Universal Emotional Health Screening at the Middle School Transition

Associations between Sex, Rumination, and Depressive Symptoms in Late Adolescence: A Four-Year Longitudinal Investigation

OBJECTIVE

The literature on the association between sex, rumination, and depression indicates significant variability from childhood to adulthood. Although this variability indicates the need for a developmental lens, a surprising lack of research has been conducted on the association between these variables from middle to late adolescence.

METHOD

The present study seeks to bridge this gap using structured equation modeling (SEM) to evaluate the reciprocal associations between sex, brooding rumination, reflective rumination, and depressive symptoms in a sample of students measured at 8th grade, 9th grade, and 12th grade time points.

RESULTS

In line with findings across the lifespan, female participants indicated significantly higher average levels of both subtypes of rumination and depressive symptoms versus males. Novel results of this study include the findings that for male participants in this age range, brooding rumination predicted later depressive symptoms, while for female participants, early depressive symptoms predicted later brooding. For female participants, early reflective rumination predicted later depressive symptoms.

CONCLUSIONS

This is the first investigation of its kind to demonstrate deleterious longitudinal effects of self-reflective rumination. Findings are interpreted through an ecological framework and mark the transition to high school as a potential risk for interrupted problem-solving of circumstances related to adolescents' distress.

Latent classes of oppositional defiant disorder in adolescence and prediction to later psychopathology

Current conceptualizations of oppositional defiant disorder (ODD) place the symptoms of this disorder within three separate but related dimensions (i.e., angry/irritable mood, argumentative/defiant behavior, vindictiveness). Variable-centered models of these dimensions have yielded discrepant findings, limiting their clinical utility. The current study utilized person-centered latent class analysis based on self and parent report of ODD symptomatology from a community-based cohort study of 521 adolescents. We tested for sex, race, and age differences in the identified classes and investigated their ability to predict later symptoms of depression and conduct disorder (CD). Diagnostic information regarding ODD, depression, and CD were collected annually from adolescents (grades 6-9; 51.9% male; 48.7% White, 28.2% Black, 18.5% Asian) and a parent. Results provided evidence for three classes of ODD (high, medium, and low endorsement of symptoms), which demonstrated important developmental differences across time. Based on self-report, Black adolescents were more likely to be in the high and medium classes, while according to parent report, White adolescents were more likely to be in the high and medium classes. Membership in the high and medium classes predicted later increases in symptoms of depression and CD, with the high class showing the greatest risk for later psychopathology.

Providing information on mental well-being during audiological consultations: exploring barriers and facilitators using the COM-B model

OBJECTIVE

To identify the barriers and facilitators of hearing healthcare clinicians (HHC) providing information to audiology consumers on (i) the mental health impacts of hearing loss, and (ii) management options for improving mental well-being.

DESIGN

A qualitative study using semi-structured individual and group interviews. Both the interview guide and the deductive process of data analysis were based on the COM-B model (Capabilities, Opportunities and Motivations required for Behaviour change).

STUDY SAMPLE

Fifteen HHCs with between 2 and 25 years of clinical experience (mean 9.3).

RESULTS

Psychological Capability barriers included lack of knowledge relating to mental health signs and symptoms, management options available, referral processes, and resources/tools to assist discussion of options. Social opportunity barriers included clients' lack of openness to receive mental health-related information from their HHC. Automatic motivation factors included feeling uncomfortable and helpless when discussing mental health. Reflective motivation factors included clinician's limiting beliefs concerning their role and responsibilities regarding provision of mental health support, and doubts about whether mental health services are truly beneficial for clients with hearing loss.

CONCLUSION

Application of the COM-B model for behaviour change identified factors that need to be addressed to increase the provision of mental health information in the audiology setting.

The Utility of the Behavior Assessment System for Children-2 Behavioral and Emotional Screening System and Strengths and Difficulties Questionnaire in Predicting Mental Disorders in the Project to Learn About Youth-Mental Health

We examined the predictive utility of the Behavior Assessment System for Children-2 Behavioral and Emotional Screening System (BASC-2-BESS) and Strengths and Difficulties Questionnaire (SDQ) in identifying students with a mental disorder. Data were collected in a two-stage study over 34 months with kindergarten-12th grade (K-12) students (aged 5-19 years) in four U.S. school districts. In Stage 1, teachers completed the BASC-2-BESS and the SDQ. In Stage 2, parents of 1,054 children completed a structured diagnostic interview to determine presence of a mental disorder. Results suggest that teacher versions of the BASC-2-BESS and SDQ have modest utility in identifying children meeting criteria for a mental disorder based on parent report. Area Under the Curve (AUC) statistics representing prediction of any externalizing disorder (.73 for both measures) were higher than the AUCs predicting any internalizing disorder (.58 for both measures). Findings can inform the use of teacher report in mental health screening, specifically the selection of measures when implementing screening procedures.

Implementing School-Based Mental Health Services: A Scoping Review of the Literature Summarizing the Factors That Affect Implementation

Background: Mental illness in children and youths has become an increasing problem. School-based mental health services (SBMHS) are an attempt to increase accessibility to mental health services. The effects of these services seem positive, with some mixed results. To date, little is known about the implementation process of SBMHS. Therefore, this scoping review synthesizes the literature on factors that affect the implementation of SBMHS. Methods: A scoping review based on four stages: (a) identifying relevant studies; (b) study selection; (c) charting the data; and (d) collating, summarizing, and reporting the results was performed. From the searches (4414 citations), 360 were include in the full-text screen and 38 in the review. Results: Implementation-related factors were found in all five domains of the Consolidated Framework for Implementation Research. However, certain subfactors were mentioned more often (e.g., the adaptability of the programs, communication, or engagement of key stakeholders). Conclusions: Even though SBMHS differed in their goals and way they were conducted, certain common implementation factors were highlighted more frequently. To minimize the challenges associated with these types of interventions, learning about the implementation of SBMHS and using this knowledge in practice when introducing SBMHS is essential to achieving the best possible effects with SMBHSs.

Bullying involvement and suicidal ideation in elementary school children across Europe

BACKGROUND

Bullying involvement is associated with suicidal ideation among adolescents, yet there are no studies examining this issue among younger children.

METHODS

The School Children Mental Health in Europe study was conducted in seven countries in 2010 using similar methods to collect cross-sectional data from children, parents, and teachers. Suicidal ideation and thoughts of death were assessed using the Dominic Interactive among children. Parent and teacher reports were used to determine bullying involvement. The sample comprised n = 5,183 children ages 6 to 11 identified as bullies (n = 740, 14.3%), victims (n = 945, 18.2%), bully-victims (n = 984, 18.2%) and not involved in bullying (n = 2,514, 48.5%). Multivariate logistic regressions were used to assess the association of bullying involvement with suicidal ideation and thoughts of death.

