Psychiatric correlates of behavioral indicators of school disengagement in the United States

Associations between internet addiction and school engagement among Turkish college students: mediating role of psychological distress

Introduction

Internet addiction has become a subject of growing concern with adverse consequences. This study aimed to investigate the mediating effect of psychological distress in the relationship between internet addiction and school engagement.

Methods

Data were obtained from 732 Turkish college students (M = 20.98, SD = 2.58). The data were collected through Young's Internet Addiction Test, Depression, Stress and Anxiety Scale (DASS21)-Short Form, and University Student Engagement Inventory. Mediation analysis was performed to investigate the mediating effects of depression, anxiety, and stress in the association between internet addiction and school engagement.

Results

The results of the study showed that internet addiction was positively associated with psychological distress and negatively associated with school engagement, whereas psychological distress had a negative relationship with school engagement. This study also found that depression, anxiety, and stress acted as mediators in the relationship between internet addiction and behavioral engagement, emotional engagement, and cognitive engagement.

Conclusion

This study has provided evidence that young adults with tendency of internet addiction may experience school engagement problems as well as psychological problems. Our findings underscore the need for special educational intervention programs aimed at encouraging college youth to limit their internet use for their future due to its negative consequences and raising awareness in this vulnerable group and their families.

Latent profile similarity of middle and high school youth risk and needs

Research concerning school success and completion has grown increasingly complex with the number of proposed associated risk and needs domains. As the number of domains expands, various data analytical techniques have been employed to understand them, including the modeling of latent profiles, to better understand how risks and needs aggregate at the level of individual persons. Latent profile analysis helps identify individuals' subgroups based on salient combinations of characteristics. The present study used latent profile analysis and a systematic profile similarity approach to examine the profiles across middle and high school student cohorts. The study replicates the profiles of previous work with high school students and extends this to middle school students. We used two independent cohorts to replicate a 3-profile solution for middle and high school samples. Results supported a similar 3-profile solution for both samples, with minor discrepancies. Results are discussed with respect to the replication and extension of the 3-profile model and its application to efforts to improve outcomes for youth in both grade level cohorts.

Association of school absence and exclusion with recorded neurodevelopmental disorders, mental disorders, or self-harm: a nationwide, retrospective, electronic cohort study of children and young people in Wales, UK

BACKGROUND

Poor attendance at school, whether due to absenteeism or exclusion, leads to multiple social, educational, and lifelong socioeconomic disadvantages. We aimed to measure the association between a broad range of diagnosed neurodevelopmental and mental disorders and recorded self-harm by the age of 24 years and school attendance and exclusion.

METHODS

In this nationwide, retrospective, electronic cohort study, we drew a cohort from the Welsh Demographic Service Dataset, which included individuals aged 7-16 years (16 years being the school leaving age in the UK) enrolled in state-funded schools in Wales in the academic years 2012/13-2015/16 (between Sept 1, 2012, and Aug 31, 2016). Using the Adolescent Mental Health Data Platform, we linked attendance and exclusion data to national demographic and primary and secondary health-care datasets. We identified all pupils with a recorded diagnosis of neurodevelopmental disorders (ADHD and autism spectrum disorder [ASD]), learning difficulties, conduct disorder, depression, anxiety, eating disorders, alcohol or drugs misuse, bipolar disorder, schizophrenia, other psychotic disorders, or recorded self-harm (our explanatory variables) before the age of 24 years. Outcomes were school absence and exclusion. Generalised estimating equations with exchangeable correlation structures using binomial distribution with the logit link function were used to calculate odds ratios (OR) for absenteeism and exclusion, adjusting for sex, age, and deprivation.

