Trajectories of depressive symptoms from adolescence to young adulthood: Chinese Americans versus non-Hispanic whites

Family socioeconomic status and adolescent depression in urban and rural China: A trajectory analysis

Background

Depression is increasingly prevalent among Chinese adolescents, with socioeconomic status (SES) serving as a significant predictor. Understanding the link between family SES and depression is of paramount concern. This study aimed to delineate the developmental paths of depressive symptoms among urban and rural Chinese adolescents, focusing on the influence of family SES on these trajectories.

Methods

Data from the China Family Panel Studies (CFPS) for 2012, 2016, and 2018 were used in this study. Participants were individuals aged 10 to 15 in the 2012 wave who also participated in the 2016 and 2018 waves (N = 1214). Family SES was measured by household income, parental education, and occupational status, while depressive symptoms were measured by the Center for Epidemiologic Studies Depression (CES-D) scale. Employing the Growth Mix Model (GMM) unveiled depression trajectories, while logistic regression scrutinized the impact of family SES on these trajectories.

Results

The study identified three depression trajectories in urban adolescents: high-decreasing, low-stable, and low-rising levels of depressive symptoms, and two depression trajectories in rural adolescents: high-decreasing and low-stable levels of depressive symptoms. On average, rural adolescents reported higher depression levels than urban peers. In urban areas, adolescents with higher maternal education and parental occupation were more likely to be classified in the low-stable trajectory, while in rural areas only maternal education had predictive power for depression trajectories.

Conclusions

Depression trajectories differ between urban and rural in China. Maternal education is an important factor influencing rural sample grouping. Targeted interventions could be implemented to reduce depression in adolescents.

Individual Trajectories of Depressive Symptoms Within Racially-Ethnically Diverse Youth: Associations with Polygenic Risk for Depression and Substance Use Intent and Perceived Harm

There are distinct individual trajectories of depressive symptoms across adolescence which are most often differentiated into low, moderate/stable, and high/increasing groups. Research has found genetic predisposition for depression associated with trajectories characterized by greater depressive symptoms. However, the majority of this research has been conducted in White youth. Moreover, a separate literature indicates that trajectories with elevated depressive symptoms can result in substance use. It is critical to identify depressive symptom trajectories, genetic predictors, and substance use outcomes in diverse samples in early adolescence to understand distinct processes and convey equitable benefits from research. Using data from the Adolescent Cognitive Brain Development Study (ABCD), we examined parent-reported depressive symptom trajectories within Black/African American (AA, n = 1783), White/European American (EA, n = 6179), and Hispanic/Latinx (LX, n = 2410) youth across four annual assessments in early adolescence (age 9-10 to 12-13). We examined racially/ethnically aligned polygenic scores (Dep-PGS) as predictors of trajectories as well as substance use intent and perceived substance use harm as outcomes at age 12-13. Differential trajectories were found in AA, EA, and LX youth but low and high trajectories were represented within each group. In EA youth, greater Dep-PGS were broadly associated with membership in trajectories with greater depressive symptoms. Genetic effects were not significant in AA and LX youth. In AA youth, membership in the low trajectory was associated with greater substance use intent. In EA youth, membership in trajectories with higher depressive symptoms was associated with greater substance use intent and less perceived harm. There were no associations between trajectories and substance use intent and perceived harm in LX youth. These findings indicate that there are distinct depressive symptom trajectories in AA, EA, and LX youth, accompanied by unique associations with genetic predisposition for depressive symptoms and substance use outcomes.

