Relationship of Beck Depression Inventory factors to depression among adolescents

Relationship between social phobia and depression differs between boys and girls in mid-adolescence

BACKGROUND

Earlier studies suggest that social phobia (SP) and depression (DEP) often have their onset in adolescence, and are highly comorbid, with SP mainly preceding depression. There is a lack of population-based prospective studies among adolescents vulnerable to both disorders, taking into account possible gender differences in the relationship between the two.

METHODS

This study is part of a prospective Adolescent Mental Health Cohort (AMHC) study. Subjects are 9th grade pupils (mean age 15.5 years (sd 0.39)) responding to a survey conducted 2002-2003 (T1) and a 2-year follow-up 2004-2005 (T2) (N=2038). Social phobia was measured by the Social Phobia Inventory (SPIN) and depression by the 13-item Beck Depression Inventory (BDI-13).

RESULTS

Risk for depression at T2 by SP at T1 was elevated only among boys (OR 3.6, 95% C.I. 1.507-8.579, p=0.004), whereas among girls, risk for SP at T2 by DEP at T1 was elevated (OR 7.8, 95% CI 4.529-13.391, p<0.001). The course of both disorders was unstable and recovery was common.

LIMITATIONS

Lack of diagnostic interviews and fairly high drop-out rate (36.9%) in follow-up.

CONCLUSIONS

The relationship between SP and depression in adolescence seems different for boys and girls. Further studies are needed to explore factors explaining the different course of these disorders among boys and girls. Clinicians need to be alert to comorbidity when examining an adolescent with SP or depression.

Dimensional and hierarchical models of depression using the Beck Depression Inventory-II in an Arab college student sample

BACKGROUND

An understanding of depressive symptomatology from the perspective of confirmatory factor analysis (CFA) could facilitate valid and interpretable comparisons across cultures. The objectives of the study were: (i) using the responses of a sample of Arab college students to the Beck Depression Inventory (BDI-II) in CFA, to compare the "goodness of fit" indices of the original dimensional three-and two-factor first-order models, and their modifications, with the corresponding hierarchical models (i.e., higher - order and bifactor models); (ii) to assess the psychometric characteristics of the BDI-II, including convergent/discriminant validity with the Hopkins Symptom Checklist (HSCL-25).

METHOD

Participants (N = 624) were Kuwaiti national college students, who completed the questionnaires in class. CFA was done by AMOS, version 16. Eleven models were compared using eight "fit" indices.

RESULTS

In CFA, all the models met most "fit" criteria. While the higher-order model did not provide improved fit over the dimensional first - order factor models, the bifactor model (BFM) had the best fit indices (CMNI/DF = 1.73; GFI = 0.96; RMSEA = 0.034). All regression weights of the dimensional models were significantly different from zero (P < 0.001). Standardized regression weights were mostly 0.27-0.60, and all covariance paths were significantly different from zero. The regression weights of the BFM showed that the variance related to the specific factors was mostly accounted for by the general depression factor, indicating that the general depression score is an adequate representation of severity. The BDI-II had adequate internal consistency and convergent/discriminant validity. The mean BDI score (15.5, SD = 8.5) was significantly higher than those of students from other countries (P < 0.001).

CONCLUSION

The broadly adequate fit of the various models indicates that they have some merit and implies that the relationship between the domains of depression probably contains hierarchical and dimensional elements. The bifactor model is emerging as the best way to account for the clinical heterogeneity of depression. The psychometric characteristics of the BDI-II lend support to our CFA results.

Comorbidity between depression and antisocial behaviour in middle adolescence: the role of perceived social support

A sample of 3278 students (aged 15-16 years) were surveyed to investigate the interrelations between depression (RBDI; The Finnish modification of the 13-item Beck Depression Inventory), antisocial behaviour (YSR; Youth Self-Report) and perceived social support from family, friends and significant other (PSSS-R; the Perceived Social Support Scale-Revised). The study aimed especially to control for the effect of perceived social support in the comorbidity between depression and antisocial behaviour. The results indicate firstly that decreased perceived social support was associated with both depression and antisocial behaviour in both sexes. Similarly, antisocial behaviour was associated with depression in both sexes. Perceived social support modified comorbidity between depression and antisocial behaviour, but antisocial behaviour still remained independently associated with depression. Thus, perceived social support did not explain the found comorbidity between depression and antisocial behaviour.

Assessment of quality of life and depression in Korean patients with Graves' ophthalmopathy

Purpose

To assess quality of life and depressive status in Korean patients with Graves' ophthalmopathy.

Methods

A cross-sectional study of 49 patients (mean age, 41 years; sex ratio, M:F=11:38) with Graves' ophthalmopathy (referred to as the Graves' group) and 48 age-matched and sex-matched controls (mean age, 40.2 years; sex ratio, M:F=11:37) was performed using the Korean version of the 36-item Short-Form General Health Survey (SF-36) questionnaire and the Beck Depression Inventory (BDI). Survey data was compared among patients with mild, moderately severe, and sight-threatening Graves' ophthalmopathy and between patients with low (0 or 1) or high (2 or 3) Gorman scores.

Results

Those in the Graves' group scored significantly lower on all categories of the SF-36, as compared to the control group (p<0.05). The 4 patients with sight-threatening Graves' had significantly lower scores for physical functioning, role limitations due to physical health, and the physical component summary of the SF-36, when compared with the 28 patients with mild Graves' and the 17 patients with moderately severe Graves' (p<0.05). The 17 patients in the high Gorman score group had lower physical component summary scores than the 32 patients in the low Gorman score group (p=0.03). The 16 patients with BDI scores ≥16 had significantly lower scores on the SF-36 and higher clinical activity scores, as compared to the 33 patients with BDI scores <16 (p<0.05).

Conclusions

Patients with Graves' ophthalmopathy had reduced health-related quality of life and were more likely to be depressed, especially those with a sight threatening condition or significant diplopia. It is important to identify these patients to provide the necessary psychological support.

