Gender differences in depressive symptoms in adolescence: comparison of national samples of clinically referred and nonreferred youths

Depression and labor supply: Evidence from the Netherlands

We estimate the relationship between depression and labor-market outcomes using data from the Longitudinal Internet studies for the Social Sciences (LISS) panel (2008 - 2018) from the Netherlands. The paper provides three main findings. First, depression is not associated with women's labor market participation, but it is associated with their likelihood of having paid employment (conditional on being in the labor force). Second, depression is associated with men's labor force participation, likelihood of having paid employment and likelihood of working full time. Third, severity of depression matters. More severe symptoms are associated with more adverse labor-market outcomes. In addition, we examine the mechanism behind the relationship between depression and labor market outcomes. We find that happiness, life satisfaction, and pessimistic beliefs about the future are partially mediating the effects.

How personality affects reaction. A mental health behavioral insight review during the Pandemic

The fear caused by the Covid-19 pandemic is changing our psychology and behavior. This ongoing negative event, imposing restrictions such as home isolation and social distancing, can result in heightened anxiety, depression and a sense of loneliness, with immediate effects on mental health. This study investigates adolescents’ reaction to the pandemic, by analyzing the behavioral mental health trends of depression, anxiety and sense of loneliness, in relation to personality traits. After controlling for demographics and family background, our results reveal strong relationships between several personality traits and psychological health indicators, during the pandemic in Greece. A total of 419 secondary school students (aged 12–18) were administered the State-Trait Anxiety Inventory for Children (STAIC), the Child Depression Inventory (CDI), the Big Five Inventory for measuring personality (BFI) and the Children’s Loneliness Questionnaire (CLS) during two time periods within pandemic. Overall, it appears that depression increased significantly in line with the escalation of the pandemic, while anxiety decreased, with the strongest predictors being the personality variables of extraversion, neuroticism and openness. Surprisingly, the study also revealed that the level of extraversion has a positive effect on changes in anxiety, while a negative one on changes in depression. On the other hand, neuroticism and openness seem to negatively correlate with anxiety changes and positively with depression changes. These findings highlight the importance of considering these variables in addressing individuals’ mental health behavior during the Covid-19 pandemic and elucidate the literature by offering a deeper understanding of the strong relationship between personality, depression and anxiety.

How does the COVID-19 affect mental health and sleep among Chinese adolescents: a longitudinal follow-up study

OBJECTIVE

The Corona Virus Disease-19 (COVID-19) pandemic has evolved into the largest public health event in the world. Earlier COVID-19 studies have reported that the pandemic caused widespread impacts on mental health and sleep in the general population. However, it remains largely unknown how the prevalence of mental health problems and sleep disturbance developed and interacted in adolescents at different times in the epidemic.

METHODS

831 teenagers (aged 14-19) underwent a longitudinal follow-up study to evaluate the prevalence of mental health problems and sleep disturbance among adolescents before, during, and after the COVID-19 breakout in China and to explore the interaction between mental health and sleep across the three measurements. The chronotype, anxiety and depression level, sleep quality, and insomnia were investigated during each measurement.

RESULTS

The adolescents had delayed sleep onset and sleep offset time, longer sleep duration during the quarantine than before and after the epidemic, whereas their chronotype tended to morning type during the epidemic. Yet, the highest prevalence of anxiety, depression, poor sleeper, and insomnia symptoms were observed before but not during the COVID-19 breakout. The females and adolescents who were eveningness type showed significantly higher anxiety and depression levels, poorer sleep quality, and severe insomnia status than the males and the intermediate and morning types. Sleep disturbance was positively associated with mental problems among three measurements. Pre-measured depression level significantly predicted sleep disturbance level at follow-ups.

CONCLUSION

These findings suggested that adolescents' high prevalence of mental health and sleep problems occurred before the COVID breakout and decreased during and after the epidemic. Gender and chronotype were significant risk factors associated with affective and sleep disturbances. Depression positively predicted later sleep problems, but not vice versa.

Self-esteem, symptom severity, and treatment response in adolescents with internalizing problems

BACKGROUND

Adolescents with low self-esteem often experience internalizing psychopathology (i.e., anxiety, depression). Self-esteem may therefore be a clinically relevant construct for assessment and treatment outcomes. We examined whether general and domain-specific (family, peer, academic) self-esteem are related to adolescents' internalizing symptom severity and response to cognitive behavioural therapy (CBT).

METHOD

Participants were 89 adolescents ages 14 to 18 years (M = 16.3, 70% females) from an outpatient clinic who were referred for CBT. Adolescents completed measures of self-esteem at baseline and measures of internalizing symptoms at baseline and at the end of a manualized group CBT intervention.

RESULTS

Lower peer and family self-esteem, but not academic self-esteem, were associated with more internalizing symptoms at baseline, after controlling for general self-esteem. However, only higher general self-esteem, and not any of the specific self-esteem domains, predicted lower internalizing symptoms at posttreatment. Follow-up analyses revealed differential associations between family and peer self-esteem domains and anxious and depressive symptoms.

LIMITATIONS

Only self-report measures were used. The relatively small sample size may have limited power to detect small effects.

CONCLUSIONS

Self-esteem in domains regarding family and peer relationships may be important in the evaluation of adolescents with internalizing problems. Adolescents with low general self-esteem may benefit less from CBT than other adolescents. Addressing negative self-perceptions may be necessary to reduce internalizing symptoms for adolescents with low self-esteem.

Demographic, Social, and Economic Factors of Internalizing Problems in Referred and Non-Referred Adolescents

Depressive symptoms and suicidal ideation are common internalizing problems during adolescence. Numerous studies have explored the role of certain demographic, social, and economic factors in their development in referred or non-referred adolescents, but not simultaneously in both groups. In this study, we examined the association between age, gender, parents’ educational level, and socioeconomic status (SES) and depressive symptoms and suicidal ideation in a referred group (n = 211) and a non-referred (n = 1401) group of adolescents. We also examined the moderating role that these factors play in the relationships between both internalizing problems. The results showed: higher levels of depressive symptoms and suicidal ideation in the referred group; an increase in both problems during early-to-middle adolescence in the non-referred group; an association between low SES and suicidal ideation in both groups; an association between low father’s education level and depressive symptoms in the non-referred group; and no gender differences in either of these two internalizing problems. The moderation analyses showed that age, in referred adolescents, and SES, in non-referred adolescents, moderated the relationship between depressive symptoms and suicidal ideation. This study contributes to the identification of groups of vulnerable adolescents that could constitute the target populations of preventive programs.

Prevalence of depression as measured by the CBDI in a predominantly adolescent school population in Turkey

Objectives

This cross-sectional randomised study involving a predominantly adolescent school population (ranging from the 6th to the 11th grades) was conducted to determine the prevalence and clinical characteristics of depression in adolescents in the city of Mersin, Turkey.

