Gender differences in adolescent depression: do symptoms differ for boys and girls?

The presentation of depression symptoms in attention-deficit/hyperactivity disorder: comparing child and parent reports

BACKGROUND

Attention-deficit/hyperactivity disorder (ADHD) frequently co-occurs with depression, and outcomes are poor when both are present. Little is known about whether depression symptoms present differently in ADHD compared to the general population, or how reliable young people with ADHD are at reporting these symptoms. This study aimed to describe depression symptoms in a clinical ADHD sample compared to a population sample, and compare self-reports of depression symptoms with parent-reports.

METHODS

Two hundred and forty-nine children with ADHD and their parents completed follow-up questionnaires around 5 years after taking part in a Cardiff University ADHD study. Child depression symptoms were measured using parent- and child-reported Mood and Feelings Questionnaires (MFQ) and compared to a population sample with MFQ data (n = 1460). Within both samples, child- and parent-reported depression symptoms were compared.

RESULTS

Although the profile of depression symptoms was similar between young people with ADHD and those in the general population, depression symptoms were much more common in the ADHD sample (parent-rated MFQ score = 24.52 vs. 9.39; child-rated = 21.02 vs. 11.86). The most common symptoms in both samples included irritability, restlessness and concentration difficulties, with core depression symptoms such as feeling miserable/unhappy also prominent. Within the ADHD sample, but not the population sample, children reported depression symptoms less frequently than their parents.

CONCLUSIONS

Young people with ADHD are at high risk of experiencing symptoms of depression but may under-report the severity of their symptoms. Obtaining parent reports of depression symptoms in this group may be important to avoid missing key indicators of risk.

Associations Between Childhood Learning Disabilities and Adult-Age Mental Health Problems, Lack of Education, and Unemployment

We studied the impact of diverse subtypes of learning disabilities (LD) on adult-age mental health, education, and employment by comparing the LD group ( n = 430) with a matched control group without a known history of LD ( n = 2,149). The clinical archived data were merged with lifelong register data on sickness allowances/disability pensions granted on the basis of psychiatric illnesses, reimbursements for psychoactive medication, having a degree after compulsory education, and having received unemployment allowances. Differences emerged between the LD and control groups in all outcomes, suggesting that a higher proportion of individuals with LD had mental health problems compared to the control group, and a notable share of them had not attained a degree after compulsory education and had been unemployed for an extended period. Subgroup comparisons indicated that math disability (MD) was associated with antidepressant use and unemployment, whereas the reading disability (RD) group showed the least problems with employment. Interactions between subgroup and gender suggested that MD (with/without RD) may pose a higher risk than RD for females, whereas RD seemed to pose a risk for males. The findings suggest the need for researchers, clinicians, and those involved with adult education to consider mental health and educational problems among individuals with LD.

Emergence of Depressive Symptoms from Kindergarten to Sixth Grade

This study documents the emergence of symptoms of anxiety and depression in a community sample of school-age children and describes the temporal progression of symptoms leading to depressive episodes. Caregivers of 468 seventh graders reported retrospectively the manifestation of 14 symptoms of depression and anxiety in their children from kindergarten through sixth grade. The sample was balanced by sex and reflected the racial and economic diversity of the urban school district. Childhood period prevalence was calculated for each symptom, and discrete time survival analyses compared likelihoods of early symptom emergence in children who did and did not meet diagnostic criteria for major depressive disorder (MDD) by ninth grade. Symptom prevalence ranged between 20% (excessive guilt) and 50% (concentration problems) during the elementary school years. The 4-year period prevalence of MDD was 8.9%, 95% confidence interval [6.5%, 12.1%]. Low energy, excessive worry, excessive guilt, anhedonia, social withdrawal, and sadness or depressed mood were each associated with a significantly higher likelihood of onset of MDD. Compared to girls, boys were more likely to exhibit sad mood, fatigue, and trouble concentrating. Children who later met criteria for MDD demonstrated a significantly higher likelihood of showing core features of depressive and anxiety disorders during their elementary school years. The findings underscore the importance of recognizing early signs and developing interventions to help children manage early symptoms and prevent later psychiatric illness.

Low mood in a sample of 5-12 year-old child psychiatric patients: a cross-sectional study

BACKGROUND

Not much is known about low mood and its associates in child psychiatric patients. In this study, we examined the prevalence of low mood, how it associates with disruptive behaviour, and affects clinician-rated global functioning in child psychiatric outpatients.

METHODS

The study population consisted of 862 5-12 year-old child psychiatric patients. The study sample was a subsample of all 1251 patients attending a child psychiatric outpatient clinic at Helsinki University Hospital in 2013-2015 formed by excluding 4 year-old and 13 year-old patients and those with missing or incomplete data. The parent-rated Strengths and Difficulties Questionnaire, collected as part of the routine clinical baseline measure, was used as a measure of psychiatric symptoms. The diagnoses were set according to ICD-10 by the clinician in charge after an initial evaluation period. The Children's Global Assessment Scale (CGAS) score set by clinicians provided the measure of the patients' global functioning. All information for the study was collected from hospital registers. Associations between emotional symptoms and conduct problems/hyperactivity scores were examined using ordinal regression in univariate and multivariate models, controlling for age and sex. The independent samples T test was used to compare the CGAS values of patient groups with low/normal mood.

RESULTS

In our sample, 512 children (59.4%) showed low mood. In multivariate ordinal regression analysis, low mood associated with conduct problems (OR 1.93, 95% CI 1.39-2.67), but no association was found between low mood and hyperactivity. Low mood was prevalent among children with oppositional defiant disorder or conduct disorder (51.8%). The global functioning score CGAS was lower among children with parent-reported low mood (52.21) than among children with normal mood (54.62, p < 0.001). The same was true in the subgroup of patients with no depression diagnosis (54.85 vs. 52.82, p = 0.001).

CONCLUSIONS

Low mood is prevalent in child psychiatric outpatients regardless of depression diagnosis and it has a negative effect on global functioning. Low mood and behavioural problems are often associated. It is important to pay attention to low mood in all child psychiatric patients. We recommend prevention measures and low-threshold services for children with low mood.