Depressive symptoms and behavioural health risks in young women attending an urban sexual health clinic

BACKGROUND

Adolescence is a time of increased health risk behaviours and depressive symptoms and disorders. Most young people with depressive disorders, however, are not under the care of specialist child and adolescent mental health services, and there is increasing interest in identifying alternative appropriate settings which are acceptable for young people and may attract those at high risk for depressive disorders.

AIM

To assess depressive and behavioural health risks in attendees to a sexual health clinic (SHC) for young people.

METHOD

Cross-sectional controlled study of women attending a SHC and school attendees, using questionnaires on depressive symptoms and mental health problems, sexual activity and substance use.

RESULTS

115/178 attendees 14-19 years old completed questionnaires. In the comparison between 66 women aged 16-18 years and 49 socio-demographically group-matched school controls, SHC attendees reported higher levels of sexual activity and substance use. They were significantly more at risk for depression (20/65 or 30% vs. 4/46 or 8%; chi(2)P < 0.01) on the Beck Depression Inventory, for emotional (12/66 or 18% vs. 1/49 or 2%; chi(2)P < 0.01), hyperactivity (11/66 or 16% vs. 2/46 or 4%; chi(2)P < 0.05) and conduct (8/66 or 12% vs. 0/49; chi(2)P < 0.05) problems on the Strengths and Difficulties Questionnaire. High depressive scores were significantly associated with a history of self-harm, earlier alcohol use and having tried cannabis, but not with sexual risk behaviours. Earlier age at first sexual intercourse was linked to higher sexual and substance use risks.

CONCLUSION

We have found high levels of depressive symptoms among attendees to a SHC for young people, which seem an appropriate setting for screening and providing guidance for depression and other health risk behaviours.

Gastrointestinal complaints among subjects with depressive symptoms in the general population

BACKGROUND

Patients with depression have irritable bowel syndrome (IBS) more often than do nondepressed patients, but the comorbidity of depression and gastrointestinal (GI) symptoms in the general population has received little study.

AIM

To study the co-occurrence of depressive and GI symptoms in a general population sample and to assess the rate of health-care utilization particularly for GI reasons among subjects with depressive symptoms.

METHODS

A questionnaire containing the Finnish version of the Beck Depression Inventory Short Form and questions covering GI symptoms according to Rome II criteria was mailed to 5000 randomly selected adults.

RESULTS

Response rate was 73%. Prevalence of depressive symptoms was 17% (95% CI: 15.7-18.2). Frequent abdominal pain, diarrhoea, constipation, dyspepsia or IBS were present in 54% of those with depressive symptoms and in 29% of nondepressed controls (P < 0.0001). Of those with depressive symptoms, 24% had visited a physician at least once because of abdominal symptoms during the previous year, compared to 13% of controls (P < 0.0001).

CONCLUSIONS

Depressive symptoms are prevalent in the general population. They are associated with a high rate of GI symptoms, leading to increased use of health-care services and work absenteeism because of abdominal complaints.

Continuity, comorbidity and longitudinal associations between depression and antisocial behaviour in middle adolescence: A 2-year prospective follow-up study

The study investigated continuity, comorbidity and longitudinal associations between depression Beck depression inventory (RBDI) and antisocial behaviour Youth self-report (YSR) in middle adolescence. Data were used from a community sample of 2070 adolescents who participated in a 2-year prospective follow-up study. The results indicate that both depression and antisocial behaviour had considerable continuity, and concurrent comorbidity between these disorders was strong. In contrast to several previous studies, antisocial behaviour did not predict subsequent depression, but conversely, depression predicted subsequent antisocial behaviour among girls. Among boys history of depression seemed to protect from subsequent antisocial behaviour. Gender differences in longitudinal associations are discussed.

Psychiatric impairment among adolescents engaging in different types of deliberate self-harm

This retrospective chart review study of 227 participants examined the psychiatric profiles of outpatient adolescents ages 12 to 19 years (M = 15.08 years, SD = 1.72 years) engaging in different types of deliberate self-harm (DSH) behaviors. Participants were divided into four groups: no deliberate self-harm (NoDSH; n = 119), nonsuicidal self-injury only (NSSI only; n = 30), suicide attempt only (n = 38), and suicide attempt plus NSSI (n = 40). Those who attempted suicide were more likely to have major depressive disorder and/or posttraumatic stress disorder than those who engaged in NSSI only. Those who engaged in any type of DSH were more likely to have features of borderline personality disorder than those who did not engage in DSH. The suicidal ideation levels of those in the NSSI group were similar to those in the NoDSH group. Findings offer empirical support for the importance of distinguishing between suicidal and nonsuicidal self-harm behaviors.

Adolescent risk factors for episodic and persistent depression in adulthood. A 16-year prospective follow-up study of adolescents

BACKGROUND

We examined mid-adolescent psychosocial problems as risk factors for subsequent depression up to adulthood proper, and differences in these for episodic and persistent depression.

METHODS

In a 16-year follow-up of an urban Finnish community cohort (547 males and 714 females) from age 16 years risk factors for subsequent depression (S-BDI) were studied. Data were collected with a classroom questionnaire at 16 years and a postal questionnaire at 22 and 32 years. Differences in predictors for episodic depression (only at age of 22 or 32 y) and persistent depression (both at 22 and 32 y) were studied using logistic and multinomial regression analyses.

RESULTS

Mid-adolescent depressive symptoms predicted persistent and female sex episodic depression. Low self-esteem, dissatisfaction with academic achievement, problems with the law, having no dating experiences, and parental divorce all predicted both episodic and persistent depression.

LIMITATIONS

We had two assessment points in adulthood, but no information about depression between these.