Subjects and methods

A stratified sample of 4256 students was selected as representative of the city’s adolescent school population. The students were divided into two groups according to diagnosis (Group I: depressive adolescents; Group II: adolescents without depression). The age range varied between 10 and 20 years, with a mean of 14.53 years (S.D. = 1.89), i.e. a mean of 14.73 years (S.D. = 1.79) for Group I, and 15.5 years (S.D. = 1.9) for Group II. Data was obtained via two structured questionnaires designed to determine the presence and clinical characteristics of depression both in adolescents and in their parents. In addition, the Child Beck Depression Inventory (CBDI) was administered to all students participating in the study. After quality control of data, the study sample was reduced to 4143 adolescents. The mean age of the students was 11.23 ± 6.44 years, and the ratio of boys/girls was 1.19:1.

Results

The prevalence of depression according to the CBDI (cut-off point: 19) was found to be 12.55% in this study group, with a significantly higher prevalence of depression in girls than in boys. Binary regression analysis demonstrated that the most important factors involved in the onset of depression in adolescents were having problems with parents, staying down a grade, and humiliation at school, and that the most common symptoms were feelings of worthlessness/guilt, sadness, emptiness, irritability and somatic disorders.

Conclusion

This cross-sectional prospective randomised school-based study has examined sociodemographic and clinical characteristics of adolescents with depression in a student population. It was found that in this study group there was a relatively high level of depressive symptoms, with a clear predominance of females over males. Other clinical characteristics of adolescents with depression have been discussed in the context of previous investigations.

The role of coping strategies in the pathway between child maltreatment and internalizing and externalizing behaviors

BACKGROUND

Child maltreatment has been repeatedly linked to internalizing and externalizing disorders, though few studies have examined the mechanisms of this pathway. Furthermore, children cope with difficult demands from their environments in a variety of ways, using emotion-focused (e.g., crying and verbal aggression), avoidant (e.g., disengaging), or problem-focused (e.g., seeking help from an adult) strategies.

OBJECTIVE

The current investigation examined if the coping strategies children employ when faced with everyday environmental stresses are a potential mechanism in the pathway between child maltreatment and internalizing and externalizing symptoms.

PARTICIPANTS AND SETTING

Participants included 198 maltreated and 222 non-maltreated children ages 4-12 who attended a day summer camp for 2 consecutive years.

METHODS

The study utilized a longitudinal design by following the children at two time points to determine if coping at Time 1 mediated the pathway between maltreatment and internalizing and externalizing symptoms at Time 2 (measured one year later).

RESULTS

Results from path analyses showed that maltreatment was associated with increased emotion-focused (b = .20, SE = .05, p < .001) and decreased problem-focused coping (b = -.25, SE = .05, p < .001). Results also indicated that emotion-focused coping represents a mechanism by which maltreated children are at increased risk for externalizing behaviors (with an indirect effect estimate of 0.023, SE = 0.053; CI: 0.004, 0.23).

CONCLUSIONS

The results highlight the impact maltreatment can have on coping strategies and that these strategies can play an important role in the development of psychopathology. This has important implications for clinicians, who could integrate reducing emotion-focused coping into intervention efforts for maltreated children.

A Factor Analysis and Test of Longitudinal Measurement Invariance of the Children's Depression Inventory (CDI) Across Adolescence

Depression increases dramatically during adolescence. This finding has been demonstrated using multiple measures, including the Children's Depression Inventory (CDI). The CDI is one of the most commonly used measures to assess depression in youth. However, there is little agreement on its factor structure, and it is possible that its factor structure changes over time. Yet, no study to date has investigated whether this structure is longitudinally invariant from early- to mid-adolescence. The present study examined the factor structure of the CDI in a sample of 227 adolescents aged approximately 13 at baseline and 16 at follow-up. The analyses revealed that a one-factor structure was a good fit to the data at each assessment. Moreover, tests of measurement invariance supported configural, metric, and scalar invariance across time. These findings suggest that changes in depressive symptoms during adolescence are due to true developmental changes, rather than changes in measurement properties.

Age-specific associations between oestradiol, cortico-amygdalar structural covariance, and verbal and spatial skills

Oestradiol is known to play an important role in the developing human brain, although little is known about the entire network of potential regions that might be affected and how these effects may vary from childhood to early adulthood, which in turn can explain sexually differentiated behaviours. In the present study, we examined the relationships between oestradiol, cortico-amygdalar structural covariance, and cognitive or behavioural measures typically showing sex differences (verbal/spatial skills, anxious-depressed symptomatology) in 152 children and adolescents (aged 6-22 years). Cortico-amygdalar structural covariance shifted from positive to negative across the age range. Oestradiol was found to diminish the impact of age on cortico-amygdalar covariance for the pre-supplementary motor area/frontal eye field and retrosplenial cortex (across the age range), as well as for the posterior cingulate cortex (in older children). Moreover, the influence of oestradiol on age-related cortico-amygdalar networks was associated with higher word identification and spatial working memory (across the age range), as well as higher reading comprehension (in older children), although it did not impact anxious-depressed symptoms. There were no significant sex effects on any of the above relationships. These findings confirm the importance of developmental timing on oestradiol-related effects and hint at the non-sexually dimorphic role of oestradiol-related cortico-amygdalar structural networks in aspects of cognition distinct from emotional processes.

Sex Moderates Relationships Among School Night Sleep Duration, Social Jetlag, and Depressive Symptoms in Adolescents

Social jetlag, a misalignment between sleep timing on the weekend and during the work week, is associated with depressive symptoms among adults across both sexes. A previous study found that later sleep timing was associated with depressive symptoms in women but not men. To date, however, no research has investigated whether the association between social jetlag and depression varies by sex among adolescents. The current study assessed self-reported sleep, depressive symptoms, and demographic information from 3058 adolescents (48% female, mean [SD] age 15.59 [0.77] years) from the age 15 wave of the Fragile Families and Child Wellbeing Study (FFCWS). Social jetlag was calculated as the absolute value of the midpoint of sleep on the weekend minus the midpoint of sleep during the school week. Depressive symptoms were measured through a modified 5-item version of the Center for Epidemiologic Studies Depression Scale (CES-D). We assessed whether the associations among sleep duration on school nights, social jetlag, and depressive symptoms were similar between male and female adolescents using multiple linear regression. In fully adjusted models, sex moderated the association between school night total sleep time and depressive symptoms ( p < 0.001) and between social jetlag and depressive symptoms ( p = 0.037). In females, but not in males, school night total sleep time was negatively associated with depressive symptoms ( p < 0.001), whereas social jetlag ( p < 0.001) was positively and independently associated with depressive symptoms. The results indicate the importance of regular sleep timing across the week and adequate sleep duration for the maintenance of optimal emotional health among female adolescents.

