Youth screening depression: Validation of the Patient Health Questionnaire-9 (PHQ-9) in a representative sample of adolescents

Latent types of cognitive emotion regulation strategies among middle school students in China and its effect on depressive symptoms

OBJECTIVE

To explore the latent categories of cognitive emotion regulation strategies among middle school students in China and their effect on depressive symptoms.

METHODS

The 535 (13.51 ± 0.93 years; 55.33 % males, 44.67 % females) middle school students from southwestern regions in China were recruited using Cognitive Emotion Regulation Questionnaire-Chinese Version and Patient Health Questionnaire-9. Correlation analysis, latent profile analysis and Bolck-Croon-Hagenaars (BCH) analysis were used to explore the latent categories of cognitive emotion regulation strategies and to analyze the relationship between latent categories and depressive symptoms.

RESULTS

The depressive symptoms prevalence among middle school students was 30.47 %. There are four latent types of cognitive emotion regulation strategies: weak cognitive emotion regulation strategy (Weak CERS), high positive cognitive emotion regulation strategy (High Positive CERS), moderate and slightly negative cognitive emotion regulation strategy (Moderate and Slightly negative CERS) and high negative cognitive emotion regulation strategy (High Negative CERS). The BCH analysis shows the scores of depressive symptoms are significantly different among four profiles of CERQ-C (Wald χ2 = 173.04, p < 0.001) and the scores of depressive symptoms are obviously different between the four profiles (Wald χ2 = 4.67-171.37, ps < 0.05) except between profile 2 and 3 (Wald χ2 = 1.376, p > 0.05).

CONCLUSION

The level of depressive symptoms among middle school students from southwestern regions in China is relatively high, and their cognitive emotion regulation strategies can be divided into four types, having significant effects on depressive symptoms.

Psychometric properties of the patient health questionnaire-8 and general anxiety disorder-7 in adolescents and young adults from three Latin American cities: Internal structure, invariance, internal consistency and divergent validity

BACKGROUND

Depression and anxiety are the most common mental disorders in the world. Screening tools allow early diagnosis and intervention, preventing disease progression and reducing years lost to disability. Internationally, the most widely used screening instruments for depression and anxiety symptoms are the Patient Health Questionnaire (PHQ-8) and the Generalised Anxiety Disorder (GAD-7). Both have been validated in various countries; however, these studies mostly focused on the adult population and clinical settings.

OBJECTIVE

This study assessed the psychometric properties of the PHQ-8 and GAD-7 in adolescents and young adults in deprived urban areas of three of the largest Latin American cities. We evaluated the internal structure, measurement invariance, internal consistency, and divergent validity through correlations with the Manchester Short Assessment of Quality of Life (MANSA).

METHODS

The study included 1056 adolescents (ages 15-16) and 1306 young adults (ages 20-24) from Bogotá (Colombia), Buenos Aires (Argentina), and Lima (Peru). Confirmatory factor analysis was performed using the Weighted Least Squares Mean and Variance (WLSMV) adjusted estimator with polychoric matrices to assess the internal structure of the model. Measurement invariance was evaluated through multi-group factor analysis. Divergent validity was examined using Spearman's rho by correlating MANSA with the PHQ-8 and GAD-7. Finally, internal consistency was assessed with Cronbach's alpha and McDonald's omega.

RESULTS

Our study found that the PHQ-8 and the GAD-7 exhibited good goodness-of-fit indices for a one-dimensional model. Both scales achieved measurement invariance across different sociodemographic variables, including gender, country, education level, and age group. On the other hand, the PHQ-8 (rs = -0.52) and GAD-7 (rs = -0.46) showed a negative correlation with the MANSA, suggesting divergent validity between the higher scores on depressive and anxious symptoms are associated with lower quality of life. Finally, the PHQ-8 and GAD-7 showed adequate internal consistency in all cases evaluated (ω and α > 0.8).

CONCLUSIONS

Both the PHQ-8 and the GAD-7 showed good goodness-of-fit indices for a unidimensional theoretical model, adequate psychometric properties, and evidence of invariance for gender, age group, education level, and country. These findings highlight the reliability and versatility of these instruments in identifying urban young people with emotional distress in Latin America.

Analysis of influencing factors on the nutritional status of non-dialysis elderly patients with chronic kidney disease and depression

BACKGROUND

The assessment of nutritional status in non-dialysis elderly patients with chronic kidney disease (CKD) and comorbid depression is clinically important. Determining key determinants of nutritional status in this population significantly improves nutritional management strategies and assists these patients overcome the disease.

AIM

To investigate the factors influencing the nutritional status of non-dialysis elderly patients with CKD and comorbid depression.

