Gender differences in associations between depressive symptoms and patterns of substance use and risky sexual behavior among a nationally representative sample of U.S. adolescents

The problem of "just for fun": patterns of use situations among active club drug users

Existing research has demonstrated the significance of situational antecedents to substance use. The current study used a cluster analytic approach to identify groups of club drug users who report using substances in similar situations (assessed by the Inventory of Drug Taking Situations) with longitudinal data from 400 active drug users. A three-cluster solution emerged in baseline data and was replicated in 12-month follow-up data. Groups were identified as Situationally Restricted, Pleasure Driven, and Situationally Broad users. Group differences were observed on measures of mental health, attitudes towards substance use, amount of substance use, and rates of substance dependence. Cluster membership predicted substance dependence after controlling for past dependence, current use, and current depression/anxiety.

Psychiatric disorders and sexual risk among adolescents in mental health treatment

OBJECTIVE

To examine the relationship between psychiatric disorders and sexual behaviors among adolescents receiving mental health treatment. Adolescents in mental health treatment have been found to have higher rates of HIV risk behavior than their peers, but data concerning the relationship between psychopathology and risk are inconsistent and limited.

METHOD

Eight hundred and forty adolescents (56% female, 58% African American, mean age = 14.9 years) and their parents completed computerized assessments of psychiatric symptoms via the Computerized Diagnostic Interview Schedule for Children (Shaffer, 2000a, 2000b). Adolescents also reported on sexual risk behaviors (vaginal/anal sex, condom use at last sex) and completed urine screens for a sexually transmitted infection (STI).

RESULTS

Adolescents meeting criteria for mania, externalizing disorders (oppositional defiant, conduct, and attention-deficit/hyperactivity disorders), or comorbid for externalizing and internalizing disorders (major depressive, generalized anxiety, and posttraumatic stress disorders) were significantly more likely to report a lifetime history of vaginal or anal sex than those who did not meet criteria for any psychiatric disorder (odds ratio [OR] = 2.0, 2.3, and 1.9, respectively). Adolescents meeting criteria for mania were significantly more likely to have 2 or more partners in the past 90 days (OR = 3.2) and to test positive for a STI (OR = 4.3) relative to adolescents who did not meet criteria for a psychiatric disorder.

CONCLUSIONS

The presence of internalizing and externalizing disorders, especially mania, suggests the need for careful screening and targeting of adolescent sexual behavior during psychiatric treatment.

Central American mothers report family history of depression and alcohol abuse as a predictor of teenage health risk behaviors

PURPOSE

The purpose of this study was to explore the relationships of family history of depression and alcohol abuse as a predictor of health risk behaviors among Central American teenagers.

DATA SOURCES

Demographic data were collected from a convenience sample of 101 Central American mothers with a teenage daughter ages 12-17 years who were living in Northern Virginia. The research questions assessed the family history of depression, alcohol abuse, and maternal depression. Scores were calculated to predict risk of teenage health risk behaviors.

CONCLUSIONS

The Hispanic mothers in this study reported that their teenagers had significant health risk behaviors, including school dropout and expulsion, alcohol and substance use, pregnancy, and gang membership. Family history of depression and alcohol abuse in a first degree relative predicted teenage risk behavior 71% of the time.

CLINICAL IMPLICATIONS

There is no consensus on a standard screening approach for depression in teenagers. Developing a standardized approach to gathering information from teenagers that includes genetic family traits may have significant effects on interventions for teenage health risk behavior and ways to provide the best services for vulnerable teenagers. The results of this study have implications for nurse practitioners caring for teenagers.

Evaluating depressive symptom interactions on adolescent smoking prevention program mediators: a mediated moderation analysis

INTRODUCTION

Smoking prevention interventions have been shown to be effective in reducing smoking prevalence in the United States. Further work is needed to address smoking in China, where over one third of the world's current smokers reside. China, with more than 60% of the male population being smokers, also presents a unique opportunity to test cognitive processes involved in depression, social influences, and smoking. Adolescents at-risk for developing depression may process social information differently from low-risk counterparts.