CONCLUSIONS

The associations between mid-adolescent psychosocial problems and subsequent depression extended up to adulthood proper, somewhat differently for episodic and persistent depression. Preventive efforts should be focused towards young people at risk.

Associations between peer victimization, self-reported depression and social phobia among adolescents: the role of comorbidity

Associations of peer victimization with adolescent depression and social phobia (SP), while controlling for comorbidity between them, have not been sufficiently explored in earlier research. A total of 3156 Finnish adolescents aged 15-16 years participated in a survey study. Self-reported peer victimization, as well as self-reported depression (Beck Depression Inventory), SP (Social Phobia Inventory), and selected background variables were assessed. Frequency of overt and covert peer victimization was examined among four groups: (1) adolescents with depression non-comorbid with SP (DEP), (2) those with SP non-comorbid with depression (SP), (3) those with both SP and depression (SP+DEP), and (4) controls, with neither. A logistic regression analysis controlling for confounding familial (family moving, parental unemployment), and psychopathology (delinquency, aggressiveness, general anxiety) covariates was conducted to confirm the associations between peer victimization and the four groups. Among boys the comorbid SP+DEP group reported the highest rates of both overt and covert victimization, these being significantly higher than among both DEP and SP groups. Among girls covert victimization was again most frequent in the SP+DEP group, but overt victimization was not more frequent in the comorbid group than it was in the DEP and SP groups. In the logistic regression analysis depression without SP did not maintain an independent association with either type of victimization. Instead, SP without depression with ORs from 2.8 to 4.3, and SP comorbid with depression, with ORs between 3.2 and 11.4 had independent associations with peer victimization. In conclusion, overt and covert peer victimization seem to be associated with SP, rather than depression, among adolescents.

Sexual and physical abuse history and adult sexual risk behaviors: relationships among women and potential mediators

OBJECTIVE

While research has supported associations between experiencing abuse and engaging in risky sexual behaviors during adolescence, research regarding these associations among adult women is much more equivocal. In addition, few studies have attempted to identify potential pathways from abuse experiences to sexual risk behaviors. The current study examined the associations between a history of physical or sexual abuse and recent sexual risk behaviors among adult women. Additionally, this study evaluated binge drinking and depressive symptomatology as potential mediators of any relationships between abuse history and sexual risk behaviors.

METHODS

A total of 1,428 women between 18 and 40 years of age attending family planning clinic appointments completed a self-report survey regarding their recent sexual behaviors and sexual and physical abuse history. Logistic regressions using backward elimination were conducted to identify factors associated with sexual risk behavior.

RESULTS

A history of physical abuse by a romantic partner was associated with several sexual risk behaviors. Few significant associations between intrafamilial physical or sexual abuse and recent sexual risk behaviors were found. Additionally, there was no evidence that these relationships were mediated by binge drinking or depressive symptomatology.

CONCLUSIONS

Familial abuse experiences are not necessarily associated with recent sexual risk behaviors among adults. In contrast, physical abuse experiences, particularly those perpetrated by a romantic partner, are associated with engaging in adult sexual risk behaviors among women. However, these associations are not mediated by alcohol use or depressive symptomatology.

Depressive symptoms in adolescents: associations with white matter volume and marijuana use

BACKGROUND

Depressed mood has been associated with decreased white matter and reduced hippocampal volumes. However, the relationship between brain structure and mood may be unique among adolescents who use marijuana heavily. The goal of this study was to examine the relationship between white matter and hippocampal volumes and depressive symptoms among adolescent marijuana users and controls.

METHODS

Data were collected from marijuana users (n = 16) and demographically similar controls (n = 16) aged 16-18. Extensive exclusionary criteria included psychiatric and neurologic disorders, including major depression. Substance use, mood, and anatomical measures were collected after 28 days of monitored abstinence.

RESULTS

Marijuana (MJ) users demonstrated more depressive symptoms than controls (p < .05). MJ use (beta = .42, p < .005) and smaller white matter volume (beta = -.34, p < .03) each predicted higher levels of depressive symptoms on the Hamilton Depression Rating Scale. MJ use interacted with white matter volume (beta = -.55, p < .03) in predicting depression scores on the Beck Depression Inventory: among MJ users, but not controls, white matter volume was negatively associated with depressive symptoms.

CONCLUSIONS

Marijuana use and white matter volume were additive and interactive in predicting depressive symptoms among adolescents. Subtle neurodevelopmental white matter abnormalities may disrupt the connections between areas involved in mood regulation.

Inventário de Depressão de Beck - BDI: validação fatorial para mulheres com câncer

Este estudo teve por objetivo validar fatorialmente o Inventário de Depressão de Beck - BDI para uma amostra de 208 mulheres com câncer. A validação fatorial do BDI foi realizada por meio da análise fatorial, método de extração dos componentes principais e rotação oblimin, tendo sido identificadas duas soluções fatoriais, uma bifatorial - sendo F1 composto por 8 itens (a = 0,82) denominado "visão negativa de si mesmo", explicando 32,4% da variância e F2 com 5 itens (a = 0,77) denominado "função física", explicando 8% da variância - e outra unifatorial com 13 itens, com fidedignidade altamente satisfatória (a = 0,86) denominada "depressão", explicando 38% da variância total.

The association of parental monitoring and family structure with diverse maladjustment outcomes in middle adolescent boys and girls

The aim of this study was to study the associations between family structure, parental monitoring and maladjustment outcomes among middle adolescent girls and boys. Data was collected through a school-based survey of a nationally representative sample of 17,643 Finnish adolescents aged 14-16 years. The less the parents knew the adolescents' friends and whereabouts, the more common were all the maladjustment outcomes studied. Non-intact family structure was associated with maladjustment and had associations independent of parental monitoring. We conclude that parental involvement with adolescents is conducive to healthy development, and that adolescents need the protection provided by parental supervision. Knowing the adolescent's whereabouts and friends is a concrete and easily measurable way of assessing parents' involvement in the adolescent's life.

