Development and validation of a depression scale for Asian adolescents

Validating the Children's Depression Inventory-2: Results from the Growing Up in Singapore Towards Healthy Outcomes (GUSTO) study

Childhood-onset depression has adverse consequences that are sustained into adulthood, which increases the significance of detection in early childhood. The Children's Depression Inventory (CDI) is used globally in evaluating depressive symptom severity in adolescents, and its second version, the CDI-2, was developed by taking into account advances in childhood depression research. Prior research has reported inconsistencies in its factor structure across populations. In addition, the CDI-2 has not yet been empirically validated with Southeast Asian populations. This study sought to empirically validate the CDI-2's psychometric properties and evaluate its factorial structure with a Singaporean community sample of non-clinical respondents. A total sample of 730 Singaporean children aged between 8.5 and 10.5 years was used. Psychometric properties of the CDI-2, including internal consistency as well as convergent and discriminant validity, were assessed. Factor analyses were conducted to assess the developers' original two-factor structure for a Southeast Asian population. This two-factor structure was not supported in our sample. Instead, the data provided the best fit for a hierarchical two-factor structure with factors namely, socio-emotional problems and cognitive-behavioural problems. This finding suggests that socio-cultural and demographic elements influence interpretation of depressive symptoms and therefore the emerging factor structure of the construct under scrutiny. This study highlights the need to further examine the CDI-2 and ensure that its interpretation is culture-specific. More qualitative work could also bring to light the idiosyncratic understanding of depressive symptomatology, which would then guide culture-specific validation of the CDI-2.

Pathological gaming: a longitudinal study from the perspectives of mental health problems and social stress model

Debates about pathological gaming continues in the wake of the World Health Organization's (WHO) decision to establish a gaming disorder diagnosis. Questions persist whether gaming disorder is best conceived as a stand-alone psychiatric disorder, or whether it heralds or accompanies other, more established conditions, such as depression or ADHD. We tested these hypotheses in a sample of 3,034 youth from Singapore. Evidence suggests that pathological gaming is a somewhat unstable construct, often remitting spontaneously. Youth with preexisting ADHD or depression were more likely to develop later pathological gaming problems, while the inverse was not true, with neither early pathological gaming nor gaming time predictive of later mental health problems. Results suggest that, whenever there is any need to conduct robust evidence-based studies, more evidence should be collected before new disorders are recognized by means of "expert consensus".

Self-evaluation as an active ingredient in the experience and treatment of adolescent depression; an integrated scoping review with expert advisory input

BACKGROUND

Negative self-perceptions is one of the most common symptoms of depression in young people, and has been found to be strongly associated with severity of depression symptoms. Psychological treatments for adolescent depression are only moderately effective. Understanding the role and importance of these self-perceptions may help to inform and improve treatments. The aim of this review was to examine self-evaluation as a characteristic of adolescent depression, and as an active ingredient in treatment for adolescent depression.

METHODS

We conducted a scoping review which included quantitative and qualitative studies of any design that reported on self-evaluation as a characteristic of, or focus of treatment for, adolescent depression. Participants were required to be 11-24 years and experiencing elevated symptoms of depression or a diagnosis. We also met with 14 expert advisory groups of young people with lived experience, clinicians, and researchers, for their input. Findings from 46 peer-reviewed research studies are presented alongside views of 64 expert advisors, to identify what is known and what is missing in the literature.

RESULTS

Three overarching topics were identified following the review and reflections from advisors: 1) What does it look like? 2) Where does it come from? and 3) How can we change it? The literature identified that young people view themselves more negatively and less positively when depressed, however expert advisors explained that view of self is complex and varies for each individual. Literature identified preliminary evidence of a bidirectional relationship between self-evaluation and depression, however, advisors raised questions regarding the influences and mechanisms involved, such as being influenced by the social environment, and by the cognitive capacity of the individual. Finally, there was a consensus from the literature and expert advisors that self-evaluation can improve across treatment. However, research literature was limited, with only 11 identified studies covering a diverse range of interventions and self-evaluation measures. Various barriers and facilitators to working on self-evaluation in treatment were highlighted by advisors, as well as suggestions for treatment approaches.