METHODS

The Wuhan Smoking Prevention Trial was a school-based longitudinal randomized controlled trial aimed at preventing initiation and escalation of adolescent smoking behaviors. Thousand three hundred and ninety-one male seventh-grade students were assessed with a 200-item paper-and-pencil baseline survey, and it was readministered 1 year later following program implementation.

RESULTS

Friend prevalence estimates were significantly higher among 30-day smokers and among those at highest risk for depression symptoms. The program appeared to be successful in changing the perception of friend smoking prevalence only among adolescents with a comorbidity of high scores of depression symptoms and who have experimented previously with smoking. This Program x Comorbidity interaction on perceived friend smoking prevalence was significant in predicting 30-day smoking 1 year after program implementation.

CONCLUSIONS

This study provides evidence that those adolescents with high levels of depressive symptoms may be more sensitive to social influences associated with smoking prevalence. Individual Disposition x Social Environmental Influences may be important when developing future effective prevention programming.

High prevalence of affective disorders among adolescents living in Rural Zimbabwe

Poor mental health accounts for considerable disease burden among young people globally. We investigated the prevalence and determinants of affective disorders among rural Zimbabwean youth in 2006. We undertook a cross-sectional survey among 1495 Zimbabwean youth aged 15-23 (median 18) from 12 rural communities in three provinces in south-eastern Zimbabwe. Mental health was assessed using the Shona Symptom Questionnaire (SSQ), a locally validated 14-item indigenous screening tool for affective disorders, notably depression and anxiety disorders. Participants scoring >or=8/14 were considered at risk of being affected and >or=11 as at risk of being severely affected. Most participants (93.1%) completed the SSQ. Of these, 51.7% (95%CI:49.0-54.3%) scored >or=8/14 and 23.8% (95%CI:21.5-26.0%) scored >or=11. Affective disorders were independently associated with household poverty (adjusted odds ratio (AOR) 1.9, 95%CI:1.4-2.7), living in a female-headed household (AOR 1.3, 95%CI:1.0-1.7), having moved home within last 5 years (AOR 1.4, 95%CI:1.0-1.9) and feeling stigmatized (AOR being shunned by others 3.7, 95%CI:2.5-5.7). There was a strong linear association between risk of affective disorders and sexual risk taking (ever sex AOR 1.5, 95%CI:1.0-2.4, and 2.8, 95%CI:1.9-4.2 for affected and severely affected, respectively, test for trend P < 0.001; >or=2 lifetime partners AOR 2.3, 95%CI:1.1-4.8 and 5.4, 95%CI:2.7-10.7, test for trend P < 0.001). This study indicates high levels of psychological morbidity among rural Zimbabwean youth which was associated with sexual risk taking. Interventions to prevent, identify and treat mental health disorders in this vulnerable population are urgently required. In HIV-endemic countries, such interventions may also help reduce HIV transmission.

Associations of risk of depression with sexual risk taking among adolescents in Nova Scotia high schools

OBJECTIVE

Several interrelated factors, including depression, influence adolescents' chances of risky sexual behaviour. We examined the relation between depression and sexual risk-taking behaviours in adolescents after accounting for the effects of other variables.

METHOD

We surveyed male (n = 1120) and female (n = 1177) adolescents at 4 high schools in central Nova Scotia, measuring factors known to be associated with sexual risk taking. Risk of depression was assessed using the Center for Epidemiologic Studies Depression Scale. Outcomes were self-reported sexual behaviours. We used logistic regression to assess associations of multiple factors with sexual risk taking.

RESULTS

In univariate analyses, risk of depression was associated with 3 risk-taking behaviours for females (being sexually active, having unplanned sex when using substances, and not using effective contraception at last intercourse) and 2 for males (having unplanned sex when using substances and having more than 1 partner in the previous year). In full multivariate models, risk of depression in females remained significantly associated with unplanned sex and nonuse of effective contraception at last intercourse, but was no longer associated with being sexually active. For males, both associations remained significant.