Predictors of adolescents' mental health problems in Saudi Arabia: findings from the Jeeluna® national study

BACKGROUND

Depression and anxiety among adolescents require further attention as they have profound harmful implications on several aspects of adolescents' wellbeing and can be associated with life threatening risk behaviors such as suicide.

OBJECTIVE

To examine the underlying risk factors for feeling so sad or hopeless and for feeling worried among adolescents in Saudi Arabia.

METHODS

Data from Jeeluna® national survey was used. A cross-sectional, multi-stage, stratified, cluster random sampling technique was applied among a sample of students aged 10-19 years attending intermediate and secondary schools in Saudi Arabia. A self-administered questionnaire assessing several domains, including feeling so sad or hopeless and worried, was used to collect data. Logistic regression models were fitted to determine the different factors associated with mental health.

RESULTS

A sample of 12,121 students was included in this study. Feeling so sad or hopeless and feeling worried were significantly more prevalent among females and older adolescents (p < 0.0001). The results showed that poor relationship with parents, negative body image, and chronic illness to be significantly associated with feeling so sad or hopeless and worried.

CONCLUSIONS

Symptoms suggestive of mental health problems among adolescents in Saudi Arabia are prevalent and deserve special attention. Adopting effective strategies, including regular screening and intervention programs are highly needed to better address, detect, and control early signs of these problems.

Do I fit in? Psychosocial ramifications of low gender typicality in early adolescence

The current longitudinal study was designed to examine one of the possible underlying mechanisms that can help account for why low gender typicality (i.e., not feeling like a typical boy or girl) is related to subsequent psychosocial adjustment problems: peer victimization. Relying on a large (N = 5,991, 52% female), ethnically diverse U.S. sample, the results suggested that peer victimization at 7th grade partially accounts for associations between 7th grade gender typicality and 8th grade social anxiety, somatic complaints, and externalizing behavior, when controlling for earlier (e.g., 6th grade) levels of adjustment. Associations were similar across ethnic groups. Peer victimization mediated associations for boys and girls across all outcomes; however, girls showed stronger associations with somatic complaints and boys showed stronger associations with externalizing behavior. These results suggest that attempts to improve adjustment for youth feeling low gender typicality should focus in part on reducing peer victimization.

Development of a potential screening measure for adolescent depression

OBJECTIVES

Few adolescent-specific depression screening instruments have been developed in recent years using multi-method approaches (qualitative and quantitative), and some of those available have limitations with an adolescent audience. We describe the development of a potential measure - the Taouk Scale for Adolescent Depression.

METHODS

Draft items were informed by findings from focus groups and reviews by adolescents and healthcare professionals, resulting in a provisional 97-item scale. This was administered to a nation-wide sample of 3087 secondary students. Exploratory factor analysis was used in a development subset to examine dimensionality of items and reduce their number, with the final item set evaluated in a validation subset.

RESULTS

Four reliable factors - negative outlook, emotional distress, behavioural changes and cognitive and somatic disturbances - were obtained from the exploratory factor analysis, resulting in a 28-item instrument, which was corroborated by confirmatory factor analysis. The final scale includes a number of novel items not included in current measures, i.e., whether respondents wear more black clothing than usual, deliberately damage property, take more risks, 'space out' at school and are engaged in substance abuse and/or increased sexual activity.

CONCLUSION

The Taouk Scale for Adolescent Depression demonstrated sound psychometric properties and may have utility for future screening and future epidemiological purposes. It appears to be a valid and reliable screening instrument for adolescent depression that includes a number of novel items. Further research is necessary to confirm its criterion validity in clinically depressed samples.

Depressive Symptoms in Adolescence: Longitudinal Links with Maternal Empathy and Psychological Control

Building on self-determination theory (Deci and Ryan in Psychological Inquiry, 11, 227-268. doi: 10.1207/S15327965PLI1104_01 , 2000), the aim of the current study was to examine the role of maternal affective and cognitive empathy in predicting adolescents' depressive symptoms, through mothers' psychological control use. Less empathic mothers may be less sensitive to adolescents' need for psychological autonomy, and thus prone to violating this need using psychological control, which may in turn predict adolescents' depressive symptoms. Moreover, according to interpersonal theory of depression (Coyne in Journal of Abnormal Psychology, 85, 186-193. doi: 10.1037/0021-843x.85.2.186 , 1976), adolescents' depressive symptoms may elicit rejecting responses, such as mothers' psychological control. For six waves, 497 adolescents (57 % boys, M age T1 = 13.03) annually completed questionnaires on depressive symptoms and maternal psychological control, while mothers reported on their empathy. Cross-lagged path analyses showed that throughout adolescence, both mothers' affective and cognitive empathy indirectly predicted boys' and girls' depressive symptoms, through psychological control. Additionally, depressive symptoms predicted psychological control for boys, and early adolescent girls. These results highlight the importance of (1) mothers' affective and cognitive empathy in predicting adolescents' depressive symptoms, and (2) taking gender into account when examining adolescent-effects.

An investigation of the longitudinal relationship between sleep and depressed mood in developing teens

OBJECTIVE

The prospective, bidirectional relationship between sleep disturbance and depressed mood was assessed in a school-based sample of adolescents.

METHOD

One hundred and thirty-eight Australian adolescents (mean age time 1 =15.69, standard deviation =0.92; 64% male) completed questionnaires to assess sleep parameters and depressed mood, on two occasions over 1 year.

RESULTS

Cross-sectional associations were observed between depressed mood and sleep duration, as well as wakefulness in bed. Prospective analyses revealed depressed mood predicted less total sleep time on school nights and a longer latency to sleep onset on weekends 1 year later. There was no prospective support for sleep predicting later depressed mood.

CONCLUSION

Contrary to prediction, our results suggest in this case that depressed mood may act as a precursor to poor sleep rather than the converse.