CONCLUSIONS

Findings indicate the importance of self-evaluation in adolescent depression, but highlight the need for more research on which treatments and treatment components are most effective in changing self-evaluation.

Prosocial Video Game Content, Empathy and Cognitive Ability in a Large Sample of Youth

Whether playing video games with prosocial content has an influence on empathy among players remains contentious in the research literature. Some evidence suggests playing cooperatively with other gamers enhances empathy, but data have not conclusively linked prosocial content with empathy. Further, mechanisms of this potential relationship are unclear, and little work has been conducted on how cognitive skills, such as fluid reasoning, may mediate this relationship. The current study examines these relationships with a large sample of 3034 youth (27.2% female, Mage = 11.2; range 8-17 at time 1) in Singapore. Data were considered longitudinally across two years in three waves. Ultimately, no evidence emerged that prosocial content in video games had any impact on empathy related outcomes, nor was fluid reasoning a mediator variable for any relationship. However, variables such as social competence and depression and anxiety symptoms were highly related to empathy measures. This evidence adds to the growing debate in the field that video games may not dramatically alter, whether positively or negatively, the development of emotional and behavioral outcomes for youth.

Comorbid Depression and Anxiety Symptoms in Chinese Adolescents: Testing the Explanatory Power of a Diathesis-Anxiety Model

Anxiety and depressive symptoms frequently co-occur in adolescence and confer greater distress compared to experiencing either symptom alone. A causal model (anxiety symptoms predicting depressive symptoms), a correlated liabilities model (vulnerabilities interacting with stressors to predict both symptoms), and a diathesis-anxiety model (vulnerabilities interacting with anxiety symptoms to predict depressive symptoms) have all been proposed as explanations for the relation between depression and anxiety. To date, however, research has mostly examined these models among North American/Western European adolescents. In response, the present study sought to identify the best explanatory model concerning the relationship between anxiety and depressive symptoms among Chinese adolescents. 494 10^th grade students were assessed for their perceived levels of family cohesion and conflict, stressors, and depressive and anxiety symptoms. Every 3 months for 18 months, youth reported their symptoms and stressors. Symptoms and stressors were person-mean and grand-mean centered to compare nomothetic and idiographic conceptualizations of vulnerability. Overall, evidence suggested a reciprocal, versus causal, relation between anxiety and depressive symptoms. Further, while cohesion and conflict independently predicted anxiety and depressive symptoms, their interactions with stressors were not supported. Ultimately, strong support was found for a diathesis-anxiety model using an idiographic conceptualization of anxiety, such that low perceived family cohesion interacted with within-subject fluctuations of anxiety to predict prospective depressive symptoms. This study provides cross-cultural support for a diathesis-anxiety model and shows the importance of distinguishing between positive and negative family functioning when examining vulnerability in Chinese adolescents. Research and clinical implications of these findings are discussed.

Aggressive Video Games Are Not a Risk Factor for Mental Health Problems in Youth: A Longitudinal Study

Recent preregistered studies and analyses have suggested that links between aggressive video games (AVGs) and aggression-related outcomes may have been exaggerated in previous literature. However, concerns about AVGs remain. Although the impact of aggressive games on aggressive behaviors has been the subject of approximately a dozen preregistered studies, the potential impact of aggressive games on the player's mental health symptoms has not been the subject of similar preregistered analyses. In the current study, a sample of more than 3000 youth from Singapore were examined by using preregistered analyses to determine whether early exposure to aggressive games was predictive of anxiety, depression, somatic symptoms, or attention deficit hyperactivity disorder 2 years later. Analyses suggested that exposure to AVGs is not a risk factor for later mental health symptoms.

Debate: COVID-19 to the under 19 - a Singapore school mental health response

The 2019 novel coronavirus (COVID-19) pandemic causes much disruption globally on sociopolitical, economic and healthcare fronts. While much of the impact has focused on the epidemiology and medical management of the pandemic, more need to be focused on the mental health impact of COVID-19. This article describes the impact of COVID-19 pandemic on Singapore's schools and the response and adaptation of the school community mental health services. Singapore's response is one of balancing the needs of the population and demands in this crisis, with the utilization of technology and outbreak and support control measures. Further consideration needs to be afforded to increase capacity of the school and mental health services to support youth and tapping on technological innovations.