METHODS

This study retrospectively collected the clinical data of 182 non-dialysis elderly patients with CKD and comorbid depression admitted at Tangdu Hospital, Air Force Medical University, from January 2022 to June 2023. The participants were categorized based on the presence of malnutrition into the nutritionally normal group (n = 97) and the malnutrition group (n = 85). The clinical data of the two groups were subjected to unifactorial and multifactorial regression to analyze the factors influencing malnutrition among the participants. Data included sex, age, body mass index (BMI), percentage body fat, basal metabolic rate (BMR), blood urea nitrogen (BUN), creatinine (Cr), albumin (Alb), hemoglobin (Hb), pre-albumin (PA), patient-generated subjective global assessment, and Patient Health Questionnaire-9 (PHQ-9) score to identify depressive symptoms. After admitting the patients to the hospital, 5 mL of peripheral serum was withdrawn, the centrifuge was operated at 3500 rpm/minute with a centrifugal radius of 10 cm for 10 minutes, serum was collected, and serum Alb, Hb, PA, BUN, and Cr levels were detected using a fully automatic biochemical analyzer. The results were assessed using Statistical Package for the Social Sciences version 21.0 for conducting technical analyses. Metric data are presented as the mean ± standard error of the mean and replaced using the t-test. Count data are expressed as case counts and percentages and were replaced using the χ² test. Effective factors were modeled using logistic return modeling.

RESULTS

BMI, BMR, and serum Alb, Hb, PA, and Cr levels were lower in the nutritionally normal group than in the malnutrition group. Furthermore, BUN levels, PHQ-9 scores, and the percentage of anxiety symptoms were greater in the nutritionally normal group than in the normal nutrition group, with statistically significant differences (P < 0.05). Multiple factorial interpretations revealed anxiety and serum Alb, Hb, and PA levels as factors influencing the nutritional status of non-dialysis elderly patients with CKD and depression (P < 0.05).

CONCLUSION

Serum Alb, Hb, PA levels, and anxiety symptoms are all factors influencing malnutrition in non-dialysis elderly patients with CKD and depression; hence, clinical interventions can be targeted to patients with the above characteristics.

Stress sensitivity, negative affect, and functioning in an early psychosis clinic

Persons with psychotic disorders frequently exhibit stress sensitivity (SS), a low tolerance for everyday stresses, often manifesting as negative affect (NA), and frequently associated with poor functional outcome. To parse the relative contributions of SS and NA on functioning, we analyzed real-world data from consecutive evaluations in an early psychosis clinic, comparing a specific measure of stress sensitivity, the Psychological Stress Index, 9-item (PSI-9), with the Patient Health Questionnaire (PHQ-9), a measure of depressive NA, on the Work and Social Adjustment Scale (WSAS). A structural equation modeling framework tested the relationship between PSI-9, PHQ-9, and perceived functioning (WSAS), testing the hypothesis that the PSI-9 would predict functioning over and above the PHQ-9. The sample consisted of 103 patients, of whom 61 had a primary psychosis diagnosis. The PSI-9, PHQ-9 and WSAS scales were highly intercorrelated (r's 0.55-0.62). The primary model showed partial mediation of the relationship of PSI-9 with WSAS by PHQ-9 scores, as predicted. Follow-up models conducted separately for patients with and without a primary psychosis diagnoses showed that this relationship existed in both groups. Sex, entered as a co-variate in the models, did not affect the relationships. In exploratory models examining the effects of early childhood adversity, the Adverse Childhood Experiences scale, was positively related to PSI-9 scores, but only in the psychosis group. In conclusion, the PSI-9 measures SS, a phenotype important for subjective sense of functioning, over and above depressive symptoms rated on the PHQ-9, identifying a target for interventions addressing SS.

Validation of the Multidimensional Scale of Perceived Social Support (MSPSS) in a Representative Sample of Adolescents: Links with Well-being, Mental Health, and Suicidal Behavior

Objective: Social support is understood as a protective factor for mental health and emotional well-being, especially at school. The Multidimensional Scale of Perceived Social Support (MSPSS) is one of the most widely used tools worldwide to assess this construct. The main purpose of the present study was to validate the scores of the MSPSS in a large sample of non-clinical adolescents. Method: The sample consisted of 2,235 compulsory secondary education students in Spain (M age = 14.49, SD age = 1.76, age range 12-18 years, 52% female) obtained by stratified random sampling. Results: The model, consisting of three interrelated factors, showed the most adequate goodness-of-fit indices. The results support the measurement invariance of the MSPSS across sex, age, and sexual orientation. McDonald's omega reliability indices between .862-.934 were obtained. MSPSS scores were significantly and negatively associated with emotional and behavioral problems, depression, and suicidal behavior, and positively associated with life satisfaction. Conclusions: The MSPSS is a reliable instrument to assess social support through self-report in school settings. In this regard, assessing social support using this tool is particularly useful in programs promoting well-being or preventing mental health disorders.

Evaluating the Agreement Between ChatGPT-4 and Validated Mental Health Scales in Older Adults: A Cross-Sectional Study

BACKGROUND

The chat generative pretrained transformer (ChatGPT), an artificial intelligence-based web application, has demonstrated substantial potential across various knowledge domains, particularly in medicine. This cross-sectional study assessed the validity and possible usefulness of ChatGPT-4 in assessing mental health by comparing several scales.