FINDINGS

School attendance, school exclusion, and health-care data were available for 414 637 pupils (201 789 [48·7%] girls and 212 848 [51·3%] boys; mean age 10·5 years [SD 3·8] on Sept 1, 2012; ethnicity data were not available). Individuals with a record of a neurodevelopmental disorder, mental disorder, or self-harm were more likely to be absent or excluded in any school year than were those without a record. Unadjusted ORs for absences ranged from 2·1 (95% CI 2·0-2·2) for those with neurodevelopmental disorders to 6·6 (4·9-8·3) for those with bipolar disorder. Adjusted ORs (aORs) for absences ranged from 2·0 (1·9-2·1) for those with neurodevelopmental disorders to 5·5 (4·2-7·2) for those with bipolar disorder. Unadjusted ORs for exclusion ranged from 1·7 (1·3-2·2) for those with eating disorders to 22·7 (20·8-24·7) for those with a record of drugs misuse. aORs for exclusion ranged from 1·8 (1·5-2·0) for those with learning difficulties to 11·0 (10·0-12·1) for those with a record of drugs misuse.

INTERPRETATION

Children and young people up to the age of 24 years with a record of a neurodevelopmental or mental disorder or self-harm before the age of 24 years were more likely to miss school than those without a record. Exclusion or persistent absence are potential indicators of current or future poor mental health that are routinely collected and could be used to target assessment and early intervention. Integrated school-based and health-care strategies to support young peoples' engagement with school life are required.

FUNDING

The Medical Research Council, MQ Mental Health Research, and the Economic and Social Research Council.

TRANSLATION

For the Welsh translation of the abstract see Supplementary Materials section.

Adolescent Health Lifestyles and Educational Risk: Findings From the Monitoring the Future Study, 2010-2016

INTRODUCTION

Research has linked educational risk to various risky health behaviors (e.g., drug use, violence, risky sexual behaviors). This study builds upon this research by examining the link between additional health lifestyle indicators-nutritional risk factors, low sleep quantity, and low exercise frequency-and academic risk factors among a recent, nationally representative sample of adolescents.

METHODS

Data from the 7 most recent cohorts (2010-2016) of the Monitoring the Future survey were analyzed in 2018 (n=45,757-46,206). A multistage random sampling technique was used to acquire the sample.

RESULTS

All examined risky health lifestyle indicators were associated with significantly greater odds of school disengagement and lower academic expectations. Youth were especially likely to exhibit educational risks when they engaged in multiple risky health behaviors. Each additional risky health lifestyle indicator conferred significant increases in the odds of every examined educational risk factor, with the odds of school disengagement increasing by a factor of 7.48 when youth engaged in 4 or more risky health behaviors (relative to none).

CONCLUSIONS

Findings suggest that activities that promote adolescent health across multiple dimensions (i.e., nutrition, physical exercise, and sleep) may also promote academic engagement and expectations for future academic achievements.

Sexual Dysfunction in Women with Depressive Disorder: A Prospective, Hospital Based Study

Background: Depression causes emotional and physical disturbances which impacts biological functions such as sleep, appetite, libido, and disinterest in sexual function. Since discussing sexual problems is considered a taboo, there is limited data available concerning the prevalence of sexual dysfunction in women with depression and its response to treatment.

Aim: To assess the prevalence of sexual dysfunction in females with depressive disorder and the effects of treatment.

Material and Methods: A total of 53 females with recurrent depression and age and sex matched normal control group were included in the study with their informed consent. All the subjects were assessed with the Hamilton Rating Scale for Depression (HAM-D), Arizona sexual experience scale (ASEX), and female sexual functioning index (FSFI), which were re-administered after 6 weeks of treatment.

Results: There was a significant difference in the HAM-D, ASEX, and FSFI scores between index and control groups at baseline. There was a significant correlation between the scores of HAM-D, ASEX, and FSFI before treatment. The correlation between the HAM-D and ASEX scores after treatment was not significant. A significant correlation was found between the HAM-D scores and the scores of arousal, lubrication, orgasm, satisfaction, pain, total domains of FSFI after treatment. No correlation was found between the HAM-D scores and desire domain score of FSFI after treatment.

Conclusion: Women with depression have a high prevalence of sexual dysfunction. A highly significant improvement in depression and sexual functioning was observed at the end of 6 weeks of antidepressant therapy. Despite the improvement in sexual dysfunctions, the individual domains of sexual functions were not comparable to the normal subjects at the end of 6 weeks suggesting the need for longer treatment.