Within-Person Changes in Individual Symptoms of Depression Predict Subsequent Depressive Episodes in Adolescents: a Prospective Study

The current longitudinal study examined which individual symptoms of depression uniquely predicted a subsequent Major Depressive Episode (MDE) in adolescents, and whether these relations differed by sex. Adolescents (N = 240) were first interviewed in grade 6 (M = 11.86 years old; SD = 0.56; 54% female; 81.5% Caucasian) and then annually through grade 12 regarding their individual symptoms of depression as well as the occurrence of MDEs. Individual symptoms of depression were assessed with the Children's Depression Rating Scale-Revised (CDRS-R) and depressive episodes were assessed with the Longitudinal Interval Follow-up Evaluation (LIFE). Results showed that within-person changes in sleep problems and low self-esteem/excessive guilt positively predicted an increased likelihood of an MDE for both boys and girls. Significant sex differences also were found. Within-person changes in anhedonia predicted an increased likelihood of a subsequent MDE among boys, whereas irritability predicted a decreased likelihood of a future MDE among boys, and concentration difficulties predicted a decreased likelihood of an MDE in girls. These results identified individual depressive symptoms that predicted subsequent depressive episodes in male and female adolescents, and may be used to guide the early detection, treatment, and prevention of depressive disorders in youth.

The CES-D as a Measure of Psychological Distress Among International Students: Measurement and Structural Invariance Across Gender

Detecting psychological distress among international students can be challenging given diverse languages, cultural backgrounds, and lack of refined measurement properties of measures tailored to international students. Despite the challenges, ensuring that a psychological distress measure works effectively has considerable potential value for assessment purposes. The current study evaluates the measurement properties of a short 10-item version of Radloff's Center for Epidemiologic Studies Depression Scale (CES-D). Grounded in long-standing evidence on gender differences in depressive symptoms, specific attention was given to examining measurement invariance of the CES-D Short-form across women and men. Based on a large, two-cohort sample of international students ( N = 468), and through multiple analyses evaluating factor structure and measurement invariance, we derived an even briefer, seven-item single-factor form of the CES-D (CES-D Short-form International) that can be used with international students.

Aberrant brain responses to emotionally valent words is normalised after cognitive behavioural therapy in female depressed adolescents

BACKGROUND

Depression in adolescence is debilitating with high recurrence in adulthood, yet its pathophysiological mechanism remains enigmatic. To examine the interaction between emotion, cognition and treatment, functional brain responses to sad and happy distractors in an affective go/no-go task were explored before and after Cognitive Behavioural Therapy (CBT) in depressed female adolescents, and healthy participants.

METHODS

Eighty-two Depressed and 24 healthy female adolescents, aged 12-17 years, performed a functional magnetic resonance imaging (fMRI) affective go/no-go task at baseline. Participants were instructed to withhold their responses upon seeing happy or sad words. Among these participants, 13 patients had CBT over approximately 30 weeks. These participants and 20 matched controls then repeated the task.

RESULTS

At baseline, increased activation in response to happy relative to neutral distractors was observed in the orbitofrontal cortex in depressed patients which was normalised after CBT. No significant group differences were found behaviourally or in brain activation in response to sad distractors. Improvements in symptoms (mean: 9.31, 95% CI: 5.35-13.27) were related at trend-level to activation changes in orbitofrontal cortex.

LIMITATIONS

In the follow-up section, a limited number of post-CBT patients were recruited.

CONCLUSIONS

To our knowledge, this is the first fMRI study addressing the effect of CBT in adolescent depression. Although a bias toward negative information is widely accepted as a hallmark of depression, aberrant brain hyperactivity to positive distractors was found and normalised after CBT. Research, assessment and treatment focused on positive stimuli could be a future consideration. Moreover, a pathophysiological mechanism distinct from adult depression may be suggested and awaits further exploration.

Well-being, gender, and psychological health in school-aged children

Background

Despite being a well-documented phenomenon, gender differences in psychological health complaints in adolescence are poorly understood. The purpose of this study was to test factors related to well-being as explanatory factors of gender differences in psychological complaints (feeling low, irritability or bad temper, nervousness, and sleeping difficulties) in adolescence.

Methods

This study was based on the 9^th Health Behaviour in School-aged Children (HBSC) study, conducted in 2010 in the Wallonia-Brussels Federation, Belgium, on 9–24 year olds. Using logistic regression analyses, we studied gender differences in psychological complaints through well-being factors (life satisfaction, self-confidence, helplessness, and body image), across age categories, and examined the variation of female excess after taking into account each factor.

Results

The four well-being factors together explained more than half of the female excess in feeling low. However, there were still significant gender differences in feeling low for children over 13. Among 13 to 15-year-olds, there were no gender differences in irritability after adjustment. An important decrease in gender differences in nervousness was observed in the multivariate analyses, although there was still significant female excess in nervousness increasing from 13 years old. After full adjustment, only gender differences in sleeping difficulties among 13–15-year-olds remained significant. For all psychological complaints studied, self-confidence caused the most important decrease in gender difference.

Conclusions

This study showed that factors related to well-being could mediate the association between gender and psychological complaints, and pointed to the importance of taking into account well-being factors in the analyses of the aetiology of gender differences in psychological complaints. However, our results suggested that future research should explore additional explanations for gender differences in psychological complaints.

Evaluation of the Psychometric Properties of the Asian Adolescent Depression Scale and Construction of a Short Form: An Item Response Theory Analysis

The present study applied item response theory to examine the psychometric properties of the Asian Adolescent Depression Scale and to construct a short form among 1,084 teenagers recruited from secondary schools in Hong Kong. Findings suggested that some items of the full form reflected higher levels of severity and were more discriminating than others, and the Asian Adolescent Depression Scale was useful in measuring a broad range of depressive severity in community youths. Differential item functioning emerged in several items where females reported higher depressive severity than males. In the short form construction, preliminary validation suggested that, relative to the 20-item full form, our derived short form offered significantly greater diagnostic performance and stronger discriminatory ability in differentiating depressed and nondepressed groups, and simultaneously maintained adequate measurement precision with a reduced response burden in assessing depression in the Asian adolescents. Cultural variance in depressive symptomatology and clinical implications are discussed.