METHODS

A cross-sectional study recruited 127 older adults (≥60 years old) from December 2023 to October 2024 in Wuhan. Scenarios contextualized to daily life were adapted using ChatGPT-4 to adapt six scales (PHQ-9, GAD-7, K10, PSS-4, ULS-6, WHO-5). The level of agreement between the ChatGPT-4 adapted scales and the traditional scales was compared using Spearman correlation, Cronbach's alpha coefficient, intraclass correlation coefficient (ICC), and Bland-Altman analysis.

RESULTS

The ChatGPT-adapted questionnaires showed moderate to strong correlations with traditionally validated measures of anxiety, depression, psychological distress, perceived stress, loneliness, and well-being. Significant positive correlations were observed for total scores, including PHQ-9 (rho = 0.61), GAD-7 (rho = 0.66), K10 (rho = 0.75), PSS-4 (rho = 0.71), and ULS-6 (rho = 0.73), with slightly weaker correlation for WHO-5 (rho = 0.41). Reliability analyses yielded Cronbach's α values ranging from 0.66 to 0.91 and ICCs ranging from 0.47 to 0.81, confirming strong internal consistency and test-retest reliability.

CONCLUSIONS

Moderate to high correlations were found between the adapted ChatGPT-4 questionnaire and the traditional scale, indicating that it shows promise as a supplemental mental health assessment tool. However, further research is needed to explore its broader applicability.

Evaluating the agreement between ChatGPT-4 and validated questionnaires in screening for anxiety and depression in college students: a cross-sectional study

BACKGROUND

The Chat Generative Pre-trained Transformer (ChatGPT), an artificial intelligence-based web application, has demonstrated substantial potential across various knowledge domains, particularly in medicine. This cross-sectional study assessed the validity and possible usefulness of the ChatGPT-4 in assessing anxiety and depression by comparing two questionnaires.

METHODS

This study tasked ChatGPT-4 with generating a structured interview questionnaire based on the validated Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder Scale-7 (GAD-7). These new measures were referred to as GPT-PHQ-9 and GPT-GAD-7. This study utilized Spearman correlation analysis, Intra-class correlation coefficients (ICC), Youden's index, receiver operating characteristic (ROC) and Bland-Altman plots to evaluate the consistency between scores from a ChatGPT-4 adapted questionnaire and those from a validated questionnaire.

RESULTS

A total of 200 college students participated. Cronbach's α indicated acceptable reliability for both GPT-PHQ-9 (α = 0.75) and GPT-GAD-7 (α = 0.76). ICC values were 0.80 for PHQ-9 and 0.70 for GAD-7. Spearman's correlation showed moderate associations with PHQ-9 (p = 0.63) and GAD-7 (p = 0.68). ROC curve analysis revealed optimal cutoffs of 9.5 for depressive symptoms and 6.5 for anxiety symptoms, both with high sensitivity and specificity.

CONCLUSIONS

The questionnaire adapted by ChatGPT-4 demonstrated good consistency with the validated questionnaire. Future studies should investigate the usefulness of the ChatGPT designed questionnaire in different populations.

Charting the course of depression care: a meta-analysis of reliability generalization of the patient health questionnaire (PHQ- 9) as the measure

BACKGROUND

Depression is a leading cause of disability worldwide, requiring reliable and adaptable screening tools. The Patient Health Questionnaire- 9 (PHQ- 9) is widely used, yet its reliability across diverse populations and cultural adaptations remains unclear.

OBJECTIVE

This meta-analysis assessed the reliability generalization of the PHQ- 9 across different populations, settings, and cultural contexts to determine its applicability in global mental health assessments.

METHODS

A reliability generalization (RG) meta-analysis was conducted on 60 studies with 232,147 participants. A random-effects model was used to estimate pooled internal consistency (Cronbach's α) and test-retest reliability. Subgroup analyses examined the effects of administration modes, cultural adaptations, and study settings.

RESULTS

The pooled Cronbach's α was 0.86 (95% CI [0.85, 0.87]), indicating high internal consistency. Test-retest reliability, based on eight studies, was 0.82 (95% CI [0.74, 0.90]). Self-administered formats had the highest reliability (α = 0.87), while face-to-face interviews were lower (α = 0.80). Substantial heterogeneity (I2 = 99.3%) was observed.

CONCLUSIONS

The PHQ- 9 is a reliable depression screening tool globally, but significant heterogeneity highlights the need for continued cultural adaptation and validation to enhance its applicability across diverse contexts.

