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Erskine HE, Maravilla JC, Wado YD, Wahdi AE, Loi VM, Fine SL, Li M, Ramaiya A, Wekesah FM, Odunga SA, Njeri A, Setyawan A, Astrini YP, Rachmawati R, Hoa DTK, Wallis K, McGrath C, Shadid J, Enright ME, Blondell SJ, Lawrence D, Fisher PW, Whiteford HA, Vinh ND, Wilopo SA, Kabiru CW, Blum RW, Scott JG. Prevalence of adolescent mental disorders in Kenya, Indonesia, and Viet Nam measured by the National Adolescent Mental Health Surveys (NAMHS): a multi-national cross-sectional study. Lancet 2024; 403:1671-1680. [PMID: 38588689 DOI: 10.1016/s0140-6736(23)02641-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 11/14/2023] [Accepted: 11/22/2023] [Indexed: 04/10/2024]
Abstract
BACKGROUND Mental disorders are the leading global cause of health burden among adolescents. However, prevalence data for mental disorders among adolescents in low-income and middle-income countries are scarce with often limited generalisability. This study aimed to generate nationally representative prevalence estimates for mental disorders in adolescents in Kenya, Indonesia, and Viet Nam. METHODS As part of the National Adolescent Mental Health Surveys (NAMHS), a multinational cross-sectional study, nationally representative household surveys were conducted in Kenya, Indonesia, and Viet Nam between March and December, 2021. Adolescents aged 10-17 years and their primary caregiver were interviewed from households selected randomly according to sampling frames specifically designed to elicit nationally representative results. Six mental disorders (social phobia, generalised anxiety disorder, major depressive disorder, post-traumatic stress disorder, conduct disorder, and attention-deficit hyperactivity disorder) were assessed with the Diagnostic Interview Schedule for Children, Version 5. Suicidal behaviours and self-harm in the past 12 months were also assessed. Prevalence in the past 12 months and past 4 weeks was calculated for each mental disorder and collectively for any mental disorder (ie, of the six mental disorders assessed). Prevalence of suicidal behaviours (ie, ideation, planning, and attempt) and self-harm in the past 12 months was calculated, along with adjusted odds ratios (aORs) to show the association with prevalence of any mental disorder in the past 12 months. Inverse probability weighting was applied to generate national estimates with corresponding 95% CIs. FINDINGS Final samples consisted of 5155 households (ie, adolescent and primary caregiver pairs) from Kenya, 5664 households from Indonesia, and 5996 households from Viet Nam. In Kenya, 2416 (46·9%) adolescents were male and 2739 (53·1%) were female; in Indonesia, 2803 (49·5%) adolescents were male and 2861 (50·5%) were female; and in Viet Nam, 3151 (52·5%) were male and 2845 (47·4%) were female. Prevalence of any mental disorder in the past 12 months was 12·1% (95% CI 10·9-13·5) in Kenya, 5·5% (4·3-6·9) in Indonesia, and 3·3% (2·7-4·1) in Viet Nam. Prevalence in the past 4 weeks was 9·4% (8·3-10·6) in Kenya, 4·4% (3·4-5·6) in Indonesia, and 2·7% (2·2-3·3) in Viet Nam. The prevalence of suicidal behaviours in the past 12 months was low in all three countries, with suicide ideation ranging from 1·4% in Indonesia (1·0-2·0) and Viet Nam (1·0-1·9) to 4·6% (3·9-5·3) in Kenya, suicide planning ranging from 0·4% in Indonesia (0·3-0·8) and Viet Nam (0·2-0·6) to 2·4% (1·9-2·9) in Kenya, and suicide attempts ranging from 0·2% in Indonesia (0·1-0·4) and Viet Nam (0·1-0·3) to 1·0% (0·7-1·4) in Kenya. The prevalence of self-harm in the past 12 months was also low in all three countries, ranging from 0·9% (0·6-1·3) in Indonesia to 1·2% (0·9-1·7) in Kenya. However, the prevalence of suicidal behaviours and self-harm in the past 12 months was significantly higher among those with any mental disorder in the past 12 months than those without (eg, aORs for suicidal ideation ranged from 7·1 [3·1-15·9] in Indonesia to 14·7 [7·5-28·6] in Viet Nam). INTERPRETATION NAMHS provides the first national adolescent mental disorders prevalence estimates for Kenya, Indonesia, and Viet Nam. These data can inform mental health and broader health policies in low-income and middle-income countries. FUNDING The University of Queensland in America (TUQIA) through support from Pivotal Ventures, a Melinda French Gates company.