RESULTS

Suicidal ideation was reported by 13.3% of those not involved in bullying, 17.1% of victims, 19.6% of bullies and 24.4% of bully-victims. Similarly, thoughts of death were reported by 19.0% of victims, 24.3% of bullies, and 25.0% of bully-victims. Children identified as being involved were more likely than those not involved to report suicidal ideation in bivariate analyses. When controlling for psychopathology and for maternal distress among other factors, the association remained significant for bullies (AOR=1.30, 95%CI=1.01-1.66), bully-victims (AOR=1.54, 95%CI=1.22-1.94), but not for victims (AOR=1.02, 95%CI=0.80-1.30).

LIMITATIONS

The study is cross-sectional. The assessment of bullying may have underestimated victimization.

CONCLUSIONS

The association of bullying involvement and child suicidal ideation is present among elementary school children across Europe, using multiple informants to avoid shared variance biases, and adjusting for key factors.

Screening in High Schools to Identify, Evaluate, and Lower Depression Among Adolescents: A Randomized Clinical Trial

IMPORTANCE

Adolescent major depressive disorder (MDD) prevalence has nearly doubled in the past decade. The US Preventive Services Task Force endorses universal adolescent MDD screening in primary care; however, most adolescents lack preventive health care, resulting in worsening disparities in MDD screening and treatment.

OBJECTIVE

To evaluate the effectiveness of universal adolescent MDD screening in the school setting in an effort to reduce disparities and improve MDD identification and treatment initiation.

DESIGN, SETTING, AND PARTICIPANTS

This randomized clinical trial, conducted from November 6, 2018, to November 20, 2020, compared the usual school practice of targeted or selected screening based on observable behaviors of concern with universal MDD screening. Students within an identified school were randomized by grade to 1 of the 2 study groups. Study groups were compared using mixed-effects logistic regression. Participants included students in grades 9 through 12 enrolled at 1 of the 14 participating Pennsylvania public high schools.

INTERVENTIONS

In targeted screening, students with behaviors prompting concern for MDD were referred to the Student Assistance Program (SAP), mandated in all Pennsylvania schools. The SAP determined follow-up recommendations. In universal screening, all students completed the Patient Health Questionnaire-9 (PHQ-9); students with positive scores proceeded to SAP. The universal screening group could also have targeted referral to SAP for concerning behavior independent of the PHQ-9.

MAIN OUTCOMES AND MEASURES

The primary outcome was initiation of MDD treatment or services based on data collected by school SAP teams during the academic year.

RESULTS

A total of 12 909 students were included (median age, 16 years [range, 13-21 years]; 6963 male [53.9%]), of whom 2687 (20.8%) were Hispanic, 2891 (22.4%) were non-Hispanic Black, 5842 (45.3%) were non-Hispanic White, and 1489 (11.5%) were multiracial or of other race or ethnicity. A total of 6473 students (50.1%) were randomized to universal screening, and 6436 (49.9%) were randomized to targeted screening. Adolescents in the universal screening group had 5.92 times higher odds (95% CI, 5.07-6.93) of being identified with MDD symptoms, 3.30 times higher odds (95% CI, 2.49-4.38) of SAP confirming follow-up needs, and 2.07 times higher odds (95% CI, 1.39-3.10) of initiating MDD treatment. No differences were identified in initiation for planned subgroup analyses by sex or race and ethnicity.

CONCLUSIONS AND RELEVANCE

In this randomized clinical trial, universal school-based MDD screening successfully increased identification of MDD symptoms and treatment initiation among adolescents, confirming the value of this approach to address this rising public health concern.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT03716869.

How Do Audiologists Respond to Emotional and Psychological Concerns Raised in the Audiology Setting? Three Case Vignettes

OBJECTIVES

Emotional and psychological well-being are essential to overall health, but there is little research showing how to approach emotional and psychological concerns in the audiological setting. This study investigated audiologists' self-reported clinical behaviors in response to emotional and psychological concerns and/or symptoms raised by audiology clients.

DESIGN

A sample of 83 Australia-based audiologists completed a survey including vignettes presenting older adults with hearing loss and experiencing symptoms consistent with either depression or grief. Content analysis was used to explore: (1) audiologists' self-reported usual response when clients present with emotional and psychological concerns and/or symptoms in the audiological setting; (2) audiologists' ability to identify and describe psychological symptoms; and (3) audiologists' self-reported clinical behaviors relating to client referral for psychological support.

RESULTS

When asked to describe their usual clinical course of action in response to the vignettes, over one half the audiologists described actions that address the clients concerns related to psychological well-being. Where audiologists described how they would provide psychological support, they described modifications to the audiological rehabilitation program including involving significant others in the rehabilitation process, recommending additional support outside of the audiology setting (such as General Practitioner or psychologists), and providing emotional support and counseling. When prompted, the majority of participants recognized the two cases with depression as having a mental health condition; however, 48% of participants indicated the control case as also having a mental health condition. When asked directly, the majority of audiologists indicated that they would refer the three vignettes for specialist support; however, less than one third described referral to a General Practitioner and less than 5% described referral to a mental health professional as their normal course of action in the open response item. Twenty-five different professions/people were reported as potential sources for referral.

CONCLUSION

These findings support the need for further training and/or resources for audiologists to enable them to appropriately detect, describe and refer for emotional and psychological concerns and/or symptoms raised by clients' in the audiology setting.

Feasibility of School-Based Identification of Children and Adolescents Experiencing, or At-risk of Developing, Mental Health Difficulties: a Systematic Review

Under-identification of mental health difficulties (MHD) in children and young people contributes to the significant unmet need for mental health care. School-based programmes have the potential to improve identification rates. This systematic review aimed to determine the feasibility of various models of school-based identification of MHD. We conducted systematic searches in Medline, Embase, PsycINFO, ERIC, British Education Index, and ASSIA using terms for mental health combined with terms for school-based identification. We included studies that assessed feasibility of school-based identification of students in formal education aged 3-18 with MHD, symptomatology of MHD, or exposed to risks for MHD. Feasibility was defined in terms of (1) intervention fit, (2) cost and resource implications, (3) intervention complexity, flexibility, manualisation, and time concerns, and (4) adverse events. Thirty-three studies met inclusion criteria. The majority focused on behavioural and socioemotional problems or suicide risk, examined universal screening models, and used cross-sectional designs. In general, school-based programmes for identifying MHD aligned with schools' priorities, but their appropriateness for students varied by condition. Time, resource, and cost concerns were the most common barriers to feasibility across models and conditions. The evidence base regarding feasibility is limited, and study heterogeneity prohibits definitive conclusions about the feasibility of different identification models. Education, health, and government agencies must determine how to allocate available resources to make the widespread adoption of school-based identification programmes more feasible. Furthermore, the definition and measurement of feasibility must be standardised to promote any future comparison between models and conditions.

Parent Views on School-Based Depression Screening: Findings From a National Survey

PURPOSE

This study explored parent views on school involvement in screening and identification of adolescent depression.