Clinical Outcomes in a Large Sample of Youth and Adult Patients Receiving Virtual Evidence-Based Treatment for ARFID: A Naturalistic Study

OBJECTIVE

Treatment outcomes research for avoidant/restrictive food intake disorder (ARFID) has been limited to small, mixed-age feasibility trials in face-to-face care settings. This study aims to examine clinical characteristics and treatment outcomes in a large sample of youth and adult patients receiving virtual multidisciplinary team treatment for ARFID.

METHOD

The sample included N = 783 patients (532 youth and 251 adults) diagnosed with ARFID. Patients received cognitive behavioral therapy for ARFID (CBT-AR) or family-based treatment for ARFID (FBT-ARFID) enhanced by specialized support from a multidisciplinary team. Patients (or caregivers) completed a number of measures assessing ARFID and mood-related symptoms upon admission and throughout treatment.

RESULTS

Youth patients on weight restoration (56%) started treatment around 85% [84%, 86%] of their target weight, and increased to 94% [93%, 96%] by week 35. Adults on weight restoration (47%) started at 85% [84%, 87%] and reached 92% [90%, 94%]. Scores improved for both groups on all PARDI-AR-Q subscales: (sensory sensitivity: b = -0.25 [-0.33, -0.16]; lack of interest: b = -0.08 [-0.16, -0.00]; fear of aversive consequences: b = -0.12 [-0.19, -0.04]). Both youth and adults demonstrated reliable improvements in willingness to try new foods (b = -0.64 [-0.89, -0.37]), anxiety symptoms (b = -0.71 [-0.95, -0.48]), and depression symptoms (b = -0.86 [-1.07, -0.64]).

DISCUSSION

Youth and adult patients demonstrated reliable symptom improvements over the course of treatment across all measures, offering preliminary support for the effectiveness of FBT-ARFID and CBT-AR delivered virtually by a multidisciplinary care team.

Depressive symptomatology in Brazil: perspectives of statistical and psychometrics analyses of the PHQ-9 at four time-points (2020-2023) in the COVID-19 pandemic

The present research assessed the psychometric properties of the Patient Health Questionnaire-9 (PHQ-9) through an examination of its internal structure, invariance analysis, and standardization. Social distribution analyses of the measure were conducted using linear and binomial logistic regression. The sample consisted of 10,069 adults from all 27 states in Brazil. The data were obtained through four collections across different years of the COVID-19 pandemic (2020, 2021, 2022, and 2023), using independent samples. Confirmatory Factor Analysis (CFA) indicated that the measure is unidimensional with satisfactory fit indices. The model was invariant in relation to the variables investigated at four different levels (configural, metric, scalar, and strict). The standardization supported hypothetical cut scores indicating the severity of depressive symptoms, categorized as very low (0 to 6), low (7 to 13), moderate (14 to 19), high (20 to 23), and very high (≥ 24). We found that sex/gender, skin color/ethnicity, age, education level, and year of the pandemic were predictors of depressive symptoms in the adjusted linear regression analysis. The logistic regression showed variables with higher chances for a positive screening diagnosis of depression, with adjusted Odds Ratio as follows: years 2021 (ORadj = 1.275) and 2023 (ORadj = 1.409), women (ORadj = 1.900), Pardos individuals (ORadj = 1.252), education up to high school (ORadj = 1.272), being a northeast region resident (ORadj = 2.127), and younger people (ORadj = 1.716). The findings of this study indicate the suitability of the PHQ-9 for assessing depression in the population and recommend its use for monitoring depressive symptoms in the coming years in Brazil. Clinical implications include developing interventions to address the psychological impact of this and any future health crises.

Depression and Anxiety Among Adolescents in Northern Sudan: A School-Based Cross-Sectional Study

Background and Objective: Adolescents' mental health, including depression and anxiety, represent a global public health problem. However, there is a paucity of data on depression and anxiety among adolescents in Sudan. Therefore, the current study aimed to investigate the prevalence and associated factors for depression and anxiety among adolescents in Northern Sudan. Methods: This school-based cross-sectional study was conducted at randomly selected schools from August to September 2022 in Almatamah, River Nile State, Sudan. Sociodemographic and clinical data were collected using a face-to-face questionnaire. Depression and anxiety were measured using the questionnaire tools of the Patient Health Questionnaire (PHQ-9) and the General Anxiety Disorder (GAD-7), respectively. Univariate and multivariate binary analyses were performed to determine the associated factors of depression and anxiety using the adjusted odd ratios (AOR) and 95.0% confidence interval (CI). Results: Of 384 adolescents, 178 (46.4%) and 206 (53.6%) were boys and girls, respectively. The median (interquartile range [IQR]) of age was 15.1 (14.0-16.3) years old. Of the total adolescents, 311 (81.0%), 42 (10.9%), 20 (5.2%), 7 (1.8%), and 4 (1.0%) had no, mild, moderate, moderate to severe, and severe depression, respectively. Of the total, 31 (8.1%) adolescents had moderate or severe depression (depression score ≥ 10). In multivariable binary analysis, female gender (AOR = 5.35, 95% CI 1.67-17.09) and anxiety (AOR = 25.98, 95% CI 7.68-87.90) were associated with increased odds of depression; there was no association between age, father's education, and BMI for age Z-score and depression. Of the 384 adolescents, 320 (83.3%), 47 (12.2%), 11 (2.9%), and 6 (1.6%) had no mild, moderate, and severe anxiety, respectively. Of the total, 17 (4.4%) had moderate and or severe anxiety (anxiety score ≥ 10). In multivariable logistic regressions, while family history of mental disorder (AOR = 6.31, 95% CI 1.36-29.27), being anemic (AOR = 3.95, 95% CI 1.19-13.12), and depression (AOR = 29.03, 95% CI 7.52-112.05) were associated with increased odds of anxiety; there was no association between age, gender, father's occupation, and BMI for age Z-score and anxiety. Conclusions: The findings indicate that 1 in 10 adolescents in Northern Sudan experiences at least one mental disorder, encompassing depression, anxiety, or a combination of both. Notably, female adolescents are at a higher risk for depression, while factors such as a family history of mental disorders and anemia significantly contribute to anxiety levels. To address these pressing mental health concerns, it is imperative to implement inclusive and holistic programs that incorporate nutritional support, integrate mental health education into school curricula, and introduce community-based interventions aiming to enhance mental well-being among all adolescents, irrespective of gender.