The Effect of Social Norm-based Intervention with Observable Behaviour on Physical Activity among Adolescents: A Randomized Controlled Trial

Background

The rising prevalence of childhood obesity in developing and developed countries poses a major public health challenge to policy makers and an effective strategy to promote physical activity among adolescents is warranted. This study aimed to evaluate the effectiveness of providing descriptive norms messages with personal identification in promoting physical activity among adolescents by measuring step counts via a randomized controlled trial (NCT03081013).

Methods

A total of 311 participants aged 13–16 were randomized into two study arms (Onymous and Anonymous Arms). Each arm consisted of 13 groups of 12 participants. During the trial, participants received weekly short message service (SMS) about their past week’s physical activity performance. Participants in the Anonymous Arm received information about step counts of group members ranked from highest to lowest. Participants in the Onymous Arm received the same information with the group members’ full names. Participants’ quality of life, depression, physical activity social support, self-efficacy and enjoyment before and after the intervention were also evaluated. This study adheres to the CONSORT guidelines.

Results

The number of steps was not higher when descriptive norm message was onymous compared to when it was anonymous. Scores in quality of life, depression, social support, self-efficacy, and enjoyment of physical activity were not significantly different between both arms (p > 0.05).

Conclusions

Our findings indicated that the effect of providing descriptive norms messages containing personal identification on physical activity promotion was not evident in the main analysis. Future studies may consider using a more relevant reference group to use social norms as a tool to increase physical activity among adolescents.

Trial registration

ClinicalTrials.gov - NCT03081013. Registered 15 Mar 2017-Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03081013

Factor Structure of the 10-Item Perceived Stress Scale and Measurement Invariance Across Genders Among Chinese Adolescents

BACKGROUND

Chinese adolescents encounter a lot of stressors, such as academic burden and parental pressure. However, little is known about their perception of stress. The 10-item Perceived Stress Scale (PSS-10) is a widely used instrument to measure individuals' appraisal of global stress in academic research and clinical practice. The current study aimed to evaluate the best-fit factor structure model of the PSS-10 and the measurement invariance across genders in Chinese adolescents.

METHODS

A total of 1,574 Chinese senior high school students completed the PSS-10 (mean age = 15.26 ± 0.56 years, female = 54%). Confirmatory factor analysis (CFA) was conducted to determine the factor structure of the PSS-10. Multigroup CFA was carried out to test the measurement invariance of the PSS-10 across genders. A subsample (N = 1,060) answered additional questionnaires measuring stressful life events, anxiety, and depression to examine the convergent and concurrent validity of the PSS-10.

RESULTS

The two-factor model was supported [i.e., χ2 (34) = 332.224, p < 0.001; non-normal fit index (NNFI) = 0.901, comparative fit index (CFI) = 0.925, root mean square error of approximation (RMSEA) = 0.075, standardized root mean square residual (SRMR) = 0.051]. Importantly, the model exhibited strong measurement invariance across female and male groups. Furthermore, the PSS-10 had adequate convergent validity for stressful life events (number: r = 0.13, p < 0.001; impact: r = 0.23, p < 0.001) and could explain incremental variance in predicting anxiety (ΔR 2 = 0.13, β = 0.38, p < 0.001) and depression (ΔR 2 = 0.16, β = 0.41, p < 0.001), suggesting excellent concurrent validity.

CONCLUSION

A two-factor model best fits the structure of PSS-10 among Chinese adolescents, with strong measurement invariance between gender groups, demonstrating its validity for assessing perceived stress among Chinese adolescents.