CONCLUSIONS

Risk of depression is consistently and independently associated with adolescent sexual risk behaviours after adjusting for other variables. Health care providers working with teenagers should screen for risky sexual behaviours and sexually transmitted infections if depression is apparent in their patients.

Individual, familial, friends-related and contextual predictors of early sexual intercourse

This study examined the unique and simultaneous contribution of adolescents' characteristics, parent-child relationship and friends' characteristics on early sexual intercourse, while accounting for family status. A longitudinal multi-sample design was used. The first sample was recruited in a suburban context (n = 265; 62% girls) and the second sample in an urban setting (n = 136; 61% girls). All predictors were measured in Grade 8 and age at first intercourse was assessed yearly for three years. Being in a non-intact family, low parental control, high antisocial behaviors, low self-disclosure, high proportion of other-sex friends and high substance use were associated with earlier sexual intercourse. When all predictors were considered simultaneously, more antisocial behaviors, high proportion of other-sex friends and non-intact family structure significantly discriminated youth reporting first intercourse at age 13 or less from those who reported first intercourse at age 14, at age 15, or were virgins at age 16 among both samples.

Relationship between mental disorders/suicidality and three sexual behaviors: results from the National Comorbidity Survey Replication

The present study examined the relationship between sexual behaviors and mental disorders and suicidality in the National Comorbidity Survey Replication, a representative sample of adults ages 18 years and older (N = 5,692). The World Health Organization Composite International Diagnostic Interview was used to make DSM-IV based disorder diagnoses. Participants were also asked about suicidality and sexual behaviors. Multiple logistic regression analyses adjusted for sociodemographic variables were used to examine the relationships of three sexual behaviors (age of first intercourse, number of past year partners, and past year condom use) with 15 mental disorders (clustered into any mood, anxiety, substance use, and disruptive behavior groups) and suicidality (ideation and attempts). Compared to ages 15-17, those with age of first intercourse between 12 and 14 had increased rates of lifetime disruptive behavior, substance use, and any mental disorder, and suicidal ideation and attempts (adjusted odds ratio (AOR) range, 1.46-2.01). Those with age of first intercourse between ages 18-25 and 26-35 were at decreased likelihood of several lifetime disorder groups (AOR range, 0.19-0.81). Individuals who had two or more sexual partners in the past year had increased rates of all past year disorder groups examined (AOR range, 1.44-5.01). Never married participants who rarely/never used condoms were more likely than those who always used condoms to experience any mood, substance use, and any mental disorder, and suicide attempts (AOR range, 1.77-8.13). Future research should longitudinally examine these associations and account better for possible familial and personality confounders.

Maternal deprivation induces depressive-like behaviours only in female rats

Maternal deprivation (MD) has been developed to study the effects of early adverse experiences on behaviour and neurobiology. It has been proposed to represent a potential animal model of major depression. The purpose of our study was to examine the responses induced by MD in male and female adult Long-Evans rats in tasks designed to explore depressive-like behaviours (forced swimming test (FST), repeated open space swim test (OSST), sucrose solution consumption) and in the novel object recognition and object location tasks. A consistent sexual dimorphism was observed in the responses of male and female rats that underwent MD. In male rats, MD led to increased transitions between behaviours in the FST and increased consumption and preference for sucrose (1%) in comparison with non-deprived rats. In female rats, MD induced a decreased swimming activity on the second day of the OSST and reduced the cognitive performance in an object location task. In both sexes, MD did not alter the swimming activity in the FST and the performance in a novel object recognition task. These divergent responses in male and female rats can be related to the gender differences which exist in depression. However, due to the low amplitude of responses obtained in our study, the MD model in Long-Evans rats does not seem to mimic symptoms of major depression. In contrast, our present results suggest the use of the MD model, especially in females, as a model of the dysthymia, a mild chronic-depressive condition, which has been related to poorer maternal relationship.