Screening for adolescent depression in a pediatric emergency department

OBJECTIVES

To describe the prevalence of depressive symptoms in adolescents presenting to the emergency department (ED) and to describe their demographics and outcomes compared with adolescents endorsing low levels of depressive symptoms.

METHODS

The Beck Depression Inventory-2nd edition (BDI-II) was used to screen all patients 13-19 years of age who presented to the ED during the period of study. The BDI-II is a 21-item self-report instrument used to measure the presence and severity of depressive symptoms in adolescents and adults. Demographics and clinical outcomes of screening-program participants were abstracted by chart review. Patients were categorized into one of four severity categories (minimal, mild, moderate, or severe) and one of three presenting complaint categories (medical, trauma, mental health).

RESULTS

Four hundred eighty-seven patients were approached, and 351(72%) completed the screening protocol. Participants endorsed minimal (n = 192, 55%), mild (n = 52, 15%), moderate (n = 41, 11%), or severe depressive symptoms (n = 66, 19%). Those with moderate or severe depressive symptoms were more likely to be hospitalized. Of patients completing the BDI-II, 72% with psychiatric, 12% with traumatic, and 19% with medical chief complaints endorsed either moderate or severe depressive symptoms.

CONCLUSIONS

Depressive symptoms are prevalent in this screening sample, regardless of presenting complaint. A substantial proportion of patients with nonpsychiatric chief complaints endorsed moderate or severe depressive symptoms. A screening program might allow earlier identification and referral of patients at risk for depression.

A Comparison of Screening Instruments for Depression in Postpartum Adolescents

TOPIC

It is important to screen postpartum adolescents for depression during routine healthcare visits so that depression can be identified and treated.

PURPOSE

The purpose of the manuscript is to compare available depression screening instruments and to provide guidance to healthcare providers on choice of instrument.

SOURCES USED

Published studies.

CONCLUSIONS

In order to capture the common symptoms of adolescent and postpartum depression, a combination of screening instruments should be used.

Delinquency and the profile of offences among depressed and non-depressed adolescents

BACKGROUND

Depression has previously been found to be closely connected to adolescent delinquency, but little is known about how depression is related to different types of delinquency.

AIM

To investigate patterns of criminal behaviour according to depression among repeatedly delinquent adolescents.

METHOD

The sample was 14- to 16-year-old repeatedly delinquent adolescents (n 3679) taking part in the Finnish School Health Promotion Study, surveyed for versatility and specialization of delinquency in relation to depression.

RESULTS

Patterns of criminal behaviour differed between depressed and non-depressed delinquent adolescents. The delinquent behaviour of depressed adolescents was more versatile than that of non-depressed adolescents who mainly specialized in one offence type. Non-depressed delinquent boys had most often specialized in violence. Most depressed delinquent boys had committed a variety of offences, but among those who did specialize the specialist category was violent offences. Non-depressed delinquent girls had specialized in shoplifting. Among depressed delinquent girls vandalism was the most typical offence.

CONCLUSION

Differences in the delinquent behaviour of depressed and non-depressed delinquent adolescents suggest the value of including clinical assessment, and treatment for some, in an appropriately comprehensive pattern of management.

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

BACKGROUND

Limited prior research suggests that depressed women are more likely to experience certain symptoms of depression than are depressed men. The purpose of this study was to examine whether such gender differences in depressive symptoms are present during adolescence.

METHODS

The Childhood Version of the Schedule for Affective Disorders and Schizophrenia and the Beck Depression Inventory were administered to adolescents presenting for evaluation at an outpatient clinic (n=383; ages 11.9 to 20.0).

RESULTS

Depressed girls and boys had similar symptom prevalence and severity ratings for most depressive symptoms. However, depressed girls had more guilt, body image dissatisfaction, self-blame, self-disappointment, feelings of failure, concentration problems, difficulty working, sadness/depressed mood, sleep problems, fatigue, and health worries than depressed boys on some comparisons. In contrast, depressed boys had higher clinician ratings of anhedonia, depressed morning mood, and morning fatigue.

LIMITATIONS

Longitudinal research is needed to test whether such relatively gender-specific symptoms play different roles in the onset, maintenance, or remittance of depression for boys and girls.

CONCLUSIONS

These findings indicate that, in general, the experience of depression is highly similar for adolescent girls and boys. However, some gender differences previously found among depressed adults appear to be present by adolescence, possibly suggesting somewhat distinct etiologies for depression among males and females.

DRD2 genotypes and substance use in adolescent children of alcoholics

Research has identified children of alcoholics (COAs) as a population at increased risk for developing substance use problems. Genetic studies support the Al allele of the D2 dopamine receptor gene (DRD2) as a risk marker for alcoholism and substance use disorders. In this study, substance use was assessed in 48 adolescent boys of alcoholics with the DRDR A1(+) allele (A1A1/A1A2 genotypes) or the A1(-) allele (A2A2 genotype). The results revealed that boys with the A1(+) allele tried (p=0.0001) and got intoxicated on alcohol more often (p=0.009) than boys with the A1(-) allele. Boys with the A1(+) allele tried more (p=0.004) and used more substances overall (p=0.008) than boys with the A1(-) allele. Boys with the A1(+) allele developed a tobacco habit more often (p=0.03) and experienced marijuana high at an earlier age (p=0.001) than boys with the A1(-) allele. The best predictors of substance use severity in boys with the A1(+) allele were Psychoticism (p=0.01) and Negative Affect (p=0.04). The results provide support for the DRD2 A1 allele as a marker identifying a subgroup of COAs at high risk for developing substance use problems.

The effect of gynecologic age, body mass index and psychosocial environment on menstrual regularity among teenaged females

BACKGROUND

The aim was to study the prevalence of menstrual irregularity at an early postmenarcheal age and various biopsychosocial factors associated with menstrual irregularity.