Anxiety, stress, depression, and psychosocial functioning of Indian adolescents

BACKGROUND

Lifetime prevalence of depression and anxiety increases from 1% of the population under age 12 years to ~17%-25% of the population by the end of adolescence. The greatest increase in new cases occurs between 15-18 years. Indian empirical studies have reported a prevalence of psychiatric morbidity in the range between 14.4% and 31.7%; thus, affecting psychosocial functioning.

AIMS

The objectives of the current study were to (i) examine the psychometric properties of the DASS and SDQ on Indian adolescents, (ii) explore the role of socio- demographic variablesand (iii) examine if there was any difference between school going and school dropouts.

METHODOLOGY

Data from 1812 students, aged 12-19 years was collected with mean age = 15.67 years (SD =1.41 years). The participants were administered a booklet containing demographic questionnaire and psychometric scales such as DASS-21 (Henry & Crawford, 2005; Lovibond & Lovibond, 1999) and Strengths and Difficulties Questionnaire (Goodman, 1997).

STATISTICAL ANALYSIS

Structure validation, correlational analysis and multivariate analysis.

RESULTS AND CONCLUSIONS

The results of validation indicated that English and Hindi version of 3 factor model of DASS and 2 factor model of SDQ was an acceptable model fit. It was noted that early adolescents were high on prosocial behaviour whereas late adolescents were high on difficulties score. Females were higher than males on prosocial behaviour. Adolescents residing in rural areas differed from their urban counterparts on prosocial behaviour and anxiety. Government school going adolescents differed from private school going adolescents on prosocial behaviour, stress and anxiety. Negative perception of relationship with family affected adolescents difficulties score, depression and stress. Similarly, negative perception of self-concept leads to higher difficulties score and lower prosocial behaviour score. The school going adolescents differed from non-school going adolescents on stress, depression and anxiety.

Depressive symptoms and suicidal ideation in adolescents accompanying a parent in recyclable trash collection

The relationship between mental health and poverty has been well documented in adults. However, few studies have addressed how low socioeconomic status and psychosocial vulnerabilities may influence depressive symptoms in adolescents. The current study was carried out in a non-randomly selected sample of 239 adolescents whose parents work as ragpickers (waste collectors for recycling) in Brazil. In-person interviews were conducted, and the presence of depressive symptoms and suicidal ideation were assessed using the Children's Depression Inventory (CDI). We observed that 23% (CI ± 5.34) of the adolescents presented with depressive symptoms and 35% (CI ± 6.05) had suicidal ideation. Fatigue or loss of energy (p = .012) and irritable mood (p = .013) were significantly higher among boys than girls according to DSM-IV criteria. However, we found no gender differences in DSM-IV criteria for Major Depressive Disorders (MDD) or Dysthymic Disorder (DD) in diminished interest or pleasure, weight loss or weight gain, decreased appetite, sleep problems, feelings of worthlessness, diminished concentration or ability to think, recurrent thoughts of death, suicidal ideation, or low self-esteem. There were no significant gender differences in total CDI score, however a greater percentage of girls presented with depressed mood than boys (29.9% vs. 17.1%, p < .05).

Mental Health Literacy and Help-Giving Responses in Irish Adolescents

This study assessed mental health literacy in Irish adolescents ( N = 187), and explored participants’ help-giving responses toward hypothetical depressed peers. Participants read five vignettes, each describing an adolescent experiencing a life difficulty; two of the characters met Diagnostic and Statistical Manual of Mental Disorders (4th ed., DSM-IV) criteria for depression. The majority of participants could not identify depression or potential suicidality, but felt concerned for the depressed characters’ well-being. Most participants stated they would provide help if they were the depressed characters’ friends. Correct identification of depression did not influence the type of help offered. A significant proportion of participants did not mention engaging an adult’s assistance, and assessing for suicidality was not mentioned by any participant. Gender differences were found in mental health literacy and the type of responses offered. Education that emphasizes the importance of informing an adult and assessing for suicidal risk is recommended.

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

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

A meta-analysis and model of the relationship between sleep and depression in adolescents: recommendations for future research and clinical practice

The purpose of this review was to quantify the strength of evidence for a directional relationship between sleep disturbance and depression in adolescents. A literature search was conducted to identify research investigating the relationship between sleep disturbance and depression in adolescent samples (12-20 y). Twenty-three studies were identified; 13 explored associations between depression and sleep disturbance; seven examined the prospective role of sleep disturbance in the development of depression; and three investigated the role of adolescent depression in the development of subsequent sleep disturbance. Average weighted mean differences in sleep/depression-related outcome variables were calculated between adolescents with depression, and non-clinical adolescents, or those in remission. Adolescents with depression experienced significantly more wakefulness in bed (sleep onset latency, wake after sleep onset, number of awakenings and sleep efficiency), lighter sleep (more stage 1), and reported more subjective sleep disturbance. Overall effect sizes from longitudinal and treatment studies suggest sleep disturbance acts as a precursor to the development of depression. At follow-up, depressed adolescents had significantly longer sleep onset, more wake after sleep onset, and lower sleep efficiency compared to adolescents who were non-clinical, or had undergone remission. Little support was found for a predictive role of depressive symptoms in the development of sleep disturbance. Based on these findings we propose a model to understand the development of depression from initial sleep disturbance, provide recommendations for clinicians and recommendations for future research.

Primary care providers' initial treatment decisions and antidepressant prescribing for adolescent depression

OBJECTIVE

Adolescent depression is a serious and undertreated public health problem. Nonetheless, pediatric primary care providers (PCPs) may have low rates of antidepressant prescribing due to structural and training barriers. This study examined the impact of symptom severity and provider characteristics on initial depression treatment decisions in a setting with fewer structural barriers, an integrated behavioral health network.

METHODS

A cross-sectional survey was administered to 58 PCPs within a large pediatric practice network. PCP reports of initial treatment decisions were compared in response to 2 vignettes describing depressed adolescents with either moderate or severe symptoms. PCP depression knowledge, attitudes toward addressing psychosocial concerns, demographics, and practice characteristics were measured.