METHODS

This was a cross-sectional Internet-based survey with the C.S. Mott Children's Hospital National Poll on Children's Health. Of 2,004 parents (63.4% response rate), 770 had a middle/high school student and were eligible for this module. Poststratification weights were generated by survey vendor Ipsos. Descriptive and bivariate results were calculated; multinomial logistic regression models controlled for parent sex, race/ethnicity, education, employment status, and school level.

RESULTS

Parent respondents were 54.8% female, 57.5% white, 64.3% above a high school education, and 79.7% employed; 76.2% were answering based on a high school student. Most parents supported school-based depression screens starting in sixth (46.7%) or seventh (15.1%) grades, although 15.9% responded no screening should be done. Among parent respondents, 93.2% wished to be informed of a positive screen. Regression analysis found parents of middle school students were 4.18 times more likely to prefer sixth versus 9th to 12th grade to start screening.

CONCLUSIONS

Most parents support middle school depression screening but overwhelmingly wished to be informed of a positive result. Guidelines for maintaining adolescent confidentiality in a school-based depression screening program will require careful consideration.

Acceptability and Feasibility of Early Identification of Mental Health Difficulties in Primary Schools: A Qualitative Exploration of UK School Staff and Parents’ Perceptions

One in eight children aged 5–19 years in the UK suffer from a psychiatric disorder, while fewer than 35% are identified and only 25% of children access mental health services. Whilst government policy states that primary schools are well-placed to spot the early warning signs of mental health issues in children, the implementation of early identification methods in schools remains under-researched. This study aims to increase understanding of the acceptability and feasibility of different early identification methods in this setting. Four primary schools in the East of England in the UK participated in a qualitative exploration of views about different methods that might enhance the early identification of mental health difficulties (MHDs). Twenty-seven staff and 20 parents took part in semi-structured interviews to explore current and future strategies for identifying pupils at risk of experiencing MHDs. We presented participants with four examples of identification methods selected from a systematic review of the literature: a curriculum-based approach delivered to pupils, staff training, universal screening, and selective screening. We used NVivo to thematically code and analyse the data, examining which models were perceived as acceptable and feasible as well as participants’ explanations for their beliefs. Three main themes were identified; benefits and facilitators; barriers and harms, and the need for a tailored approach to implementation. Parents and staff perceived staff training as the most acceptable and feasible approach to systematic identification, followed by a curriculum-based approach. Universal and selective screening garnered mixed responses. Findings suggest that a systematic and tailored approach to early identification would be most acceptable and feasible, taking into consideration school context. Teacher training should be a core component in all schools.

Acceptability and Utility of an Open-Access, Online Single-Session Intervention Platform for Adolescent Mental Health

BACKGROUND

Many youths with mental health needs are unable to access care. Single-session interventions (SSIs) have helped reduce youth psychopathology across multiple trials, promising to broaden access to effective, low-intensity supports. Online, self-guided SSIs may be uniquely scalable, particularly if they are freely available for as-needed use. However, the acceptability of online SSI and their efficacy have remained unexamined outside of controlled trials, and their practical utility is poorly understood.

OBJECTIVE

We evaluated the perceived acceptability and proximal effects of Project YES (Youth Empowerment & Support), an open-access platform offering three online SSIs for youth internalizing distress.

METHODS

After selecting one of three SSIs to complete, participants (ages 11-17 years) reported pre- and post-SSI levels of clinically relevant outcomes that SSIs may target (eg, hopelessness, self-hate) and perceived SSI acceptability. User-pattern variables, demographics, and depressive symptoms were collected to characterize youths engaging with YES.

RESULTS

From September 2019 through March 2020, 694 youths accessed YES, 539 began, and 187 completed a 30-minute, self-guided SSI. SSI completers reported clinically elevated depressive symptoms, on average, and were diverse on several dimensions (53.75% non-white; 78.10% female; 43.23% sexual minorities). Regardless of SSI selection, completers reported pre- to post-program reductions in hopelessness (dav=0.53; dz=0.71), self-hate (dav=0.32; dz=0.61), perceived control (dav=0.60; dz=0.72) and agency (dav=0.39; dz=0.50). Youths rated all SSIs as acceptable (eg, enjoyable, likely to help peers).

CONCLUSIONS

Results support the perceived acceptability and utility of open-access, free-of-charge SSIs for youth experiencing internalizing distress.

TRIAL REGISTRATION

Open Science Framework; osf.io/e52p3.

Mechanisms of Change in the Prevention of Depression: An Indicated School-Based Prevention Trial at the Transition to High School

OBJECTIVE

Depression represents a major public health concern, and prevalence increases significantly during adolescence. The high school transition may exacerbate the risk of depression for youth with pre-existing vulnerability. The High School Transition Program (HSTP) is a brief, skills-based intervention that has demonstrated efficacy in preventing depression in adolescents. The current study aimed to evaluate the theorized mechanisms of change of the HSTP intervention by testing a multiple mediation model including school attachment (SA) and self-esteem (SE) as two mediators of treatment outcomes.

METHOD

Students (N= 497; 61.5% girls) with elevated depressive symptoms, identified for the intervention program via an eighth-grade screening, were randomized to a brief intervention (n = 247) or the HSTP (n = 233) from 2003 to 2008. Participants completed measures at five time points. The first assessment occurred at the start of the second semester of eighth grade and the last assessment occurred at the end of ninth grade. A multiple mediation model tested whether SA and SE contributed to changes in depression for youth in the HSTP.

RESULTS

The mediation model, including contemporaneously assessed SE and SA, was not supported. There was evidence of sequential mediation, such that students who participated in the HSTP intervention reported higher SA, which in turn predicted improved SE, and in turn contributed to amelioration of depressive symptoms.

CONCLUSION

The HSTP intervention ameliorated depressive symptoms by targeting factors specific to the school transition (ie, SA). Results suggest youth at risk for depression may benefit from prevention efforts that enhance students' capacity to effectively manage identified environmental stressors, such as school transitions.

CLINICAL TRIAL REGISTRATION INFORMATION

Middle School to High School Transition Project: Depression and Substance Abuse Prevention; https://clinicaltrials.gov/; NCT00071513.