METHODS

The study was conducted in Tartu, Estonia. The 70-item questionnaire and the 21-item Beck Depression Inventory (BDI) were completed by 580 female students of grades 9-12 in four high schools. Their height and weight were measured and body mass index (BMI) calculated. The effects associated with regularity of the menstrual cycle were studied.

RESULTS

Irregularity of the menstrual cycle was reported by 40% of respondents at an early postmenarcheal age. The risks for irregular menstrual cycles (IRM) were BMI <17.5 kg/m(2)[odds ratio (OR) 2.06; 95% confidence interval (95% CI) 1.06-4.00], low economic status IRM [OR 1.77 (95% CI 1.41-2.20)], insufficient communication with parents [OR 1.46 (95% CI 1.02-2.09)], and never pleased to go to school [OR 1.27 (95% CI 1.03-1.56)]. Comparison of the answers to the BDI with the regularity of periods revealed a difference in the total score [OR 1.54 (95% CI 1.21-1.97)], with a mean score of 8.3 +/- 0.4 for the respondents with regular menstrual cycles (RM) vs. 10.6 +/- 0.5 for the respondents with IRM.

CONCLUSION

Menstrual irregularity at an early postmenarcheal age can be considered as an indicator of difficulties in psychosocial adaptability of teenaged females.

Long-term outcome of a school-based, universal approach to prevention of depression in adolescents

In this study, the authors examined the 2-, 3-, and 4-year outcomes of a school-based, universal approach to the prevention of adolescent depression. Despite initial short-term positive effects, these benefits were not maintained over time. Adolescents who completed the teacher-administered cognitive-behavioral intervention did not differ significantly from adolescents in the monitoring-control condition in terms of changes in depressive symptoms, problem solving, attributional style, or other indicators of psychopathology from preintervention to 4-year follow-up. Results were equivalent irrespective of initial level of depressive symptoms.

The validity of the Beck Depression Inventory-Short Form as a screening and diagnostic instrument for moderate and severe depression in medical inpatients

OBJECTIVE

To examine the concurrent validity of the Beck Depression Inventory-Short Form (BDI-SF) to detect moderate and severe depressive episodes according to the International Classification of Diseases, 10th edition (ICD-10) criteria in inpatients with heterogeneous medical conditions and to set cut-off scores for its use in medical wards.

METHODS

One hundred and fifty-five patients [53% female; mean age (+/- S.D.) = 49.5 (+/- 17) years; mean number of years of education (+/- S.D.) = 6 (+/- 4) years] consecutively admitted to the adult medical wards in a General Hospital were interviewed during the first 72 h of hospitalization. The Clinical Interview Schedule [CIS] was used to make ICD-10 psychiatric diagnoses. All patients completed the BDI-SF. A "receiver operating characteristics" (ROC) curve was obtained and the sensitivity, specificity, positive and negative predictive values were calculated for different cut-off points of the BDI-SF.

RESULTS

High sensitivity and negative predictive value (NPV) were obtained with a cut-off score of 9/10 (sensitivity = 100%, specificity = 83.1%, NPV = 100%). High sensitivity and positive predictive value (PPV) were obtained with a cut-off score of 13/14 (sensitivity = 93.5%, specificity = 96%, PPV = 85.3%). The area under the ROC curve was 98.4% (95% Confidence Interval = 0.97-1.00).

CONCLUSIONS

The BDI-SF is a valid instrument for detecting moderate and severe depression in medical inpatients. For screening purposes, a 9/10 cut-off score is indicated, but if a high specificity is desired, a 13/14 cut-off score is warranted.

Expression of depressive symptoms in a nonclinical Brazilian adolescent sample

OBJECTIVE

This study aimed to detect the prevalence of depressive symptomatology and its expression in a nonclinical Brazilian adolescent student sample.

METHOD

A sample of students from private and public schools (n = 1555, aged 13 to 17 years) answered the Beck Depression Inventory (BDI). We performed factor analysis of the BDI as an indicator of the expression of depressive symptomatology. The following cut-off scores defined nonclinical subgroups: "nondepressed," BDI < 15; "dysphoria," BDI 16 to 20; and "depressed," BDI > 20. We used discriminant analysis to test whether these subgroups could be separated by the depression-specific and nonspecific items.

RESULTS

The point prevalence of depression was 7.6%, according to the BDI cut-off of 20. Girls had higher scores than boys in several items. Scores increased with age. Students from public schools had higher scores than did private school students. Factor analysis showed 2 common factors for the total sample and for each sex: the cognitive affective dimension and the somatic nonspecific dimension. In the adolescents showing clinical depression, items related to self-depreciation, sense of failure, guilty feelings, self-dislike, suicidal wishes, and distortion of body image were common components of BDI factors. Discriminant analysis showed that the BDI highly discriminates depressive symptomatology in adolescent students and also measures specific aspects of depression.

CONCLUSIONS

The BDI is useful as a measure of specific aspects of depression in nonclinical adolescent samples; it was able to detect depression in approximately 7% of the surveyed population. The expression of depressive symptoms in a Brazilian adolescent population is compatible with international studies in this age group. Detecting depressive symptoms in a school population is a critical preventive strategy; to avoid damage to the learning process, it should be followed with further referral to treatment when needed.

Brief report: Delinquent behaviour and depression in middle adolescence: a Finnish community sample

A large number (N 50,569) of 14-16 year old Finnish adolescents taking part in the School Health Promotion Study were surveyed for delinquent behaviour in relation to depression. The results indicate a robust association between delinquency and depression. Among girls risk for depression varied between 1.3 and 3.1 according to various antisocial behaviours (the equivalent risk among boys was 1.3-2.5). Depression increased according to the frequency of delinquent behaviour. The results emphasize the importance of comprehensive clinical assessment and treatment of delinquent adolescents.