RESULTS

Few PCPs (25% for moderate, 32% for severe) recommended an antidepressant. Compared with treatment recommendations for moderate depression, severe depression was associated with a greater likelihood of child psychiatry referral (odds ratio [OR], 5.50; 95% confidence interval [CI], 2.47-12.2] p < .001). Depression severity did not affect the likelihood of antidepressant recommendation (OR, 1.58 [95% CI, 0.80-3.11] p = .19). Antidepressants were more likely to be recommended by PCPs with greater depression knowledge (OR, 1.72 [95% CI, 1.14-2.59] p = .009) and access to an on-site mental health provider (OR, 5.13 [95% CI, 1.24-21.2] p = .02) and less likely to be recommended by PCPs who reported higher provider burden when addressing psychosocial concerns (OR, 0.85 [95% CI, 0.75-0.98] p = .02).

CONCLUSION

PCPs infrequently recommended antidepressants for adolescents, regardless of depression severity. Continued PCP support through experiential training, accounting for provider burden when addressing psychosocial concerns, and co-management with mental health providers may increase PCPs' antidepressant prescribing.

The role of gender and race in the relation between adolescent distress tolerance and externalizing and internalizing psychopathology

Distress tolerance (DT) is an established construct contributing to the onset and maintenance of psychopathology in adulthood; however, few studies have examined the role of DT in older adolescent psychopathology. Emerging data suggest that gender and race may influence this relation. Therefore, the current study examined the relation between gender, race, and DT on parent-reported internalizing and externalizing DSM-oriented symptoms among a community sample of 128, 14-18 year old adolescents. Results indicated a moderating effect of gender on affective problems, such that females with low DT, but not males, displayed significantly greater affective problems. Findings also indicated a significant moderating effect of race, such that Caucasians with low DT, but not African Americans, displayed significantly higher somatic, oppositional defiant, and conduct problems. These findings suggest that DT is an important clinical variable in older adolescence, particularly among Caucasians and females.

The role played by depression associated with somatic symptomatology in accounting for the gender difference in the prevalence of depression

PURPOSE

A variety of studies suggest the existence of a distinct phenotype of somatic depression, i.e., depression accompanied by significant somatic symptomatology. Previous research suggests that the gender difference in the prevalence of depression is primarily due to a difference in somatic depression. The aim of this study was to compare the gender difference in the prevalence of somatic depression and of depression not accompanied by significant somatic symptomatology (labelled "pure" depression) in two representative samples, the National Comorbidity Survey-Replication (NCS-R) and the Zurich Study.

METHOD

The gender difference in lifetime somatic depression was compared to that of pure depression based on analyses weighted back to the general population in two representative samples. The NCS-R analyses involved a narrow definition of somatic depression with items from the DSM criteria for depression--appetite, sleep, and fatigue. The analysis of the Zurich study added headaches, body image issues, and breathing difficulties to the criteria and comparison to atypical depression.

RESULTS

In both samples, the gender difference in depressive prevalence was due to a large difference in somatic depression with other phenotypes showing little or no gender difference. The gender differences were found to be due to the somatic symptoms rather than the number of symptoms and were much larger for somatic than for atypical depression.

CONCLUSION

The gender difference in the prevalence of depression results from the higher prevalence among women of a specific phenotype, somatic depression.

How robust is the evidence of an emerging or increasing female excess in physical morbidity between childhood and adolescence? Results of a systematic literature review and meta-analyses

For asthma and psychological morbidity, it is well established that higher prevalence among males in childhood is replaced by higher prevalence among females by adolescence. This review investigates whether there is evidence for a similar emerging female ‘excess’ in relation to a broad range of physical morbidity measures. Establishing whether this pattern is generalised or health outcome-specific will further understandings of the aetiology of gender differences in health. Databases (Medline; Embase; CINAHL; PsycINFO; ERIC) were searched for English language studies (published 1992–2010) presenting physical morbidity prevalence data for males and females, for at least two age-bands within the age-range 4–17 years. A three-stage screening process (initial sifting; detailed inspection; extraction of full papers), was followed by study quality appraisals. Of 11 245 identified studies, 41 met the inclusion criteria. Most (n = 31) presented self-report survey data (five longitudinal, 26 cross-sectional); 10 presented routinely collected data (GP/hospital statistics). Extracted data, supplemented by additional data obtained from authors of the included studies, were used to calculate odds ratios of a female excess, or female:male incident rate ratios as appropriate. To test whether these changed with age, the values were logged and regressed on age in random effects meta-regressions. These showed strongest evidence of an emerging/increasing female excess for self-reported measures of headache, abdominal pain, tiredness, migraine and self-assessed health. Type 1 diabetes and epilepsy, based on routinely collected data, did not show a significant emerging/increasing female excess. For most physical morbidity measures reviewed, the evidence broadly points towards an emerging/increasing female excess during the transition to adolescence, although results varied by morbidity measure and study design, and suggest that this may occur at a younger age than previously thought.

Potential causal relationship between depressive symptoms and academic achievement in the Hawaiian high schools health survey using contemporary longitudinal latent variable change models

There is a relatively consistent negative relationship between adolescent depressive symptoms and educational achievement (e.g., grade point average [GPA]). However, the causal direction for this association is less certain due to the lack of longitudinal data with both indicators measured across at least 2 time periods and due to the lack of application of more sophisticated contemporary statistical techniques. We present multivariate results from a large longitudinal cohort-sequential study of high school students (N = 7,317) with measures of self-reported depressive symptoms and self-reported GPAs across multiple time points (following McArdle, 2009, and McArdle, Johnson, Hishinuma, Miyamoto, & Andrade, 2001) using an ethnically diverse sample from Hawai'i. Contemporary statistical techniques included bivariate dynamic structural equation modeling (DSEM), multigroup ethnic and gender DSEMs, ordinal scale measurement of key outcomes, and imputation for incomplete longitudinal data. The findings suggest that depressive symptoms affect subsequent academic achievement and not the other way around, especially for Native Hawaiians compared with female non-Hawaiians. We further discuss the scientific, applied, and methodological-statistical implications of the results, including the need for further theorizing and research on mediating variables. We also discuss the need for increased prevention, early intervention, screening, identification, and treatment of depressive symptoms and disorders. Finally, we argue for utilization of more contemporary methodological-statistical techniques, especially when violating parametric test assumptions.