Gonadal and adrenal hormones interact with pubertal maturation to predict depressive symptoms in a group of high-school females

Adolescent females are at elevated risk for the development of depression. In this study, we addressed two questions: Are pubertal hormones associated with adolescent mental health? Might this association depend on pubertal development? We tested the hypothesis that estradiol, which has been associated with adolescent social sensitivity, might interact with pubertal stage to predict depression risk at three time points in ninth and tenth grade. Hormones and pubertal development were measured ninth-grade females. Linear regression analyses were used to predict fall ninth-grade (N = 79), spring ninth-grade (N = 76), and spring tenth-grade (N = 67) Children's Depression Inventory (CDI) scores. The hypothesized model was not statistically significant, but exploratory analyses revealed that two- and three-way interactions incorporating estradiol, puberty (stage and perceived onset), and cortisol predicted current and future CDI scores. Our exploratory model did not predict changes in CDI but did account for future (spring of ninth grade) CDI scores. Specifically, estradiol was positively correlated with fall and spring ninth-grade depressive symptoms in participants with high cortisol who also reported earlier stages and later perceived onset of pubertal development. These findings suggest that hormones associated with sensitivity to the social environment deserve consideration in models of adolescent depression risk.

Racial and ethnic differences in major depressive episode, severe role impairment, and mental health service utilization in U.S. adolescents

BACKGROUND/OBJECTIVES

This study aimed to examine racial and ethnic variations in national trends, past-year prevalence, determinants of major depressive episode (MDE), MDE-related role impairment and mental health (MH) services utilization in U.S. adolescents.

METHODS

Data was extracted from the National Survey on Drug Use and Health (NSDUH) from 2010 to 2018. A total of 137,671 nationally representative adolescents aged 12-17 were included in the study. Weighted temporal trends in the past-year prevalence of MDE, and MDE with severe role impairment were estimated both overall and by race and ethnicity. Weighted multivariate logistic regressions were conducted to assess racial/ethnic differences in determinants of MDE, MDE-related severe role impairment, and MH services utilization after adjusting for sociodemographic characteristics, family structure, substance use, activity participation, and problem-solving group engagement.

RESULTS

The prevalence of MDE and MDE with severe role impairment among U.S. adolescents has steadily increased, while MDE-related health services utilization remained low from 2010 to 2018. Racial and ethnic minority adolescents were more likely to experience an MDE, but less likely to use MH services compared to their White counterparts. Participating in school, family, community, or faith-based activities was significantly associated with lower MDE incidence. Problem-solving group engagement was associated with MH services utilization (all p-values < 0.05).

CONCLUSION

High prevalence of depression and low MH service utilization among U.S. adolescents remains a public health issue. Moreover, racial/ethnic disparities persist in MH and service utilization outcomes. Future research must investigate the burden and predictors of mental illness, and the factors influencing MH services utilization in diverse adolescent populations.

Two Sides to Face: Integrity- and Achievement-Centered Face-Saving, Parental Psychological Control, and Depressive Symptoms in Chinese American Adolescents

Depressive symptoms can be serious, but often overlooked, health risk factors, especially for Asian Americans who are vulnerable to acculturation stress but tend to underreport mental health problems. The present study examines how specific cultural values and parenting practices are associated with Chinese American adolescents’ depressive symptoms. One hundred and nine Chinese American adolescents (61% females; Mage = 15.93 years, SDage = 1.39 years) and their parents completed online surveys about their endorsement of traditional Chinese cultural values that reflect integrity and achievement as two forms of face-saving, parents’ use of psychological control, and adolescents’ depressive symptoms. Parents’ endorsement of Conformity To Norms was positively associated with adolescents’ endorsement of the same value, which further correlated positively with adolescents’ depressive symptoms. However, adolescents’ endorsement of Family Recognition Through Achievement was neither associated with parents’ endorsement of the value nor with adolescents’ depressive symptoms. In addition, while parental psychological control was positively related to adolescents’ value belief in Conformity To Norms and depressive symptoms, parental psychological control was negatively related to adolescents’ value belief in Family Recognition Through Achievement. The findings suggest the richness and complexities of the face-saving cultural values and the usefulness of unpacking parenting dimensions in understanding familial processes and developmental specificity among immigrant youth.