Effect of dietary live microbe intake on the prevalence and mortality risks of depression and suicidal ideation in adults: Evidence from a nationwide population-based study

BACKGROUND

Gut microbial dysbiosis has been implicated in the pathogenesis of depression. Dietary interventions offer promising microbial-targeted therapeutics for depression. However, limited evidence exists regarding the associations between dietary live microbe intake and the prevalence of depression, as well as its impact on mortality risks.

METHODS

This study included 28,133 participants from the U.S. National Health and Nutrition Examination Survey (2005-2018), and ascertained their underlying causes of death. Weighted logistic regression was utilized to assess the relationships between live microbe intake and risks of depression and suicidal ideation. Independent and joint associations between live microbe and mortality outcomes were evaluated using multivariable Cox regression and Kaplan-Meier survival curves to calculate relative risks.

RESULTS

In the fully adjusted model, participants with high dietary live microbe intake had a significantly lower prevalence of depression (OR = 0.727, 95%CI: 0.627,0.844) and suicidal ideation (OR = 0.778, 95%CI: 0.648,0.935) than those with low intake. The multivariable-adjusted HRs for individuals in the G1 were 1.217 (95%CI, 1.081, 1.370) for all-cause mortality and 1.307 (95%CI, 1.029,1.661) for cardiovascular disease mortality, compared to participants in the G3. Kaplan-Meier survival analysis revealed that cumulative hazard of cardiovascular mortality was progressively lower among participants with depression in the G3 than those without depression.

CONCLUSIONS

Higher live microbe intake was associated with a lower prevalence of depression and suicidal ideation, and was linked to significantly decreased risks of all-cause and cardiovascular mortality. Further larger prospective studies are essential to verify the health effects of live microbes, and personalized dietary recommendations are necessary.

Depression and health literacy among adolescents and adults in Germany: findings from two representative samples

Introduction

Depressive disorders constitute a significant public health challenge. Health literacy might be an important factor to consider in prevention strategies for depressive disorders, which is why this study aimed at exploring the association between depressive symptom levels and severity and health literacy, along with additional sociodemographic factors.

Materials and methods

Data were collected from two large samples of adults (N = 3,011) and adolescents (N = 1,021) representative of the German-speaking population in Germany. Levels of health literacy (HLS-EU-Q16 questionnaire), depressive symptom severity, rates of depression levels (PHQ-9 questionnaire) and sociodemographic information (age, gender, social status, level of education) were obtained. The associations between sociodemographic factors, health literacy and depression were analyzed using t-tests, analyses of variance and χ2-tests.

Results

Overall, rates of depression were high in both samples (16.5% in adults and 18.4% in adolescents) when measured with the sum score ≥ 10 cut-off criterion and substantially lower when assessed with the diagnostic algorithm criterion (7.2% in adults and 9.8% in adolescents). Rates of depression and severity of depressive symptoms were higher in female than male individuals in both samples. Depressive symptom severity and depression rates increased with increasing age in adolescents and decreased with increasing age in adults. Higher levels of education and lower social status were associated with higher depressive symptom severity and rates in adults, with a more heterogeneous picture in adolescents. In both samples, depressive symptom severity and rates were higher in individuals with poorer health literacy.

Discussion

The results point to a potential role for health literacy in preventing depressive disorders. More research is needed with longitudinal and experimental study designs into the question whether public health interventions targeting health literacy improvements could play a critical role in reducing the burden of depression across different age cohorts.