Differential item functioning due to gender between depression and anxiety items among Chilean adolescents

BACKGROUND

Although much is known about the higher prevalence of anxiety and depressive disorders among adolescent females, less is known about the differential item endorsement due to gender in items of scales commonly used to measure anxiety and depression.

AIMS

We conducted a study to examine if adolescent males and females from Chile differed on how they endorsed the items of the Youth Self Report (YSR) anxious/depressed problem scale. We used data from a cross-sectional sample consisting of 925 participants (mean age = 14, SD 1.3, 49% females) of low to lower-middle socioeconomic status.

METHODS

A two-parameter logistic (2PL) IRT DIF model was fit.

RESULTS

RESULT

s revealed differential item functioning (DIF) by gender for six of the 13 items, with adolescent females being more likely to endorse a depression item while males were found more likely to endorse anxiety items.

CONCLUSIONS

Findings suggest that items found in commonly used measures of anxiety and depression symptoms may not equally capture the true levels of these behavioural problems in adolescent males and females. Given the high levels of mental disorders in Chile and the surrounding countries, further attention should be focused on increasing the number of empirical studies examining potential gender differences in the assessment of mental health problems among Latin American populations to better aid our understanding of the phenomenology and determinants of these problems in the region.

Screening for depression in a sample of Egyptian secondary school female students

BACKGROUND

Depression is common in female adolescents. Data on prevalence rates, socio-demographic correlates, and putative risk factors in Egyptian population are needed along with better screening tools to inform future research and service development. We aimed to estimate the point prevalence of depression in a representative sample of Egyptian female students; to detect the sensitivity and specificity of CDI as a screening tool, and to highlight some putative risk factors associated with depression.

METHOD

Multistage random selection of 602 female students from public and private secondary schools in Eastern Cairo. All participants were subjected to screening using the Children Depression Inventory (CDI) and the Non-patient version of the Structured Clinical Interview for DSM-IV axis-I disorders.

RESULTS

Depression was estimated to be 15.3% by CDI in comparison to 13.3% by SCID-I/NP. The sensitivity and specificity of CDI were 74.8% and 97.6% respectively. Regression Analysis pointed to a number of predictive factors as; academic underachievement, quarrelsome family atmosphere, socioeconomic status, negative life events and family history of psychiatric disorders.

LIMITATIONS

The cross-sectional design, the lack of collateral information and access to records precluded inference of casualty. The lack of the rural comparator and samples from other governorates limits the generalisation of results.

CONCLUSION

Depression was prevalent in a sample of Egyptian female secondary school students. It correlated with some psychosocial factors and can be effectively screened using CDI. Hence, there is a need for better screening, Psychoeducational programmes, and services for better identification, early intervention and targeting for those at risk.

Depressive symptomatology in children and adolescents with chronic renal insufficiency undergoing chronic dialysis

This paper presents a descriptive study, using the Birleson Scale to determine the frequency of depressive symptomatology in children and adolescents with chronic renal insufficiency (CRI) undergoing hemodialysis (HD) and chronic peritoneal dialysis (CPD). There were 67 patients (40 female and 27 male) with a mean age of 14.76 ± 2.71 years, duration of illness ≥3 months, 43 (64.18%) patients with CPD and 24 (35.82%) undergoing HD. The frequency of high occurrence, low occurrence, and absence of depressive symptomatology was 10.45% (n = 7), 43.28% (n = 29), and 46.27% (n = 31), respectively; all of the seven (100%) patients with high occurrence of depressive symptomatology were female (P = 0.04), and none of these (0%) had a friend to confide in (P = 0.03). Depressive symptomatology in patients with CPD was associated with a lower weekly K(t)/V compared to those without depressive symptomatology (2.15 ± 0.68 versus 2.52 ± 0.65; P = 0.01). There was no association with patient age, caregiver, time and dialysis type, anemia, bone disease, nutritional or financial status, origin, schooling, or employment.

Sex differences in adolescent depression: do sex hormones determine vulnerability?

Depression is one of the most common, costly and severe psychopathologies worldwide. Its incidence, however, differs significantly between the sexes, and depression rates in women are twice those of men. Interestingly, this sex difference emerges during adolescence. Although the adolescent period is characterised by major physical and behavioural transformations, it is unclear why the incidence of depression increases so dramatically in girls during this otherwise generally healthy developmental period. Although psychological and environmental factors are also involved, we discuss the neuroendocrinological factors determining adolescent vulnerability to depression. In particular, we address the role of sex steroids in mood regulation, hypothalamic-pituitary-adrenal axis maturation and sexual differentiation of the brain, with a focus on hippocampal plasticity.

Major depressive disorder: gender differences in symptoms, life quality, and sexual function

OBJECTIVE

To investigate the gender differences of symptoms, life quality, functional impairment, and sexual function of patients with moderately severe major depressive disorder (MDD).

METHOD

One hundred forty-six outpatients with MDD were enrolled into this study with specific selection criteria (male, 57; female, 89; mean ± SD age, 38.30 ± 11.69 years). All the patients self-rated the Quick Inventory of Depressive Symptomatology--Self-Report (QIDS-SR16) and the Integral Inventory for Depression (IID) for the assessment of symptoms assessment as well as the EuroQol life quality scale (EQ5D) was for the subjective life quality, the Sheehan disability scale was for the functional impairments, and the Arizona Sexual Experience Scale was for sexual function evaluation. All data were analyzed to estimate correlation and gender difference.

RESULTS

Female patients had higher scores of the QIDS-SR16, IID, and Arizona Sexual Experience scales. Significant gender differences of sadness, sleep, appetite, calmness, painful symptoms, and sexual functioning were observed. The female-specific sexual dysfunctions included lower sexual drive, lower sexual arousal, lower horny feelings, lower orgasms, and lower satisfaction of orgasm. The MDD episodes were related to the EuroQol life quality scale and the SDS. Interepisode years were associated with the IID. The Sheehan disability scale was correlated with QIDS-SR16 with statistical significance.