Factors Associated with Depression among School-going Adolescent Girls in a District of Northern India: A Cross-sectional Study

CONTEXT

Depression among adolescents, especially among girls, is a rising public health problem worldwide. It has been associated with a profound negative impact on their physical, social, and mental well-being.

AIM OF THE STUDY

To ascertain the factors associated with depression among school-going adolescent girls in district Barabanki of Uttar Pradesh.

SETTINGS AND DESIGN

School-based cross-sectional study.

SUBJECT AND METHODS

The study was conducted among 2187 school-going adolescent girls (10-19 years) in Barabanki district from September 2016 to September 2017 using multistage sampling. Sociodemographic characteristics such as age, residence, family background, and socioeconomic status were assessed through direct interview of the adolescent girl, with its reconfirmation from school records. Eleven-item Kutcher Adolescent Depression Scale was used for assessment of depression.

STATISTICAL ANALYSIS USED

Probability (P) was calculated to test for statistical significance at 5% level of statistical significance. Association between risk factors and depression was determined using bivariate analysis followed by multivariate logistic regression.

RESULTS

The prevalence of depression was found to be 39.7%. Multiple logistic regression revealed that depression was significantly higher among those residing in rural areas [odds ratio (OR) 3.32; P < 0.001], those in early and mid-adolescent age group (OR 2.51; P < 0.001), those studying in private schools (OR 3.22; P < 0.001), and those with Hindi as the medium of instruction (OR12.50; P < 0.001). Depression was also found to be significantly higher among those whose mothers were educated up to primary (OR 3.19; P < 0.01) or up to intercollege (OR 1.59; P < 0.001) when compared with illiterate mothers. Similarly, depression was found to be more common among those girls whose fathers were educated up to intercollege (OR 1.29; P < 0.05) or were graduate and above (OR 1.58; P < 0.001).

CONCLUSION

A significant proportion of school-going adolescent girls were suffering from depression, which reflects the need for reinforcement and strengthening of school-based mental health screening programs. Parents, teachers, and community health workers should work as a team to deal with the problem in a more effective way.

Can Mother-Daughter Communication Buffer Adolescent Risk for Mental Health Problems Associated With Maternal Depressive Symptoms?

The current study sought to test whether higher quality mother-daughter communication would buffer associations between maternal depressive symptoms and girls' internalizing and externalizing psychopathology symptoms among urban African American girls across a 12-month period. One hundred ninety-four treatment-seeking urban African American adolescent girls, ages 12-16, and their mothers participated in the study. Every 6 months (for up to 3 assessments), daughters reported on their internalizing and externalizing symptoms, mothers reported on their depressive symptoms, and both mothers and daughters reported on the quality of their dyadic communication. Daughters additionally reported on the extent to which they felt accepted by their mothers at each assessment. Results of multilevel modeling revealed that quality of communication significantly interacted with maternal depressive symptoms to predict externalizing and internalizing symptoms in daughters, such that the risk associated with maternal depressive symptoms was fully buffered for daughters in high-quality communication dyads. Secondary analyses demonstrated that these patterns of results were not accounted for by higher levels of social status or maternal acceptance. Drawing on a vulnerable and understudied population of urban African American adolescent girls, this work suggests that family communication may contribute to important intergenerational psychopathology transmission processes, above and beyond more general features of the family environment.

School-Based Curriculum to Improve Depression Literacy Among US Secondary School Students: A Randomized Effectiveness Trial

OBJECTIVES

To determine the effectiveness of a universal school-based depression education program.

METHODS

In 2012-2015, we matched 6679 students from 66 secondary schools into pairs by state (Maryland, Delaware, Pennsylvania, Michigan, and Oklahoma) and randomized to the Adolescent Depression Awareness Program (ADAP; n = 3681) or to a waitlist control condition (n = 2998). Trained teachers delivered ADAP as part of the health education curriculum to students aged 14 to 15 years. The primary outcome was depression literacy. Secondary outcomes included mental health stigma and, in a subset of the sample, the receipt of mental health services. Follow-up was at 4 months.

RESULTS

ADAP resulted in significantly higher levels of depression literacy among participating students than did waitlist controls, after adjusting for pretest assessment depression literacy (P < .001). Overall, ADAP did not significantly affect stigma (P = .1). After ADAP, students approached 46% of teachers with concerns about themselves or others. Of students who reported the need for depression treatment, 44% received treatment within 4 months of ADAP implementation.

CONCLUSIONS

ADAP is an effective public health intervention for improving depression literacy among students.

TRIAL REGISTRATION

Clinicaltrials.gov NCT02099305.

Change trajectories of aggressive behavior among children in long-term residential care

This study examined change trajectories of aggressive behaviors among children in long-term residential care in Israel and identified various child-, family-, and placement-related predictors of the change trajectories. Records of 799 children (average age at the beginning of the four years=10.4, 33.1% female) in their first four consecutive years in care were analyzed using the TRF aggressive behavior subscale (Achenbach, 1991) to measure the outcome variable. Children's and parents' characteristics and placement-related factors were used to explain variance in change trajectories. Latent Class Growth Analyses identified four aggressive behavior trajectories: 'stable-low' levels of aggressiveness over time (45% of the children), 'stable-high' levels (13%), 'improvement' (20%), and 'deterioration' (22%). Predictors of less resilient trajectories (i.e., stable-high or increasing aggressiveness) included mothers' difficulties and disabilities, children's attendance of special education classes, more intensive type of care, and non-immigrant status. The Attachment Theory, Life Course Perspective theories, and the General Strain Theory are used to interpret some of the findings of the study. Identifying the factors that predispose children to certain patterns of change may help direct resources to children at risk of having high or increasing levels of aggression while in residential care.

Factors influencing the probability of a diagnosis of autism spectrum disorder in girls versus boys

In order to shed more light on why referred girls are less likely to be diagnosed with autism spectrum disorder than boys, this study examined whether behavioral characteristics influence the probability of an autism spectrum disorder diagnosis differently in girls versus boys derived from a multicenter sample of consecutively referred children aged 2.5-10 years. Based on information from the short version of the Developmental, Dimensional and Diagnostic Interview and the Autism Diagnostic Observation Schedule, 130 children (106 boys and 24 girls) received a diagnosis of autism spectrum disorder according to Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.) criteria and 101 children (61 boys and 40 girls) did not. Higher overall levels of parent-reported repetitive and restricted behavior symptoms were less predictive of an autism spectrum disorder diagnosis in girls than in boys (odds ratio interaction = 0.41, 95% confidence interval = 0.18-0.92, p = 0.03). In contrast, higher overall levels of parent-reported emotional and behavioral problems increased the probability of an autism spectrum disorder diagnosis more in girls than in boys (odds ratio interaction = 2.44, 95% confidence interval = 1.13-5.29, p = 0.02). No differences were found between girls and boys in the prediction of an autism spectrum disorder diagnosis by overall autistic impairment, sensory symptoms, and cognitive functioning. These findings provide insight into possible explanations for the assumed underidentification of autism spectrum disorder in girls in the clinic.