Possible insomnia predicts some risky behaviors among adolescents when controlling for depressive symptoms

This study investigated whether previously reported links between sleep and risk taking among adolescents (E. M. O'Brien & J. A. Mindell, 2005) are associated-concurrently, longitudinally, or both-with sleep or underlying depression. The present study analyzed data from a nationally representative sample of 4,353 adolescents in the United States who had participated in Waves I and II of the National Longitudinal Study of Adolescent Health (J. R. Udry, 1998). In the present study, grade, gender, depressive symptoms, and possible insomnia served as predictor variables to calculate the odds ratios for 4 categories of risky behaviors. After the authors accounted for other predictors, possible insomnia significantly predicted smoking, delinquency (within each wave but not longitudinally), and drinking and driving (Wave II and longitudinally). Possible insomnia may contribute to some types of risky behaviors over the effects of depressive symptoms.

Preventing substance use among adolescent girls: 1-year outcomes of a computerized, mother-daughter program

This study tested a computerized gender-specific, parent-involvement intervention program grounded in family interaction theory and aimed at preventing substance use among adolescent girls. Following program delivery and 1 year later, girls randomly assigned to the intervention arm improved more than girls in a control arm on variables associated with reduced risks for substance use, including communication with their mothers, knowledge of family rules about substance use, awareness of parental monitoring of their discretionary time, non-acceptance of peer substance use, problem-solving skills, and ability to refuse peer pressure to use substances. Relative to control-arm girls, those in the intervention arm also reported less 30-day use of alcohol and marijuana and lower intentions to smoke, drink, and take illicit drugs in the future. Girls' mothers in the intervention arm reported greater improvements after the program and relative to control-arm mothers in their communication with their daughters, establishment of family rules about substance use, and monitoring of their daughters' discretionary time. Study findings lend support to the potential of gender-specific, parent-involvement, and computerized approaches to preventing substance use among adolescent girls.

Depression, sexually transmitted infection, and sexual risk behavior among young adults in the United States

OBJECTIVE

To measure associations among depression, sexual risk behaviors, and sexually transmitted infection (STI) among white and black youth in the United States.

DESIGN

Analysis of prospective cohort study data. Wave I of the National Longitudinal Study of Adolescent Health occurred in 1995 when participants were in grades 7 through 12. Six years later, all Wave I participants who could be located were invited to participate in Wave III and to provide a urine specimen for STI testing.

SETTING

In-home interviews in the continental United States, Alaska, and Hawaii.

PARTICIPANTS

Population-based sample. A total of 10 783 Wave I (adolescence) and Wave III (adulthood) white and black respondents with sample weight variables. Main Exposures Chronic depression (detected at Waves I and III) and recent depression (detected at Wave III only) vs no adult depression (not detected at Wave III).

OUTCOME MEASURES

Multiple sexual partners and inconsistent condom use in the past year and a current positive test result for Chlamydia trachomatis, Neisseria gonorrhoeae, or Trichomonas vaginalis (adulthood).

RESULTS

Recent or chronic depression in adulthood was more common for blacks (women, 19.3%; men, 11.9%) than for whites (women, 13.0%; men, 8.1%). Among all groups (white men and women, and black men and women), adult depression was associated with multiple partners but not with condom use. Among black men, depression was strongly associated with STI (recent: adjusted prevalence ratio, 2.36; 95% confidence interval, 1.26-4.43; chronic: adjusted prevalence ratio, 3.05; 95% confidence interval, 1.48-6.28); having multiple partners did not mediate associations between depression and STI.

CONCLUSIONS

Integration of mental health and STI programs for youth is warranted. Further research is needed to elucidate how depression may influence the prevalence of STI among black men.

Depressive symptoms and sexual risk behavior in young, chlamydia-infected, heterosexual dyads

PURPOSE

To examine associations between depressive symptoms and dyad-level sexual risk behavior in young heterosexual dyads with sexually transmitted infection (STI).

METHODS

Chlamydia-positive 14-24-year-old, heterosexually active outpatients and their opposite-sex partners completed an assessment that included demographics, past and recent STI risk behaviors, and the Beck Depression Inventory (BDI). Participants in the top 25% of BDI scores within gender were categorized as depressed. Variables were created to identify dyads in which the female or male partner was depressed, as well as a measure of concordance of depression between partners. Dyad-level STI risk variables were created from the STI risk characteristics reported by each dyad member, and associations between these and the depression variables were analyzed.