CONCLUSIONS

Patients with MDD showed a correlation between symptoms and functional impairment. Female patients might be more sexually impaired, more vegetative, more depressed, and experiencing more sadness and physical pain.

Depressive symptoms and psychosocial functioning in preadolescent children

The current study was designed to determine the percentage of children "at-risk" of depression or evidencing clinical levels of depression. In addition, the study examined how the "at-risk" and the clinical groups differed from children who demonstrated no depressive symptoms on positive and negative affect, four aspects of self-concept, and peer ratings of popularity. Respondents were 510 children (270 boys 240 girls) who ranged in age from 7 to 13 years (mean = 9.39). The results demonstrated that 23% of children were either in the "at-risk" or clinical range of depression. Children in both the clinical and the "at-risk" range demonstrated higher negative affect but lower positive affect and lower self-concepts than children in the normal range. However, children's peers only differentiated between the "clinical" and "normal" groups. It is harder for peers, and other informants such as teachers and parents, to detect the problems of children with elevated depressive symptoms but who do not meet the diagnostic criteria. It is important to implement intervention programs for children who evidence depression symptoms, as well as "at-risk" children. "At-risk" children with elevated levels of depressive symptoms may be more disadvantaged, as their problems are less likely to be detected and treated.

Body dissatisfaction and weight-related teasing: a model of cognitive vulnerability to depression among women

Although a number of studies have linked body dissatisfaction to depressive symptoms, few have done so within the framework of a vulnerability-stress model. We hypothesized that women's levels of body dissatisfaction would interact with recent experiences of vulnerability-congruent negative life events (i.e., weight-related teasing) to predict prospective changes in depressive symptoms. Consistent with these hypotheses, experiences of weight-related teasing were more strongly related to depressive symptom increases among women with high, compared to low, levels of body dissatisfaction. These results support the hypothesis that body dissatisfaction moderates the impact of weight-related teasing on depressive symptom changes.

Neuroticism, life events and negative thoughts in the development of depression in adolescent girls

Theories of depression suggest that cognitive and environmental factors may explain the relationship between personality and depression. This study tested such a model in early adolescence, incorporating neuroticism, stress-generation and negative automatic thoughts in the development of depressive symptoms. Participants (896 girls, mean age 12.3 years) completed measures of personality and depressive symptoms, and 12 months later completed measures of depressive symptoms, recent stressors and negative automatic thoughts. Path analysis supported a model in which neuroticism serves as a distal vulnerability for depression, conferring a risk of experiencing dependent negative events and negative automatic thoughts, which fully mediate the effect of neuroticism on later depression. A second path supported a maintenance model for depression in adolescence, with initial levels of depression predicting dependent negative events, negative automatic thoughts and subsequent depressive symptoms. Unexpectedly, initial depression was also associated with later independent life events. This study establishes potential mechanisms through which personality contributes to the development of depression in adolescent girls.

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

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

Comparison of demographic and clinical characteristics between children and adolescents with major depressive disorder

OBJECTIVE

To compare clinical characteristics of major depressive disorder symptoms between children and adolescents.

METHOD

The subjects were 58 patients of a Child and Adolescent Affective Disorder Clinic consecutively admitted during a six-month period. Children aged 5-9 years old and adolescents from 10-17 years old currently meeting DSM-IV criteria diagnosis of major depressive disorder were chosen. Current MDD diagnosis and depressive psychopathology were assessed by a clinical interview and the Diagnostic Interview for Children and Adolescents-DSM-IV version. The Children's Depression Rating Scale-Revised Version and the Children Global Assessment Scale rated the severity and global functioning of major depressive disorder.

RESULTS

The most common depressive symptoms were: anhedonia (72.4%), depressed mood (72.4%), decreased concentration (62.1%), and irritability (58.6%). The intensity of depressive episodes of this sample ranged from mild to moderate. Fifty percent reported thoughts of death, and 29.3% presented a variety of psychotic symptoms. When compared with children, adolescents reported a significantly more depressed mood (p = 0.043), lower self-esteem (p = 0.002), and had more difficulty concentrating (p = 0.020). Female adolescents had lower self-esteem (p = 0.003), and male adolescents showed more decreased concentration (p = 0.016).

CONCLUSION

This study suggests that age and gender differences might influence the clinical presentation of major depressive disorder in children and adolescents. Further studies with larger samples are needed.

Molecular epidemiology of major depressive disorder

Major depressive disorder causes significant morbidity, affecting people's ability to work, function in relationships, and engage in social activities. Moreover, major depressive disorder increases the risk of suicidal ideation, attempted suicide and death by completed suicide. There is evidence that chronic stress can cause major depressive disorder. As for genetic factors, only minor susceptibility genes have been reliably identified. The serotonin system provides a logical source of susceptibility genes for depression, because this system is the target of selective serotonin reuptake-inhibitor drugs that are effective in treating depression. The 5-hydroxytryptamine (serotonin) transporter (5-HTT) has received particular attention because it is involved in the reuptake of serotonin at brain synapses. One common polymorphic variant of the 5-HTT-linked polymorphic region (5-HTTLPR), which affects the promoter of the 5-HTT gene, causes reduced uptake of the neurotransmitter serotonin into the presynaptic cells in the brain. The authors discussed the relationship between genetic polymorphisms and major depressive disorder, with special emphasis on the 5-HTTTLPR polymorphism. As the 5-HTTLPR polymorphism was significantly associated with an increased risk of major depressive disorder, the 5-HTT gene may be a candidate for a major depressive disorder susceptibility gene. As major depressive disorder is a multifactorial disease, an improved understanding of the interplay of environmental and genetic polymorphisms at multiple loci may help identify individuals who are at increased risk for major depressive disorder. Hopefully, in the future we will be able to screen for major depressive disorder susceptibility by using specific biomarkers.