Self-Esteem, Depressive Symptoms, and Adolescents' Sexual Onset

We examine whether self-esteem and depressive symptoms influence sexual onset when important controls such as age, dating, race, and income are examined. Analyses are based on the first two waves of the restricted-use sample of the National Longitudinal Study of Adolescent Health. We examine adolescents who reported at wave 1 that they had not had sexual intercourse. Using logistic regression models run separately for males and for females, we find that depressive symptoms, when entered simultaneously, exert a greater effect than self-esteem on sexual onset. Depressive symptoms have less effect on sexual onset for African-American girls than for white girls. Higher self-esteem is associated with greater likelihood of sexual debut at older ages for boys. Our findings suggest that although many positive benefits of self-esteem have been suggested, the conceptual and empirical link between depressive symptoms and adolescent sexual onset may be more crucial.

Predictors of change in depressive symptoms from preschool to first grade

Children's depressive symptoms in the transition from preschool to school are rarely investigated. We therefore tested whether children's temperament (effortful control and negative affect), social skills, child psychopathology, environmental stressors (life events), parental accuracy of predicting their child's emotion understanding (parental accuracy), parental emotional availability, and parental depression predict changes in depressive symptoms from preschool to first grade. Parents of a community sample of 995 4-year-olds were interviewed using the Preschool Age Psychiatric Assessment. The children and parents were reassessed when the children started first grade (n = 795). The results showed that DSM-5 defined depressive symptoms increased. Child temperamental negative affect and parental depression predicted increased, whereas social skills predicted decreased, depressive symptoms. However, such social skills were only protective among children with low and medium effortful control. Further, high parental accuracy proved protective among children with low effortful control and high negative affect. Thus, interventions that treat parental depression may be important for young children. Children with low effortful control and high negative affect may especially benefit from having parents who accurately perceive their emotional understanding. Efforts to enhance social skills may prove particularly important for children with low or medium effortful control.

Anhedonia and depressed mood in adolescence: course, stability, and reciprocal relation in the TRAILS study

Adolescence is marked by increases in the incidence of major depression (MDD), a disorder recognized as one of the leading causes of disability. Anhedonia and depressed mood predict both onset and chronicity of major depression (MDD), but have never been studied together longitudinally in the general adolescent population. The present study examined (1) the course and the stability of anhedonia and depressed mood and (2) their cross-sectional and longitudinal relations during adolescence. The study cohort consisted of 2,230 adolescents. Anhedonia and depressed mood were assessed with items of the YSR and ASR self-report forms at four measurement waves between ages 11 and 19. The proportion of adolescents reporting anhedonia decreased between ages 11 and 19, while the proportion of female adolescents reporting depressed mood increased. The stability of anhedonia and the cross-sectional association between anhedonia and depressed mood was larger at age 19 than at age 11. We found a mutual association between anhedonia and depressed mood without a clear temporal sequence. The presence of anhedonia at the end of adolescence might put adolescents at increased risk for MDD given the increasingly stronger stability and association with depressed mood. This suggests that it becomes more difficult to prevent MDD during late adolescence compared with early and middle adolescence.

Persistence of psychological problems in adolescence: a one year follow-up study

Objectives: To examine the prevalence and persistence of psychological problems in older adolescents.

Methods: This study is a one year follow-up of 110 adolescents, 64 girls and 46 boys attending three secondary schools in Ireland. All were 16 at initial testing. The Youth Self Report (YSR) was the measure used.

Results: Over a fifth of adolescents have problems in the clinical range. These problems persisted from 16 to 17. Females reported more problems than males at both ages. Some females showed a slight reduction in internalising problems at 17. Both males and females showed an increase in externalising problems at 17. Odds ratios indicate that those in the clinical ranges of the YSR at 16, had increased risk of being in the clinical range at 17 compared to those in the no problem range at 16. In comparison to those with no suicidal feeling, those with suicidal feelings at 16 were at an increased risk of still feeling suicidal at 17. More males remained psychologically healthy than girls.

Conclusions: A large proportion of adolescents in this sample have psychological problems and these appear to persist over a one year period. These problems impact substantially on the adolescents themselves, their families and society. Given the increasing suicide rate in young people and the persistence of suicidal feelings in this cohort, the inadequacy of mental health services in Ireland for adolescents, particularly those ages 16-18 is highlighted. The challenge of developing and providing adolescent friendly services is addressed.

Comorbidity of anxiety and depression in children and adolescents: 20 years after

Brady and Kendall (1992) concluded that although anxiety and depression in youths are meaningfully linked, there are important distinctions, and additional research is needed. Since then, studies of anxiety-depression comorbidity in youths have increased exponentially. Following a discussion of comorbidity, we review existing conceptual models and propose a multiple pathways model to anxiety-depression comorbidity. Pathway 1 describes youths with a diathesis for anxiety, with subsequent comorbid depression resulting from anxiety-related impairment. Pathway 2 refers to youths with a shared diathesis for anxiety and depression, who may experience both disorders simultaneously. Pathway 3 describes youths with a diathesis for depression, with subsequent comorbid anxiety resulting from depression-related impairment. Additionally, shared and stratified risk factors contribute to the development of the comorbid disorder, either by interacting with disorder-related impairment or by predicting the simultaneous development of the disorders. Our review addresses descriptive and developmental factors, gender differences, suicidality, assessments, and treatment-outcome research as they relate to comorbid anxiety and depression and to our proposed pathways. Research since 1992 indicates that comorbidity varies depending on the specific anxiety disorder, with Pathway 1 describing youths with either social phobia or separation anxiety disorder and subsequent depression, Pathway 2 applying to youths with coprimary generalized anxiety disorder and depression, and Pathway 3 including depressed youths with subsequent social phobia. The need to test the proposed multiple pathways model and to examine (a) developmental change and (b) specific anxiety disorders is highlighted.

Diet Pills, Powders, and Liquids

About 35% of healthy weight adolescent females describe themselves as overweight, and 66% report planning to lose weight. Body weight dissatisfaction is associated with unhealthy weight loss practices including diet pill/powder/liquid (PPL) use. Few studies have examined diet PPL use in healthy weight adolescent females; therefore, Youth Risk Behavior Survey data ( n = 247) were analyzed to identify predictors of use. Descriptive statistics and logistic regression analyses were conducted using Statistical Package for the Social Sciences Complex Samples software. Social cognitive theory served as the framework guiding the analysis. Approximately 8% of healthy weight females reported using diet PPL for weight loss. Describing self as overweight, planning to lose weight, being offered drugs at school, fasting to lose weight, cigarette/alcohol use, vomiting, and laxative use were significantly associated ( p < .05) with diet PPL use. Health professionals, including school nurses, must assess for unhealthy weight loss practices in healthy weight females, in order to adequately address related issues.

