The correlates of depressed mood in adolescents in Hong Kong

Referring students for professional psychological help: A qualitative study of teachers' experience in Hong Kong

Teachers have frequent interaction with students and are well positioned to refer students for mental health assistance when needed. Twelve secondary schoolteachers in Hong Kong were interviewed about their experience referring students to mental health professionals (MHPs). Using consensual qualitative research, multiple factors were found to influence teachers' referral decisions, including problem severity, students' willingness, stigma of help-seeking, parent/guardian's beliefs, teacher-parent/guardian relationship, MHPs' effectiveness and availability, quality of interaction with MHPs, and teachers' self-efficacy in handling student issues. Based on the findings, we propose a conceptual model of factors influencing teachers' referral decisions. Implications for research, practice, and training are discussed.

Factors associated with severe depressive symptoms among Chinese secondary school students in Hong Kong: a large cross-sectional survey

Background

Many adolescents were reported to have severe depressive symptoms, and a careful assessment of its correlates is essential for prevention and intervention programs. This study aimed to gain insight into the prevalence of severe depressive symptoms and its association with factors at four levels (individual, relationship, school and society) in a large sample of Hong Kong Chinese secondary school students.

Methods

Secondary school students from Secondary 1 through 7 were selected as participants using a cluster random sampling method. A questionnaire including inventories measuring 24 factors at the four levels (six individual factors, 11 relationship factors, three school factors, and four society factors) was completed by 8,963 participants (56.3% female) with a mean age of 15.1 (SD = 1.8) years. Students with a score of ≥15 on the Patient Health Questionnaire were defined as having severe depressive symptoms. The association between severe depressive symptoms and correlates were examined by t-test and χ2 test. Logistic regression models using a hierarchical approach then examined the individual contribution of these 24 factors to severe depressive symptoms with the control of other factors in the model.

Results

7.4% of the students have severe depressive symptoms. Twenty-two of the 24 factors were significantly associated with severe depressive symptoms in bivariate analyses. In the logistic regression, 11 factors (three individual factors: age, self-esteem and self-mastery; six relationship factors: tobacco use, alcohol drinking, drug use, paternal psychological control, dinner with parents, and perceived social support from friends; one school factor: felt pressure from homework; and one society factor: number of sibling) were statistically significant. Felt pressure from homework, alcohol drinking, and perceived social support from friends were the strongest correlates of severe depressive symptoms.

Conclusion

The prevalence of self-reported severe depressive symptoms in Hong Kong Chinese secondary school students was high, and the identification of multiple associated factors at the four levels simultaneously provides a knowledge basis for the development of a comprehensive, multivariate model of factors influencing severe depressive symptoms in Chinese secondary school students. The factors identified in the present study may be helpful when designing and implementing preventive intervention programs.

The effects of mindfulness training on suicide ideation among left-behind children in China: A randomized controlled trial

BACKGROUND

The population of left-behind children is growing rapidly in China in recent years. Without parents' company, left-behind children may develop severe emotional problems, which can trigger extreme behaviours such as self-harm and suicide. Previous literature suggests that mindfulness-based intervention could effectively alleviate a variety of sufferings such as anxiety and suicide ideation. The current study sought to examine the effectiveness of mindfulness-based intervention on suicide ideation among left-behind children in China.

METHODS

This study investigated the effects of an 8-week mindfulness training programme on suicide ideation of left-behind children in China. Forty-nine left-behind children completed a pretest and posttest on mindfulness level, social anxiety, self-esteem, and suicide ideation, with 21 in the mindfulness training group and 28 in the waitlist control group.

RESULTS

Adjusting for pretest differences analyses of covariance found that, compared with waitlist control group, the mindfulness training group showed a significant improvement in mindfulness level and decreases in social anxiety and suicide ideation after the 8-week mindfulness training.

CONCLUSION

The findings from this study support that the use of mindfulness-based intervention can effectively reduce the suicide ideation and social anxiety of left-behind children in China.