The mental health of canadians with self-reported learning disabilities

There has been growing concern as to the mental health status of persons with learning disabilities (PWLD). This study examined rates of mental health problems among PWLD aged 15 to 44 years using a large, nationally representative data set. PWLD were more than twice as likely to report high levels of distress, depression, anxiety disorders, suicidal thoughts, visits to mental health professionals, and poorer overall mental health than were persons without disabilities (PWOD). Multivariate regression analyses determined that these significantly higher rates of mental health problems remained for all six measures after controlling for confounding factors including income, education, social support, and physical health. Differences found in the older adult sample (ages 30-44) were even larger than in the adolescent sample (ages 15-21) for suicidal thoughts, depression, and distress. Males with learning disabilities were more likely to report depressive episodes, anxiety disorders, and consultations with health professionals, whereas females with learning disabilities were more likely to report high distress, suicidal thoughts, and poor general mental health relative to PWOD. On balance, learning disabilities were not found to be more detrimental to mental health for one gender or the other.

Fifteen years after parental divorce: mental health and experienced life-events

The children who experienced their parents' divorce when the divorce rate in Sweden had begun to grow to higher levels than in preceding decades are today adults. The aim of this study was to investigate if adults who had experienced parental divorce 15 years before the time of our study, differed in mental health from those with continuously married parents, taking into account life events other than the divorce. Instruments used were the Symptom Checklist (SCL-90) measuring mental health and the Life Event questionnaire capturing the number and experience of occurred events. Forty-eight persons, who were 7-18 years old when their parents divorced, constituted the divorce group, and 48 persons matched on age, sex and growth environment formed the study groups. The SCL-90 showed a limited difference between the groups, but not concerning total mental health. A main finding was a difference with regard to sex and age; women aged 22-27 in the divorce group displayed poorer mental health than other participants in both groups. The results from the Life Event questionnaire showed that the divorce group had experienced a significantly larger number of events, and more life events were described as negative with difficult adjustment. A regression analysis showed a significant relation between the SCL-90, Global Severity Index and life events experienced as negative with difficult adjustment, divorce events excluded, but not with the divorce itself. It seems highly desirable to pay more attention than has thus far been paid to girls with experience of childhood divorce at age 7-12.

Differences in depressive symptom profile between males and females

BACKGROUND

It is widely held that there are no differences in the symptom profile of male and female depression. Studies to date that have found differences have used different methodologies and had inconsistent findings. Here we compare the clinical profile of major depression for men and women from a sample of almost 600 well-characterized individuals with recurrent major depressive disorder (MDD).

METHODS

Subjects were recruited as part of a large genetic-epidemiological study of MDD. Clinical assessments included semi-structured interviews and case-note review. Clinical profiles during 'worst ever' (WE) depressive episode were scored using the OPCRIT checklist. Profiles for 199 males were compared to 399 females.

RESULTS

Females with depression tended to have an earlier age-at-onset (p<0.0001), exhibited more frequent depressive episodes (p<0.005), had a greater number of depressive symptoms (p<0.001), and reported much higher rates of atypical depressive features (p<0.007) during their WE episode of depression. Logistic regression analysis identified that earlier age-at-onset of depression, excessive self-reproach and diminished libido were the best predictors of female depression.

LIMITATIONS

Retrospective recall by subjects of depressive symptoms, which may be prone to recall bias.

CONCLUSIONS

There are differences in the clinical course and symptom profile of male and female depression. Further study is required to identify the biological correlates of these differences and to characterize their clinical importance.

Prevalence of students with symptoms of depression among high school students in a district of western Turkey: an epidemiological study

BACKGROUND

To determine the factors affecting the prevalence of depression and also to present some pertinent comments concerning prevention of depression among high school students. This study was deemed important and relevant due to the increasing importance of depression among high school students.

METHODS

A sample of students aged 14-19 years from the 6 high schools of 1 district of western Turkey were surveyed. The students selected were all attending the school during March and April 2006. The Beck Depression Inventory was used as a screening test.

RESULTS

During the study, a total of 846 students completed the survey. Of the study group, 51.9% (439) were male and 48.1% (407) female, with an age average of 16.3 +/- 1.1 years. According to the scale, the prevalence of depression was 30.7% (n = 260), 22.6% for males (n = 99) and 39.6% for females (n = 161). The most depression was seen in males (22.6%), those with any kind of physical problem (37.3%), those with diseases necessitating the use of medication (51.1%), those with acne vulgaris (35.2%), and those having previously experienced any kind of problem (47.3%).

CONCLUSIONS

These results highlight not only the need for students' parents and teachers to be well informed on the subject of depression in terms of students' health but also the need for more education programs to be aimed at students relating to the problems they may experience during the period of adolescence. Furthermore, these results show that students identified as depressed should be referred for an appropriate diagnosis to specialized psychiatry centers.

Measurement matters in the association between early adolescent depressive symptoms and body mass index

OBJECTIVE

The objectives of this study were to examine associations between depressive symptoms and body mass over 1 year during early adolescence and to assess how the associations might differ depending upon whether self-reported or directly measured height and weight were used.

METHOD

Participants were 446 sixth-grade Seattle students. Depressive symptoms were assessed using the Mood and Feelings Questionnaire. Regression models were used to examine whether baseline depression status was associated with 12-month body mass index (BMI; using self-reported height and weight) and whether baseline overweight status was associated with 12-month depressive symptom score. Analyses were rerun among a subsample (n=165) who had height and weight directly measured.

RESULTS

Using BMI derived from self-reported values, depressed males had a significantly lower BMI than nondepressed males, while depressed females had a significantly higher BMI than nondepressed females, after adjusting for covariates. Among a subsample using measured height and weight values, however, depression was no longer associated with BMI in either gender. Baseline overweight status did not predict 12-month depression score.

CONCLUSIONS

Observed associations between depression and subsequent BMI were explained by differential misclassification of self-reported height and weight by depression status and gender. Direct measurement of height and weight may be necessary to ensure validity in studies of adolescent depression and weight-related outcomes.

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.