Pilot study of anxiety and depression in prepubertal children

Depression risk of 'left-behind children' in rural China

The study aims to explore the risk of depression in left-behind children in grades four-six in rural China and to identify the factors associated with increased depression risk in this population. In Hubei Xiantao, a school-based sample of 1000 children was recruited with 875 children (590 left-behind children, 285 controls) providing all relevant information. The adjusted mean children's depression inventory (CDI) score of left-behind children was significantly higher than that of controls (P<0.01). Left-behind children's depression risk rate was much higher than control's (P<0.01). Left-behind children had a higher likelihood of depression risk than controls (migrant fathers: adjusted odds ratio (OR)=3.42, 95% confidence interval (CI)=1.86-6.28; migrant mothers: OR=2.62, 95% CI=1.10-6.22; migrant parents: OR=2.73, 95% CI=1.77-4.20). Respondents with low socioeconomic status (SES) (OR=2.64, 95% CI=1.42-4.93) had a higher likelihood of depression risk than the middle SES cohort. With middle levels of social support as the referent, respondents with low levels of social support (OR=5.86, 95% CI=3.90-8.79) had a higher likelihood of depression risk; respondents with high levels of social support (OR=0.50, 95% CI=0.29-0.86) had a lower likelihood of depression risk. The results indicate that the left-behind children are at greater risk for developing depression.

Epidemiology of depression in an urban population of Turkish children and adolescents

BACKGROUND

In Turkey, studies of childhood depression have been limited to those using only scales.

METHODS

This is a two-stage cross-sectional epidemiological study. Three schools in Fatih, Istanbul, Turkey were selected by cluster sampling. The study included 1482 students between the fourth and eighth grades. The Child Depression Inventory (CDI) was used for screening in the first stage. According to test results, 320 children were interviewed using the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version. Depressive disorders were diagnosed in 62 students, constituting the case group. The control group was matched to the case group on school, grade, age, gender, and socioeconomic status (SES).

RESULTS

The prevalence rate was 4.2% for some form of depressive disorder, 1.55% for major depressive disorder, 1.75% for dysthymic disorder, 0.26% for double depression, and 0.60% for depressive disorder-not otherwise specified. According to the logistic regression analysis, increasing age, having a working mother and low maternal education were all positively associated with CDI score. Low SES, perception of paternal health and relations with father as negatively, low popularity and behavior subscales of the Piers-Harris self-concept scale, and high trait anxiety were associated with the presence of a depressive disorder.

LIMITATIONS

Parents were not included in the diagnostic interviews.

CONCLUSIONS

Dysthymic disorder was the most common depressive disorder. Low maternal education, low SES, dysfunctional interaction with the father, anxiety, and low self-esteem, which were all associated with depression, may be the target of interventions for prevention and treatment of depression.

Self-report problem scales and subscales and behavioral ratings provided by peers: unique evidence of test validity

The relationship between children's self-reported problems on the Personality Inventory for Youth (PIY) and peer descriptors derived from the Pupil Evaluation Inventory was examined in a regular education sample of 156 children in fourth through eighth grade. The relative contributions of the PIY scales and subscales to the prediction of peer ratings were compared. Peer ratings of withdrawn, disruptive, and prosocial behaviors were substantially correlated to self-report problem scales made up of logically related content. The addition of more content-specific PIY subscales contributed to the prediction made by PIY scales of peer-reported disruptive behaviors and withdrawal.

Adolescent depression in Trinidad and Tobago

This study investigates depression in adolescents in Trinidad and Tobago and identifies any significant trends associated with its occurrence. A stratified random sample of 1.845 adolescent students from 24 schools was administered a questionnaire requesting demographic information and responses to the Reynolds Adolescent Depression Scale. In all, 14% of the sample was depressed. Depression was 2.18 times more likely to occur in females than males (17.9 % vs. 8.2 %). The peak age was 16 years with a rate of 15.9%. Both attendance at a religious institution and prayer with the family resulted in lower depression rates. Intact families had the lowest rate (11.7 %),while the reconstituted family had the highest rate (25.7 %). Individuals who had alcohol abuse in their family were 1.8 times more likely to be depressed than those without abuse. Adolescents from non-prestige schools were more likely to be depressed than those from prestige schools (p < 0.01). There were no ethnic differences in depression. The findings of this study are comparable to those of developed countries and provide guidelines for the planning and development of strategies for fighting depression in developing countries.