Predictors of remission from probable depression among Hong Kong adolescents - A large-scale longitudinal study

BACKGROUND

This study investigated the incidence of remission from probable depression among adolescents in Hong Kong. Remissions were defined as having Center for Epidemiological Studies Depression Scale (CESD) scores changed from ≥16 at baseline to <16 over the 12-month follow-up period. The study tested the predictors of remissions, including perceived changes in family support, self-efficacy, self-esteem, positive affect, negative events, social anxiety, and loneliness.

METHODS

The study surveyed 9666 secondary school students and identified 5487 (57%) students with probable depression in Hong Kong. A questionnaire assessing the levels of the aforementioned variables was completed at baseline and at the 12-month follow-up.

RESULTS

Among participants with probable depression at baseline, 23.2% remitted from depression at follow-up. Remissions were more common among males than females. Univariate logistic regression showed that perceived changes in all the aforementioned variables significantly predicted remission for both males and females. The same is true for most of these variables when they were entered together into multiple logistic regression models (with and without controlling for baseline CESD scores), except for family support in the female model and self-efficacy in both male and female models.

LIMITATIONS

Limitations include potential self-report bias and only one follow-up observation over time. The design treats cases of probable mild to severe depression as a single group (CESD≥16).

CONCLUSIONS

The findings are potentially useful for designing and guiding related intervention programs. Results highlight the importance of long-term follow-up of those screened as probable depression to understand the course of changes in levels of depression.

Exploring the East-West Divide in Prevalence of Affective Disorder: A Case for Cultural Differences in Coping With Negative Emotion

Lifetime rates of clinical depression and anxiety in the West tend to be approximately 4 to 10 times greater than rates in Asia. In this review, we explore one possible reason for this cross-cultural difference, that Asian cultures think differently about emotion than do Western cultures and that these different systems of thought help explain why negative affect does not escalate into clinical disorder at the same rate. We review research from multiple disciplines-including cross-cultural psychology, social cognition, clinical psychology, and psychiatry-to make the case that the Eastern holistic principles of contradiction (each experience is associated with its opposite), change (the world exists in a state of constant flux), and context (the interconnectedness of all things) fundamentally shape people's experience of emotions in different cultures. We then review evidence for how these cultural differences influence how successfully people use common emotion regulation strategies such as rumination and suppression.

Potential impact of internet addiction and protective psychosocial factors onto depression among Hong Kong Chinese adolescents - direct, mediation and moderation effects

BACKGROUND

Internet addiction (IA) is a risk factor while some psychosocial factors can be protective against depression among adolescents. Mechanisms of IA onto depression in terms of mediations and moderations involving protective factors are unknown and were investigated in this study.

METHODS

A representative cross-sectional study was conducted among Hong Kong Chinese secondary school students (n=9518).

RESULTS

Among males and females, prevalence of depression at moderate or severe level (CES-D≥21) was 38.36% and 46.13%, and that of IA (CIAS>63) was 17.64% and 14.01%, respectively. Adjusted for socio-demographics, depression was positively associated with IA [males: adjusted odds ratio (AOR)=4.22, 95% CI=3.61-4.94; females: AOR=4.79, 95% CI=3.91-5.87] and negatively associated with psychosocial factors including self-esteem, positive affect, family support, and self-efficacy (males: AOR=0.76-0.94; females: AOR=0.72-0.92, p<.05). The positive association between IA and depression was partially mediated by the protective psychosocial factors (mainly self-esteem) across sexes. Through significant moderations, IA also reduced magnitude of protective effects of self-efficacy and family support among males and that of positive affect among both sexes against depression.

CONCLUSIONS

The high IA prevalence contributes to increased risk of prevalent depression through its direct effect, mediation (reduced level of protective factors) and moderation (reduced magnitude of protective effects) effects. Understanding to mechanisms between IA and depression through protective factors is enhanced. Screening and interventions for IA and depression are warranted, and should cultivate protective factors, and unlink negative impact of IA onto levels and effects of protective factors.