Scale development: Chinese Irrational Beliefs and Rational Attitude Scale

University study has been considered to be one of the most stressful periods in a person's life. University students may have irrational beliefs that could play a significant role in causing emotional disturbance. Nevertheless, a suitable instrument for measuring irrational beliefs in college students in Chinese society has been lacking. The aim of this study was to construct a culturally relevant scale for measuring irrational beliefs among university students in the Hong Kong Chinese context. The construction of the Chinese Irrational Beliefs and Rational Attitude Scale (CIBRAS) for university students was based on (1) literature review and expert panel review for evaluation on content validity, (2) a pilot test of 200 local Hong Kong university students to determine the scale's psychometric properties and probe the exploratory factor analysis, and (3) confirmatory factor analysis to test for construct validity of the CIBRAS (conducted with a further 655 local Hong Kong university students). The results showed that the five-factor 19-item CIBRAS has good psychometric properties, including good internal consistency (Cronbach's alphas ranging from .64 to .80), content validity (content validity index = .96 for relevance, .94 for clarity, and .94 for representativeness), construct validity (explaining 60.1% of the total variance), and adequate fit indices (normed chi-square = 2.8, comparative fit index = .94, normal fit index = .93, non-normed fit index = .93, incremental fit index = .94, root-mean-square error of approximation = .077, and standardized root-mean residual = .074). The limitations and implications of the study were discussed.

Association between Internet Gaming Disorder or Pathological Video-Game Use and Comorbid Psychopathology: A Comprehensive Review

The addictive use of video games is recognized as a problem with clinical relevance and is included in international diagnostic manuals and classifications of diseases. The association between "Internet addiction" and mental health has been well documented across a range of investigations. However, a major drawback of these studies is that no controls have been placed on the type of Internet use investigated. The aim of this study is to review systematically the current literature in order to explore the association between Internet Gaming Disorder (IGD) and psychopathology. An electronic literature search was conducted using PubMed, PsychINFO, ScienceDirect, Web of Science and Google Scholar (r.n. CRD42018082398). The effect sizes for the observed correlations were identified or computed. Twenty-four articles met the eligibility criteria. The studies included comprised 21 cross-sectional and three prospective designs. Most of the research was conducted in Europe. The significant correlations reported comprised: 92% between IGD and anxiety, 89% with depression, 85% with symptoms of attention deficit hyperactivity disorder (ADHD), and 75% with social phobia/anxiety and obsessive-compulsive symptoms. Most of the studies reported higher rates of IGD in males. The lack of longitudinal studies and the contradictory results obtained prevent detection of the directionality of the associations and, furthermore, show the complex relationship between both phenomena.

Child Community Mental Health Services in Asia Pacific and Singapore's REACH Model

In recent decades, there have been concerted efforts to improve mental health services for youths alongside the challenges of rising healthcare costs and increasing demand for mental health needs. One important phenomenon is the shift from traditional clinic-based care to community-based mental health services to improve accessibility to services and provide patient-centred care. In this article, we discuss the child and adolescent community mental health efforts within the Asia-Pacific region. We also discuss Singapore’s community and school-based mental health service, known as the Response, Early Intervention and Assessment in Community Mental Health (REACH). This article discusses how REACH has evolved over the years in response to the changing needs of youths in Singapore. Finally, we discuss the current challenges and future directions for youth mental health care.

A study on the influence of internet addiction and online interpersonal influences on health-related quality of life in young Vietnamese

Background

Internet addiction (IA) is a common problem found in young Asians. This study aimed to study the influence of IA and online activities on health-related quality of life (HRQOL) in young Vietnamese. This study also compared the frequencies of anxiety, depression and other addiction of young Vietnamese with and without IA.

Methods

This study recruited 566 young Vietnamese (56.7% female, 43.3% male) ranging from 15 to 25 years of age via the respondent-driven sampling technique. Chi-squared, t-test and analysis of variance were used to compare young Vietnamese with and without IA. Regression analyses were used to examine the association between internet usage characteristics and HRQOL.

Results

Results from this cross-sectional study showed that 21.2% of participants suffered from IA. Online relationship demonstrated significantly higher influences on behaviors and lifestyles in participants with IA than those without IA. Participants with IA were more likely to have problems with self-care, difficulty in performing daily routine, suffer from pain and discomfort, anxiety and depression. Contrary to previous studies, we found that there were no differences in gender, sociodemographic, the number of participants with cigarette smoking, water-pipe smoking and alcohol dependence between the IA and non-IA groups. IA was significantly associated with poor HRQOL in young Vietnamese.

Conclusion

IA is a common problem among young Vietnamese and the prevalence of IA is the highest as compared to other Asian countries. Our findings suggest that gender may not play a key role in IA. This can be an emerging trend when both genders have equal access to the internet. By studying the impact of IA on HRQOL, healthcare professionals can design effective intervention to alleviate the negative consequences of IA in Vietnam.