What kinds of factors affect the academic outcomes of university students with mental disorders? A retrospective study based on medical records

AIMS

University students that suffer from mental disorders seem to have difficulty graduating. Therefore, we investigated risk and protective factors of dropping out with the aim of improving such students' academic outcomes.

METHODS

First, we statistically compared the academic outcomes of 203 undergraduate students who received treatment in the Department of Psychiatry of the Tsukuba University Health Center to those of matched controls. Second, clinical factors of 370 mentally ill students were statistically compared between the dropout and graduate groups.

RESULTS

Mentally ill students experienced significantly greater difficulties graduating. Furthermore, the ratio of females and the year of study at initial consultation were significantly lower in the dropout group. However, duration of illness, social withdrawal, temporary leaves of absence, percentage of diagnosis of F2, history of truancy, CGI-S/GI score, number of suicide attempts, visits to us, family consultations with us and grade repeating were longer or greater in the dropout group. Ultimately, the number of suicide attempts, CGI-S score, social withdrawal and leaves of absence were significantly associated with dropping out. Moreover, duration of social withdrawal and leaves of absence were significantly correlated with CGI-GI score.

CONCLUSION

We found that the number of suicide attempts, CGI-S score, social withdrawal and extended enrollment were risk factors for dropping out, while the therapeutic effect seemed to be a protective factor. As risk factors involved states of social maladjustment, it is necessary not only to treat mental disorders, but also to provide assistance such as educational and individual support for daily living.

The relationship between personality disorder traits, emotional intelligence, and college adjustment

OBJECTIVE

The current study examined the relationship between emotional intelligence, personality disorder traits, and college adjustment.

METHOD

A sample of 246 first-semester, first-time freshmen (73.6% female, age mean = 18.7, standard deviation = 2.0) at a large university in the Eastern United States completed the Trait Emotional Intelligence Questionnaire (Petrides, 2009), the Schedule for Nonadaptive and Adaptive Personality-2 (Clark, Simms, Wu, & Casillas, 2014), and the Student Adaptation to College Questionnaire (Baker & Siryk, 1998).

RESULTS

As predicted, personality disorder symptoms and emotional intelligence were generally related, and both were related to adjustment. Unique patterns of association between traits reflecting personality disorder clusters and emotional intelligence deficits also emerged. Contrary to expectation, however, emotional intelligence did not moderate the relationship between personality disorders and adjustment.

CONCLUSION

The results suggest an alternative model implicating emotional intelligence as a mediator of the relationship between personality difficulties and college adjustment.

How school climate relates to chronic absence: A multi-level latent profile analysis

Chronic absence is a significant problem in schools. School climate may play an important role in influencing chronic absence rates among schools, yet little research has evaluated how school climate constructs relate to chronic absence. Using multilevel latent profile analysis, we evaluated how profiles of student perceptions of school climate at both the student and school level differentiated school-level rates of chronic absence. Participants included 25,776 middle and high school students from 106 schools who completed a district administered school climate survey. Students attended schools in a large urban school district where 89% of 6th through 12th grade students were African-American and 61% were eligible for the federally subsidized school meals program. Three student-level profiles of perceptions of school climate emerged that corresponded to "positive," "moderate," and "negative" climate. Two predominant patterns regarding the distribution of these profiles within schools emerged that corresponded to the two school-level profiles of "marginal climate" and "climate challenged" schools. Students reporting "moderate" and "negative" climate in their schools were more likely to attend schools with higher chronic absence rates than students reporting that their school had "positive" climate. Likewise, "climate challenged" schools had significantly higher chronic absence rates than "marginal climate" schools. These results suggest that school climate shares an important relation with chronic absence among adolescent students attending urban schools. Implications for prevention and intervention programs are discussed.

The National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) Waves 1 and 2: review and summary of findings

PURPOSE

The NESARC, a "third-generation" psychiatric epidemiologic survey that integrated detailed measures of alcohol and drug use and problems has been the data source for over >850 publications. A comprehensive review of NESARC findings and their implications is lacking.