RESULTS

The 130 dyads were comprised of young men and women at high STI risk. One-third of dyads had at least one depressed partner. Dyads in which the female partner was depressed had greater partner age difference, greater total number of lifetime partners, and one or more partners reporting substance use within 2 hours before sex, compared with dyads in which the female partner was not depressed. Dyads in which the male partner was depressed were more likely than the nondepressed-male dyads to report substance use before sex. All dyads in which both partners were depressed reported substance use before sex.

CONCLUSIONS

In young, chlamydia-infected, heterosexual dyads, depressive symptoms, especially in women, is related to increased dyad-level STI risk, including greater partner age difference, more partners, and substance use before sex.

Gender differences in adolescent substance abuse

Gender differences in the epidemiology, comorbidities, and treatment responses of substance abuse have been described in adults. However, a growing body of data suggests that gender differences also exist in adolescents with substance abuse. Unfortunately, research is still limited in this age group. This article reviews gender differences in the diagnosis, presentation, course of illness, and treatment response of substance abuse in adults and adolescents. Adolescent substance abuse treatments that take into account these gender differences are also discussed.

The Effect of Positive Adolescent Life Skills Training on Long Term Outcomes for High-Risk Teens

This paper reports on long term follow-up data-12 months post intervention-from a clinical trial of an intervention designed to enhance teen resilience by supporting the development of social skills needed to make positive connections and overcome the influence of negative environmental influences. Sixteen adolescents aged 12 to 16 (10 boys and 6 girls) attending an inner city urban secondary school participated in a 32 week intervention study. Subjects were randomly assigned within sex to Teen Club plus Positive Adolescent Life Skills (PALS) or Teen Club intervention groups. The Problem Oriented Screening Instrument for Teenagers (POSIT) was used to measure the dependent variables (problems related to substance use, health, mental health, family relations, peer relations, education status, vocational status, social skills, leisure and recreation, and aggression). The small sample size limited the ability to determine statistical differences between the POSIT subscale scores for PALS plus Teen Club or Teen Club only interventions. Descriptive data suggest mixed results for both interventions and sex groups. Most important were reductions in mental health problems for all boys in both groups and only slightly increased numbers of problems in substance use for PALS boys and girls over time. Other trends by group and sex are reported.

Health risk behaviors in adolescents with chronic conditions

OBJECTIVE

The objective of this study was to compare the frequency of risk behaviors and to measure the extent of co-occurrence of these behaviors in chronically ill and healthy adolescents.

METHODS

Data were drawn from the 2002 Swiss Multicenter Adolescent Survey on Health database, a nationally representative survey of 7548 adolescents in postmandatory school aged 16 to 20 years. There were 760 subjects who reported a chronic illness and/or a disability. The comparison group consisted of 6493 subjects who answered negatively to both questions. We defined 8 risk behaviors: daily smoking, alcohol misuse, current cannabis use, current use of any other illegal drug, early sexual debut, eating disorder, violent acts, and antisocial acts. We analyzed each behavior and the sum of behaviors, controlling for age, gender, academic track, parents' education level, depression, and health status. Results are given as adjusted odds ratios using the comparison group as the reference category.

RESULTS

Youth with a chronic condition were more likely to smoke daily, to be current cannabis users, and to have performed violent or antisocial acts. Youth with a chronic condition were also more likely to report 3 or >or=4 risk behaviors.

CONCLUSIONS

These results indicate that having a chronic condition carries additional risks for engaging in health risk behaviors and emphasize the importance of health risk screening and preventive counseling for young people in general and among those suffering from chronic conditions in particular.