Meta-analysis of the factor structures of four depression questionnaires: Beck, CES-D, Hamilton, and Zung

Four separate metaanalyses of factor analyses were conducted for the Beck Depression Inventory (BDI), the Center for Epidemiological Studies Depression Scale (CES-D), the Hamilton Rating Scale for Depression (HRSD), and the Zung Self-Rating Depression Scale (SDS). The total number of participants (N) and studies (k) included in each of the metaanalyses were the following: BDI (N = 13,643, k = 33), CES-D (N = 22,340, k = 28), HRSD (N = 2,606, k = 17), and SDS (N = 12,621, k = 13). Metaanalysis results suggest that the specific depression symptom factors within each test appear to be relatively robust and well established and match fairly closely previously hypothesized factor structures. A general Depression Severity factor and a small Somatic Symptoms factor are found in all four tests and two tests had a small Positive Affect factor. There were fewer common specific depression symptom factors across tests than expected.

Reliability and Validity of the Beck Depression Inventory--II With Adolescent Psychiatric Inpatients

This investigation was conducted to validate the Beck Depression Inventory--II (BDI-II; A. T. Beck, R. A. Steer, & G. K. Brown, 1996) in samples of adolescent psychiatric inpatients. The sample in each substudy was primarily Caucasian. In Study 1, expert raters (N=7) and adolescent psychiatric inpatients (N=13) evaluated the BDI-II items to assess content validity. In Study 2, confirmatory factor analyses of several first-order solutions failed to provide adequate fit estimates to data for 205 boys, 203 girls, and the combined sample. Exploratory factor analyses identified new item-factor solutions. Reliability estimates were good (range =.72 to.91) for the BDI-II total and scale scores. In Study 3 (N=161 boys and 158 girls from Study 2), preliminary evidence for estimates of concurrent, convergent, and discriminant validity were established for the BDI-II.

Prevalence of depression among adolescents

OBJECTIVE

To find out the prevalence and pattern of depression among adolescents.

METHODS

Adolescents of age group from 13 to 19 belonging to school/college students and school dropouts were assessed using Beck's Depression Inventory (BDI) by a team consisting of a pediatrician, psychologist and PGDCCD (Post Graduate Diploma in Clinical Child Development) students.

RESULTS

11.2% of school dropouts had severe and extreme grades of depression as against 3% among school going and nil among college going adolescents.

Adolescent tobacco smoking and associated psychosocial health risk factors

OBJECTIVE

To determine the relationship between tobacco smoking and psychosocial health risk factors in adolescents.

DESIGN

An in-class survey of schoolchildren in the final grade of basic school and in all three grades of secondary school.

SETTING

Four of the 11 secondary schools in Tartu, Estonia.

SUBJECTS

977 schoolchildren, ages ranging from 14 to 18.

MAIN OUTCOME MEASURES

A questionnaire was developed to explore various psychosocial aspects of tobacco smoking behaviour. The 21-item Beck Depression Inventory was used to measure depression.

RESULTS

In the total sample, smokers accounted for 24.5% of the girls and 26.5% of the boys, of which 13% of the girls and 19% of the boys were daily smokers. Not enjoying time spent with parents (OR = 0.6), skipping breakfast (OR = 1.3), frequent headache (OR = 1.3) and stomach-ache (OR = 1.4), dislike of school (OR = 0.7), using illicit drugs (OR = 5.0) and having multiple sexual partners (OR = 2.4) were all associated with daily smoking. Higher BDI scores were seen among adolescent smokers, particularly in girls and among pupils whose parents were non-smokers. The girls who smoked daily showed a higher risk of having suicidal thoughts (OR = 2.4) compared with non-smokers.

CONCLUSION

Smoking by adolescents is an indicator of risk for depression, distress and risk-taking health-damaging behaviours.

The Greek translation of the symptoms rating scale for depression and anxiety: preliminary results of the validation study

BACKGROUND

The aim of the current study was to assess the reliability, validity and the psychometric properties of the Greek translation of the Symptoms Rating Scale For Depression and Anxiety. The scale consists of 42 items and permits the calculation of the scores of the Beck Depression Inventory (BDI)-21, the BDI 13, the Melancholia Subscale, the Asthenia Subscale, the Anxiety Subscale and the Mania Subscale

METHODS

29 depressed patients 30.48 +/- 9.83 years old, and 120 normal controls 27.45 +/- 10.85 years old entered the study. In 20 of them (8 patients and 12 controls) the instrument was re-applied 1-2 days later. Translation and Back Translation was made. Clinical Diagnosis was reached by consensus of two examiners with the use of the SCAN v.2.0 and the IPDE. CES-D and ZDRS were used for cross-validation purposes. The Statistical Analysis included ANOVA, the Spearman Correlation Coefficient, Principal Components Analysis and the calculation of Cronbach's alpha.

RESULTS

The optimal cut-off points were: BDI-21: 14/15, BDI-13: 7/8, Melancholia: 8/9, Asthenia: 9/10, Anxiety: 10/11. Chronbach's alpha ranged between 0.86 and 0.92 for individual scales. Only the Mania subscale had very low alpha (0.12). The test-retest reliability was excellent for all scales with Spearman's Rho between 0.79 and 0.91.

CONCLUSIONS

The Greek translation of the SRSDA and the scales that consist it are both reliable and valid and are suitable for clinical and research use with satisfactory properties. Their properties are close to those reported in the international literature. However one should always have in mind the limitations inherent in the use of self-report scales.

