Depressive symptoms among adolescents in Sri Lanka: prevalence and behavioral correlates

Examining the Association between Sports Participation and Mental Health of Adolescents

Sports participation has been linked to various health outcomes; however, there is scant literature exploring this relationship in developing countries. We used a mixed method approach to examine the association between sports participation and mental health of Bangladeshi adolescents (n = 320; 13-17 years; 59% boys) and to explore sports preferences and barriers to sports participation across genders. A survey collected team and non-team sports participation, depression, and life satisfaction. Focus groups (16 boys, 16 girls) explored preferences for, and barriers to, sports participation. Regression analysis showed that higher team and non-team sports participation were associated with lower depressive symptoms in boys (β = -1.22, 95% CI:-2.55 to -0.10; β = -2.50, 95% CI:-3.83 to -1.16, respectively), while greater participation in team sports was associated with less depression in girls (β = -2.44, 95% CI:-4.63 to -0.24). Participation in team and non-team sports was positively associated with life satisfaction for boys and girls. Boys reported preferences for playing football and cricket, while girls favored skipping and running. Prolonged time on electronic devices was reported as barriers to sports participation in both genders. Furthermore, household chores, family restrictions, and unsafe environment were reported by girls. Participation in team sports may provide mental health benefits for both genders, while non-team sports may be more beneficial to boys than girls.

Prevalence and correlates of depressive symptoms in secondary school children in Dhaka city, Bangladesh

Objectives: Depression is a leading contributor to the global burden of disease, and often starts at a young age. Depression in young people can increase the risk of unhealthy lifestyle behaviour and can lead to substantial disability, social problems, poor health, and suicide. Other research has examined depressive symptoms among adult populations in Bangladesh, but little is known about other age groups. The aim of this study was to assess the prevalence and socio-demographic correlates of depressive symptoms among secondary school children of Dhaka city, Bangladesh.Design: A self-completed questionnaire was administered to 898 students from eight secondary schools of Dhaka, the capital City of Bangladesh. Of the respondents, 755 (372 males, 383 females; average age 14.26 years; SD 1.15) completed the 10-item Center for Epidemiological Studies Depression Scale (CESD-10). A score of 10 or more was used to indicate depressive symptoms. Parents completed a separate questionnaire to provide individual and household/family-level data. Generalized Estimating Equations (GEE) was used to assess sociodemographic and lifestyle factors associated with adolescent depressive symptoms.Results: Among the responding adolescents, 25% reported depressive symptoms with prevalence more common among females than males (30% vs. 19%). Factors significantly associated with symptoms of depression included being female, aged 15-16 years, self-perception of non-normal weight, feeling unsafe at school, sleep disturbance, low life satisfaction, high intake of sugary drinks, and regularly skipping breakfast.Conclusion: Depressive symptoms are prevalent among secondary school children in urban Bangladesh. Interventions for adolescents with depressive symptoms could focus on lifestyle practices such as weight management, personal safety, sleep hygiene and healthy eating.

Impact of exposure to conflict, tsunami and mental disorders on school absenteeism: findings from a national sample of Sri Lankan children aged 12-17 years

BACKGROUND

Armed conflicts and natural disasters are common. Millions of people, including children are killed, injured, disabled and displaced as a result. The effects of conflict and natural disaster on mental health, especially of children are well established but effects on education have received less attention. This study investigated associations between conflict and/or tsunami exposure in Sri Lanka and their associations with absenteeism in a national sample of school children.

METHODS

A cross-sectional survey was conducted in 2006-7 among 1,505 randomly selected school children aged 12-17 years attending government schools in 17 districts. The hypotheses were that absenteeism would be more common in children previously affected by conflict or the 2004 tsunami and that at least part of this effect would be accounted for by mental disorders. Survey information included socio-demographic, conflict and tsunami exposure, mental health status (Strengths and Difficulties Questionnaire) and information on absenteeism (defined as 20% or greater non-attendance over one year).