Brain Insights and Resolution of Youth Depression through Neurotechnology

As per United Nations, the youth constitute 16% of total population globally whereas World Health Organization reported that one in every seven young individual suffers from depression. Among various tested therapeutic solutions for depression management, the efficacy of transcranial Direct Current Stimulation (tDCS) is still unexplored specifically in young participants. Therefore, this study aims to investigate the cross hemispheric tDCS intervention with a smaller number of sessions in youth population by means of neurological, neuropsychological, and behavioural measures. A total of 50 young participants were recruited comprising of 25 healthy and 25 depressed individuals. The participants of depressed group were randomly assigned to active tDCS and sham tDCS sub groups and completed 150 min of training over 5 consecutive days. The active tDCS group received stimulation of 2 mA over dorsolateral prefrontal cortex. Unlike healthy individuals, depressed participants demonstrated reduced difference of brain activity between eyes opened and closed resting conditions which gets restored following the intervention in active group. Additionally, the tDCS intervention effectively modified the previously reduced alpha asymmetry observed in depressed participants compared to healthy individuals. These neurological outcomes may also be supported with enhanced neuropsychological score of depression (t = 5.47, P < .01) in active group. The attention score (t = 5.14, P < .01) and reaction time (t = 2.22, P = .02) evaluated through behavioural measure of Stroop task were also significantly improved in active group post tDCS intervention. The reported outcomes of the study highlighted the ability of tDCS for prompt and efficient youth depression management.

An examination of depression severity and treatment adherence among racially and ethnically minoritized, low-income individuals during the COVID-19 transition to telehealth

Mental healthcare was fundamentally altered during the COVID-19 pandemic, perhaps most prominently through the massive shift towards telehealth. Herein, we evaluated effects of the transition to teletherapy on treatment adherence and depressive symptoms for 3,476 patients at three outpatient psychiatric clinics, the majority of whom were low-income and experienced ethnoracial minoritization. Number of missed appointments decreased (mean: 6.27 vs. 3.77, p < .0001), and PHQ-9 scores decreased (mean: 8.17 vs. 6.82, p < .0001) between six months prior to and following the March 18, 2020 switch to telehealth. These conclusions held when adjusting for covariates including age, sex, race/ethnicity, and insurance status (i.e., socioeconomic status). Stratified analyses (i.e., adults, emerging adults, and youth) yielded the same conclusions, with the exception of emerging adults, for whom the PHQ-9 change was not significant. Results indicated the transition from in-person to teletherapy was associated with significantly reduced mean numbers of missed visits and depressive symptoms. Such results during this especially tumultuous period may underscore telehealth's effectiveness. Future research should explore whether there is a causal relationship between telehealth or mixed hybrid options, positive treatment outcomes, and prescriptive care delivery models, as well as applications of e-mental health tools for diverse, underserved patient populations.

Trends in Adolescent Depression Screening Outcomes Over the COVID-19 Pandemic at a Large, Integrated Health Care System in Southern California

PURPOSE

Little is known about changes in depression screening outcomes among adolescents in primary healthcare across the COVID-19 pandemic. We describe trends in depression screening outcomes within a large integrated health care system in Southern California.

METHODS

Retrospective electronic health record data from preventative healthcare visits of 11-12-year-olds and 13-17-year-olds screened for depression from March 1, 2017, to August 31, 2022, were extracted in 6-month blocks. The percentages of screens meeting "threshold depression" were reported overall, and by sex, race or ethnicity, and median household income quintiles. We used Poisson regression to estimate rate ratios of threshold depression in 3 winter blocks (September to February) comparing lockdown (2020), reopening (2021) to a pre-COVID (2019) period, and reopening relative to lockdown. Disparities in trends by sex, race, or ethnicity and household income were tested using interaction terms.

RESULTS

Of 735,333 visits with complete screening (183,550 for 11-12-year-olds and 551,783 for 13-17-year-olds), 4.6%, 6.5%, and 7.4% of 11-12-year-olds had "threshold depression" during winter blocks of pre-COVID, lockdown and reopening, respectively. The corresponding rates were 5.8%, 8.5%, and 9.8% for 13-17-year-olds. The rates were higher during lockdown and reopening relative to pre-COVID and higher during reopening relative to lockdown for both age groups (all p-values <.001). Trends differed by sex in both age groups (p-values <.001) and by race or ethnicity (p = .001) in the 13-17-year age group.

DISCUSSION

Californian adolescents demonstrated an increase in threshold depression since COVID lockdown starting March 2020 with further increase observed during reopening in September 2021. Future studies are needed to determine the long-term trends.

Suicidality and Self-Harm Behavior of Adolescents During the Early Phase of the War in Ukraine

OBJECTIVE

War profoundly impacts people's lives, causing death, displacement, and psychological trauma, but research investigating suicidality of adolescents in this context has been limited. We compared suicidality or self-harm behavior among adolescents in regions that were, and were not, affected by Russia's initial invasion of Ukraine in 2014.