METHOD

NESARC was a survey of 43,093 participants that covered alcohol, drug and psychiatric disorders, risk factors, and consequences. Wave 1 of the NESARC was conducted in 2001-2002. Three years later, Wave 2 follow-up re-interviews were conducted with 34,653 of the original participants. Scopus and Pubmed were used to search for NESARC papers, which were sorted into topic areas and summarized.

RESULT

The most common disorders were alcohol and posttraumatic stress disorders, and major depression. Females had more internalizing disorders and males had more externalizing disorders, although the preponderance of males with alcohol disorders (the "gender gap") was less pronounced than it was in previous decades. A race/ethnic "paradox" (lower risk among disadvantaged minorities than whites) remains unexplained. Younger participants had higher risk for substance and personality disorders, but not unipolar depressive or anxiety disorders. Psychiatric comorbidity was extensive and often formed latent trans-diagnostic domains. Since 1991-1992, risk for marijuana and prescription drug disorders increased, while smoking decreased, although smoking decreases were less pronounced among those with comorbidity. A nexus of comorbidity, social support, and stress predicted transitions in diagnostic status between Waves 1 and 2. Childhood maltreatment predicted psychopathology. Alcohol and drug use disorders were seldom treated; attitudinal barriers (little perceived need, perceived alcoholism stigma, pessimism about efficacy) were more important in predicting non-treatment than financial barriers.

CONCLUSIONS

Understanding comorbidity and the effects of early stressors will require research incorporating biologic components, e.g., genetic variants and brain imaging. The lack of treatment for alcohol and drug disorders, predicted by attitudinal rather than financial variables, suggests an urgent need for public and professional education to reduce the stigma associated with these disorders and increase knowledge of treatment options.

The role of delinquency, proactive aggression, psychopathy and behavioral school engagement in reported youth gang membership

Given the robust positive association between gangs and crime, a better understanding of factors related to reported youth gang membership is critical and especially since youth in gangs are a universal concern. The present study investigated the role of delinquency, proactive aggression, psychopathy and behavioral school engagement in reported youth gang membership using a large sample of 1027 Singapore adolescents. Results from logistic regression showed that delinquency, proactive aggression, and behavioral school engagement were statistically significant risk factors for reported youth gang membership, and that psychopathy was not related to reported gang membership. Implications for prevention and intervention work with respect to youth gang membership were discussed. In particular, strengthening students' engagement with school and meaningful school-related activities and developing supportive teacher-student relationships are particularly important in working with young people with respect to prevention work. Additionally, the present study's theoretical and empirical contributions were also discussed.

Association between ADH1C and ALDH2 polymorphisms and alcoholism in a Turkish sample

BACKGROUND

Polymorphisms in the genes encoding alcohol metabolizing enzymes are associated with alcohol dependence.

AIM

To evaluate the association between the alcohol dehydrogenase 1C (ADH1C) Ile350Val and aldehyde dehydrogenase 2 (ALDH2) Glu504Lys polymorphisms and alcohol dependence in a Turkish sample.

METHODS

235 individuals (115 alcohol-dependent patients and 120 controls) were genotyped for ADH1C and ALDH2 with PCR-RFLP (polymerase chain reaction-restriction fragment length polymorphism). Association between the polymorphisms and family history, daily and maximum amount of alcohol consumed was investigated. The associations between alcohol dependence, severity of consumption and family history and the polymorphisms were analyzed by chi-square or Fisher's exact test where necessary. Relationship between genotypes and dependence related features was evaluated using analysis of variance (ANOVA).

RESULTS

The -350Val allele for ADH1C (ADH1C*2) was increased in alcohol-dependent patients (P = 0.05). In individuals with a positive family history, the genotype distribution differed significantly (P = 0.031) and more patients carried the Val allele compared with controls (P = 0.025). Genotyping of 162 participants did not reveal the -504Lys allele in ALDH2.

CONCLUSIONS

These findings suggest that ADH1C*2 is associated with alcohol dependence in the Turkish population displaying a dominant inheritance model. ADH1C*2 allele may contribute to the variance in heritability of alcohol dependence. The ALDH2 -504Lys/Lys or Glu/Lys genotypes were not present in alcohol-dependent patients, similar to that seen in European populations and in contrast to the findings in the Asian populations.