Psychological distress and adherence to the medical regimen among adolescent renal transplant recipients

This longitudinal pilot study of adolescent renal transplant recipients (a) describes the prevalence of psychological distress, (b) describes the prevalence of nonadherence, and (c) explores the association between the recipient's psychological distress and his/her subsequent medical adherence. Twenty-two adolescents, aged 13-18 years, completed two interviews that were separated by approximately 12 months. Psychological distress was assessed in three domains: symptoms of depression, anxiety, and anger. Adherence was assessed in three domains: medication taking, blood work, and clinic attendance. At the initial interview, 36.4% had symptoms of depression, 36.4% endorsed anxiety, and 18.2% endorsed excessive state anger. Non-adherence rates were 13.6% for medication, 22.7% for blood work, and 50% for missed clinic. At the second interview, nonadherence with medication remained the same and the other domains decreased. Our small pilot sample, however, limited our ability to detect statistically significant changes over time. Predictive analyses demonstrated that adolescents with excessive anger were at greater risk for subsequently missing medications than adolescents without excessive anger. These findings suggest that while symptoms of depression and anxiety are observed among some adolescents with renal transplants, only anger is associated with elevated risk for nonadherence with medication.

Differential associations of sex and D2 dopamine receptor (DRD2) genotype with negative affect and other substance abuse risk markers in children of alcoholics

Children of alcoholics have increased risk for substance abuse problems. Self-medication of negative affect may be one developmental path to future substance abuse. Because the 146 young (adolescent) children of alcoholics in the current sample had not used enough abused substances to study substance use directly, the relation of substance abuse risk markers to negative affect was assessed. Because the D2 dopamine receptor (DRD2) A1 allele has been associated with alcoholism and other substance use disorders, negative affect, measured by the Beck Depression Inventory (BDI), was determined in four groups of children: boys and girls with the A1+ allele (A1A1 and A1A2 genotypes) and with the A1- allele (A2A2 genotype). The other risk markers were stress, low amplitude of the P300 evoked potential, poor visuospatial functioning, novelty seeking (NS), and harm avoidance (HA). Stress was correlated with BDI scores in all groups. In contrast, low P300 was associated with BDI scores only in boys with the A1+ allele (P = .04), NS was associated with BDI scores only in girls with the A1+ allele (P = .02), and HA was associated with BDI scores only in boys with the A1- allele (P = .01). In addition, boys with the A1+ allele had lower BDI (P = .05) and HA (P = .005) scores than the respective scores for boys with the A1- allele. Girls with the A1- allele had lower HA scores compared with scores for boys with the A1- allele (P = .02). Girls with the A1+ allele had lower visuospatial functioning than that of boys with the A1+ allele (P<.001). Results indicate that both sex and DRD2 genotype modify associations between negative affect and other substance abuse risk markers.

Factors in the psychological adjustment of homeless adolescent males: the role of coping style

OBJECTIVE

This cross-sectional study explored differences in and the association of self-reported coping style, negative life events, self-esteem, and perceived social support with the psychological adjustment (i.e., depressive symptoms, internalizing and externalizing behavior problems) of homeless and nonhomeless adolescent males.

METHOD

Data were collected from 100 youths accessing an emergency shelter and two comparison groups of nonhomeless youths: 70 youths accessing local community drop-in centers and 54 high school youths who had never accessed a shelter or drop-in. Data were collected from January 2000 to January 2001 in Ottawa.

RESULTS

Homeless youths reported a higher prevalence of family dysfunction, school difficulties, suicide attempts, legal problems, and substance use than nonhomeless youths. Homeless youths differed from nonhomeless youths for each outcome measure, reporting a greater use of the disengagement coping style, higher negative life events index, less perceived parental support, and higher levels of depressive symptoms and internalizing and externalizing behavior problems. Hierarchical regression analyses indicated that disengagement coping and self-worth accounted for significant amounts of variance in depressive symptomatology, and both internalizing and externalizing behavior problems in homeless youths.

CONCLUSIONS

Findings reflect the merit of considering coping style as a factor in the prevalence of psychological maladjustment among homeless youths.

Clinical recovery in cognitive functioning and self-image among adolescents with major depressive disorder and conduct disorder during psychiatric inpatient care

This prospective study examined psychosocial and cognitive functioning among adolescents with major depressive disorder and conduct disorder under comprehensive psychiatric inpatient care. Nonverbal and general cognitive performance, self-image, and overall psychosocial functioning improved in both groups. Nevertheless, more changes in self-image and family functioning were found among patients with major depressive disorder. Mental health services should still have the capability of offering long-term residential care for adolescents with the most severe mental disturbance.

Preventing adolescent depression: an evaluation of the problem solving for life program

This study evaluated the effectiveness of the Problem Solving For Life program as a universal approach to the prevention of adolescent depression. Short-term results indicated that participants with initially elevated depressions scores (high risk) who received the intervention showed a significantly greater decrease in depressive symptoms and increase in life problem-solving scores from pre- to postintervention compared with a high-risk control group. Low-risk participants who received the intervention reported a small but significant decrease in depression scores over the intervention period, whereas the low-risk controls reported an increase in depression scores. The low-risk group reported a significantly greater increase in problem-solving scores over the intervention period compared with low-risk controls. These results were not maintained, however, at 12-month follow-up.

Taxonicity of adolescent melancholia: a categorical or dimensional construct?

A taxometric analysis was conducted to test the hypothesis that the latent structure of melancholia in adolescents is categorical. Two taxometric procedures were used: Mean Above Minus Below a Cut (MAMBAC) and Maximum Covariance (MAXCOV) analyses. Participants were 378 adolescents presenting for a depression evaluation. Indicators of melancholia were constructed using items from the Schedule for Affective Disorders and Schizophrenia for School Aged Children (K-SADS) and the Beck Depression Inventory (BDI). The indicators of melancholia were consistent with a categorical latent variable. The findings suggest that the latent structure of melancholia in adolescents is similar to its previously identified categorical structure in adults. Implications for clinical research are discussed.

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

OBJECTIVE

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

METHOD

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

RESULTS

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

CONCLUSIONS

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

Problem-solving orientation and attributional style: moderators of the impact of negative life events on the development of depressive symptoms in adolescence?