Symptom Patterns in Depression and “Subthreshold” Depression among Adolescents in Hong Kong and the United States

This study compared the Diagnostic and Statistical Manual of Mental Disorders (4th ed.) Major Depressive Disorder (MDD) diagnostic interview information from a representative, stratified sample of 85 (selected from 2,212) Hong Kong and 1,706 age- and sex-matched U.S. adolescents. Current prevalence rates (Hong Kong: 2.2%, 95% Confidence Interval [CI] = 1.3% to 3.1%; United States: 2.2%, 95% CI = 1.6% to 3.0%) were similar in the two cultures. More Hong Kong compared to U.S. adolescents reported fatigue/loss of energy and fewer reported irritability. All Hong Kong participants with MDD reported fatigue, sleep, and concentration difficulties. Hong Kong adolescents who did not meet criteria for MDD but reported high levels of depressive symptoms showed social function and cognitions similar to youth with MDD and dissimilar to nondepressed youth. The results suggest that adolescent MDD is as prevalent in Hong Kong as in the West and that “subthreshold” depression is not a benign condition. Comparisons of symptom patterns in the two cultures showed culture’s influences on expressions of distress.

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.

Emotion regulation and depressive symptoms: examining the mediation effects of school connectedness in Chinese late adolescents

This study tested Gross's process model of emotion regulation in a Chinese adolescent sample. It hypothesized that emotion regulation strategies (cognitive reappraisal and expressive suppression) would predict adolescents' perception of school connectedness and depressive symptoms. It also posited that school connectedness may be a possible mediator between emotion regulation and depressive symptoms. Participants were 504 adolescents aged 16-18 from two Chinese public upper secondary schools. Structural equation modeling analyses indicated that reappraisal and suppression significantly associated with school connectedness and depressive symptoms, and school connectedness mediated the link between emotion regulation and depressive symptoms, even when the general emotion experiences were controlled. Although boys unexpectedly reported higher level depressive symptoms, the hypothesized model was invariant across gender except for the link between suppression and depressive symptoms. These findings demonstrate that it is meaningful to involve both emotion regulation processes and school connectedness in explaining adolescent depressive symptoms.

Asociación entre religiosidad y síntomas ansiosos y depresivos en estudiantes universitarios

Introducción: Existe información divergente acerca de la asociación entre religiosidad y síntomas emocionales. Un estudio con adolescentes colombianos observó falta de asociación estadísticamente significativa entre religiosidad y síntomas depresivos. No se conocen datos sobre este tópico en estudiantes universitarios. Objetivo: Estimar la asociación entre religiosidad y síntomas ansiosos y depresivos en universitarios de una institución colombiana. Método: Se realizó una investigación transversal correlacional. Los universitarios diligenciaron la escala breve de Zung para ansiedad, el Índice de Bienestar General para síntomas depresivos y la escala breve de Francis para religiosidad. Se calcularon correlaciones de Pearson (r) y se aceptaron diferencias significativas r superiores a 0,300 con probabilidad (p)<0,01. Resultados: Un total de 1.349 estudiantes de distintos programas académicos participó en la investigación. La media para la edad fue 20,6 años (DE=3,4) y el 50,7% eran hombres. Los coeficientes de alfa de Cronbach  fueron 0,720, 0,763 y 0,966 para la escala breve de Zung para ansiedad, el Índice de Bienestar General para síntomas depresivos y la escala breve de Francis para religiosidad, respectivamente. Se encontró una asociación sin importancia estadística entre síntomas ansiosos (r=0,062; p>0,01) y síntomas depresivos (r=0,036; p>0,01) y la religiosidad. Conclusiones: El bienestar emocional de universitarios de una universidad colombiana cuantificado por síntomas ansiosos y depresivos es independiente de las puntuaciones en religiosidad. Este hallazgo corrobora la falta de asociación entre síntomas depresivos y religiosidad en adolescentes de Cartagena, Colombia. Se necesitan investigaciones en otras regiones del país.