METHOD

This cross-sectional study comprised 2,752 school students aged 11 to 17 years from the war-affected Donetsk region and non-war Kirovograd region. Data collection occurred in 2016 and 2017 using self-report tools to assess suicidality or self-harm behavior; psychopathology including posttraumatic stress disorder (PTSD), depression, and anxiety; and war trauma exposure.

RESULTS

Adolescent girls in the war-affected region reported more suicide attempts (9.5% vs 5.1%; adjusted odds ratio [aOR] 1.8, 95% CI 1.2-2.8), suicidal ideation (39.3% vs 19.6%; aOR 2.6, 95% CI 2.01-3.3), or self-harm behavior (19.6% vs 13.1%; aOR 1.6, 95% CI 1.2-2.1), and boys reported more suicidal ideation (17.0% vs 9.8%; aOR 1.7, 95% CI 1.2-2.4). Boys and girls with PTSD, depression, or anxiety showed increased risks for any suicidality or self-harm. A dose-effect relation was observed between war trauma exposure and suicidality or self-harm. The association was strongest for adolescents who had experienced 5 or more different war trauma exposures (aOR 3.2, 95% CI 2.2-4.8).

CONCLUSION

War trauma exposure and psychopathology were strongly associated with suicidality or self-harm behavior, with a greater impact in girls than boys. The high prevalence of suicidality found in this study emphasizes the need for intervention on a large scale for adolescents living in war situations.

PLAIN LANGUAGE SUMMARY

In a cross-sectional study of two thousand seven hundred fifty-two 11- to 17-year-olds, adolescents who were exposed to the early phase of war in Ukraine showed increased risk for suicide attempts, suicidal ideation, or self-harm behavior among girls living in war-affected region compared to those in non-war region while boys reported increased risk for suicidal ideation only.

Gender, age, and longitudinal measurement invariance of child and adolescent depression scales: A systematic review

Understanding developmental trajectories and gender differences in depressive symptoms is clinically relevant. Discerning true differences across gender, age groups, and time is based on the often-neglected premise of measurement invariance (MI) of child and adolescent depression scales. In this systematic review, we assessed available evidence for MI across gender, age groups, and time for depression scales validated in children and adolescents, in studies with at least one assessment under age 18. A literature search using Medline, PsychInfo, Scopus, Web of Science, and Google Scholar databases identified 42 studies that examined MI. MI of eleven scales was tested in 1-9 studies per scale. Conclusions are hampered by different factor solutions tested within some scales. All included questionnaires showed preliminary evidence for MI across gender. Across some studies, crying had higher factor loadings in females compared to males, indicating that crying may be differently related to depression across gender. MI evidence was preliminary in just four scales across time, mostly confined to ages 13-17. One study showed developmental conclusions differed when non-invariance is not accounted for in observed scores. Overall, evidence for MI in child and adolescent depression scales is currently limited.

Agreement for posttraumatic stress symptoms among unaccompanied young refugees and professional caregivers

Background: Prevalence rates for posttraumatic stress symptoms (PTSS) in unaccompanied young refugees (UYRs) are high. Research with biological parents indicates low agreement rates between self and caregiver reports for PTSS, although caregivers play an important role as gatekeepers to ensure appropriate treatment.Objective: This study examines youth and caregiver agreement on the endorsement of different trauma types, the PTSS severity score and symptom clusters, as well as the potential association between youth factors (age, comorbidity, and duration in facility) and disagreement.Method: The sample consisted of N = 610 UYRs, aged M = 16.75 (SD = 1.33, range: 12-20) years. Of these, 91.0% were male, and 43.4% were from Afghanistan, currently residing in German children and youth welfare facilities.Results: Agreement rates across trauma types were poor (accidental trauma: Cohen's k = .13; community violence: Cohen's k = .07; domestic violence: Cohen's k = .19; sexual abuse: Cohen's k = .38). Agreement rates for the PTSS severity score (ICC = .22) and symptom clusters were poor (re-experiencing: ICC = .27; avoidance: ICC = .02; negative alterations in cognitions and mood ICC = .12; hyperarousal: ICC = .25), with youth reporting significantly higher scores. Regression models showed that having comorbid symptoms and a shorter duration in the facility were associated with higher disagreement at the PTSS severity score (Adjusted -R2 = .21) and across symptom clusters (re-experiencing: Adjusted -R2 = .13; avoidance: Adjusted -R2 = .07; negative alterations in cognitions and mood: Adjusted -R2 = .16; hyperarousal: Adjusted- R2 = .16). Age was not significantly associated with disagreement rates.Conclusion: It is important to enhance the awareness and comprehension of caregivers regarding recognition of mental illnesses and their symptoms as well as assessing mental health among UYRs.