Suicidal behaviors in depressed adolescents: role of perceived relationships in the family

CONTEXT

Suicide is the second leading cause of death in adolescents and young adults in Europe. Reducing suicides is therefore a key public health target. Previous studies have shown associations between suicidal behaviors, depression and family factors.

OBJECTIVE

To assess the role of family factors in depression and suicidality in a large community-based sample of adolescents and to explore specific contributions (e.g. mother vs. father; conflict vs. no conflict; separation vs. no separation) taking into account other risk factors.

METHODS

A cross-sectional sample of adolescents aged 17 years was recruited in 2008. 36,757 French adolescents (18,593 girls and 18,164 boys) completed a questionnaire including socio-demographic characteristics, drug use, family variables, suicidal ideations and attempts. Current depression was assessed with the Adolescent Depression Rating Scale (ADRS). Adolescents were divided into 4 groups according to suicide risk severity (grade 1 = depressed without suicidal ideation and without suicide attempts, grade 2 = depressed with suicidal ideations and grade 3 = depressed with suicide attempts; grade 0 = control group). Multivariate regressions were applied to assess the Odds Ratio of potential risk factors comparing grade 1, 2 or 3 risk with grade 0.

RESULTS

7.5% of adolescents (10.4% among girls vs. 4.5% among boys) had ADRS scores compatible with depression; 16.2% reported suicidal ideations in the past 12 months and 8.2% reported lifetime suicide attempts. Repeating a year in school was significantly associated to severity grade of suicide risk (1 and 3), as well as all substance use, tobacco use (severity grades 2 and 3) and marijuana use (severity grade 3), for girls and boys. After adjustment, negative relationships with either or both parents, and parents living together but with a negative relationship were significantly associated with suicide risk and/or depression in both genders (all risk grades), and Odds Ratios increased according to risk severity grade.

CONCLUSION

Family discord and negative relationship with parents were associated with an increased suicide risk in depressed adolescents. So it appears essential to take intrafamilial relationships into account in depressed adolescents to prevent suicidal behaviours.

Profiles of Systems Involvement in a Sample of High-Risk Urban Adolescents with Unmet Treatment Needs

This study examined profiles of involvement in four systems (education, child welfare, legal, and treatment) in a sample of 253 high-risk urban adolescents with unmet behavioral health needs. Self-report data were collected on multiple dimensions of involvement within each system, demographics, and DSM-IV diagnoses. Latent class analysis revealed four profiles: Education System: Academic and Disciplinary, Education System: Academic Only, Legal/Juvenile Justice Involved, and Multiple Systems/Child Welfare. Profiles differed based on gender and psychiatric diagnoses. Boys were overrepresented in Education System: Academic and Disciplinary and Legal/Juvenile Justice Involved, and girls were overrepresented in Multiple Systems/Child Welfare. The two education system focused classes were characterized by depressive disorders and ADHD. Youth in Legal/Juvenile Justice Involved and Multiple Systems/Child Welfare were characterized by conduct disorder and substance abuse. Implications for assessment and treatment planning for high-risk youth and for the organization of community-based behavioral health services are discussed.

Association between Body Mass Index and depression: the "fat and jolly" hypothesis for adolescents girls

BACKGROUND

Results concerning the association between Body Mass Index (BMI) and depression in adolescence are conflicting, some describing a linear association (increase in BMI with level of depression), some a U-shaped association (both underweight and obesity are associated with high levels of depression), and they mostly concern small samples. The purpose of this study was to describe the association between BMI and depression in a large representative sample of French adolescents.

METHODS

The association between BMI and depression, measured on the Adolescent Depression Rating Scale (ADRS), was tested in a French national representative sample of 39542 adolescents aged 17. Self-report data is derived from the 2008 ESCAPAD study, an epidemiological study based on a questionnaire focused on health and drug consumption. We used spline function analysis to describe the association between BMI and depression.

RESULTS

The association between BMI and depression is significant (p < 0.001) and non-linear for both genders, with no effect of parental working and marital status. For boys, there is U-shaped association. For girls the shape of the association is complex and shows inverted convexity for high levels of BMI. The spline shows higher scores for depression among overweight girls than among obese girls.

CONCLUSION

There is evidence for a gender difference in the association between BMI and depression in adolescents, supporting the need to study boys and girls separately. Overweight adolescent girls are more likely to be depressed than obese adolescent girls, giving support for "fat and jolly" hypothesis not only among older women but also among adolescent girls.

Depressive symptoms and romantic relationship qualities from adolescence through emerging adulthood: a longitudinal examination of influences

Research has consistently demonstrated the negative consequences of depression on adolescents' functioning in peer and family relationships, but little work has examined how depressive symptoms affect the quality of adolescents' and emerging adults' romantic relationships. Five waves of data on depressive symptoms, romantic relationship conflict, and use of positive problem solving were collected from 188 boys and girls during middle adolescence to emerging adulthood. Latent growth curve models indicated that having more depressive symptoms when 15 years old was associated with both more increase in relationship conflict and less increase in positive problem solving as compared to adolescents with fewer depressive symptoms. These results suggest that depression in middle adolescence may impair subsequent romantic relationship qualities into late adolescence and emerging adulthood.

Psychopharmacology of depression in children and adolescents

Although much debate continues about the prevalence of depressive disorders in prepubertal children, depression clearly is common in adolescents, increasing rapidly throughout the teen years. All physicians who work with young patients must to be able to recognize and treat these disorders. This article provides a brief overview of depressive disorders in children and adolescence, including their clinical presentation, prevalence, etiology, course, and prognosis. Psychopharmacological treatment options are reviewed in detail, including practical information for medication management including patient education, making the decision to treat with medication, selection of specific medications, strategies for nonresponsive patients, and decisions about stopping medication.