Psychological distress and its correlates in Chinese adolescents

OBJECTIVES

The aim of the present study was to estimate the prevalence of severe psychological distress in Chinese adolescents, and to identify the demographic and psychosocial factors associated with psychological distress in this population.

METHOD

A multi-stage stratified sampling procedure was used to select a sample of adolescents (n = 3109) in Heilongjiang Province (Northeast of China), who were aged 13-18 years old. Psychological distress was measured by the Kessler Psychological Distress Scale (K10). A K10 score between 22 and 30 was defined as moderate psychological distress; a score of >or= 31 was defined as severe psychological distress in this study.

RESULTS

The rates of moderate and severe psychological distress were 27.9% and 12.2%, respectively in the participants. There were no statistical differences in severe psychological distress by gender. Multivariate analysis showed that family environmental variables, schooling variables, self-perception with life and appearance, perceived health and negative life events were significantly associated with psychological distress.

CONCLUSION

Severe psychological distress is prevalent in the Chinese adolescent population. Family dysfunction, higher academic pressure, poor relationship with others and negative self-perception are important risk factors associated with psychological distress in adolescents. More studies using the K10 scale are needed so that national and international comparisons can be made.

Socio-demographic correlates of suicidal ideation among Chinese adolescents in Hong Kong

Several socio-demographic correlates, including age of adolescents, family economic status, parental marital status, parental occupational status and parental educational level of adolescent suicidal ideation among Chinese adolescents (N = 5,557) were examined in this study. The results showed that older adolescents had a significantly higher level of suicidal ideation than did younger ones. Adolescents living in non-intact families had a significantly higher level of suicidal ideation than those in intact families. Adolescents with lower socioeconomic status (indexed by economic disadvantage, parental occupational status, and parental educational attainment) displayed higher levels of suicidal ideation than did adolescents with higher suicidal ideation. Although these socio-demographic correlates were significantly related to suicidal ideation, the practical significance was not high.

Depression and its association with self-esteem, family, peer and school factors in a population of 9586 adolescents in southern Taiwan

AIMS

The aim of the present study was to gain insight into the prevalence of depression and its association with self-esteem, family, peer and school factors in a large-scale representative Taiwanese adolescent population.

METHODS

A total of 12,210 adolescent students were recruited into the present study. Subjects with a score >28 on the Center for Epidemiological Studies' Depression Scale were defined as having significant depression; the Rosenberg Self-Esteem Scale, Adolescent Family and Social Life Questionnaire and Family C-APGAR Index were applied to assess subjects' self-esteem, family, peer and school factors. The association between depression and correlates were examined on t-test and chi(2) test. The significant factors were further included in logistic regression analysis.

RESULTS

Among 9586 participants (response rate: 86.3%), the prevalence of depression was 12.3%. The risk factors associated with depression in univariate analysis included female gender, older age, residency in urban areas, lower self-esteem, disruptive parental marriage, low family income, family conflict, poorer family function, less satisfaction with peer relationships, less connectedness to school, and poor academic performance. After adjusting the effects of sex, age and location, only subjects with lower self-esteem, higher family conflict, poorer family function, lower rank and decreased satisfaction in their peer group, and less connectedness to school were prone to depression on logistic regression.

CONCLUSION

The prevalence of depression is high in Taiwanese adolescents, and the multiple factors of family, peer, school and individuals are associated with adolescent depression. The factors identified in the present study may be helpful when designing and implementing preventive intervention programs.

Relations between parent-child acculturation differences and adjustment within immigrant Chinese families

The relations between parent and child acculturation and family and child adjustment were examined among 91 immigrant Chinese families in Canada with early adolescents (average age of 12). Acculturation was assessed in public (e.g., language use) and private (e.g., values) domains separately in Chinese and Canadian cultures. With one exception, interactions between parent and child acculturation in Canadian domains were unrelated to adjustment (conflict intensity, depressive feelings, and achievement motivation). Interactions in Chinese domains were more clearly associated with adjustment. Specifically, mother-child interactions in Chinese public domains and father-child interactions in the Chinese private domain predicted adjustment. In all interactions, when parents were strongly orientated toward Chinese culture, lower levels of Chinese orientation among children were associated with lower adjustment.