Influencing Factors of Depression among Adolescent Asians in North America: A Systematic Review

Background: Asian American adolescents experience rates of depression comparable to or greater than those of other ethnic minorities. The purpose of this systematic review is to summarize psychosocial factors related to depressive symptoms of Asian American adolescents between the ages of 10 to 19. Methods: Various electronic databases were systematically searched to identify research articles published from 2000 to 2021, and the psychosocial factors influencing depression among Asian adolescents in North America were examined. Results: A total of 81 studies were included in this systematic review. Consistent findings on relationships between depressive symptoms and influencing factors included (a) acculturative stress, (b) religious or spiritual significance for females, (c) parent–child cohesion, (d) harsh parenting style, (e) responsive parenting style, (f) racial or ethnic discrimination, (g) being bullied, (h) positive mentor presence, and (i) exposure to community violence. Collectively, the majority of included studies suggest that depressive symptoms were more likely found among Asian American adolescents who (a) are older, (b) are female, (c) have immigrant status, (d) exhibit coping behaviours, (e) face academic challenges, (f) face a poor socioeconomic situation, (g) perceive parent–child conflict, (h) perceive maternal disconnectedness, and (i) perceive negative peer relations. A number of conflictive findings also existed. Discussion/Conclusions: This systematic review provides a summary of the various psychosocial factors on individual, familial, and social levels, which influenced the depressive symptoms of Asian American adolescents. Such findings offer a starting point to examine what factors should be necessarily included in related depression-preventive intervention design and evaluation. Culturally sensitive care, strengthened family–school–community collaboration, and targeted research efforts are needed to meet the needs of Asian adolescents experiencing a range of depressive symptoms.

Intersectionality and depression in adolescence and early adulthood: A MAIHDA analysis of the national longitudinal study of adolescent to adult health, 1995-2008

Depression in adolescents and young adults remains a pressing public health concern and there is increasing interest in evaluating population-level inequalities in depression intersectionally. A recent advancement in quantitative methods-multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA)-has many practical and theoretical advantages over conventional models of intercategorical intersectionality, including the ability to more easily evaluate numerous points of intersection between axes of marginalization. This study is the first to apply the MAIHDA approach to investigate mental health outcomes intersectionally in any population. We examine intersectionality and depression among adolescents and young adults in the U.S. along dimensions of gender, race/ethnicity, immigration status, and family income using a large, nationally representative sample-the National Longitudinal Study of Adolescent to Adult Health. We find evidence of considerable inequalities between social strata, with women, racial/ethnic minorities, immigrants, and low income strata experiencing elevated depression scores. Importantly, the majority of between-strata variation is explained by additive main effects, with no strata experiencing statistically significant residual "interaction" effects. We compare these findings to previous intersectional research on depression and discuss possible sources of differences between MAIHDA and conventional intersectional models.

Relationships between affective states and childhood internalizing disorders

Internalizing disorders are mainly defined as psychosomatic, anxiety and depression problems. The aim of this study was to analyze the relationships between dairy affective states and internalizing disorders in early adolescence (10-12 years old), considering the influence of sex. The participants of the study were 367 children aged between 10 and 12 (190 girls and 177 boys). The results showed that fear was the best predictor for all internalizing disorders, and the only common predictor for all of them. The prediction of boys' internalizing disorders was based only in fear, whereas the prediction for girls involved more variables besides fear. An early detection/regulation of these affective states (particularly fear) may be useful for the prevention and treatment of child internalizing disorders.

Review: Longitudinal trajectories of child and adolescent depressive symptoms and their predictors - a systematic review and meta-analysis

BACKGROUND

With depression predicted to contribute to an increased disease burden in coming decades, prevention efforts have become increasingly important. In order to prevent depression it is valuable to identify and classify longitudinal patterns of depressive symptoms across development, ideally beginning early in childhood. To achieve this, longitudinal studies are increasingly using person-centered data-analytic methods to model subgroups with similar developmental patterns (trajectories) of depressive symptoms.

METHOD

A search was completed for English language studies that longitudinally modeled depressive symptom trajectories in nonclinical populations with a baseline age of <19 years. Study characteristics were extracted, prevalence rates and risk factors were summarized, a random-effect meta-analysis was undertaken, and risk of bias analysis completed.