The effect of adolescent virginity status on psychological well-being

Although previous research has found that sexually active teens are more likely to suffer from depression, it is not clear whether this association is causal or spurious in nature. This study uses data from the National Longitudinal Study of Adolescent Health to examine whether virginity status affects self-esteem and depression. For males, fixed effects and instrumental variables (IV) estimates provide little evidence that sex is causally related to psychological well-being. In contrast, IV estimates indicate that sexually active female adolescents are at increased risk of exhibiting the symptoms of depression relative to their counterparts who are not sexually active. Comparing the psychological well-being of females who used contraception at last intercourse with that of virgins suggests that these effects may be ameliorated, but not eliminated, by contraceptive use.

Timing of sexual debut and initiation of postsecondary education by early adulthood

CONTEXT

Although sexual debut has been negatively associated with adolescent educational performance and aspirations, it is not clear whether such relationships continue beyond adolescence.

METHODS

Initiation of postsecondary education by young adulthood was assessed among 3,965 participants in the National Longitudinal Study of Adolescent Health who had not experienced sexual intercourse at baseline. Associations between age at sexual debut and educational progress were examined in bivariate and multivariable Poisson regression analyses.

RESULTS

Most respondents experienced sexual debut during adolescence: 15% before age 16 (early) and 53% at ages 16-18 (typical). Sixty-five percent of respondents initiated postsecondary education by early adulthood; however, the proportion was significantly lower among those who had had an early (49%) or typical sexual debut (63%) than among those who debuted late (78%). In unadjusted analyses, early and typical debut were associated with a reduced likelihood of initiation of postsecondary education for both females (relative risk ratios, 0.6 and 0.8, respectively) and males (0.7 and 0.8). However, in adjusted analyses, the associations were attenuated for females (0.8 and 0.9) and were at best marginally significant for males. Childbearing was a significant mediator of this relationship.

CONCLUSIONS

Adolescent sexual debut appears to be modestly negatively associated with early adult postsecondary education initiation, particularly for females. Targeting mediators of the sexual debut-education relationship, such as early childbearing, could lead to effective interventions.

Predicting sexual risk behaviors among adolescent and young women using a prospective diary method

We describe the sexual risk behaviors, psychological distress, and substance use of 102 late adolescent girls and identify predictors of protected and unprotected vaginal sex. Participants completed questionnaires assessing hypothesized predictors and then daily behavioral diaries for 12 weeks. Protected intercourse was predicted by baseline sexual behavior, greater knowledge, positive condom attitudes, lower perceived condom-use difficulty, greater condom-use intentions, more drinking days, less binge drinking, less Ecstasy use, and lower psychological distress. Unprotected intercourse was predicted by baseline sexual behavior, binge drinking, Ecstasy and opiate use, fewer drinking days, and fewer daily drinks. These findings suggest that psychological distress, substance use, and sexual risk behavior are interconnected and should be considered collectively in interventions for adolescent females.

Sexual Debut Timing and Depressive Symptoms in Emerging Adulthood

The association between sexual debut timing and depressive symptomatology in adolescence and emerging adulthood was examined using data from Waves I, II and III of the National Longitudinal Study of Adolescent Health. Respondents who reported never having sexual intercourse at Wave I and were 18-22 years of age at Wave III were included (n=5,061). Twenty percent of respondents experienced early (<age 16) and 49% experienced typical (ages 16-18) sexual debut. In bivariate analyses, pre-debut depressive symptoms were associated with earlier sexual debut among female but not male adolescents. In models adjusting for demographic characteristics and pre-debut depressive symptoms, sexual debut was positively related to adolescent (Wave II) depressive symptomatology, but only among female adolescents age less than sixteen. However, sexual debut timing was unassociated with emerging adult (Wave III) depressive symptomatology for both male and female respondents. Findings suggest sexual debut timing does not have implications for depressive symptomatology beyond adolescence.

Substance use disorders among adolescents with bipolar spectrum disorders

OBJECTIVE

We set out to examine the prevalence and correlates of substance use disorders (SUD) in a large sample of adolescents with bipolar disorder (BP).