Predictors of treatment outcome in higher levels of care among a large sample of adolescents with heterogeneous eating disorders

BACKGROUND

Despite widespread use of higher levels of care in treating eating disorders in adolescents, research supporting the use of these treatments remains limited by small sample sizes and a predominant focus on anorexia nervosa. Further, existing data regarding predictors of outcome have yielded mixed findings. In the current study, we evaluated treatment outcomes and predictors of outcome among a large sample of adolescents with eating disorders presenting to inpatient, residential, partial hospitalization programs, and intensive outpatient programs across the United States.

METHODS

Adolescents (N = 1,971) completed self-report measures of eating disorder symptoms, depression, and anxiety at treatment admission, stepdown, and discharge. Using linear mixed effect models, we evaluated changes in symptoms over treatment separately among youth admitted to inpatient/residential treatment and those admitted to partial hospitalization/intensive outpatient programs, and used established metrics to gauge frequency of reliable (i.e., statistically reliable) and clinically significant change.

RESULTS

Results suggested decreases in eating disorder symptoms, depression, and anxiety from intake to discharge. Around 50% of the sample reported reliable decreases in eating disorder symptoms at stepdown and discharge, with 30% of the sample reporting reliable reductions in depression and anxiety. Psychiatric comorbidity, primary diagnosis, age, and eating disorder symptoms at admission consistently predicted treatment-related change, although patterns in findings varied across symptoms.

CONCLUSIONS

Data from our sample are consistent with past work suggesting that adolescents enrolled in higher levels of care report clinical benefit; however, these effects are heterogenous, and a significant portion of individuals may not report reliable change in symptoms. Ultimately, ongoing work is required to better understand how and for whom higher levels of care may achieve their benefit and to identify the optimal approach for improving outcomes for adolescents with eating disorders.

The assessment of transdiagnostic dimensions of emotional disorders: Validation of the Multidimensional Emotional Disorders Inventory (MEDI) in adolescents with subthreshold anxiety and depression

BACKGROUND

The transdiagnostic approach to psychopathology has emerged as an alternative to traditional taxonomic approaches. The Multidimensional Emotional Disorders Inventory (MEDI) is a specifically designed self-report to measure the transdiagnostic dimensions proposed by Brown and Barlow (2009). This study aims to analyse the psychometric properties of the MEDI scores in adolescents with subthreshold anxiety and depression.

METHOD

The sample consisted of a total of 476 students. The mean age was 13.77 years (SD = 1.43) (range 10 to 18 years), 73.9 % were females. Several questionnaires assessing positive affect, negative affect, mental health difficulties, and quality of life were used.

RESULTS

The original 9-factor structure of the MEDI was confirmed with good fit indices. Satisfactory levels of internal consistency were observed in most of the MEDI scores using McDonald's Omega, ranging from 0.58 to 0.87. The MEDI dimensions were associated with psychopathology, positive affect, negative affect, and quality of life.

LIMITATIONS

Reliance on self-reported data, a cross-sectional design limiting temporal assessment, and a 73.9 % female gender imbalance.

CONCLUSION

The MEDI scores showed adequate psychometric properties among adolescents with subclinical emotional symptoms. The results found might have potential clinical implications for conceptualization, assessment, intervention, and prevention of emotional disorders at both clinical and research levels.

A Chinese adaptation of the Patient Health Questionnaire for Adolescents (PHQ-A): factor structure and psychometric properties

BACKGROUND

To examine the factor structure and psychometric properties of the Patient Health Questionnaire for Adolescents (PHQ-A) in Chinese children and adolescents with major depressive disorder (MDD).

METHODS

A total of 248 MDD patients aged between 12 and 18 years were recruited and evaluated by the Patient Health Questionnaire for Adolescents (PHQ-A), the Center for Epidemiological Survey Depression Scale (CES-D), the Mood and Feelings Questionnaire (MFQ), and the improved Clinical Global Impression Scale, Severity item (iCGI-S). Thirty-one patients were selected randomly to complete the PHQ-A again one week later. Confirmatory factor analysis (CFA) was used to test the construct validity of the scale. Reliability was evaluated by Macdonald Omega coefficient. Pearson correlation coefficient was used to assess the item-total correlation and the correlation of PHQ-A with CES-D and MFQ respectively. Spearman correlation coefficient was used to assess test-retest reliability. The optimal cut-off value, sensitivity, and specificity of the PHQ-A were achieved by estimating the Receiver Operating Characteristics (ROC) curve.

RESULTS

CFA reported adequate loadings for all items, except for item 3. Macdonald Omega coefficient of the PHQ-A was 0.87. The Spearman correlation coefficient of the test-retest reliability was 0.70. The Pearson correlation coefficients of the PHQ-A with CES-D and MFQ were 0.87 and 0.85, respectively (p < 0.01). By taking the iCGI-S as the remission criteria for MDD, the optimal cut-off value, sensitivity and specificity of the PHQ-A were 7, 98.7%, 94.7% respectively.

CONCLUSION

The PHQ-A presented as a unidimensional construct and demonstrated satisfactory reliability and validity among the Chinese children and adolescents with MDD. A cut-off value of 7 was suggested for remission.