Relevance of the tripartite dimensions of affect for anxiety and depression in youth: examining sex and psychopathology status

Using a combined sample (N=1,215) of referred children and children from the general population aged between 8 and 14 years, the present study addressed two research goals: First, latent mean differences (depending on the individual's sex or psychopathology level) in anxiety, depression, Positive Affect (PA), Negative Affect (NA) and Physiological Hyperarousal (PH) were examined. Secondly, the structure of anxiety and depression was investigated from a tripartite model perspective in boys and girls with high versus low levels of psychopathology respectively. When relating the latent mean level differences in NA, PA, and PH with those in anxiety and depression, the results suggest that higher levels (depending on the individual's sex and psychopathology status) of anxiety or depression are associated with higher levels of PH and lower levels of PA, whereas no consistent pattern was found between mean level differences in NA on the one hand and mean level differences in anxiety/depression on the other. Results further demonstrated that a better fit was obtained for the dual than for the unitary construct representation in boys or girls with high or low levels of psychopathology, thereby suggesting that a valid distinction can be made between anxiety and depression in children between 8 and 14 years old, irrespective of their sex or level of psychopathology. However, when looking at the structural relations of the dual construct representation of anxiety and depression with NA, PA and PH in each of the four groups separately, it became evident that the PH and PA tripartite dimensions could not account for the unique aspects of anxiety and depression respectively. Moreover, PH rather than NA was found to be common for anxiety and depression.

Perceived Changes in Personal Circumstances Related to Social Change

Social change is a ubiquitous phenomenon comprising tendencies such as globalization, demographic change, and pluralization of biographical trajectories. Based on stress theories and related challenge-response models, the present study investigated whether depressive symptoms were related to an accumulation of perceived demands associated with social change in a sample of 2,522 German adolescents and adults. In addition, buffering effects of personal and social resources on the association between perceived demands and depressive symptoms were tested. By means of structural equation modeling, we found that accumulations of work-, family-, and public life-related demands were associated with higher levels of depressive symptoms, even after controlling for demographic and other confounding variables. Optimism and social support were found to be associated with lower depressive symptoms. Furthermore, both optimism and social support reduced the size of associations between demands of social change and depressive symptoms. Overall, these results underscore the association of social change and psychosocial resources with individuals’ depressive symptoms.

Clinical characteristics of depression among adolescent females: a cross-sectional study

BACKGROUND

Adolescents rarely seek psychiatric help; they even hesitate to disclose their feelings to their parents. However; the adolescents especially the females experience depressive symptoms more frequently than general population. Do they experience classic depressive symptoms? Are there symptoms specific to this subpopulation?

AIM OF THE STUDY

Through this study, the authors aimed to estimate the prevalence of depressive disorders in Egyptian adolescent female students. They also expected a characteristic profile of symptoms for the adolescent females. However available literature provides no guidance in the description of this profile of symptoms.

METHODS

A number of 602 adolescent females were interviewed, and subjected to General Health Questionnaire (GHQ); Children Depression Inventory (CDI), Structured Clinical Interview for DSM-IV Axis-I Disorders (SCID-I), then Hamilton Rating Scale for Depression (Ham-D). Results were analyzed by the use of SPSS-15.

RESULTS

The study revealed the prevalence of depression in the sample of the study to be 15.3% (measured by CDI), and 13.3% (measured by SCID-I). Fatigue was the most common presenting depressive symptom (81.3%), in addition to other emotional, cognitive and physiological symptoms. Suicidal ideations were the most common suicidal symptoms in depressed adolescent females (20%), with 2.5% serious suicidal attempts.

CONCLUSIONS

The somatic symptoms were by far the most common presenting symptom for female adolescents suffering from depressive disorders. Depressive phenomena including unexplained fatigue, decreased energy, psychomotor changes, lack of concentration, weight changes and suicidal ideations may be the presenting complaints instead of the classic sad mood.

Participatory action research (PAR) in middle school: opportunities, constraints, and key processes

Late childhood and early adolescence represent a critical transition in the developmental and academic trajectory of youth, a time in which there is an upsurge in academic disengagement and psychopathology. PAR projects that can promote youth's sense of meaningful engagement in school and a sense of efficacy and mattering can be particularly powerful given the challenges of this developmental stage. In the present study, we draw on data from our own collaborative implementation of PAR projects in secondary schools to consider two central questions: (1) How do features of middle school settings and the developmental characteristics of the youth promote or inhibit the processes, outcomes, and sustainability of the PAR endeavor? and (2) How can the broad principles and concepts of PAR be effectively translated into specific intervention activities in schools, both within and outside of the classroom? In particular, we discuss a participatory research project conducted with 6th and 7th graders at an urban middle school as a means of highlighting the opportunities, constraints, and lessons learned in our efforts to contribute to the high-quality implementation and evaluation of PAR in diverse urban public schools.

Criterion validity of the Short Mood and Feelings Questionnaire and one- and two-item depression screens in young adolescents

BACKGROUND

The use of short screening questionnaires may be a promising option for identifying children at risk for depression in a community setting. The objective of this study was to assess the validity of the Short Mood and Feelings Questionnaire (SMFQ) and one- and two-item screening instruments for depressive disorders in a school-based sample of young adolescents.

METHODS

Participants were 521 sixth-grade students attending public middle schools. Child and parent versions of the SMFQ were administered to evaluate the child's depressive symptoms. The presence of any depressive disorder during the previous month was assessed using the Diagnostic Interview Schedule for Children (DISC) as the criterion standard. First, we assessed the diagnostic accuracy of child, parent, and combined scores of the full 13-item SMFQ by calculating the area under the receiver operating characteristic curve (AUC), sensitivity and specificity. The same approach was then used to evaluate the accuracy of a two-item scale consisting of only depressed mood and anhedonia items, and a single depressed mood item.

RESULTS

The combined child + parent SMFQ score showed the highest accuracy (AUC = 0.86). Diagnostic accuracy was lower for child (AUC = 0.73) and parent (AUC = 0.74) SMFQ versions. Corresponding versions of one- and two-item screens had lower AUC estimates, but the combined versions of the brief screens each still showed moderate accuracy. Furthermore, child and combined versions of the two-item screen demonstrated higher sensitivity (although lower specificity) than either the one-item screen or the full SMFQ.

CONCLUSIONS

Under conditions where parents accompany children to screening settings (e.g. primary care), use of a child + parent version of the SMFQ is recommended. However, when parents are not available, and the cost of a false positive result is minimal, then a one- or two-item screen may be useful for initial identification of at-risk youth.

Anxiety and depression in children and adolescents with spinal cord injuries

Aim To determine the levels of anxiety and depression in young people with spinal cord injuries (SCI) and their associated factors and outcomes. Method Children and adolescents aged 7 to 17 years at interview who had sustained SCI at least 1 year before the study were assessed using the Children's Depression Inventory, the Revised Children's Manifest Anxiety Scale, the Pediatric Quality of Life Inventory, the Children's Assessment of Participation and Enjoyment, and a demographic questionnaire designed for the study. Results The 118 participants (61 males, 57 females) had a mean age of 12 years 4 months, SD 3 y 1 mo, range 7-17 y. Mean age at injury was 5 years 11 months, SD 4 y 11 m, range 0-16 y; 89 participants (75%) had paraplegia and 29 (25%) had tetraplegia. Fifty-seven (52%) had complete injuries and 52 (48%) had incomplete injuries according to the American Spinal Injury Association impairment scale. Thirteen participants (13%) reported significant symptoms of anxiety, and seven (6%) reported significant levels of depression, which were comparable to the normative population. Age, race, and sex were not associated with anxiety or depression, but participants with shorter duration of injury were more likely to be anxious, and those with less functional independence were more likely to be depressed. Only one dimension of participation was associated with anxiety and depression, but all aspects of quality of life were decreased among those with anxiety or depression. Interpretation The levels of anxiety and depression in young people with SCI are comparable to the normative range. When anxiety and depression occur they are associated with reduced levels of quality of life.