Randomized Trial of a Single-Session Growth Mind-Set Intervention for Rural Adolescents' Internalizing and Externalizing Problems

Adolescents living in rural regions of the United States face substantial barriers to accessing mental health services, creating needs for more accessible, nonstigmatizing, briefer interventions. Research suggests that single-session "growth mind-set" interventions (GM-SSIs)-which teach the belief that personal traits are malleable through effort-may reduce internalizing and externalizing problems in adolescents. However, GM-SSIs have not been evaluated among rural youth, and their effects on internalizing and externalizing problems have not been assessed within a single trial, rendering their relative benefits for different problem types unclear. We examined whether a computerized GM-SSI could reduce depressive symptoms, social anxiety symptoms, and conduct problems in female adolescents from rural areas of the United States. Tenth-grade female adolescents (N = 222, M age = 15.2, 38% White, 25% Black, 29% Hispanic) from 4 rural, low-income high schools in the southeastern United States were randomized to receive a 45-min GM-SSI or a computer-based active control program, teaching healthy sexual behaviors. Young women self-reported depression symptoms, social anxiety symptoms, and conduct problem behaviors at baseline and 4-month follow-up. Relative to the female students in the control group, the students receiving the GM-SSI reported modest but significantly greater reductions in depressive symptoms (d= .23) and likelihood of reporting elevated depressive symptoms (d= .29) from baseline to follow-up. GM-SSI effects were nonsignificant for social anxiety symptoms, although a small effect size emerged in the hypothesized direction (d= .21), and nonsignificant for change in conduct problems (d= .01). A free-of-charge 45-min GM-SSI may help reduce internalizing distress, especially depression-but not conduct problems-in rural female adolescents.

A latent transition analysis of the longitudinal stability of dual-factor mental health in adolescence

Dual-factor models of mental health are increasingly supported but little is known about longitudinal trends in dual-factor mental health. The current study used latent profile analysis (LPA) to empirically identify dual-factor mental health classes at each of Grades 9 through 12 and latent transition analysis (LTA) to examine stability of classes over four academic years. A sample of 875 adolescents from two cohorts reported on their social-emotional strengths and psychological distress. Cross-sectional LPAs for each grade year resulted in four mental health classes: complete mental health, moderately mentally healthy, symptomatic but content, and troubled. An LTA model indicated that the complete mental health class exhibited the most stability, followed by moderately mentally healthy and symptomatic but content classes. The troubled class exhibited the least stability. Less than 24% of participants remained in the same mental health class across all years. Findings support regular monitoring of students' dual-factor mental health to accurately inform mental health promotion, prevention, and intervention efforts.

School-based assessment of mental health risk in children: the preliminary development of the Child RADAR

BACKGROUND

Screening young people for risk of mental health difficulties in schools is an effective method to facilitate monitoring and early intervention. This study is a preliminary report on the adaptation of the Youth RADAR screening instrument for primary school children. Specifically designed to be used in schools, the Child RADAR assesses a child's balance of risk and protective factors known to be associated with the development of mental health problems.

METHOD

Three hundred and thirty-nine children drawn from six primary schools across NSW, Australia, completed the alpha version of the Child RADAR in addition to an assessment of depression and anxiety symptoms and subjective well-being.

RESULTS

Confirmatory factor analysis revealed the Child RADAR to have an acceptable factor structure. Reliability for the Total Child RADAR was satisfactory based on both internal consistency (α = .86) and test-retest reliability (r = .85). Convergent validity was demonstrated through significant associations with symptoms of anxiety and depression.

CONCLUSIONS

The Child RADAR shows preliminary promise as a school-based screener of mental health risk. Further evaluation is required to demonstrate the generalizability of the instrument across different populations.

Self-reported mental health in children ages 6-12 years across eight European countries

Worldwide, approximately one in eight children or adolescents suffers from a mental disorder. The present study was designed to determine the self-reported prevalence of mental health problems in children aged 6-11 years across eight European countries including Italy, France, Germany, the Netherlands, Lithuania, Bulgaria, Romania, and Turkey. Data were drawn from 6245 children participating in the School Children Mental Health in Europe (SCHME) study and a large cross-sectional survey in France. Self-reported child mental health was assessed using the Dominique Interactive (DI). Overall, 22.0% of children were identified per their own evaluation as having at least one mental disorder, ranging from 16.4% in the Netherlands to 27.9% in Bulgaria. The prevalence of internalizing disorders was 18.4% across countries and ranged from 11.8% in the Netherlands to 24.3% in Turkey. The prevalence of externalizing disorders was lower with an average of 7.8%, ranging from 3.5% in Turkey to 10.5% in Bulgaria. Combining samples across European countries, 1 in 5 children reported internalizing problems and 1 in 12 children externalizing problems. The net completion rates of 4.1-74.3% preclude conclusions about national differences in prevalence rates.

Examination of cumulative effects of early adolescent depression on cannabis and alcohol use disorder in late adolescence in a community-based cohort

BACKGROUND AND AIMS

Although they often co-occur, the longitudinal relationship between depression and substance use disorders during adolescence remains unclear. This study estimated the effects of cumulative depression during early adolescence (ages 13-15 years) on the likelihood of cannabis use disorder (CUD) and alcohol use disorder (AUD) at age 18.

DESIGN

Prospective cohort study of youth assessed at least annually between 6th and 9th grades (~ age 12-15) and again at age 18. Marginal structural models based on a counterfactual framework that accounted for both potential fixed and time-varying confounders were used to estimate cumulative effects of depressive symptoms over early adolescence.

SETTING

The sample originated from four public middle schools in Seattle, Washington, USA.

PARTICIPANTS

The sample consisted of 521 youth (48.4% female; 44.5% were non-Hispanic White).

MEASUREMENTS

Structured in-person interviews with youth and their parents were conducted to assess diagnostic symptom counts of depression during early adolescence; diagnoses of CUD and AUD at age 18 was based the Voice-Diagnostic Interview Schedule for Children. Cumulative depression was defined as the sum of depression symptom counts from grades 7-9.

FINDINGS

The past-year prevalence of cannabis and alcohol use disorder at the age 18 study wave was 20.9 and 19.8%, respectively. A 1 standard deviation increase in cumulative depression during early adolescence was associated with a 50% higher likelihood of CUD [prevalence ratio (PR) = 1.50; 95% confidence interval (CI) = 1.07, 2.10]. Although similar in direction, there was no statistically significant association between depression and AUD (PR = 1.41; 95% CI = 0.94, 2.11). Further, there were no differences in associations according to gender.

CONCLUSIONS

Youth with more chronic or severe forms of depression during early adolescence may be at elevated risk for developing cannabis use disorder compared with otherwise similar youth who experience fewer depressive symptoms during early adolescence.

Examining Subtypes of Behavioral/Emotional Risk Using Cluster Analysis

Behavioral and emotional problems among children and adolescents can lead to numerous negative outcomes without intervention. From a prevention standpoint, screening for behavioral and emotional risk is an important step toward identifying such problems before the point of diagnosis or referral. The present study conducted a k-means cluster analysis to determine the subtypes of risk captured by one such screening instrument, the Behavioral and Emotional Screening System (BESS). The final solution produced four clusters: Well-Adapted, Internalizing/Adjustment Problems, Mild Externalizing Problems, and General Problems-Severe; these results were similar to those found with the full Behavioral Assessment System for Children, Second Edition (BASC-2), suggesting that the BESS assesses similar constructs. Predictive validity evidence suggested that cluster membership was associated with standard achievement scores and in-school disciplinary incidents.