RESULTS

The total sample of consisted of 1,505 students aged 12-17 years with a mean age of 13.7 years. 120 children reported at least one conflict exposure and 65 reported at least one tsunami exposure while only 15 reported exposure to both conflict and tsunami. Prevalence of emotional disorder caseness was 2.7%, conduct disorder caseness 5.8%, hyperactivity disorder caseness 0.6%, and 8.5% were identified as having any psychiatric disorder. Absenteeism was present in 26.8%. Overall, previous exposure to tsunami (OR 2.29 95% CI 1.36-3.84) was significantly associated with absenteeism whereas exposure to conflict was not (OR 1.32 95% CI 0.88-1.97), although some specific conflict-related exposures were significant risk factors. Mental disorder was strongly associated with absenteeism but did not account for its association with tsunami or conflict exposure.

CONCLUSIONS

Exposure to traumatic events may have a detrimental effect on subsequent school attendance. This may give rise to perpetuating socioeconomic inequality and needs further research to inform policy and intervention.

Testing a model of depression among Thai adolescents

PROBLEM

This predictive correlational study was designed to test a comprehensive model of depression for Thai adolescents.

METHODS

This sample included 800 high school students in Chiang Mai, Thailand. Data were collected using self-reported measures of depression, negative automatic thoughts, effective social problem solving, ineffective social problem solving, rumination, parental care, parental overprotection, and negative life events.

FINDINGS

Structural equation modeling revealed that negative automatic thoughts, effective and ineffective social problem solving mediated the effects of rumination, negative life events, and parental care and overprotection on adolescent depression.

CONCLUSION

These findings provide new knowledge about identified factors and the mechanisms of their influence on depression among Thai adolescents, which are appropriate for targeting preventive interventions.

Physical activity and depression in adolescents: cross-sectional findings from the ALSPAC cohort

PURPOSE

Few studies have examined the association between physical activity (PA), measured objectively, and adolescent depressive symptoms. The aim of this study was to determine whether there is an association between objective measures of PA (total PA and time spent in moderate and vigorous PA (MVPA)) and adolescent depressive symptoms.

METHODS

Data on 2,951 adolescents participating in ALSPAC were used. Depressive symptoms were measured using the self-report Mood and Feelings Questionnaire (MFQ) (short version). Measures of PA were based on accelerometry. The association between PA and MFQ scores was modelled using ordinal regression.

RESULTS

Adolescents who were more physically active (total PA or minutes of MVPA) had a reduced odds of depressive symptoms [OR(adj) total PA (tertiles): medium 0.82 (95% CI: 0.69, 0.97); high 0.69 (95% CI: 0.57, 0.83)]; OR(adj) per 15 min MVPA: 0.92 (95% CI: 0.86, 0.98). In a multivariable model including both total PA and the percentage of time spent in MVPA, total PA was associated with depressive symptoms (OR(adj) total PA (tertiles): medium 0.82 (95% CI: 0.70, 0.98); high 0.70 (95% CI: 0.58, 0.85) but the percentage of time spent in MVPA was not independently associated with depressive symptoms [OR(adj) MVPA (tertiles) medium 1.05 (95% CI: 0.88, 1.24), high 0.91 (95% CI: 0.77, 1.09)].

CONCLUSIONS

The total amount of PA undertaken was associated with adolescent depressive symptoms, but the amount of time spent in MVPA, once total PA was accounted for, was not. If confirmed in longitudinal studies and randomised controlled trials, this would have important implications for public health messages.

Using the World Health Organization's 4S-Framework to Strengthen National Strategies, Policies and Services to Address Mental Health Problems in Adolescents in Resource-Constrained Settings

BACKGROUND

Most adolescents live in resource-constrained countries and their mental health has been less well recognised than other aspects of their health. The World Health Organization's 4-S Framework provides a structure for national initiatives to improve adolescent health through: gathering and using strategic information; developing evidence-informed policies; scaling up provision and use of health services; and strengthening linkages with other government sectors. The aim of this paper is to discuss how the findings of a recent systematic review of mental health problems in adolescents in resource-constrained settings might be applied using the 4-S Framework.