Characteristics, correlates, and outcomes of childhood and adolescent depressive disorders

Depressive illness beginning early in life can have serious developmental and functional consequences. Therefore, understanding the disorder during this developmental stage is critical for determining its etiology and course, as well as for deveiopinq effective intervention straieqies. This paper summarizes current knoviedqe reqardinq the etiology, phenomenoiogy, correlates, natural course, and consequences of unipolar depression in children and adolescents. Using adult depression as a framevork, the unique aspects of childhood and adolescence are considered in order to better understand depression within a developmental context. The data suggest that the clinical presentation, correlates, and natural course of depression are remarkably similar across the lifespan. There are, however, important developmental differences. Specifically, the familial and psychological context in which depression develops in youngsters is associated with variability in the frequency and nature of depressive symptoms and comorbid conditions among children and adolescents. Maturational differences have also been identified in the neurobiological correlates of depression. These developmental differences may be associated with the observed variability in clinical response to treatment and longitudinal course. Characterization of the developmental differences will be helpful in developing more specific and effective interventions for youngsters, thereby allowing them to reach their full potential as adults.

Distress tolerance and early adolescent externalizing and internalizing symptoms: the moderating role of gender and ethnicity

A large body of research has examined the development of internalizing and externalizing symptoms in childhood and early adolescence. Notably, there is significant concomitant impairment associated with early adolescent symptomatology, as well as association of these symptoms with future development of psychopathology, poor physical health, self-destructive thoughts and behaviors, criminal behavior, and HIV risk behaviors. Drawing on negative reinforcement theory, the current study sought to examine the potential role of distress tolerance, defined as the ability to persist in goal-directed activity while experiencing emotional distress, as a potential mechanism that may underlie both internalizing and externalizing symptoms among 231 Caucasian and African American youth (M age=10.9 years; 45.5% female; 54.5% Caucasian ethnicity). A series of regressions resulted in significant moderated relationships, such that low distress tolerance conferred increased risk for alcohol use among Caucasians, delinquent behavior among African Americans, and internalizing symptoms among females. Clinical implications, including the potential role of negative reinforcement models in early intervention with young adolescents, are discussed.

Anxiety symptoms in rural Mexican adolescents: a social-ecological analysis

BACKGROUND

We investigated the contributions of individual, family, and community-level factors for explaining anxiety symptoms among rural adolescents in Mexico.

METHOD

As part of a large-scale survey, 3,553 adolescents and their mothers from 333 poor, rural communities in seven Mexican states provided cross-sectional data on family level, socio-economic and psychosocial factors, and individual-level data on anxiety symptoms. Community standard of living indicators were also gathered.

RESULTS

Linear regressions adjusted for sampling design indicated that adolescents' anxiety symptoms were uniquely predicted by mothers' depressive symptoms, maternal perceived stress, larger family size, and lower maternal and adolescent educational attainment. Family income and community standard of living were not directly associated with adolescent symptoms. Adolescent females reported more symptoms than males, but gender did not moderate the relationship between the predictors and adolescents' symptoms.

CONCLUSIONS

We found that maternal mental health was a key factor in adolescent children's psychological wellbeing; this finding extends prior research in economically developed countries that emphasizes the importance of maternal functioning for child mental health. Family size, gender, and the educational attainment of mothers and adolescents also uniquely contributed to adolescents' anxiety symptoms in these rural Mexican communities.

Defining risk heterogeneity for internalizing symptoms among children of alcoholic parents

Adopting a developmental epidemiology perspective, the current study examines sources of risk heterogeneity for internalizing symptomatology among children of alcoholic parents (COAs). Parent-based factors, including comorbid diagnoses and the number of alcoholic parents in the family, as well as child-based factors, namely child gender, formed the indicators of heterogeneity. Following a novel approach to cross-study methods, we present a three-stage analysis involving measurement development using item response theory, examination of study effects on latent trajectories over time using latent curve modeling, and prediction of these latent trajectories testing our theoretically derived hypotheses in two longitudinal investigations across both mother- and self-reported symptomatology. Specifically, we replicated previous findings that parent alcoholism has a unique effect on child internalizing symptoms, above and beyond those of both parent depression and antisocial personality disorder. However, we also found important subgroup differences, explaining heterogeneity within COAs' risk profile in terms of the number of alcoholic parents in the family, comorbid diagnoses for the alcoholic parent and, for self-reported symptoms, child gender. Such factors serve to refine the definition of risk among COAs, suggesting a more severely impaired target group for preventive interventions, identifying the significance of familial alcoholism in individual differences underlying internalizing symptoms over time, and further specifying the distal risk matrix for an internalizing pathway to alcohol involvement.

Subjective unmet need for mental health services in depressed children grown up

BACKGROUND

Limited attention has been devoted to characterizing unmet need for treatment among individuals with mental disorders. A longitudinal follow-up of depressed, anxious, and psychiatrically normal children into adulthood provided an opportunity to examine factors associated with subjective unmet need.

METHODS

Respondents (n = 208) comprise a subsample of a cohort ascertained between 1977 and 1985 consisting of three subgroups: one with major depressive disorder (MDD), one with anxiety disorders but no MDD, and controls with no psychiatric disorder up to ascertainment. Psychiatric status was reassessed in adulthood using the SADS-LA by interviewers blind to childhood diagnoses. Best-estimate diagnoses describing participants' lifetime clinical course were formulated by senior clinicians. Participants who completed SADS-LA interviews about themselves were invited to complete an additional interview about experiences with health care, including subjective unmet need for and barriers to mental health treatment.

RESULTS

About 37% of respondents reported lifetime histories of subjective unmet need for mental health services. Unmet need was associated with female gender and lifetime mood and substance dependence disorders. The most commonly cited barriers included attitudes toward treatment, not knowing where to obtain it, and financial concerns.

CONCLUSIONS

Subjective unmet need was common in this sample. Approaches to reducing it might include public health initiatives to foster more favorable attitudes toward treatment, increase knowledge of where to obtain it, and lower financial barriers.