Practitioner perspectives of implementing check & connect

While there is a growing reserve of evidence-based practices (EBPs) available to practitioners, much can be learned about how to implement EBPs in real-world settings. Evidence of the effects of a widely disseminated student engagement intervention, Check & Connect (C&C), is emerging yet little is known about the implementation of C&C in community-based settings. The purpose of the authors in this study was to examine practitioner attitudes and perspectives related to the C&C intervention and implementation to gain an understanding of core implementation components that facilitated or impeded implementation. A researcher-developed survey instrument was used to assess practitioner attitudes related to the C&C model and implementation among 14 school-based practitioners working in a dropout prevention program. Findings indicate that practitioners were highly positive about the C&C intervention and in their attitudes about implementing EBPs. Benefits of C&C identified by practitioners included increased relationship building with students, tracking students on a consistent and timely basis, and addressing attendance issues as a main focus of treatment. The most common implementation challenges were time constraints, paperwork, and targeting absentee students. These findings contribute to the emerging literature on C&C and the implementation of EBPs in schools and community-based settings.

Factors affecting unhappiness at school among Japanese adolescents: an epidemiological study

Background

Unhappiness at school is one of the main reasons for truancy among adolescents. In order to assess this problem more thoroughly in the context of Japanese adolescents, the present study examined the associations between feelings of unhappiness at school and lifestyle habits, school life realities, and mental health status.

Method

This study was designed as a cross-sectional survey. A self-administered questionnaire was provided to students enrolled in randomly selected junior and senior high schools throughout Japan. We calculated the percentages of both junior and senior high school students who felt unhappy at school based on factors related to school life, lifestyle habits, and mental health status. Multiple logistic regression analyses were performed in order to examine the associations between those factors and students' feelings of unhappiness at school.

Results

A total of 98,867 valid responses were analysed, 7.9% (Boys: 8.4%, Girls: 7.4%) of which came from students who responded that they felt unhappy at school. For both junior and senior high school students, the percentages of those who felt unhappy at school were significantly higher among those who had not yet decided on their future life course, who did not participate in extracurricular activities, did not eat breakfast every day, went to bed late, had used tobacco or alcohol in the previous 30 days, and had poor mental health compared with others. The results of multiple logistic regression analyses indicated that the adjusted odds ratios for feeling unhappy at school with regard to the above-mentioned factors were significantly high for both junior and senior high school students.

Conclusions

The present results suggest that school employees and administrators must provide health guidance to students, considering that irregular lifestyle habits, lower school engagement, smoking, drinking alcohol, and poor mental health status are all associated with maladaptation to school among adolescents.

Examining statewide capacity for school health and mental health promotion: a post hoc application of a district capacity-building framework

Schools must possess a variety of capacities to effectively support comprehensive and coordinated school health promotion activities, and researchers have developed a district-level capacity-building framework specific to school health promotion. State-level school health coalitions often support such capacity-building efforts and should embed this work within a data-based, decision-making model. However, there is a lack of guidance for state school health coalitions on how they should collect and use data. This article uses a district-level capacity-building framework to interpret findings from a statewide coordinated school health needs/resource assessment in order to examine statewide capacity for school health promotion. Participants included school personnel (N = 643) from one state. Descriptive statistics were calculated for survey items, with further examination of subgroup differences among school administrators and nurses. Results were then interpreted via a post hoc application of a district-level capacity-building framework. Findings across districts revealed statewide strengths and gaps with regard to leadership and management capacities, internal and external supports, and an indicator of global capacity. Findings support the utility of using a common framework across local and state levels to align efforts and embed capacity-building activities within a data-driven, continuous improvement model.

Toward a Bioecological Model of School Engagement: A Biometric Analysis of Gene and Environmental Factors

School disengagement is associated with poor academic achievement, dropout, and risk behaviors such as truancy, delinquency, and substance use. Despite empirical research identifying risk correlates of school disengagement across the ecology, it is unclear from which domain these correlates arise. To redress this issue, the current study used intraclass correlation and DeFries-Fulker analyses to longitudinally decompose variance in three domains of engagement (academic, behavioral, and emotional) using data from the National Longitudinal Study of Adolescent Health. Findings suggest that nonshared environmental factors (that is, environmental contexts and experiences that are unique to each sibling) account for approximately half of the variance in indicators of school disengagement when controlling for genetic influences, and that this variance increases as adolescents grow older and rely less on their immediate family. The present study contributes new evidence on the biosocial underpinnings of school engagement and highlights the importance of interventions targeting factors in the nonshared environment.