Reliability and Validity of the Beck Depression Inventory-II among Korean Adolescents

OBJECTIVE

The Beck Depression Inventory-II (BDI-II) is one of the most popular scales for evaluating the severity of depression in adolescents as well as adults. The prevalence of depression increases during adolescence, and it has shown a rapid increase with occurrence at an earlier age and a tendency to continue into adulthood. Data from an adolescent nonclinical sample provides us more information related to depressive symptoms as potential risk factors. The current study was designed to two objectives: 1) to analyze the reliability and validity the BDI-II among Korean adolescents and 2) to evaluate the factorial structure in a Korean nonclinical adolescent sample.

METHODS

The participants included 1072 adolescent boys and girls. We assessed the internal consistency, corrected item-total correlation, and the convergent validity of the BDI-II. We also performed confirmatory factor analyses to determine the internal structure of the BDI-II for Korean adolescents using Mplus 6.1.

RESULTS

The Cronbach's alpha for the BDI-II total score was 0.89. The correlation between the BDI-II and the PHQ-9 was strong (r=0.75), and anxiety-related measures were 0.68 and 0.71, which were also in the high range. Among the five different factor structures, the modified three-factor model demonstrated the best overall fit.

CONCLUSION

The BDI-II is a reliable tool for measuring the severity of depressive symptoms in Korean adolescents. Therefore, the findings can provide basic information for examining the prevalence rate, intervention strategies for depression in adolescents.

Effectiveness of taking in the good based-bibliotherapy intervention program among depressed Filipino female adolescents

Adolescent depression is a severe mental health problem. Philippines has the highest incidence of depression in South East Asia. Depressed female adolescents habitually seek and retain negative experiences. Aim of this research was to develop and to assess effectiveness of a Taking in the Good Based-Bibliotherapy Intervention Program for female adolescents. As an innovative type of psychotherapy treatment, program aimed to build up their inner strengths by experiencing, enriching and absorbing daily events with a positive attitude and installing them in brain. Program was conducted in two phases: 1. Development of taking in the good based-bibliotherapy intervention. 2. Implementation and assessment of pioneering treatment for alleviating depression and thereby increasing positive cognitive appraisal by employing true experimental research design particularly between subjects. Beck Depression Inventory-II, Asian Adolescent Depression Scale and Kutcher Adolescent Depression Scale-11 were administered before and after implementation of the program. A total of 30 female adolescents, Filipino High School students, (mean age=13.9), were randomly assigned to experimental (n=15) and control (n=15) conditions. Data analysis was done by employing percentage and frequency distribution, mean scores, standard deviation, dependent t-test, independent t-test statistics and Cohen's d. The null hypothesis was tested at the 0.05 level of significance. Statistical analysis between the pre-test and post-test scores of the experimental group showed significant difference (p=0.000) and scores of control and experimental group showed significant difference (p=0.000) in all dependent variables in the post-test. These results revealed that "Taking in the Good based-Bibliotherapy Intervention" was effective in reducing depression in female adolescents.

Evaluation of the Psychometric Properties of the Asian Adolescent Depression Scale and Construction of a Short Form: An Item Response Theory Analysis

The present study applied item response theory to examine the psychometric properties of the Asian Adolescent Depression Scale and to construct a short form among 1,084 teenagers recruited from secondary schools in Hong Kong. Findings suggested that some items of the full form reflected higher levels of severity and were more discriminating than others, and the Asian Adolescent Depression Scale was useful in measuring a broad range of depressive severity in community youths. Differential item functioning emerged in several items where females reported higher depressive severity than males. In the short form construction, preliminary validation suggested that, relative to the 20-item full form, our derived short form offered significantly greater diagnostic performance and stronger discriminatory ability in differentiating depressed and nondepressed groups, and simultaneously maintained adequate measurement precision with a reduced response burden in assessing depression in the Asian adolescents. Cultural variance in depressive symptomatology and clinical implications are discussed.

What are the factors associated with depressive symptoms among orphans and vulnerable children in Cambodia?

BACKGROUND

Compared to general children, orphans and vulnerable children (OVC) are more exposed to negative outcomes in life such as abuse and neglect. Consequently, OVC are more susceptible to depression. This paper investigated factors associated with depressive symptoms among OVC in Cambodia.