Academic Performance in Primary School Children With Common Emotional and Behavioral Problems

BACKGROUND

Many emotional and behavioral problems first emerge in primary school and are the forerunners of mental health problems occurring in adolescence. However, the extent that these problems may be associated with academic failure has been explored less. We aimed to quantify the association between emotional and behavioral problems with academic performance.

METHODS

A stratified random sample of 8- to 9-year-olds (N = 1239) were recruited from schools in Australia. Data linkage was performed with a national assessment of academic performance to assess reading and numeracy. Parent report assessed emotional and behavioral problems with students dichotomized into "borderline/abnormal" and "normal" categories.

RESULTS

One in 5 grade 3 students fell in the "borderline/abnormal" category. Boys with total difficulties (β = -47.8, 95% CI: -62.8 to -32.8), conduct problems, and peer problems scored lower on reading. Numeracy scores were lower in boys with total difficulties (β = -37.7, 95% CI: -53.9 to -21.5) and emotional symptoms. Children with hyperactivity/inattention scored lower in numeracy. Girls with peer problems scored lower in numeracy.

CONCLUSIONS

Boys with emotional and behavioral problems in mid-primary school were 12 months behind their peers. Children with emotional and behavioral problems are at high risk for academic failure, and this risk is evident in mid-primary school.

The utility of single-item readiness screeners in middle school

This study examined the benefit of utilizing one-item academic and one-item behavior readiness teacher-rated screeners at the beginning of the school year to predict end-of-school year outcomes for middle school students. The Middle School Academic and Behavior Readiness (M-ABR) screeners were developed to provide an efficient and effective way to assess readiness in students. Participants included 889 students in 62 middle school classrooms in an urban Missouri school district. Concurrent validity with the M-ABR items and other indicators of readiness in the fall were evaluated using Pearson product-moment correlation coefficients, with the academic readiness item having medium to strong correlations with other baseline academic indicators (r=±0.56 to 0.91) and the behavior readiness item having low to strong correlations with baseline behavior items (r=±0.20 to 0.79). Next, the predictive validity of the M-ABR items was analyzed with hierarchical linear regressions using end-of-year outcomes as the dependent variable. The academic and behavior readiness items demonstrated adequate validity for all outcomes with moderate effects (β=±0.31 to 0.73 for academic outcomes and β=±0.24 to 0.59 for behavioral outcomes) after controlling for baseline demographics. Even after controlling for baseline scores, the M-ABR items predicted unique variance in almost all outcome variables. Four conditional probability indices were calculated to obtain an optimal cut score, to determine ready vs. not ready, for both single-item M-ABR scales. The cut point of "fair" yielded the most acceptable values for the indices. The odd ratios (OR) of experiencing negative outcomes given a "fair" or lower readiness rating (2 or below on the M-ABR screeners) at the beginning of the year were significant and strong for all outcomes (OR=2.29 to OR=14.46), except for internalizing problems. These findings suggest promise for using single readiness items to screen for varying negative end-of-year student outcomes.

Family Communication Styles and Resilience among Adolescents

Some adolescents manage to be resilient, whereas others develop posttraumatic stress disorder (PTSD) symptoms after experiencing trauma, but the mechanisms underlying these differences are unclear. Public secondary school students (N = 98) referred for counseling completed questionnaires assessing exposure to stressful events, family communication, and PTSD. Seventy percent of the sample reported PTSD symptoms in the clinical range. Open family communication was negatively associated with female gender, problem family communication (PFC), and PTSD symptom severity. PFC was positively associated with female gender, number of stressful events, and PTSD symptom severity. Family storytelling style had a negative association with age, PFC, and avoidance symptoms. In the full regression model only the number of life events and PFC appeared to have an independent effect on PTSD symptom severity. Results indicate that exposure to stressful life events and poor family communication are associated with increased risk for PTSD symptoms. Findings may be useful in family-focused approaches to treating adolescents with trauma histories and highlighting the importance of PTSD screening in school-based counseling.

Proactive Parent Engagement in Public Schools: Using a Brief Strengths and Needs Assessment in a Multiple-Gating Risk Management Strategy

This study examined the viability of a brief, parent-reported strengths and needs assessment as the first step in a multiple-gating approach to proactive positive behavior support for families. The Positive Family Support-Strengths and Needs Assessment (PFS-SaNA) was designed to collaboratively engage parents early in the school year in a home-school coordinated Positive Family Support (PFS) system. In this study, we evaluated the reliability and validity of the PFS-SaNA in the context of public middle schools. Findings suggest that the 14-item, unidimensional PFS-SaNA shows convergent validity with teacher ratings of risk. It can be easily and cost-effectively used by school personnel when parents register their children for school at the beginning of each school year.

Childhood Maltreatment Exposure and Disruptions in Emotion Regulation: A Transdiagnostic Pathway to Adolescent Internalizing and Externalizing Psychopathology

Child maltreatment is a robust risk factor for internalizing and externalizing psychopathology in children and adolescents. We examined the role of disruptions in emotion regulation processes as a developmental mechanism linking child maltreatment to the onset of multiple forms of psychopathology in adolescents. Specifically, we examined whether child maltreatment was associated with emotional reactivity and maladaptive cognitive and behavioral responses to distress, including rumination and impulsive behaviors, in two separate samples. We additionally investigated whether each of these components of emotion regulation were associated with internalizing and externalizing psychopathology and mediated the association between child maltreatment and psychopathology. Study 1 included a sample of 167 adolescents recruited based on exposure to physical, sexual, or emotional abuse. Study 2 included a sample of 439 adolescents in a community-based cohort study followed prospectively for 5 years. In both samples, child maltreatment was associated with higher levels of internalizing psychopathology, elevated emotional reactivity, and greater habitual engagement in rumination and impulsive responses to distress. In Study 2, emotional reactivity and maladaptive responses to distress mediated the association between child maltreatment and both internalizing and externalizing psychopathology. These findings provide converging evidence for the role of emotion regulation deficits as a transdiagnostic developmental pathway linking child maltreatment with multiple forms of psychopathology.

Measurement Invariance Testing of a Three-Factor Model of Parental Warmth, Psychological Control, and Knowledge across European and Asian/Pacific Islander American Youth

While the interpretation and effects of parenting on developmental outcomes may be different across European and Asian/Pacific Islander (API) American youth, measurement invariance of parenting constructs has rarely been examined. Utilizing multiple-group confirmatory factor analysis, we examined whether the latent structure of parenting measures are equivalent or different across European and API American youth. Perceived parental warmth, psychological control, and knowledge were reported by a community sample of 325 adolescents (242 Europeans and 83 APIs). Results indicated that one item did not load on mother psychological control for API American youth. After removing this item, we found metric invariance for all parenting dimensions, providing support for cross-cultural consistency in the interpretation of parenting items. Scalar invariance was found for father parenting, whereas three mother parenting items were non-invariant across groups at the scalar level. After taking into account several minor forms of measurement non-invariance, non-invariant factor means suggested that API Americans perceived lower parental warmth and knowledge but higher parental psychological control than European Americans. Overall, the degree of measurement non-invariance was not extensive and was primarily driven by a few parenting items. All but one parenting item included in this study may be used for future studies across European and API American youth.