Conduct problems, depressive symptomatology and their co-occurring presentation in childhood as predictors of adjustment in early adolescence

The present study investigated patterns in the development of conduct problems (CP), depressive symptoms, and their co-occurrence, and relations to adjustment problems, over the transition from late childhood to early adolescence. Rates of depressive symptoms and CP during this developmental period vary by gender; yet, few studies involving non-clinical samples have examined co-occurring problems and adjustment outcomes across boys and girls. This study investigates the manifestation and change in CP and depressive symptom patterns in a large, multisite, gender-and ethnically-diverse sample of 431 youth from 5th to 7th grade. Indicators of CP, depressive symptoms, their co-occurrence, and adjustment outcomes were created from multiple reporters and measures. Hypotheses regarding gender differences were tested utilizing both categorical (i.e., elevated symptom groups) and continuous analyses (i.e., regressions predicting symptomatology and adjustment outcomes). Results were partially supportive of the dual failure model (Capaldi, 1991, 1992), with youth with co-occurring problems in 5th grade demonstrating significantly lower academic adjustment and social competence two years later. Both depressive symptoms and CP were risk factors for multiple negative adjustment outcomes. Co-occurring symptomatology and CP demonstrated more stability and was associated with more severe adjustment problems than depressive symptoms over time. Categorical analyses suggested that, in terms of adjustment problems, youth with co-occurring symptomatology were generally no worse off than those with CP-alone, and those with depressive symptoms-alone were similar over time to those showing no symptomatology at all. Few gender differences were noted in the relations among CP, depressive symptoms, and adjustment over time.

THE RELATIONSHIPS BETWEEN COPING STRATEGIES AND DEPRESSION AMONG TURKISH ADOLESCENTS

The relationships between coping strategies and depression were examined in a sample of 543 Turkish adolescents using a Turkish version of the Coping Across Situations Questionnaire (Seiffge-Krenke, 1995). MANOVA results revealed significant main effects for gender, school type and grade level in coping strategies. Females compared to males and adolescents from state high schools compared to adolescents from Anatolian high schools used higher levels of approach-oriented coping. Males compared to females, adolescents from state high schools compared to adolescents from Anatolian high schools and 9th graders compared to 11th graders used higher levels of avoidant coping. Four groups were formed to explore group differences in depression. ANOVA revealed that low generic copers (those who used low levels of both coping strategies) reported more symptoms of depression than high generic copers (those who used high levels of both coping strategies), approachers, and avoiders.

Longitudinal associations between sibling relationship quality, parental differential treatment, and children's adjustment

This study examined associations between changes in sibling relationships and changes in parental differential treatment and corresponding changes in children's adjustment. One hundred thirty-three families were assessed at 3 time points. Parents rated children's externalizing problems, and children reported on sibling relationship quality, parental differential treatment, and depressive symptoms. On average, older siblings were 10, 12, and 16 years old, and younger siblings were 8, 10, and 14 years old at Waves 1, 2, and 3, respectively. Results from hierarchical linear modeling indicated that as sibling relationships improved over time, children's depressive symptoms decreased over time. In addition, as children were less favored over their siblings over time, children's externalizing problems increased over time. Findings highlight the developmental interplay between the sibling context and children's adjustment.

Adverse health consequences that co-occur with depression: a longitudinal study of black adolescent females

OBJECTIVE

The purpose of this study was to identify adverse health consequences that may co-occur with depression among black female adolescents.

METHODS

Adolescents were recruited from high-risk neighborhoods in Birmingham, Alabama. The sample comprised 460 black female adolescents (aged 14-18 years) who completed assessments at baseline and at 6 and 12 months. Only adolescents who consistently scored above the threshold for depression at all 3 assessments (n = 76) or below the threshold at all 3 assessments (n = 174) were included (N = 250) in the data analysis. Within this sample, adolescents who were depressed were compared with those who were not depressed with respect to the following health consequences: low self-esteem, emotional abuse, physical abuse, verbal abuse, poor body image, and antisocial behavior.

RESULTS

Using generalized estimating equations and controlling for covariates, depressed adolescents were 5.3 times more likely to report low self-esteem, 4.3 times more likely to report emotional abuse, 3.7 times more likely to report being physically abused, and almost 3 times as likely to report being verbally abused. Furthermore, depressed adolescents were more than twice as likely to report poor body image and nearly twice as likely to report engaging in antisocial behaviors.

CONCLUSIONS

The findings suggest that a broad range of adverse health consequences may accompany depression among black female adolescents. Physicians need to be alert to the co-occurrence of depression and low self-esteem; emotional, physical, and verbal abuse; poor body image; and antisocial behaviors among this population.

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.

Behavioral outcomes and evidence of psychopathology among very low birth weight infants at age 20 years

OBJECTIVE

Information on the mental health of very low birth weight (VLBW; <1500 g) children in young adulthood is sparse. We thus sought to examine gender-specific behavioral outcomes and evidence of psychopathology in a cohort of VLBW young adults at 20 years of age.

METHODS

We compared a cohort of 241 survivors among VLBW infants who were born between 1977 and 1979 (mean birth weight: 1180 g; mean gestational age at birth: 29.7 weeks), 116 of whom were men and 125 of whom were women, with 233 control subjects from the same population in Cleveland who had normal birth weights (108 men and 124 women). Young adult behavior was assessed at 20 years of age with the Achenbach Young Adult Self-Report and the Young Adult Behavior Checklist for parents. In addition, the young adults and parents completed the ADHD Rating Scale for Adults. Gender-specific outcomes were adjusted for sociodemographic status.

RESULTS

VLBW men reported having significantly fewer delinquent behaviors than normal birth weight (NBW) control subjects, but there were no differences on the Internalizing, Externalizing, or Total Problem Behavior scales. Parents of VLBW men reported significantly more thought problems for their sons than did parents of control subjects. VLBW women reported significantly more withdrawn behaviors and fewer delinquent behavior problems than control subjects. Their rates of internalizing behaviors (which includes anxious/depressed and withdrawn behaviors) above the borderline clinical cutoff were 30% versus 16% (odds ratio: 2.2; 95% confidence interval [CI]: 1.2-4.1). Parents of VLBW women reported significantly higher scores for their daughters on the anxious/depressed, withdrawn, and attention problem subscales compared with control parents. The odds ratios for parent-reported rates above the borderline-clinical cutoff among women for the anxious/depressed subscale was 4.4 (95% CI: 1.4-13.5), for thought problems was 3.7 (95% CI: 1.2-11.6), and for attention problems was 2.4 (95% CI: 1.0-5.5). There were no differences in the young adult self-report of attention-deficit/hyperactivity disorder (ADHD). Parents of VLBW men reported higher mean scores on the attention subtype of ADHD but not higher rates of ADHD.

CONCLUSION

The increase in psychopathology among VLBW survivors in young adulthood indicates a need for anticipatory guidance and early intervention that might help to prevent or ameliorate potential psychopathology.