METHOD

Analysis of the implications of the findings of a systematic search of the English-language literature for national strategies, policies, services and cross-sectoral linkages to improve the mental health of adolescents in resource-constrained settings.

RESULTS

Data are available for only 33/112 [29%] resource-constrained countries, but in all where data are available, non-psychotic mental health problems in adolescents are identifiable, prevalent and associated with reduced quality of life, impaired participation and compromised development. In the absence of evidence about effective interventions in these settings expert opinion is that a broad public policy response which addresses direct strategies for prevention, early intervention and treatment; health service and health workforce requirements; social inclusion of marginalised groups of adolescents; and specific education is required. Specific endorsed strategies include public education, parent education, training for teachers and primary healthcare workers, psycho-educational curricula, identification through periodic screening of the most vulnerable and referral for care, and the availability of counsellors or other identified trained staff members in schools from whom adolescents can seek assistance for personal, peer and family relationship problems.

CONCLUSION

The predominant endorsed action is not that dedicated mental health services for adolescents are required, but that mental health care should be integrated using cross-sectoral strategies into the communities in which adolescents live, the institutions they attend and the organisations in which they participate.

Prevalence and correlates of clinically significant depressive symptoms among elderly people in Sri Lanka: findings from a national survey

BACKGROUND

Elderly Sri Lankans (11.2% of the nation's population) have witnessed many years of ethnic conflict, a destructive tsunami and increasing emigration of young adults. However, very little is known about the prevalence and correlates of depression among them. The present study utilizes data from a national aging survey to document the prevalence and correlates of clinically significant depressive symptoms among community-dwelling elderly Sri Lankans (aged > or =60 years).

METHODS

The 15-item Geriatric Depression Scale (GDS-15) was administered to 1181 elderly Sri Lankans; the presence of clinically significant depressive symptoms was defined as a GDS-15 score of > or =6. Sociodemographic and health correlates of depressive symptoms were assessed using logistic regression analysis. Interactions between gender and other correlates were also assessed.

RESULTS

The prevalence of depressive symptoms was observed to be 27.8% overall: 24.0% for men, and 30.8% for women. Certain subgroups of the elderly, i.e. those with disabilities, functional limitations, perceived income inadequacy, minorities, and elderly living alone, were significantly more likely to report depressive symptoms. There was a significant interaction between gender and ethnicity.

CONCLUSION

The prevalence of depressive symptoms among Sri Lankan elderly people is higher than that reported for most Asian countries. Clinicians and caregivers need to be aware of the potential presence of depressive symptoms among the elderly, especially among those with lower educational levels, functional limitations, hearing difficulty, physical disability, perceived income inadequacy, and among those who live alone, and ethnic minority males.

Examining student perspectives on suicidal behaviour and its prevention in Sri Lanka

BACKGROUND

Suicidal behaviour, primarily through self-poisoning, is a major public health problem among youth in Sri Lanka.

METHODS

This article describes a qualitative study of student perspectives on suicidal behaviour and its prevention. Focus groups were held with students 17-20 years of age. A discussion of the perceived causes of suicidal behaviour provided the context for discussing prevention efforts.

CONCLUSION

Participants identified pathways to suicidal behaviour and emphasized experiential aspects and the variability of fatal intent. Suggestions for prevention tended to emphasize the strengthening of community-oriented actions in order to better realize lethal means restrictions.

Physical activity and emotional problems amongst adolescents : a longitudinal study

BACKGROUND

Promotion of physical activity (PA) is at the top of the public health agenda. However, there are few longitudinal studies investigating the relationship between PA and children's mental health. Therefore, we aimed to investigate the association between self-reported physical activity (PA) and emotional problems 1-year later in a cohort of schoolchildren.

METHODS

A total of 1,446 children aged 11-14 years from 39 schools in the North West of England completed a self-report questionnaire in class. Each child reported the total number of sessions of sporting activities (lasting more than 20 min) in which they participated during the previous week, including activities both in school and out of school. This total was averaged for the week in order to determine whether the child was physically active at recommended levels (1 h per day). Childhood emotional problems were measured using the Strengths and Difficulties Questionnaire (SDQ) (self-report) at baseline and 1-year later. Data on potential confounders were also collected by self-report questionnaire at baseline.