A Nationally-Representative Epidemiological and Risk Factor Assessment of Child Mental Health in Vietnam

As part of the global mental health movement's focus on identifying and reducing international disparities, this study conducted the first nationally representative child mental health epidemiological survey in Vietnam. We assessed as risk/protective factors several family social structure characteristics (e.g., presence of grandparents, number of siblings in the home) of particular relevance to non-Western countries. Epidemiological data using the Child Behavior Checklist and the Strengths and Difficulties Questionnaire were collected at 60 sites in 10 of Vietnam's 63 provinces selected to provide a nationally representative sample, which included 1,314 adult informants of children 6-16 years of age, and 591 children aged 12-16. Vietnamese children's mental health functioning was reported overall to be better by approximately a third standard deviation than the international average; this international difference was particularly large for externalizing (behavior) problems as compared to internalizing (emotional) problems, suggesting that a cultural problem suppression model may be operating in Vietnam. Significant variability in mental health problems was found across provinces, emphasizing the need for nationally representative samples when conducting child mental health epidemiological surveys. Contrary to many other studies, in Vietnam higher SES was found to be a risk factor for attention/hyperactivity problems.

The prevalence of risk for mental health problems among high school students in the Western Cape Province, South Africa

The aim of this article is to describe the prevalence of risk for developing mental health problems in a large survey of high school students in the Western Cape Province in South Africa. The study population comprised students in Grades 8, 9, and 10 attending public schools in the Western Cape Province. Schools were randomly sampled proportional to total school size (all grades). A total of 227 schools and a total of 20,855 students completed the survey. Overall, 14.9% of students were categorised as ‘high risk’ for mental health problems. A significantly higher proportion of female participants were in the ‘high-risk’ category (18.5%; confidence interval = [17.2, 19.8]) than male participants (10.1%; confidence interval = [9.3, 10.8]). Female students who reported more days absent from school in the previous school quarter were more likely to be in the ‘high-risk’ category for mental health problems. Findings highlight the need for screening for mental health problems among adolescents attending high school in South Africa, and the need to develop intervention programmes for students at risk of mental health problems.

Prevalence of mental health disorders among low-income African American adolescents

PURPOSE

Data on the prevalence of mental health disorders for low-income, urban African American adolescents are scarce. This study presents data about the burden of mental disorders for this understudied population.

METHODS

Mental disorders were assessed using the Diagnostic Interview Schedule for Children (C-DISC), Youth Self-Report (YSR), and Child Behavior Checklist (CBCL) among a sample of adolescents and their caregivers from very impoverished neighborhoods in a Southern city.

RESULTS

Based on the C-DISC, 3.8, 5.1 and 7.7% of adolescents met diagnostic criteria for major depression, post-traumatic stress disorder, and conduct disorder, respectively. There were significant differences among some of the mental health disorders based on adolescent and caregiver characteristics such as sex, school status, caregiver work status, and income level. We found a low prevalence of alcohol, marijuana, and substance abuse and dependence disorders.

CONCLUSIONS

Information about the prevalence of mental health disorders in specific communities and populations can assist in addressing unmet needs, planning for services and treatment, and reducing health disparities.

The epidemiology of depression across cultures

Epidemiological data are reviewed on the prevalence, course, socio-demographic correlates, and societal costs of major depression throughout the world. Major depression is estimated in these surveys to be a commonly occurring disorder. Although estimates of lifetime prevalence and course vary substantially across countries for reasons that could involve both substantive and methodological processes, the cross-national data are clear in documenting meaningful lifetime prevalence with wide variation in age-of-onset and high risk of lifelong chronic-recurrent persistence. A number of sociodemographic correlates of major depression are found consistently across countries, and cross-national data also document associations with numerous adverse outcomes, including difficulties in role transitions (e.g., low education, high teen childbearing, marital disruption, unstable employment), reduced role functioning (e.g., low marital quality, low work performance, low earnings), elevated risk of onset, persistence and severity of a wide range of secondary disorders, and increased risk of early mortality due to physical disorders and suicide.