Suicidal ideation in early to middle adolescence: sex-specific trajectories and predictors

BACKGROUND

The present study examined developmental trajectories of suicidal ideation (SI) and predictors of the course of SI across early to middle adolescence in a sample of 521 children utilizing a prospective longitudinal design.

METHOD

A baseline assessment including structured interviews and parent- and adolescent-reported measures was conducted at age 11-12 years, with follow-up assessments occurring 6, 12, 18, and 36 months later.

RESULTS

Group-based trajectory analyses revealed three groups of individuals, one group that remained at low ideation scores throughout the time period examined, another group with moderate ideation scores and a minority of children who had fluctuating SI. Sex differences in SI trajectories were revealed with the highest SI scores at age 12 for boys. For boys in this group, high ideation followed by a steady decline in the slope over time. SI in girls demonstrated a quadratic function increasing from age 12 to 13, and decreasing from age 14 to 15. Factors that predicted SI group membership were identified. Depression, externalizing problems, family and friend support discriminated SI trajectories for both boys and girls. History of a suicide attempt was associated with moderate- and high-declining ideation groups for boys, and moderate and high ideation group for girls.

CONCLUSIONS

Assessment of SI in adolescents should occur in early adolescents, particularly around the time of school transitions.

Fostering SMART partnerships to develop an effective continuum of behavioral health services and supports in schools

The education sector offers compelling opportunities to address the shortcomings of traditional mental health delivery systems and to prevent and treat youth mental, emotional, and behavioral (MEB) problems. Recognizing that social and emotional wellness is intrinsically related to academic success, schools are moving to adopt multi-tier frameworks based on the public health model that provide a continuum of services to all children, including services to address both academic and MEB problems. In this article, we review the potential value of multi-tier frameworks in facilitating access to, and increasing the effectiveness of, mental health services in schools, and review the empirical support for school-based mental health interventions by tier. We go on to describe a community-academic partnership between the Seattle Public Schools and the University of Washington School Mental Health Assessment, Research, and Training (SMART) Center that exemplifies how multi-tier educational frameworks, research and evidence, and purposeful collaboration can combine to improve development and implementation of a range of school-based strategies focused on MEB needs of students. Finally, we present a set of 10 recommendations that may help guide other research and practice improvement efforts to address MEB problems in youth through effective school mental health programming. (PsycINFO Database Record

Modeling the Impact of School-Based Universal Depression Screening on Additional Service Capacity Needs: A System Dynamics Approach

Although it is widely known that the occurrence of depression increases over the course of adolescence, symptoms of mood disorders frequently go undetected. While schools are viable settings for conducting universal screening to systematically identify students in need of services for common health conditions, particularly those that adversely affect school performance, few school districts routinely screen their students for depression. Among the most commonly referenced barriers are concerns that the number of students identified may exceed schools' service delivery capacities, but few studies have evaluated this concern systematically. System dynamics (SD) modeling may prove a useful approach for answering questions of this sort. The goal of the current paper is therefore to demonstrate how SD modeling can be applied to inform implementation decisions in communities. In our demonstration, we used SD modeling to estimate the additional service demand generated by universal depression screening in a typical high school. We then simulated the effects of implementing "compensatory approaches" designed to address anticipated increases in service need through (1) the allocation of additional staff time and (2) improvements in the effectiveness of mental health interventions. Results support the ability of screening to facilitate more rapid entry into services and suggest that improving the effectiveness of mental health services for students with depression via the implementation of an evidence-based treatment protocol may have a limited impact on overall recovery rates and service availability. In our example, the SD approach proved useful in informing systems' decision-making about the adoption of a new school mental health service.

Examining gene-environment interactions in comorbid depressive and disruptive behavior disorders using a Bayesian approach

OBJECTIVE

The objective of this study was to apply a Bayesian statistical analytic approach that minimizes multiple testing problems to explore the combined effects of chronic low familial support and variants in 12 candidate genes on risk for a common and debilitating childhood mental health condition.

METHOD

Bayesian mixture modeling was used to examine gene by environment interactions among genetic variants and environmental factors (family support) associated in previous studies with the occurrence of comorbid depression and disruptive behavior disorders youth, using a sample of 255 children.

RESULTS

One main effect, variants in the oxytocin receptor (OXTR, rs53576) was associated with increased risk for comorbid disorders. Two significant gene × environment and one signification gene × gene interactions emerged. Variants in the nicotinic acetylcholine receptor α5 subunit (CHRNA5, rs16969968) and in the glucocorticoid receptor chaperone protein FK506 binding protein 5 (FKBP5, rs4713902) interacted with chronic low family support in association with child mental health status. One gene × gene interaction, 5-HTTLPR variant of the serotonin transporter (SERT/SLC6A4) in combination with μ opioid receptor (OPRM1, rs1799971) was associated with comorbid depression and conduct problems.

CONCLUSIONS

Results indicate that Bayesian modeling is a feasible strategy for conducting behavioral genetics research. This approach, combined with an optimized genetic selection strategy (Vrieze et al., 2012), revealed genetic variants involved in stress regulation (FKBP5, SERT × OPMR), social bonding (OXTR), and nicotine responsivity (CHRNA5) in predicting comorbid status.

The internalizing pathway to adolescent substance use disorders: mediation by ruminative reflection and ruminative brooding

Two subtypes of rumination were examined in relationship to substance use and substance use disorders in adolescents. In the 8th and 9th grade, 521 adolescents completed measures assessing depressive symptoms, conduct problems, and reflective and brooding subtypes of rumination. In 12th grade, adolescents reported substance use and were administered the substance use disorders modules from the DISC. Path analyses conducted with data from 428 participants indicated that neither depression nor rumination variables significantly affected the presence of substance use. However, indirect effects of depression through reflection and brooding were differentially related to risk of developing substance use disorders, with brooding positively associated with Marijuana Use Disorders, and reflection negatively related to both Marijuana and Alcohol Use Disorders. Pathways did not differ by sex. These findings suggest that promoting self-reflection may be an effective strategy to prevent and intervene with the development of problematic substance use.

Relationship-specific alcohol expectancies and gender moderate the effects of relationship drinking contexts on daily relationship functioning

OBJECTIVE

Research shows that drinking with one's partner in romantic relationships is associated with positive relationship functioning (e.g., increased intimacy), whereas drinking apart from one's partner is associated with negative relationship functioning (e.g., increased negative behaviors/events). Relationship-specific alcohol expectancies (RSAE) may moderate these associations and illuminate for whom these processes are more positive or negative. The current study tested RSAE as a moderator of the time-lagged daily associations between relationship drinking contexts and next-day relationship functioning in a sample of mostly adult, married, moderate-drinking couples.