METHODS

Subjects were 249 adolescents ages 12 to 17 years old who fulfilled DSM-IV criteria for bipolar I disorder [(BPI), n = 154], or bipolar II disorder [(BPII), n = 25], or operationalized criteria for BP not otherwise specified [(BP NOS), n = 70], via the Schedule for Affective Disorders and Schizophrenia for School-Aged Children (K-SADS). As part of the multi-site Course and Outcome of Bipolar Youth study, demographic, clinical, and family history variables were measured via intake clinical interview with the subject and a parent/guardian.

RESULTS

The lifetime prevalence of SUD among adolescents with BP was 16% (40/249). Results from univariate analyses indicated that subjects with, as compared to without, SUD were significantly less likely to be living with both biological parents, and that there was significantly greater lifetime prevalence of physical abuse, sexual abuse, suicide attempts, conduct disorder, and posttraumatic stress disorder among subjects with SUD. Subjects with SUD reported significantly greater 12-month prevalence of trouble with police, and females with SUD reported significantly greater 12-month prevalence of pregnancy and abortion. Significant predictors of SUD in a logistic regression model included living with both biological parents (lower prevalence), conduct disorder and suicide attempts (increased prevalence). In logistic regression analyses controlling for demographic differences and conduct disorder, SUD remained significantly associated with trouble with police, whereas the association of SUD with pregnancy and abortion was reduced to a statistical trend. The prevalence of SUD was not significantly different among child- versus adolescent-onset BP subjects.

CONCLUSIONS

SUD among adolescents with BP is associated with profound hazards including suicide attempts, trouble with police, and teenage pregnancy and abortion.

Cardiovascular disease risk factors in adolescents: do negative emotions and hypothalamic-pituitary-adrenal axis function play a role?

PURPOSE OF REVIEW

Negative emotions such as depression and hostility/anger are important risk factors for cardiovascular disease in adults, but are often neglected in treatment or prevention programs. Adolescence is a stage of life when negative emotions often first become problematic and is also a time when the pathogenesis of cardiovascular disease appears to accelerate. The literature on negative emotions and cardiovascular disease risk factors in adolescents is reviewed here.

RECENT FINDINGS

Research indicates that negative emotions are associated with cardiovascular disease risk factors in adolescence. Negative emotions are also associated with several types of hypothalamic-pituitary-adrenal axis dysregulation. Such dysregulation appears to have a facilitatory effect on cardiovascular disease development and progression in adults. Thus, it is possible that negative emotions in adolescents may be risk factors for the development of cardiovascular disease via dysregulation of the hypothalamic-pituitary-adrenal axis. Although this hypothesis has not been directly tested, some studies indirectly support the hypothesis.

SUMMARY

Negative emotions are associated with cardiovascular disease risk factors in adolescents; it is possible that hypothalamic-pituitary-adrenal axis dysregulation is an important mechanism. This hypothesis merits further research. If the hypothesis is valid, it has significant implications for early prevention of cardiovascular disease.

Early initiation of substance use and subsequent risk factors related to suicide among urban high school students

OBJECTIVE

To examine the association between onset of substance use and risk factors related to suicide.

METHOD

1252 adolescents in two urban school districts completed surveys as part of a large, randomized controlled prevention effectiveness trial. Risk factors measured included depressive symptoms, suicide ideation, suicide ideation specifically with alcohol and/or drug use, endorsement of suicide as a personal option, and suicide attempt.

RESULTS

In our final multivariate models that controlled for current substance use and demographic characteristics, we found that earlier onset of hard drug use among boys was associated with all five suicide risk factors. In comparison, among girls, earlier onset of regular cigarette smoking, getting drunk, and hard drug use was associated with some of suicide risk factors.

CONCLUSIONS

The findings confirm the importance of screening for substance use in early adolescence. The association between early substance use and suicide risk factors differed by gender; both research and intervention efforts need to incorporate gender differences.