Adolescent suicide attempters in Hong Kong and the United States

Using a nested case-control design drawing from a larger sample of 2272 adolescents, this study examined the characteristics of adolescents from Hong Kong (n = 99) and the United States (US) (n = 60), who indicated that they had made a suicide attempt at least once in the past, compared to their equally depressed sex- and age-matched counterparts who had not attempted suicide. The cross-cultural literature suggested three hypotheses which were tested: (a) depressive symptoms would differentiate between suicide attempters compared to non-attempters less in Hong Kong and more in the US; (b) discord in interpersonal relationships would be a more important distinguishing factor in suicide attempts in Hong Kong than in the US and (c) cognitive variables such as hopelessness would be less associated with suicide attempts in Hong Kong compared to the US. There were strong similarities in the two cultures with regard to characteristics that distinguished between attempters and matched controls. Hypotheses regarding cultural differences between attempters in Hong Kong and the US were not supported. Depression, current and lifetime suicide ideation, hopelessness, poor interpersonal relationships and exposure to suicide attempters and completers distinguished attempters from controls equally in the two cultures and in both genders. These findings do not support the proposition that depression is a less relevant variable in suicide attempts in Chinese versus western groups.

An investigation of the prevalence of depressive symptoms in soldiers during military training

OBJECTIVES

A cross-sectional study was conducted to determine the prevalence of depressive symptoms in soldiers during military training in Chinese army and to identify associations between depressive symptoms and socio-demographic characteristics.

METHODS

The self-rating depression scale (SDS) was used to assess self-reported experiences of depression among 1107 young adult males during military training. The following socio-demographic variables are considered as independent variables: age, service time, settlement type, education, levels of family income, family type, education of parents, health status, history of negative accidents, social support status and hobby status. A logistic regression model was used to estimate the association of these variables with depressive symptoms.

RESULTS

25.20% (n = 279) of the servicemen had depressive symptoms. The soldiers who had high education level (OR = 1.74; 95%CI: 1.37-2.12), come from city or town (OR = 1.39; 95%CI: 1.18-1.61), have served in army for a shorter time (OR = 1.63; 95%CI: 1.43-1.88), had head ache during training course (OR = 1.39; 95%CI: 1.12-2.09), had abdomen ache or diarrhea during training course (OR = 1.85; 95%CI: 1.47-2.13) and had training injury during training course (OR = 1.67; 95%CI: 1.29-1.83) are associated with depressive symptoms.

CONCLUSIONS

There was a high prevalence rate of depressive symptoms among soldiers during military training. Special attention should be paid to avoiding depressive symptoms in those who have high education level, come from city or town, have served in army for a shorter time and have health problems during training course.

Hopelessness and suicidal ideation among adolescents in two cultures

BACKGROUND

This study examines the cross-sectional and longitudinal associations among cognitive variables, depressive symptoms and suicidal ideation in Hong Kong Chinese and Caucasian American adolescents.

METHODS

Community adolescents (n = 2,044) ages 14-18 years from Hong Kong and the United States provided information regarding their suicidal ideation, depressive symptoms, and cognitions (self-efficacy, cognitive errors and hopelessness), at two surveys, six months apart.

RESULTS

Self-efficacy was a weak unique predictor of suicidal ideation in both cultures. Hopelessness was the strongest of cognitive variables in concurrent associations with suicidal ideation in bivariate and multivariate models, in both cultures, and in both boys and girls. Hopelessness continued to offer unique prediction when depressive symptoms were controlled, both concurrently and prospectively.