RESULTS

In unadjusted analyses, children who, on average, participated in at least 1 h of sporting activity on a daily basis had fewer emotional problems at 1-year follow-up. This attenuated substantially after adjustment for gender (girls were less active but more likely to report emotional problems than boys). After adjustment for additional confounders including emotional problems at baseline, children who met recommended levels for PA had, on average, a score on the emotional problems sub-scale that was 0.29 units lower (-0.29 (95%CI: -0.61, 0.022)) at 1 year follow-up compared to children who did not undertake recommended levels of PA. Children who were physical activity also had higher scores on the hyperactivity sub-scale of the SDQ 1 year later, but there was no evidence to support an association between PA and other behavioural problems.

CONCLUSIONS

Children who met recommended levels for PA had fewer emotional problems 1-year later, although the magnitude of this difference was reduced after adjustment for confounders, particularly gender. Future longitudinal studies need to record both PA and emotional problems at more frequent intervals in order to enable us to determine the effect of maintaining a physically active lifestyle on adolescent mental health outcomes.

Exercise in the Prevention and Treatment of Adolescent Depression: A Promising but Little Researched Intervention

Despite a dramatic increase in the number of treatment studies for adolescent major depressive disorder in the past 15 years, the majority being clinical trials of medications and cognitive behavioral therapy, response rates have been modest and remission rates low. Moreover, most positive responders posttreatment have many residual symptoms, significant functional impairment, and high rates of relapse. There is a need for the development of new, more effective interventions to treat this severe, chronic condition that usually persists into adulthood with poor long-term outcomes. Findings from preliminary treatment studies suggest that exercise may have the potential to be efficacious as a monotherapy or as part of a combined treatment for adolescent major depressive disorder. This review summarizes the findings and analyzes the design flaws of randomized trials of exercise to treat adolescent depression, offering recommendations on how to design more methodologically sound studies with an emphasis on subject selection criteria; issues related to control conditions, types of diagnostic interviews, and measures needed to establish the diagnosis of depression; types of exercise treatments; and appropriate outcome measures. Future studies of exercise to treat and prevent adolescent major depressive disorder need to be comparable to state-of-the-art treatment studies of pharmacotherapy and cognitive behavioral therapy in this population to more accurately determine its efficacy and potential public health benefits.

Sintomatologia depressiva em adolescentes iniciais: estudo de base populacional

OBJETIVO: Verificar a prevalência de sintomatologia depressiva em adolescentes entre 11 e 15 anos em Pelotas, RS, e identificar seus fatores associados. MÉTODOS: Estudo transversal de base populacional com amostra representativa de adolescentes da zona urbana da cidade de Pelotas, RS. Dos 448 setores censitários existentes no município, 79 foram aleatoriamente sorteados. Os jovens entre 11 e 15 anos localizados nestes setores foram convidados a responder o questionário auto-aplicado que continha perguntas sobre: idade, sexo, vida escolar, religião, atividades físicas, entretenimento, tabaco, consumo de álcool, uso de outras drogas, relacionamentos sexuais e conduta. Além disso, a sintomatologia depressiva dos adolescentes foi avaliada por meio da escala Children's Depression Inventory (CDI), também presente no instrumento de pesquisa. Para a análise dos dados foi utilizada a regressão logística ajustada ao modelo hierárquico. RESULTADOS: A prevalência de depressão foi de 2,1%. Após a regressão logística ajustada ao modelo hierárquico, estiveram significativamente associados à depressão: baixa condição socioeconômica, histórico de fracasso acadêmico, ausência de prática religiosa, abuso de álcool nos últimos 30 dias e indicativo de transtorno de conduta. CONCLUSÃO: É evidenciada a necessidade de programas preventivos e integrados de política na adolescência para depressão e comportamentos de risco à saúde.