Association of sexual abstinence in adolescence with mental health in adulthood

We examined whether adolescent sexual abstinence predicts better adult mental health. 1,917 adolescents, recruited from middle schools at age 13, were surveyed at ages 13, 18, 23, and 29. In bivariate analyses, adolescent sexual abstinence was associated with better mental health at age 29 for females, but not males; three adolescent factors, educational prospects, family bonding, and unconventionality were investigated as explanatory variables of this relationship. The abstinence-mental health relationship was nonsignificant when educational prospects was included in multivariate models, and marginally significant when family bonding and unconventionality were included; all three explanatory factors accounted for significant proportions of the variance in adult mental health. Girls who are uninvolved in school, have weak family backgrounds, and exhibit unconventionality may have poor adult mental health, whether or not they abstain from sex in adolescence. Interventions that strengthen adolescents' connections to families and schools may reduce risk for long-term mental health problems.

Factors associated with recruitment and screening in the Treatment for Adolescents With Depression Study (TADS)

OBJECTIVE

To examine factors associated with eligibility and randomization and consider the efficiency of recruitment methods.

METHOD

Adolescents, ages 12 to 17 years, were telephone screened (N = 2,804) followed by in-person evaluation (N = 1,088) for the Treatment for Adolescents With Depression Study. Separate logistic regression models, controlling for site, examined whether sex, age, race, or source of recruitment was associated with eligibility, providing written consent, or randomization. Efficiency was calculated from the number of completed telephone screens per each enrolled participant.

RESULTS

Older adolescents were less likely to be eligible at telephone screening (odds ratio [OR] 0.81). Regardless of race, eligible adolescents who were referred by a professional had higher odds of presenting in-person for consent (OR 1.56). African Americans had statistically lower odds of providing consent (OR 0.67), particularly if recruited by advertisement (OR 0.54). Females were more likely to be diagnosed with major depressive disorder (OR 1.69). No significant differences were found between randomized participants and eligible adolescents who withdrew from the study before randomization.

CONCLUSIONS

These findings underscore the importance of using multiple strategies to recruit adolescents for clinical trial participation and enhancing sensitivity to cultural variations, especially when reaching out to depressed African Americans.

Gender differences in trajectories of depressive symptomatology and substance use during the transition from adolescence to young adulthood

This study examines gender differences in the association between symptoms of depression and substance use during the transition from adolescence to young adulthood. Data are from three waves of the US-based National Longitudinal Study of Adolescent Health (n=10,828). Results from latent growth curve analysis demonstrate that the association between depressive symptomatology and substance use is bi-directional. Adolescents who are initially more depressed begin the study period with substantially higher levels of substance use than their better-adjusted peers, yet they are less vulnerable to increases in smoking (girls only), binge drinking (girls and boys), and illicit drug use (girls only) across the transition to young adulthood. Also, adolescents who start out with higher than average cigarette, alcohol, and illicit drug use experience a faster rate of decline in symptoms of depression over time compared to those who start out with lower levels of substance use. This association appears to be more pronounced for girls than for boys. Despite their faster rate of decline in depressive symptoms, girls and boys who have higher initial levels of substance use report higher levels of depressive symptomatology at all three time points.

Gender differences of acute and chronic administration of dehydroepiandrosterone in rats submitted to the forced swimming test

Previous pre-clinical and clinical studies investigating the antidepressant potential of DHEA revealed conflicting results. In this study, the effects of exogenous DHEA on performance in the forced swimming test (FST) were examined in male and female Wistar rats in different phases of the estrous cycle. Furthermore, the effects of treatment and of the FST, on corticosterone and DHEA serum levels were investigated. Acute administration of DHEA (2 mg/kg) significantly increased freezing only in proestrus female rats. Similarly, the chronic administration of DHEA (2 mg/kg) increased freezing duration and decreased climbing behavior but only in females in diestrus II compared to those given vehicle. These results demonstrate that chronically administered DHEA induces a depressant-like effect, and this effect is sex dependent. There was no direct correlation between corticosterone levels or the corticosterone/DHEA ratio and the behaviors studied. After the FST, serum DHEA and corticosterone levels were increased, with females showing higher DHEA levels than males. Nevertheless, corticosterone levels were unaltered with chronic procedure; an effect that was independent of sex and treatment. These findings are relevant for research examining alternative treatment for depression and may elucidate the gender differences involved in stress-related diseases.