Followed up 733 adolescents, ages 12 to 14 years, from a community sample over a 1-year period. Depressive symptoms at 1-year follow-up, controlling for baseline depression levels, were predicted by negative life events (NLEs) in the previous 12 months, attributional style (AS), negative problem solving orientation (NPSO), and the interaction between NLEs and NPSO. In the presence, but not absence, of high NLEs, NPSO predicted increases in depressive symptoms. In contrast, pessimistic AS predicted future increases in depression irrespective of the occurrence of NLEs. The findings supported a congnitive diathesis-stress model of the development of depression for NPSO but not AS.

The development and psychometric properties of a measure of social and adaptive functioning for children and adolescents

Developed, piloted, and examined the psychometric properties of the Child and Adolescent Social and Adaptive Functioning Scale (CASAFS), a self-report measure designed to examine the social functioning of young people in the areas of school performance, peer relationships, family relationships, and home duties/self-care. The findings of confirmatory and exploratory factor analysis support a 4-factor solution consistent with the hypothesized domains. Fit indexes suggested that the 4-correlated factor model represented a satisfactory solution for the data, with the covariation between factors being satisfactorily explained by a single, higher order factor reflecting social and adaptive functioning in general. The internal consistency and 12-month test-retest reliability of the total scale was acceptable. A significant, negative correlation was found between the CASAFS and a measure of depressive symptoms, showing that high levels of social functioning are associated with low levels of depression. Significant differences in CASAFS total and subscale scores were found between clinically depressed adolescents and a matched sample of nonclinical controls. Adolescents who reported elevated but subclinical levels of depression also reported lower levels of social functioning in comparison to nonclinical controls.

Adolescent depression: the role of discontinuities in life course and social support

OBJECTIVE

To study sociodemographic determinants of depression among 14-16 years old girls and boys, and the role of perceived social support in mediating the effects of the background variables.

METHOD

16464 adolescents aged 14-16 participated the School Health Promotion Study, a survey about health, health behaviour and school behaviour. Depression was measured by the Finnish modification of the 13-item Beck Depression Inventory. Moderate to severe symptoms in this scale were recorded as depression.

RESULTS

Depression was associated with family structure in both sexes. Among girls, having moved recently and low parental education increased the risk for depression, among boys, unemployment in the family. Accumulating number of discontinuities in life course increased the proportion of the depressed among both girls and boys. Perceived lack of social support had the same effect. Lack of support did not explain the effect on depression of the discontinuities in life course.

CONCLUSION

To detect risk groups for adolescent depressive disorders, health services should pay attention to adolescents who have experienced life changes. Perceived social support should be enquired.

Bullying at school--an indicator of adolescents at risk for mental disorders

A number of 14-16 year old Finnish adolescents taking part in the School Health Promotion Study (n=8787 in 1995, n=17643 in 1997) were surveyed about bullying and victimization in relation to psychosomatic symptoms, depression, anxiety, eating disorders and substance use. A total of 9 per cent of girls and 17 per cent of boys were involved in bullying on a weekly basis. Anxiety, depression and psychosomatic symptoms were most frequent among bully-victims and equally common among bullies and victims. Frequent excessive drinking and use of any other substance were most common among bullies and thereafter among bully-victims. Among girls, eating disorders were associated with involvement in bullying in any role, among boys with being bully-victims. Bullying should be seen as an indicator of risk of various mental disorders in adolescence.

Depression: a comparison study between blind and sighted adolescents

An exploratory study was conducted to identify whether the incidence of depression was greater among blind adolescents than among a sighted comparison group. A convenience sample of 22 adolescents, legally blind since birth, and 29 sighted adolescents participated in the study. The adolescents in both samples were between the ages of 12 and 18. The Beck Depression Inventory (BDI) was used to measure depression. The findings indicated that the incidence of depression among the blind adolescents was significantly higher than the incidence of depression among the sighted adolescents (t = 2.937, df = 50, p < .005). Mean BDI score was 7.103 for the sighted group and 13.652 for the blind group. There were no significant relationships between demographic variables and depression. This study serves as a pilot for more extensive research that can expand the empirical base for understanding depression and its relationship to visual impairment among adolescents.

Bullying, depression, and suicidal ideation in Finnish adolescents: school survey

OBJECTIVE

To assess the relation between being bullied or being a bully at school, depression, and severe suicidal ideation.

DESIGN

A school based survey of health, health behaviour, and behaviour in school which included questions about bullying and the Beck depression inventory, which includes items asking about suicidal ideation.

SETTING

Secondary schools in two regions of Finland.

PARTICIPANTS

16 410 adolescents aged 14-16.

RESULTS

There was an increased prevalence of depression and severe suicidal ideation among both those who were bullied and those who were bullies. Depression was equally likely to occur among those who were bullied and those who were bullies. It was most common among those students who were both bullied by others and who were also bullies themselves. When symptoms of depression were controlled for, suicidal ideation occurred most often among adolescents who were bullies.

CONCLUSION

Adolescents who are being bullied and those who are bullies are at an increased risk of depression and suicide. The need for psychiatric intervention should be considered not only for victims of bullying but also for bullies.

Empirically derived factor indices for the Beck Depression Inventory

Factor analytic studies of the Beck Depression Inventory routinely yield a small number of factors that parsimoniously summarize the 21 items of the inventory. To improve the utility of such factor data within clinical or applied research settings, the present study aimed to develop a set of empirically derived depression indices based on the factor structure of the Beck Depression Inventory. In Study 1, principal-axis factor analysis of the responses of 303 undergraduate students yielded a 2-factor solution that accounted for 33% of the common variance. Easily calculated factor indices were developed to reflect individual performance on each factor, and normative data from the sample were used to establish preliminary guidelines for evaluating severity on each index. In Study 2, analyses of the factor-index scores obtained from a clinical sample of 55 medical patients supported the utility of the index scores for discriminating among various aspects of dysphoric experience.