METHODS

In this cross-sectional study, data of 606 OVC from the Sustainable Action against HIV and AIDS in Communities (SAHACOM) project were analyzed. The data were collected from five provinces and analyzed separately for boys and girls. Multiple linear regression analysis was used to identify factors independently associated with levels of depressive symptoms.

RESULTS

Both boys and girls who reported having been too sick making them unable to attend school or go to work in the past six months (boys: B = 3.5; 95 % CI = 0.7, 6.2; girls: B = 5.7; 95 % CI = 2.9, 8.5) and who had witnessed violence in the family (boys: B = 5.6; 95 % CI = 1.6, 9.6; girls: B = 5.8; 95 % CI = 1.7, 9.9) had a higher level of depressive symptoms. Girls who were older (B = 8.5; 95 % CI = 3.0, 14.0), who did not have enough food in the past six months (B = -8.7; 95 % CI = -13.7, -3.7) and whose parents were separated, divorced or dead (B = 3.9; 95 % CI = 0.5, 7.2) had a higher level of depressive symptoms. Higher level of school attachment was negatively associated with depressive symptoms in both genders (boys: B = -1.4; 95 % CI = -2.0, -0.9; girls: B = -1.4; 95 % CI = -2.0,-0.9).

CONCLUSIONS

Factors such as physical health and exposure to violence may affect mental health of OVC in Cambodia. As health is of utmost importance, better healthcare services should be made easily accessible for OVC. Schools have the potential to act as a buffer against depressive symptoms. Therefore, efforts should be made to keep OVC in school and to improve the roles of school in Cambodia.

Child and adolescent psychiatry services in Singapore

Singapore is a small young city state with a multi-ethnic and multi-cultural population. This article reviews the development of the country's child and adolescent psychiatry services through the years, in the background of other developments within the country's education, social and legal services. Research and other available data on the prevalence of psychiatric problems among children and adolescents in Singapore are summarized, although there has been no nation-wide epidemiological study done. One of the most recent developments has been the establishment of a community mental health service, which works collaboratively with schools and community partners. Some challenges are also discussed especially in the area of child and adolescent psychiatry training. Possible future directions include providing mental heath care for preschool children as well as epidemiological studies to identify disease prevalence and mental health needs among children and adolescents in Singapore.

Exposure to violence in relation to depressive symptoms among male and female adolescent students in Cambodia

PURPOSE

In spite of the apparent increases in family and community violence, research into its effects on adolescent mental health has received limited attention in Cambodia. This study examines the association between exposure to violence and depressive symptoms among adolescents controlling for the effects of several factors in family and school domains.

METHODS

We randomly selected 993 male and 950 female students proportionally from 11 junior high schools and high schools in Battembang provincial city. Students were questioned about the violence to which they were subjected and which they witnessed in their family and community. The Asian adolescent depression scale was used to measure depressive symptoms.

RESULTS

In this study, 27.9% of male students and 21.5% of female students had been victimized in at least one case of family violence, while 18.0% of male and 5.8% of female students had been victimized in at least one case of community violence. After adjustment, increased levels of depressive symptoms were significantly associated with being the victim of or witnessing family or community violence among both male and female students. However, the positive association between the levels of depressive symptoms and being a witness to community violence was found only in female students.

CONCLUSIONS

Efforts to prevent depression in adolescent students should focus on reducing family and community violence; such efforts should also consider gender differences.

Sibling care, school performance, and depression among adolescent caretakers in Cambodia

In many resource-poor countries, home-based care for young children is crucial. Yet little has been known about the negative impacts of sibling caretaking on mental health conditions of adolescent student caretakers. This study explored associations between sibling caretaking, school performance, and depression among 1943 students randomly selected from 11 junior high and high schools in Cambodia. The Asian Adolescent Depression Scale was used to measure depressive symptoms. In bivariate analyses, we used χ(2) test or Fisher's exact test for categorical variables and t-test or one-way analysis of variance for continuous variables. Multiple linear regression models were then constructed. Of total, 60.1% of our participants took care of their younger sibling(s) regularly during the past one year. The number of siblings under their care ranged from one to nine, and the time they spent for sibling care ranged from one to 10h per day. After adjustment, increased levels of depressive symptoms remained significantly associated among boys with sibling caretaking (p<0.001), as well as poor school performance (p=0.001) and perceived likelihood of dropping out of school in the near future (p=0.002). Among girls, increased levels of depressive symptoms retained their significant association with sibling caretaking (p<0.001); also poor school performance (p<0.001). Sibling care responsibility might have negative impact on school performance and the mental health condition of adolescent caretakers.