CONCLUSIONS

Our results support hopelessness theories of suicidal ideation and behavior in Hong Kong, and extend the cognitive theory of suicidality to a modernized Asian culture.

Development and validation of a depression scale for Asian adolescents

Items covering both core and culture-specific facets of depression were generated based on literature review and clinical experience. They were modified following focus group discussions with depressed adolescents and adolescents in the community. The newly constructed Asian Adolescent Depression Scale (AADS) was administered to a clinical and a community sample of adolescents together with other rating scales. The AADS comprised 4 factors (negative self-evaluation, negative affect, cognitive inefficiency and lack of motivation) and demonstrated sound psychometric properties. Negative socially oriented self-evaluation and cognitive inefficiency were important in Singaporean adolescents' conceptualization of depression and are likely to be Asian culture-specific dimensions.

Validation of the Beck Depression Inventory for a Portuguese-speaking Chinese community in Brazil

The objective of the present study was to investigate the psychometric properties and cross-cultural validity of the Beck Depression Inventory (BDI) among ethnic Chinese living in the city of São Paulo, Brazil. The study was conducted on 208 community individuals. Reliability and discriminant analysis were used to test the psychometric properties and validity of the BDI. Principal component analysis was performed to assess the BDI's factor structure for the total sample and by gender. The mean BDI score was lower (6.74, SD = 5.98) than observed in Western counterparts and showed no gender difference, good internal consistency (Cronbach's alpha 0.82), and high discrimination of depressive symptoms (75-100%). Factor analysis extracted two factors for the total sample and each gender: cognitive-affective dimension and somatic dimension. We conclude that depressive symptoms can be reliably assessed by the BDI in the Brazilian Chinese population, with a validity comparable to that for international studies. Indeed, cultural and measurement biases might have influenced the response of Chinese subjects.

Expression of depressive symptoms in a nonclinical Brazilian adolescent sample

OBJECTIVE

This study aimed to detect the prevalence of depressive symptomatology and its expression in a nonclinical Brazilian adolescent student sample.

METHOD

A sample of students from private and public schools (n = 1555, aged 13 to 17 years) answered the Beck Depression Inventory (BDI). We performed factor analysis of the BDI as an indicator of the expression of depressive symptomatology. The following cut-off scores defined nonclinical subgroups: "nondepressed," BDI < 15; "dysphoria," BDI 16 to 20; and "depressed," BDI > 20. We used discriminant analysis to test whether these subgroups could be separated by the depression-specific and nonspecific items.

RESULTS

The point prevalence of depression was 7.6%, according to the BDI cut-off of 20. Girls had higher scores than boys in several items. Scores increased with age. Students from public schools had higher scores than did private school students. Factor analysis showed 2 common factors for the total sample and for each sex: the cognitive affective dimension and the somatic nonspecific dimension. In the adolescents showing clinical depression, items related to self-depreciation, sense of failure, guilty feelings, self-dislike, suicidal wishes, and distortion of body image were common components of BDI factors. Discriminant analysis showed that the BDI highly discriminates depressive symptomatology in adolescent students and also measures specific aspects of depression.

CONCLUSIONS

The BDI is useful as a measure of specific aspects of depression in nonclinical adolescent samples; it was able to detect depression in approximately 7% of the surveyed population. The expression of depressive symptoms in a Brazilian adolescent population is compatible with international studies in this age group. Detecting depressive symptoms in a school population is a critical preventive strategy; to avoid damage to the learning process, it should be followed with further referral to treatment when needed.

Mental health, life stress and social support among young Norwegian adolescents with immigrant and host national background

The first aim of the study was to investigate differences in level of mental health, life stress and social support among adolescents with immigrant and domestic background. A second aim was to identify culture group and gender specific sources of risk and protective factors and their relation to mental health. Questionnaire data were collected from 633 students, aged 13, in Oslo, Norway. Immigrant adolescents reported higher level of psychological distress and lower social support than host students. Of the four gender-culture groups, immigrant boys reported the highest level of problems, with a 28% prevalence of anxiety/depression. There were no significant differences in prevalence among the girls. Specific patterns of relationships between life stress, support, and mental health were found across gender and culture. The results were discussed within a framework of culture differences in values and gender role expectancies, underscoring the importance of studying each gender/culture group separately.

