Risk Factors for Substance Misuse and Adolescents' Symptoms of Depression

Cross-sectional and longitudinal associations of adherence to the 24-hour movement guidelines with mental health problems among Chinese adolescents

OBJECTIVE

This study aimed to examine the cross-sectional and longitudinal associations between meeting the 24-Hour Movement Guidelines (recommendations for the optimal amount of moderate-to-vigorous physical activity, screen time, and sleep duration per day) and mental health problems among Chinese adolescents.

METHODS

A two-wave longitudinal survey was conducted in Huizhou, Guangdong province. A total of 906 junior high school students were recruited in the six-month follow-up survey. Moderate-to-vigorous physical activity, screen time, sleep duration, anxiety symptoms (GAD-7 score), and depressive symptoms (PHQ-9 score) were measured using a self-administered questionnaire. At baseline, participants were classified as meeting: 1) no recommendation, 2) one recommendation, 3) two recommendations, or 4) all three recommendations.

RESULTS

Overall, the proportions of adolescents meeting moderate-to-vigorous physical activity, screen time, and sleep recommendations at T₁ were 33.3%, 68.2%, and 64.7%, respectively. Cross-sectionally, the severity of anxiety and depressive symptoms at T₁ significantly decreased as the number of recommendations met increased (adjusted regression coefficients [95% CI] for three recommendations met versus none: -2.80 [-4.05, -1.55] and - 3.42 [-4.85, -1.99], respectively). Longitudinally, adolescents who met three recommendations at T₁ displayed lower anxiety and depressive symptoms six months later than those who did not (adjusted regression coefficients [95% CI]: -1.00 [-1.98, -0.02] and - 1.43 [-2.53, -0.32], respectively). Furthermore, meeting three recommendations was associated with the alleviation of depressive symptoms (adjusted OR [95% CI]: 0.39 [0.17, 0.90]).

CONCLUSIONS

Promoting adolescents to adhere to the 24-Hour Movement Guidelines could be considered an intervention target for mental health problems at a population level.

A latent class approach to understanding longitudinal sleep health and the association with alcohol and cannabis use during late adolescence and emerging adulthood

OBJECTIVE

Sleep is a multi-dimensional health behavior associated with elevated risk of substance use. This is the first study to utilize a latent class approach to characterize sleep health across multiple dimensions and across time from late adolescence to emerging adulthood, and to examine associations with alcohol and cannabis use trajectories.

METHODS

The sample included 2995 emerging adults (mean ages = 18 to 24 years across six waves of data collection; 54% female) who provided data on sleep dimensions (quality, duration, and social jetlag) and frequency and consequences of alcohol and cannabis use. Longitudinal latent class analysis (LLCA) models characterized participants according to the three sleep dimensions. Latent growth models examined trajectories of frequency and consequences of alcohol or cannabis use over time among emergent sleep classes, with and without controlling for covariates.

RESULTS

LLCA models identified four sleep classes: good sleepers (n = 451; 15.2%); untroubled poor sleepers (n = 1024; 34.2%); troubled, moderately good sleepers (n = 1056; 35.3%); and suboptimal sleepers (n = 460; 15.4%). Good sleepers reported significantly lower levels of alcohol or cannabis use and consequences, and less of an increase in alcohol consequences as compared to suboptimal sleepers.

CONCLUSIONS

Persistent poor sleep health was associated with higher levels of alcohol and cannabis use and consequences, and greater increases in alcohol-related consequences during the transition from late adolescence to emerging adulthood. Findings have important clinical implications, highlighting that addressing multi-dimensional sleep health may be an important, novel target of intervention to reduce substance use frequency and consequences.

Prevalence of and factors associated with depression in the hill tribe population aged 40 years and older in northern Thailand

Background

Depression is globally recognized as a major mental health problem in all age categories, particularly among those living in poor economic conditions and with low levels of education, including the hill tribe people in northern Thailand.

Methods

This cross-sectional study aimed to estimate the prevalence of depression and determine the factors associated with depression in the hill tribe population aged 40 and over in northern Thailand. Hill tribe people who lived in the selected villages and met the inclusion criteria were invited to participate in the study. A validated questionnaire and the Patient Health Questionnaire-9 (PHQ-9) were used for data collection. An interview was conducted in a private and confidential room in the selected villages between January and April 2019. Logistic regression was used to determine the factors associated with depression at a significance level of α = 0.05.

Results

A total of 601 participants were recruited into the study. More than half (64.23%) were women, 46.76% were Akha, 61.90% were aged 40–59 years, and 76.37% were married. Half of the participants were Christian (57.07%) and had no monthly income (51.25%), and 85% were illiterate. The overall prevalence of depression was 39.10%: 75.74% had mild depression, 17.88% had moderate depression, and 6.38% had severe depression. In the multivariate model, three variables were found to be associated with depression: being female, having a history of substance abuse, and experiencing stress six months prior. Compared to men, women were 2.09 times (95% CI 1.30–3.35) more likely to have depression. Those who had a history of substance abuse were more likely to have depression than those who did not have a history of substance abuse (AOR = 1.97; 95% CI 1.25–3.10). Those who had a history of stress in the prior 6 months were more likely to have depression than those who did not (AOR = 6.43; 95% CI 4.20–9.85).

Conclusion

Public health screening programs to identify depression in the hill tribe population are urgently needed, particularly for women, those who have abused psychoactive substances, and those who have experienced stress.

Youth with Co-occurring Delinquency and Depressive Symptoms: Do They Have Better or Worse Delinquent Outcomes?

Delinquent youth often experience depression, but depression's impact on their future deviance is unclear. Using survey and social network data on a panel of 9th graders (N = 8701; M_age at baseline = 15.6; 48% male; 85% white; 18% eligible for free or reduced-price school lunch) followed throughout high school, this study tested whether depressive symptoms predicted later deviance or deviant peer affiliations among already delinquent youth. A latent class analysis revealed that 4% of respondents showed above-average levels of delinquency but not depressive symptoms, and 3% were above average on both. Compared to the delinquent-only group, the delinquent-depressed group went on to have less deviant friends, and to engage in less deviance themselves. However, peer deviance was not a reliable explanation for the reductions in respondents' own future deviance. Depressive symptoms thus may play a protective role against continued delinquency and substance use among youth who are already delinquent, but it is not because they reduce deviant peer affiliations.

Adolescent Internalizing Symptoms and the "Tightknittedness" of Friendship Groups

Adolescents with depression have lower peer status overall, but tend to befriend each other. We examined the "tightknittedness" of their friendship groups by testing whether adolescent friendship groups' average levels of or variability in internalizing symptoms predict group cohesiveness. We used four waves (9th-12th grades) of survey and social network data on 3,013 friendship groups from the PROmoting School-Community-University Partnerships to Enhance Resilience study. Friendship groups with higher average depressive symptoms were less cohesive; groups with higher average anxiety symptoms had greater reciprocity. Groups with greater variability in depressive symptoms had greater density; variability in anxiety symptoms was not consistently associated with cohesion. The friendship groups of depressed adolescents appear less cohesive than the "typical" adolescent friendship group.