Online gaming addiction in children and adolescents: A review of empirical research

BACKGROUND AND AIMS

Research suggests that excessive online gaming may lead to symptoms commonly experienced by substance addicts. Since games are particularly appealing to children and adolescents, these individuals may be more at risk than other groups of developing gaming addiction.

METHODS

Given these potential concerns, a literature review was undertaken in order (i) to present the classification basis of online gaming addiction using official mental disorder frameworks, (ii) to identify empirical studies that assess online gaming addiction in children and adolescents, and (iii) to present and evaluate the findings against the background of related and established mental disorder criteria.

RESULTS

Empirical evidence comprising 30 studies indicates that for some adolescents, gaming addiction exists and that as the addiction develops, online gaming addicts spend increasing amounts of time preparing for, organizing, and actually gaming.

CONCLUSIONS

Evidence suggests that problematic online gaming can be conceptualized as a behavioral addiction rather than a disorder of impulse control.

A measure of depression in a modern asian community: singapore

The construct validity of two depression measures, Zung's Self-rating Depression Scale (SDS) and the Asian Adolescents Depression Scale (AADS), was investigated. Three studies were conducted using two samples collected in two stages, and the results were used to construct the Asian Depression Scale (ADS). Participants responded to the SDS and AADS in random order of presentation during stage 1; two months later, validation variables were collected. Study 1 found that the SDS is a reliable and valid measure of depression for Singaporean Chinese, but it does not cover the interpersonal dimension found in the AADS. Study 2 combined the two measures and found six factors. One of these factors, negative social self, which was a unique Asian depressive symptom cluster, consisted only of AADS items, while the affective manifestation and psychosomatic symptoms factor primarily consisted of items from the SDS. Study 3 selected high-loading items from the identified factors to construct the ADS, which showed excellent internal reliability, and good convergent and discriminant validity. Incremental predictive validity found on criterion data collected in stage 2, supported the nonspuriousness of the Asian Depression Scale.

God attachment, mother attachment, and father attachment in early and middle adolescence

The present study examined the interplay of attachment to God, attachment to mother, and attachment to father with respect to adjustment (hope, self-esteem, depression) for 130 early and 106 middle adolescents in Singapore. Results showed that the parental attachments were generally linked (in expected directions) to adjustment. God attachment, however, had unique results. At the bivariate level, God attachment was only linked to early adolescents' self-esteem. When considered together with parental attachments (including interactions), God attachment did not emerge as the key moderator in attachment interactions and yielded some unexpected results (e.g., being positively linked to depression). These results are discussed viz-a-viz the secure base and safe haven functions that God and parental attachments may play during adolescence.

Pathological video game use among youths: a two-year longitudinal study

OBJECTIVES

We aimed to measure the prevalence and length of the problem of pathological video gaming or Internet use, to identify risk and protective factors, to determine whether pathological gaming is a primary or secondary problem, and to identify outcomes for individuals who become or stop being pathological gamers.

METHODS

A 2-year, longitudinal, panel study was performed with a general elementary and secondary school population in Singapore, including 3034 children in grades 3 (N = 743), 4 (N = 711), 7 (N = 916), and 8 (N = 664). Several hypothesized risk and protective factors for developing or overcoming pathological gaming were measured, including weekly amount of game play, impulsivity, social competence, depression, social phobia, anxiety, and school performance.

RESULTS

The prevalence of pathological gaming was similar to that in other countries (∼9%). Greater amounts of gaming, lower social competence, and greater impulsivity seemed to act as risk factors for becoming pathological gamers, whereas depression, anxiety, social phobias, and lower school performance seemed to act as outcomes of pathological gaming.

CONCLUSION

This study adds important information to the discussion about whether video game "addiction" is similar to other addictive behaviors, demonstrating that it can last for years and is not solely a symptom of comorbid disorders.