Suicidality and cultural values among Hong Kong adolescents

Scholars have proposed that individualistic values resulting from globalization are associated with increasing behavioral and emotional problems among youth in modernizing cultures. This study examined specific individualistic and traditional values in the context of suicidal ideation and behaviors in Hong Kong among community adolescent youths (N=2427) ages 14-18 years. Participants indicated the extent to which self-direction/independence and obedience/respect for elders were important to them. They also reported on four progressive levels of suicidality: whether in the last year they had experienced suicidal ideation, made plans for a suicide attempt, attempted suicide, and (for attemptors) made a serious attempt requiring medical attention. After controlling for quality of family relationships and depressive symptoms, at least one of the values predicted suicidality at all but the highest level. There were sex-specific associations between values and suicidality. In general, endorsement of self-direction was correlated with reduced risk of suicidality for boys and was irrelevant to girls. In contrast, traditional emphases on obedience and respect for elders were more frequently protective against suicidality for girls and were inconsistent predictors for boys. The relationship between values and suicidality was generally independent of the effect of family relationships and depressive symptoms. Thus, values were associated with adolescent suicidality, but not consistently in the direction predicted by some theorists, and the association depended upon the adolescent's sex.

Assessment of depression and anxiety in East Asia

This article provides a critical review of the literature on research with self-report measures of depression and anxiety in East Asia. Three trends are noteworthy. First, research on depression and anxiety in East Asia has relied heavily on the use of a limited number of translated instruments. Second, available research suggests that the Asian language versions of these instruments are reliable and valid for use with Asian populations. Third, some subpopulations in East Asia have been studied extensively with respect to depression and anxiety, but there are many regions of Asia where little research literature is available outside of those published in native language journals. The review concludes with recommendations for future research.

A Cross-Cultural Investigation of Cognitions and Depressive Symptoms in Adolescents

Adolescents (N=2,272) from Hong Kong and the United States provided information regarding their depressive symptoms, cognitions (self-efficacy, negative cognitive errors, and hopelessness), and stressful events between 2 surveys 6 months apart. Depressive symptoms and hopelessness were higher, and self-efficacy and negative cognitive errors were lower in Hong Kong than in the United States. Cognitions were associated with concurrent depressive symptoms and predicted depressive symptoms 6 months later in both cultures. The "reverse" model was also supported with more variance predicted by depressive symptoms to later cognitions than from cognitions to depressive symptoms. There was some support for the hypothesis that self-efficacy is less salient in collective compared with individualistic cultures. These findings extend cognitive theories of depression to a non-Western culture.

Prevalence and correlates of smoking and sexual activity among Hong Kong adolescents

PURPOSE

To report on the prevalence and correlates of smoking and sexual activity in a community sample of Hong Kong Chinese adolescents.

METHODS

Participants (N = 4116) aged 13 to 18 years were surveyed regarding smoking and physical heterosexual activity, relationships with family members, family involvement, social support, school performance and emotional adjustment. Data were analyzed using logistic regression analyses.

RESULTS

About 30% of participants reported ever smoking and 3.5% reported sexual intercourse. Current smoking was correlated with age, school performance and quality of relationship with mother. Sexual intercourse was correlated with age, gender, family involvement and social support. Smoking and sexual activity were significantly correlated with each other. Smoking and increasing levels of heterosexual physical contact were negatively correlated with emotional adjustment, even after controlling for common predictors to health-endangering behaviors and emotional adjustment.

CONCLUSIONS

Smoking and sexual activity among adolescents are far less common in Hong Kong than in the West and their presence in a Hong Kong adolescent should alert the health practitioner to the possibility of significant psychosocial stress and maladjustment.