RESULTS

Twenty studies published between 2002 and 2015 were included. Participants were recruited at ages 4 through 17 (average age 12.34) and followed longitudinally for an average of 7.45 years. Between 3 and 11 trajectory subgroups were identified. A random pooled effect estimate identified 56% [95% Confidence Interval (CI) 46-65%] of the sampled study populations (N = 41,236) on 'No or low' depressive symptom trajectories and 26% (CI 14-40%) on a 'Moderate' trajectory. 'High', 'Increasing', and 'Decreasing' depressive symptom subgroups were evident for 12% (CI 8-17%). Moderate symptoms were associated with poorer adjustment and outcomes relative to low symptom groups. 'High' or 'Increasing' trajectories were predominantly predicted by: female gender, low socioeconomic status, higher stress reactivity; conduct issues; substance misuse, and problems in peer and parental relationships.

CONCLUSIONS

The review highlighted consistent evidence of subgroups of children and adolescents who differ in their depressive symptom development over time. The findings suggest preventative interventions should evaluate the longer term benefits of increasing membership in low and moderate trajectories, while also targeting reductions in high-risk subgroups. Considerable between-study method and measurement variation indicate the need for future trajectory studies to use standardized methods.

Which girls, which boys? The intersectional risk for depression by race and ethnicity, and gender in the U.S

We sought to conduct the first systematic review of studies applying an intersectional lens to assessing risk and protective factors for depression in minority adolescents in the United States. Twenty-five studies were identified which investigated the role of racial and ethnic identity and gender for minority groups and how marginalization may be associated with differential outcomes in depression symptomology. The results showed substantial variability in whether studies intentionally operationalized intersectionality through theoretical frameworks, study design, sampling, and analyses. Studies were rated on a scale of 1 through 5; those with scores of 3 or higher were included in the review. A rating of 5 indicated studies had explicitly used an intersectional theoretical framework, integrating the process of racial/ethnic identity development and gender socialization during adolescence. Three studies met the criteria for 5, one study was rated 4, and 21 studies were rated 3. Attention to experiences with discrimination was common throughout. Overall, the collective findings point to the importance of using an intersectional lens for understanding differential mechanisms for how and why specific adolescent minority youth are at greater risk for reporting depression symptoms, identifying cultural and developmental protective factors, and informing how interventions can effectively target specific mechanisms for prevention and treatment.

Depressive symptom trajectories in late adolescence and early adulthood: A systematic review

OBJECTIVE

In adolescents and young adults, depressive symptoms are highly prevalent and dynamic. For clinicians, it is difficult to determine whether a young person reporting depressive symptoms is at risk of developing ongoing mood difficulties or whether symptoms form part of a transient maturational process. Trajectory analyses of longitudinally assessed symptoms in large cohorts have the potential to untangle clinical heterogeneity by determining subgroups or classes of symptom course and their risk factors, by interrogating the impact of known or suspected risk factors on trajectory slope and intercept and by tracing the interrelation between depressive symptoms and other clinical outcomes over time.

METHOD

We conducted a systematic review of trajectory studies conducted in cohorts including people aged between 15 and 25 years.

RESULTS

We retrieved 47 relevant articles. These studies suggest that young people fall into common mood trajectory classes and that class membership and symptom course are mediated by biological and environmental risk factors. Furthermore, studies provide evidence that high and persistent depressive symptoms are associated with a range of concurrent health and behavioral outcomes.

CONCLUSION

Findings could assist in the formulation of novel concepts of depressive disorders in young people and inform preventive strategies and predictive models for clinical practice.