THE CHILDREN'S DEPRESSION INVENTORY AS A RELIABLE MEASURE FOR POST-IRAQI INVASION KUWAITI YOUTH

This study examined the reliability of the Children's Depression Inventory (CDI, in Arabic form Kovacs, 1980) among elementary, middle, and high school students in Kuwait. The subjects (N= 2,299, ages 9–17) were selected from six districts across Kuwait. Children completed the CDI as a depression measurement tool with respect to gender and age. The overall alpha reliability coefficient for the CDI is 0.85. Girls attained higher and statistically more significant mean scores than did their male counterparts. The results indicate that the CDI shows reliability and internal consistency for use in Kuwait as a measure of childhood depression.

Legal decisions of preadolescent and adolescent defendants: predictors of confessions, pleas, communication with attorneys, and appeals

While there is an increasing recognition that developmental differences may exist in legal decision-making, little research has examined this. This study examined the legal judgments of 152 defendants aged 11-17 (73 females, 79 males). Adolescents aged 15 and younger were more likely than older adolescents to confess and waive their right to counsel, and less likely to report that they would appeal their case or discuss disagreements with their attorneys. Also, while adolescents aged 15-17 were more likely to confess, plead guilty, and accept a plea bargain if they perceived that there was strong evidence against them, younger defendants' legal decisions were not predicted by the strength of evidence. Importantly, defendants with poor legal abilities were more likely to waive legal protections, such as the right to counsel and to appeal. Defendants from below-average socioeconomic backgrounds were more likely to waive their interrogation rights, and defendants from ethnic minority groups were less likely to report that they would disclose information to their attorneys. The advice of attorneys, parents, and peers emerged as important predictors of plea decisions. None of the defendants reported that their parents advised them to assert the right to silence during police interrogation.

Adolescent depression in Tobago

The purpose of this study was to investigate the prevalence of depressive symptomatology, major depression and dysthymia in a sample of Tobagonian adolescents. A stratified random sample of 203 adolescent students was selected from three schools in Tobago by random number generation of the total number of schools. The subjects were administered the Reynolds Adolescent Depression Scale (RADS) and the Patient Health Questionnaire (PHQ-9). The ages of the adolescents ranged from 14-18 years (mean 16.3). Females comprised 60% of the sample. Eighty-five percent were Africans, 14% mixed and 1% Indians. Ninety-nine percent belonged to Christian-based religions. Females were more likely to have depressive symptomatology (p < 0.01) and major depression than males (p < 0.05). There were no gender differences in dysthymia. Separate analyses of the RADS and PHQ-9 were consistent with a finding of 10.1% of the sample having a depressive symptomatology and 10.1% suffering from a depressive disorder of which 6.06% were rated as dysthymia and 4.04% as major depression. The rate of adolescent depression in Tobago was 10.1 percent and at the lower range similar to international data of developed countries. This may be explained by the presence of a well-integrated, homogeneous Christian-based society devoid of multiculturalism. The Reynolds Adolescent Depression Scale (RADS) is an effective screening measure for depression in Tobagonian adolescents and can be used in other Caribbean countries. The PHQ-9 can be employed to identify adolescents in the community that meet the criteria for depressive disorders.

Ten-year review of rating scales. II: Scales for internalizing disorders

OBJECTIVE

This article, the second in the Journal's series of 10-year updates on rating scales, summarizes scales assessing internalizing disorders.

METHOD

The authors sampled articles on mood and anxiety disorders over the past 25 years, selected scales with multiple citations over many years, and reviewed their properties. Those with adequate psychometric properties, plus continued wide literature citations or a current special niche, are presented here.

RESULTS

Rating scales for depression were developed and/or examined in the 1980s. Despite generally strong properties, they lack clear construct validity. Most have parent-report forms that broaden their suitability with youths. Anxiety scales were developed bimodally. Those developed in the 1960s to 1970s were downward modifications of adult scales. They have been criticized for unclear constructs and unsuitability for youths. Newer scales developed in the 1990s have addressed these problems and have parent-report forms. However, their utility is still being determined.

CONCLUSIONS

Rating scales can reliably, validly, and efficiently measure youths' internalizing psychopathology. They have great utility in research, treatment planning, and accountability in practice. However, the user must define the goals of measurement, consider the construct the scale measures, and use the scale within its defined capabilities. The use of more than one scale for a task is recommended.

The brief psychiatric rating scale for children (BPRS-C): validity and reliability of an anchored version

OBJECTIVE

Because the accuracy of problems reported by referred children may be compromised by their academic, cognitive, or motivational limitations, clinician rating forms may contribute to the accurate assessment of youth adjustment. One such measure, the 21-item Brief Psychiatric Rating Scale for Children (BPRS-C), received psychometric study to estimate its potential contribution to the measurement of symptom dimensions. BPRS-C reliability and concurrent validity were calculated for youths who were receiving psychiatric services within a medical school department.