Role of risk and protective factors in risky sexual behavior among high school students in Cambodia

Background

In many developing countries, adolescents have become increasingly prone to engage in habitual risky sexual behavior such as early sexual initiation and unprotected sex. The objective of this study was to identify the operation of risk and protective factors in individual, family, peer, school, and community domains in predicting risky sexual behavior among male and female adolescents in Cambodia.

Methods

From October 2007 to January 2008, we collected data from 1,049 students aged 14 to 20 years. Risky sexual behavior was measured using a scale consisting of four items: sexual intercourse during the past three months, number of sex partners during the past three months, age at first experience of sexual intercourse, and use of condom in last sexual intercourse. The risk factors examined included substance use, depression, peer delinquency, family violence, and community violence. Studied protective factors included family support function, frequency of family dinner, and school attachment.

Results

Of the 1,049 students surveyed, 12.7% reported sexual intercourse during the past three months. Out of those sexually active students, 34.6% reported having two or more sex partners over the same period, and 52.6% did not use a condom during their last sexual intercourse. After controlling for other covariates, a higher likelihood of risky sexual behavior remained significantly associated among male participants with higher levels of substance use, higher levels of peer delinquency, and higher family income. In contrast, risky sexual behavior did not retain its associations with any of the measured protective factors among male participants. Among female participants, a higher likelihood of risky sexual behavior remained significantly associated with higher levels of substance use, higher levels of community-violence witnessing, and lower levels of family support.

Conclusions

The findings suggest the importance of considering gender-related differences in the effects of risk and protective factors when designing and implementing prevention programs. In interventions for both male and female adolescents, prevention of substance use and risky sexual behavior should be integrated. For boys, efforts should focus on the reduction of peer delinquency, while, for girls, improvement of family support should be emphasized.

Validation of the Perinatal Grief Scale for use in Chinese women who have experienced recent reproductive loss

The primary objective of this research was to validate the short version of the Perinatal Grief Scale (SVPGS) in the Chinese population. The Chinese SVPGS was administered to a sample of Chinese women who had experienced recent reproductive loss (N = 314). The results of the confirmatory factor analysis rejected the original 3-factor model delineated by Potvin (1989). A follow-up exploratory factor analysis suggested an alternative 3-factor model, consisting of a 12-item Sense of Worthlessness subscale, a 7-item Social Detachment subscale, and a 7-item Painful Recollection subscale. Further analysis showed that both the original and Chinese SVPGS demonstrated good internal consistency. Cronbach's alpha equaled .86, .83, .90, and .95, respectively, for the three subscales of Active Grief, Difficulty Coping, and Despair, and the total original SVPGS, and .85, .93, .91, and .95, respectively, for the new subscales of Sense of Worthlessness, Social Detachment, and Painful Recollection, and the total Chinese SVPGS. Both versions demonstrated satisfactory correlations with the participants' psychological distress and spousal emotional support. The authors suggest that both versions are useful in measuring the responses of Chinese women to reproductive loss; the original SVPGS should be used for cross-cultural studies, whereas the Chinese SVPGS should be used for local studies.

Conceptualization and manifestation of depression in an asian context: formal construction and validation of a children's depression scale in Singapore

Understanding that the conceptualization and manifestation of depression vary across cultures, in a preliminary study, Koh and colleagues (2002) identified a cultural model and a prototype measure of depression for Asian children. The present study sought to provide further examination of the initially identified conceptualization, manifestation, and measurement of depression in Asian children. Involving a community sample of 442 Singaporean Chinese children (6 to 12 years old), a culturally salient factor, Negative Social Self, was established to constitute part of depression, in addition to three universally recognized factors: Negative Affect and Cognitive Dysfunction, Loss of Interest, and Psychosomatic Manifestations. The Asian Children Depression Scale (ACDS) and Negative Social Self (NSS) were found to be positively related to hopelessness and negatively related to self-esteem, subjective well-being, and control-related beliefs, establishing support for convergent validity. Notably, NSS was found to account for significant incremental validity over that of the universally recognized factors in predicting most of the above-mentioned variables, supporting its added value as a factor of depression in Asian children. The results suggested that the ACDS and the culturally salient dimension reflect the phenomenological experiences and manifestations of depression in Asian children.