Risk Factors of Suicide and Depression among Asian American, Native Hawaiian, and Pacific Islander Youth: A Systematic Literature Review

Suicide has become an increasing public health challenge, with growing incidence among Asian American, Native Hawaiian, and Pacific Islander (AA and NHPI) youth. Using an ecological framework, the purpose of this systematic review was to explicate risk and protective factors for depression or suicide among AA and NHPI youth from available peer reviewed research. The ecological framework provides a useful blueprint for translating social determinants of health to explain the experience of depression and suicidal behaviors among AA and NHPI youth. Sixty-six studies were extracted from PsychInfo, Ovid Med-line, EMBASE, CINAHL, and Web of Science. Policy and practice recommendations are offered in light of relevant themes that emerged. Further research and data disaggregation is needed to develop and strengthen population health strategies, interventions, and policies that address the underlying social conditions and cultural contexts of mental health disparities associated with depression and suicide among AA and NHPI youth.

Handling Missing Data With Multilevel Structural Equation Modeling and Full Information Maximum Likelihood Techniques

With increasing access to population-based data and electronic health records for secondary analysis, missing data are common. In the social and behavioral sciences, missing data frequently are handled with multiple imputation methods or full information maximum likelihood (FIML) techniques, but healthcare researchers have not embraced these methodologies to the same extent and more often use either traditional imputation techniques or complete case analysis, which can compromise power and introduce unintended bias. This article is a review of options for handling missing data, concluding with a case study demonstrating the utility of multilevel structural equation modeling using full information maximum likelihood (MSEM with FIML) to handle large amounts of missing data. MSEM with FIML is a parsimonious and hypothesis-driven strategy to cope with large amounts of missing data without compromising power or introducing bias. This technique is relevant for nurse researchers faced with ever-increasing amounts of electronic data and decreasing research budgets. © 2016 Wiley Periodicals, Inc.

Acculturation and its implications on parenting for Chinese immigrants: a systematic review

PURPOSE

To systematically review and synthesize existing findings on acculturation and its implications on parenting for Chinese immigrants.

METHOD

Three electronic databases were searched for original research articles that examined acculturation and its influence on parenting in Chinese immigrants.

RESULTS

Twenty-two studies were included. Findings suggest that acculturation influences parenting beliefs, attitudes, and practices, as well as parent-child relationships among Chinese immigrants. Acculturation discrepancies between parents and children are associated with negative child outcomes.

DISCUSSION AND CONCLUSIONS

Further research is needed to better understand the relationships among acculturation and parenting perceptions, parent-child relationships, and parent-child acculturation discrepancies and associated child outcomes. In particular, longitudinal studies with larger samples and multiple methods are needed to suggest causal inferences and validate these relationships.

IMPLICATIONS FOR PRACTICE

Nurses are at the unique junction to identify these problems through interacting with individuals and families at the clinical and mental/community health levels.

Chinese American adolescents: perceived parenting styles and adolescents' psychosocial health

BACKGROUND

Asian Americans are one of the fastest-growing minority groups in the USA, and Chinese constitute the largest group. Evidence suggests that Asian American adolescents experience higher levels of depressive symptoms than their same-gender white counterparts. Quantitative findings suggest associations between parenting factors and Chinese American adolescents' mental health. A qualitative understanding regarding Chinese American adolescents' perceived parenting styles and its relationship with adolescents' psychosocial health is warranted.

AIM

To gain an in-depth understanding of Chinese American adolescents' perceived parenting styles and how parenting styles might influence adolescents' psychosocial health.

METHODS

In this qualitative study, we recruited 15 Chinese American adolescents aged 12-17 years in a southwest metropolitan area. We conducted two focus group interviews. Participants also filled out a brief questionnaire that included their socio-demographic information, immigration history and level of acculturation.

RESULTS

Participants reported perceiving that parents had high expectations about academic performance and moral values. They also perceived stricter family rules regarding choices of friends compared with their non-Asian peers. Parents tended to be more protective of girls than of boys. Both Chinese American boys and girls reported poor or ineffective communication with their parents, which contributed to increased conflict between parents and adolescents and emotional distress of the adolescents.

CONCLUSIONS

The findings provide evidence for nurses to develop linguistically and culturally tailored resources (e.g. parent support groups, programs aimed to improving parent-child communication) or connect these families with existing resources to enhance parenting skills and consequently reduce emotional distress of their adolescent children.