METHOD

Five hundred forty-seven children aged 3 to 18 years were rated by faculty or trainees; a subsample of 90 was concurrently rated by two observers. BPRS-C psychometric performance was demonstrated through interrater agreement, factor analysis, and multivariate analyses of variance across seven diagnosis-based groups.

RESULTS

Although items and scales demonstrated substantial reliability and concurrent validity, item factor analysis revealed a few apparent errors in item-to-scale assignment. These errors were minimized by the use of three new second-order factor-derived scales: Internalization, Developmental Maladjustment, and Externalization.

CONCLUSIONS

The BPRS-C can be easily integrated into academic clinical practice and is a reliable and valid method of child description. Additional study of three new BPRS-C factor scales and the application of the BPRS-C to the quantification of clinician observation of child symptomatic status are warranted.

Prevalence of anxiety and depression in Australian adolescents: comparisons with worldwide data

Data from two Australian studies were combined so that the prevalence of anxiety and depression in a large, normative sample of Australian adolescents could be investigated. The combined sample comprised 1,299 adolescents randomly selected from metropolitan and country schools in Melbourne, a large Australian city. The data were examined in order to ascertain the percentages of adolescents who scored above the clinical cut-off on two self-report instruments--the Revised Children's Manifest Anxiety Scale (C. R. Reynolds & B. O. Richmond, 1985) and the Reynolds Adolescent Depression Scale (W. M. Reynolds, 1986). The results of these analyses were then compared with previously reported prevalence rates from studies worldwide. This comparison revealed striking differences in the prevalence of anxiety and depression across different countries and cultures. Limitations attributable to different self-report measures and imposed-etic approaches are discussed. Issues pertaining to social and political climate are also raised.

IDENTIFYING PSYCHOSOCIAL DYSFUNCTION IN SCHOOL-AGE CHILDREN: THE PEDIATRIC SYMPTOM CHECKLIST AS A SELF-REPORT MEASURE

The Pediatric Symptom Checklist (PSC) is a brief, well-validated parent-report questionnaire designed to detect psychosocial dysfunction in school-age children during pediatric primary care visits. This study assessed the utility of the PSC when completed by children (PSC-Y) ages 9-14 in a public school when parents are not available (n = 173). The PSC-Y identified 20% of children as having psychosocial problems, a rate similar to other low-income samples. When compared with teacher ratings of attention and behavior problems, the PSC-Y showed a sensitivity of 94% and a specificity of 88%. The PSC-Y correlated significantly with teacher and parent measures of child dysfunction, and with child-reported symptoms of depression and anxiety. Three quarters of the children identified by the PSC-Y were not identified by parents on the PSC. These children had impairment on all other measures, but fewer than one in five had received mental health services, suggesting the PSC-Y identified children with unmet mental health needs. The PSC-Y has the potential to be a rapid, easily administered tool for large-scale mental health screening in schools.

Performance of the Personality Inventory for Youth validity scales

Response sets as well as cognitive and academic deficits compromise the validity of child and adolescent self-report of emotional adjustment. Three studies using clinical and asymptomatic samples of 4th to 12th grade students detail applications of the four validity scales of the Personality Inventory for Youth (PIY), namely, (a) Validity (VAL) a scale of six highly improbable statements, (b) Inconsistency (INC) consisting of pairs of highly correlated statements, (c) Dissimulation (FB) constructed of statements that were infrequent and characteristic of intentional distortion, and (d) Defensiveness (DEF) an extension of the Lie scale of the parent-report Personality Inventory for Children. The effects of minimizing, malingering, and random response sets on the PIY validity scales are reported. The importance of such validity scales derived from child and adolescent response is discussed.

The phenomenology of homesickness in boys

Homesickness is the distress or impairment caused by an actual or anticipated separation from home. It is characterized by acute longing and preoccupying thoughts of home and attachment objects. This study extended previous research on the phenomenology of childhood homesickness by assessing a sample of 316 boys, ages 8-16, who were spending 2 weeks at a single-sex residential summer camp. Some 18% of the children reported moderate or high levels of homesickness; 7% reported concomitant severe depressive and anxious symptoms. Homesickness intensity was negatively correlated with separation experience and age. It was most commonly associated with depressive symptoms and internalizing behavior problems. For severely homesick boys, intensity increased over time, decreasing just prior to their return home. Preseparation assessment suggested that severely homesick boys had elevated levels of homesickness and negative emotions months before arriving at camp. One-year follow-up data suggested that the intensity of severe homesickness decreased with age and experience. However, severely homesick boys were less likely than other boys to return to camp. The results demonstrate how brief separations can affect children's well-being and attitudes about separations. Severe homesickness is distinct from separation anxiety disorder, but has elements of this and other psychopathologies. Theories of negative emotion, attachment, and coping complement emerging theories of homesickness.