of psychosocial impairment, only a few of them did seek professional help in the last 12 months before the T2-interview.

Reliability and validity of the Spence Children's Anxiety Scale and the Screen for Child Anxiety Related Emotional Disorders in German children

The reliability and validity of the Spence Children's Anxiety Scale (SCAS) and the Screen for Child Anxiety Related Emotional Disorders (SCARED) were evaluated in a sample of 556 German primary school children. Both the SCAS (alpha = 0.92) and the SCARED (alpha = 0.91) were demonstrated to have high internal consistency. The validity of the SCAS and the SCARED was supported by a number of findings. First, in agreement with previous studies, girls displayed significantly higher levels of anxiety symptoms than boys. Furthermore, SCAS and SCARED scores were substantially interrelated. Finally, significant correlations were found between these two measures of anxiety symptoms and the Youth Self-Report and the Columbia Impairment Scale. The utility of the SCAS and the SCARED as screening instruments for anxiety symptoms in children is briefly discussed.