METHOD

Both members of 118 couples completed daily diary reports of drinking episodes and positive and negative relationship functioning for up to 56 days. Multilevel models predicted next-day relationship functioning from time-lagged relationship drinking contexts and between-person differences in RSAE and gender.

RESULTS

The results replicate previous research showing decreased negative and increased positive relationship functioning following drinking with (vs. apart from) one's partner. RSAE interacted with gender to moderate the association between drinking-with-partner and next-day positive relationship functioning. Men high in social expectancies and women high in intimacy expectancies reported significantly greater next-day positive relationship functioning following drinking-with-partner. In addition, both men and women high in intimacy expectancies reported significantly greater next-day negative relationship functioning following drinking-apart-from-partner. No effects were found for other RSAE domains.

CONCLUSIONS

These results support and extend prior research showing that women's relationship drinking is associated with intimacy enhancement, whereas among men it is associated with social effects. The current study has implications for future research and theory on relationship-motivated drinking processes.

Early adolescent substance use as a risk factor for developing conduct disorder and depression symptoms

OBJECTIVE

Conduct disorder and depression symptoms are well-established risk factors for substance use during adolescence. However, few investigations have examined whether early substance use increases adolescents' risk of developing conduct disorder/depression symptoms.

METHOD

Using the Developmental Pathways Project sample of 521 middle school students (51.6% male), we tested whether substance use (indicated by alcohol and marijuana use, and use-related impairment) in 8th and 9th grade increased risk of conduct disorder and depression symptoms in 9th and 12th grade over and above prior symptoms. We examined whether associations between substance use and conduct disorder/depression symptoms were consistent across self- or parent-reported symptoms and whether associations were moderated by gender.

RESULTS

Analyses indicated that, over and above prior symptoms, elevated substance use in 8th grade predicted elevated conduct disorder symptoms in 9th grade, and substance use in 9th grade predicted conduct disorder symptoms in 12th grade. In contrast, substance use failed to predict later depression symptoms independent of prior symptoms. These findings were consistent across self- and parent-reported conduct disorder/depression symptoms. With one exception (association between substance use in 8th grade and self-reported conduct disorder symptoms in 9th grade), relations between early substance use and later conduct disorder symptoms did not differ between boys and girls.

CONCLUSIONS

Study findings underscore the unique contribution of substance use during early adolescence to the development of conduct disorder symptoms by late adolescence.

Early adolescent growth in depression and conduct problem symptoms as predictors of later substance use impairment

Most studies of adolescent substance use and psychological comorbidity have examined the contributions of conduct problems and depressive symptoms measured only at particular points-in-time. Yet, during adolescence, risk factors such as conduct problems and depression exist within a developmental context, and vary over time. Though internalizing and comorbid pathways to substance use have been theorized (Hussong et al. Psychology of Addictive Behaviors 25:390-404, 2011), the degree to which developmental increases in depressive symptoms and conduct problems elevate risk for substance use impairment among adolescents, in either an additive or potentially a synergistic fashion, is unclear. Using a school-based sample of 521 adolescents, we tested additive and synergistic influences of changes in depressive symptoms and conduct problems from 6th to 9th grade using parallel process growth curve modeling with latent interactions in the prediction of late adolescent (12th grade) substance use impairment, while examining gender as a moderator. We found that the interaction between growth in depression and conduct disorder symptoms uniquely predicted later substance use problems, in addition to main effects of each, across boys and girls. Results indicated that adolescents whose parents reported increases in both depression and conduct disorder symptoms from 6th to 9th grade reported the most substance use-related impairment in 12th grade. The current study demonstrates that patterns of depression and conduct problems (e.g., growth vs. decreasing) are likely more important than the static levels at any particular point-in-time in relation to substance use risk.

Callous-unemotional traits and conduct disorder symptoms as prospective risk factors for adolescent sexual activity

Conduct disorder (CD) has been shown to increase risk for adolescent sexual activity and pregnancy. Despite increasing evidence underscoring callous-unemotional (CU) traits as a marker for youth with CD prone to especially poor outcomes, researchers have yet to explore whether CU traits confer additional risk of early sexual intercourse, unprotected sex, and pregnancy. The Developmental Pathways Project sample, including 471 ethnically diverse 6th-grade boys and girls followed into 12th grade, was used to examine whether CU traits and CD symptoms in 6th grade uniquely and/or synergistically predicted having sexual intercourse by age 13 as well as unprotected sex and pregnancy by 12th grade. Parent-rated CU traits and CD symptoms interacted to predict young adolescents having sexual intercourse, such that youth with elevated CU traits and CD symptoms in 6th grade were more likely to reporting having sex by age 13 than those with low CU traits and/or low CD symptoms. Elevated CD symptoms, but not CU traits, uniquely increased risk of pregnancy by 12th grade. Neither CU traits nor CD symptoms predicted engagement in unprotected sex in 12th grade. Our findings indicate that adolescents with conduct problems and CU traits are especially at risk for early sexual intercourse. Conversely, elevated CU traits do not appear to increase risk of unprotected sex or pregnancy among young adolescents with conduct problems. Research is needed to replicate these findings and to explore mechanisms underlying the association between CU traits, CD symptoms, and early adolescent sexual activity.

Callous-unemotional traits as unique prospective risk factors for substance use in early adolescent boys and girls

Youth with elevated conduct disorder (CD) symptoms who also have callous-unemotional (CU) traits exhibit more antisocial behavior than youth without CU traits. However, evidence regarding whether CU traits increase risk of substance use over and above CD symptoms, and whether these associations differ for boys and girls, is scarce. Using the Developmental Pathways Project sample of 521 middle school students, we examined whether adolescent- and parent-reported CU traits measured in 6th grade prospectively predicted the onset and recurrence of substance use and use-related impairment by 9th grade. We also examined the degree to which CU traits uniquely predicted substance use and impairment over and above CD symptoms, as well as whether gender moderated these associations. Results indicated that adolescent-reported CU traits increased the likelihood of substance use and impairment onset and recurrence by 9th grade. Analyses revealed that CD symptoms accounted for prospective associations between adolescent-reported CU and substance use, but gender moderated these associations. Boys with elevated CU traits and CD symptoms were not more likely to report alcohol use onset or recurrence, but they were at highest risk of recurrent marijuana use, use of both alcohol and marijuana, and use-related impairment by 9th grade. Girls with low CU traits and high CD symptoms were most likely to report onset and recurrent use of alcohol, as well as recurrent marijuana use, use of both substances and impairment. Study findings highlight the importance of accounting for CD symptoms and gender when examining links between CU traits and substance use in early adolescence.

How to identify students for school-based depression intervention: can school record review be substituted for universal depression screening?