Implementing a Case Management Initiative in High-Need Schools

States continue to experiment with ways of improving health and human service use by people with complex needs. Such efforts have often sought to increase individual and family control over services as well as to enhance coordination among providers. Paths to achieving these goals are not well understood. This study draws on two previously distinct conceptual frameworks to examine how 71 public schools implemented a team approach to increasing family and agency engagement for children at risk. Results from longitudinal data fit the core components expected to affect implementation and also indicated sustainability, but in ways distinctive to the initiative's public school settings. Accountability to the state appeared to be a major catalyst, yet in some respects also constrained local agencies from participating as intended. School inertia may have both undermined the program through some evaluation practices and gaps in administrative support, and supported integration into organizational routines and successful experimentation over time in increasing caregiver involvement. Family hesitation about sharing information with multiple agencies may also help explain why the goal of seamless coordination remains elusive.

Who are truant youth? Examining distinctive profiles of truant youth using latent profile analysis

The present study explored the heterogeneity of truant youth to provide a more nuanced examination of the nature of adolescent truancy and examine distinct profiles of truant youth as they relate to externalizing behaviors. Latent profile analysis was employed to examine the heterogeneity of truant youth by using a nationally representative sample of 1,646 truant adolescents (49.8 % female) from the 2010 National Survey on Drug Use and Health. Five key indicator variables were utilized to identify latent classes: school engagement, participation in school-based activities, grades, parental academic involvement, and number of school days skipped. Additionally, multinomial regression was employed to examine the relationship between latent truant youth classes and externalizing behaviors. Four classes of truant youth were identified: achievers (28.55 %), moderate students (24.30 %), academically disengaged (40.89 %), and chronic skippers (6.26 %). Additionally, group membership was found to be associated differentially with marijuana use, fighting, theft and selling drugs. Results from the present study suggest that truant youth are not a homogenous group, but rather present with different risk profiles as they relate to key indicators, demographic characteristics and externalizing behaviors. Implications for practice, policy and future research are discussed.

The costs of depression

The data reported herein show clearly that major depression is a commonly occurring and burdensome disorder. The high prevalence, early age of onset, and high persistence of MDD in the many different countries where epidemiologic surveys have been administered confirm the high worldwide importance of depression. Although evidence is not definitive that MDD plays a causal role in its associations with the many adverse outcomes reviewed here, there is clear evidence that depression has causal effects on a number of important mediators, making it difficult to assume anything other than that depression has strong causal effects on many dimensions of burden. These results have been used to argue for the likely cost -effectiveness of expanded depression treatment from a societal perspective. Two separate, large-scale, randomized, workplace depression treatment effectiveness trials have been carried out in the United States to evaluate the cost effectiveness of expanded treatment from an employer perspective. Both trials had positive returns on investment to employers. A substantial expansion of worksite depression care management programs has occurred in the United States subsequent to the publication of these trials. However, the proportion of people with depression who receive treatment remains low in the United States and even lower in other parts of the world. A recent US study found that only about half of workers with MDD received treatment in the year of interview and that fewer than half of treated workers received treatment consistent with published treatment guidelines. Although the treatment rate was higher for more severe cases, even some with severe MDD often failed to receive treatment. The WMH surveys show that treatment rates are even lower in many other developed countries and consistently much lower in developing countries. Less information is available on rates of depression treatment among patients with chronic physical disorders, but available evidence suggests that expanded treatment could be of considerable value. Randomized, controlled trials are needed to expand our understanding of the effects of detection and treatment of depression among people in treatment for chronic physical disorders. In addition, controlled effectiveness trials with long-term follow-ups are needed to increase our understanding of the effects of early MDD treatment interventions on changes in life course role trajectories, role performance, and onset of secondary physical disorders.