PROBLEM

Early identification and intervention are critical for reducing the adverse effects of depression on academic and occupational performance. Cost-effective approaches are needed for identifying adolescents at high depression risk. This study evaluated the utility of school record review versus universal school-based depression screening for determining eligibility for an indicated depression intervention program implemented in the middle school setting.

METHODS

Algorithms derived from grades, attendance, suspensions, and basic demographic information were evaluated with regard to their ability to predict students' depression screening scores.

FINDINGS

The school information-based algorithms proved poor proxies for individual students' depression screening results. However, school records showed promise for identifying low, medium, and high-yield subgroups on the basis of which efficient screening targeting decisions could be made.

CONCLUSIONS

Study results will help to guide school nurses who coordinate indicated depression intervention programs in school settings as they evaluate options of approaches for determining which students are eligible for participation.

Universal Screening in Middle School

Universal screening is a promising approach for identifying students at risk for behavioral and emotional problems. Due to the frequent adolescent onset of behavioral and emotional problems, middle school is an important time for early identification. This study explored the ability of the Behavioral and Emotional Screening System (BESS) to predict behavioral outcomes (i.e., behavioral grades, suspensions, and office disciplinary referrals) in a sample of 694 middle-school students. Both the teacher and student rated BESS forms were able to significantly predict behavioral outcomes. Findings suggest that the BESS can be an effective tool for identifying students at risk of experiencing behavior problems.

Identifying comorbid depression and disruptive behavior disorders: comparison of two approaches used in adolescent studies

Interest in commonly co-occurring depression and disruptive behavior disorders in children has yielded a small body of research that estimates the prevalence of this comorbid condition and compares children with the comorbid condition and children with depression or disruptive behavior disorders alone with respect to antecedents and outcomes. Prior studies have used one of two different approaches to measure comorbid disorders: (1) meeting criteria for two DSM or ICD diagnoses or (2) scoring .5 SD above the mean or higher on two dimensional scales. This study compares two snapshots of comorbidity taken simultaneously in the same sample with each of the measurement approaches. The Developmental Pathways Project administered structured diagnostic interviews as well as dimensional scales to a community-based sample of 521 11-12 year olds to assess depression and disruptive behavior disorders. Clinical caseness indicators of children identified as "comorbid" by each method were examined concurrently and 3-years later. Cross-classification of adolescents via the two approaches revealed low agreement. When other indicators of caseness, including functional impairment, need for services, and clinical elevations on other symptom scales were examined, adolescents identified as comorbid via dimensional scales only were similar to those who were identified as comorbid via DSM-IV diagnostic criteria. Findings suggest that when relying solely on DSM diagnostic criteria for comorbid depression and disruptive behavior disorders, many adolescents with significant impairment will be overlooked. Findings also suggest that lower dimensional scale thresholds can be set when comorbid conditions, rather than single forms of psychopathology, are being identified.

Developmental consistency in associations between depressive symptoms and alcohol use in early adolescence

OBJECTIVE

Despite frequent theorizing, prior literature on the association between depressive symptoms and alcohol use in adolescence has been inconsistent. Yet studies have varied widely with respect to age at assessments, time frame of prediction, and controls for comorbid conditions and demographic factors. The current study examined whether the associations between depressive symptoms and alcohol use were similar in valence and magnitude over a 4-year period in early adolescence.

METHOD

A sample of 521 young adolescents and their parents were interviewed every year from sixth (Mage = 12.0 years) through ninth grades. At each interview, symptom counts on depressive and conduct disorders were generated from the Diagnostic Interview Schedule for Children. Adolescents also reported on their alcohol use, which was converted to a binary variable. Autoregressive, cross-lagged panel models specifying depressive and conduct disorder symptoms as predictors of alcohol use 1 year later with equality constraints were tested and compared with models allowing path coefficients to vary over time.

RESULTS

For youth self-report, depressive symptoms were positively associated with alcohol use 1 year later over and above conduct problems and earlier alcohol use throughout early adolescence. By parental report, only very early adolescent depressive symptoms (sixth to seventh grades) were associated with alcohol use. Gender did not moderate findings for analyses with self- or parental-report data.

CONCLUSIONS

These results indicate that, even in the context of conduct disorder symptoms, depressive symptoms are important indicators of risk for use of alcohol across early adolescence.

Mental health screening and follow-up care in public high schools

OBJECTIVE

Despite increased interest in screening adolescents for mental health problems and suicide risk, little is known regarding the extent to which youth are identified and connected with appropriate services.

METHOD

Between 2005 and 2009, a total of 4,509 ninth-grade students were offered screening. We reviewed the records of the 2,488 students who were screened. Students identified as being at risk were provided with a referral. Data were collected on screening results, mental health referrals, and completion of recommended treatment over approximately 90 days.

RESULTS

Among students screened, 19.6% were identified as being at risk, 73.6% of whom were not currently receiving any treatment. Students referred for school services tended to be less severely ill than those referred for community services, with lower rates of suicidal ideation, prior suicide attempts, and self-injury. Among at-risk students not currently in treatment, 76.3% of students referred received at least one mental health visit during the follow-up period. Overall, 74.0% of students were referred to school and 57.3% to community services. A great majority of school referrals (80.2%) successfully accessed services, although a smaller proportion of community services referrals successfully accessed treatment (41.9%).

CONCLUSIONS

Systematic voluntary school-based mental health screening and referral offers a feasible means of identifying and connecting high-risk adolescents to school- and community-based mental health services, although linkages to community-based services may require considerable coordination.

Risk for suicidal ideation and suicide attempts associated with co-occurring depression and conduct problems in early adolescence

This study investigates the early manifestation of co-occurring depression and conduct problems as a predictor of heightened risk for later suicidal ideation and behavior in a community sample of 521 adolescents. Self-reported symptoms of depression and conduct problems were evaluated in early 6th grade. Suicidal thoughts and behaviors were tracked through multiple assessments carried out over the middle school years. Compared to adolescents with depression symptoms only, conduct problem symptoms only, or low psychopathology, those with co-occurring depression and conduct problem symptoms had the highest risk for subsequent suicidal ideation, recurrent suicidal behaviors, and suicide attempts.

Identifying adolescents at risk through voluntary school-based mental health screening

This study compares referrals for mental health services among high school students randomized to two means of referral to mental health services: referral via systematic identification through a brief mental health screening procedure (n = 365) or referral via the usual process of identification by school personnel, parents, or students themselves (n = 291). Screened students were significantly more likely than control students (AOR: 21.64 95%CI 6.66-70.36) to receive a referral for mental health services, whether it be to school-based services (AOR: 11.68 95%CI 3.52-8.73) or community-based services (AOR: 20.02 95%CI 2.66-150.41). Post-study, for those screened, 95.5% of school-based mental health services referrals, and 39.3% of community-based referrals were accessed. School based mental health screening identified a significantly greater proportion of youth to be in clinical need of mental health services than would have likely been identified without screening, and increased rates of referral resulted in greater access to mental health services.

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.