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Affiliation(s)
- Holly E Erskine
- School of Public Health, The University of Queensland, Brisbane, QLD, Australia; Queensland Centre for Mental Health Research, Brisbane, QLD, Australia; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
| | - Joemer C Maravilla
- School of Public Health, The University of Queensland, Brisbane, QLD, Australia; Queensland Centre for Mental Health Research, Brisbane, QLD, Australia; Institute of Health Sciences and Nursing, Far Eastern University, Manila, Philippines
| | | | - Amirah Ellyza Wahdi
- Center for Reproductive Health, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia; Department of Biostatistics, Epidemiology, and Population Health, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Vu Manh Loi
- Institute of Sociology, Vietnam Academy of Social Sciences, Hanoi, Viet Nam
| | - Shoshanna L Fine
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Mengmeng Li
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Astha Ramaiya
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Frederick Murunga Wekesah
- African Population and Health Research Center, Nairobi, Kenya; Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | | | - Anne Njeri
- African Population and Health Research Center, Nairobi, Kenya
| | - Althaf Setyawan
- Center for Reproductive Health, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Yufan Putri Astrini
- Center for Reproductive Health, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Rizka Rachmawati
- Center for Reproductive Health, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | | | - Krystina Wallis
- School of Public Health, The University of Queensland, Brisbane, QLD, Australia; Queensland Centre for Mental Health Research, Brisbane, QLD, Australia
| | - Cartiah McGrath
- Queensland Centre for Mental Health Research, Brisbane, QLD, Australia
| | - Jamileh Shadid
- School of Public Health, The University of Queensland, Brisbane, QLD, Australia; Queensland Centre for Mental Health Research, Brisbane, QLD, Australia; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Meaghan E Enright
- Queensland Centre for Mental Health Research, Brisbane, QLD, Australia
| | - Sarah J Blondell
- Queensland Centre for Mental Health Research, Brisbane, QLD, Australia
| | - David Lawrence
- School of Population Health, Curtin University, Perth, WA, Australia
| | - Prudence W Fisher
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY, USA
| | - Harvey A Whiteford
- School of Public Health, The University of Queensland, Brisbane, QLD, Australia; Queensland Centre for Mental Health Research, Brisbane, QLD, Australia; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Nguyen Duc Vinh
- Institute of Sociology, Vietnam Academy of Social Sciences, Hanoi, Viet Nam
| | - Siswanto Agus Wilopo
- Center for Reproductive Health, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia; Department of Biostatistics, Epidemiology, and Population Health, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | | | - Robert Wm Blum
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - James G Scott
- Child Health Research Centre, The University of Queensland, Brisbane, QLD, Australia; Queensland Centre for Mental Health Research, Brisbane, QLD, Australia; Child and Youth Mental Health Service, Children's Health Queensland, Brisbane, QLD, Australia
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Wang J, Huang X, Li Z, Chen K, Jin Z, He J, Han B, Feng L, Meng N, Yang C, Liu Z. Effect of parenting style on the emotional and behavioral problems among Chinese adolescents: the mediating effect of resilience. BMC Public Health 2024; 24:787. [PMID: 38481184 PMCID: PMC10935827 DOI: 10.1186/s12889-024-18167-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 02/20/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Although previous studies have found that parenting style significantly predicts emotional and behavioral problems (EBPs) among Chinese adolescents, the mechanism between different parenting styles and EBPs requires in-depth investigation. In our study, we aimed to investigate the mediating effect of resilience, a positive psychological characteristic, between parenting style and EBPs among Chinese adolescents. METHODS In this cross-sectional study, we used a multistage stratified cluster random sampling method to collect data in Shenyang, Liaoning Province from November to December 2019. Self-developed questionnaires were distributed to 1028 adolescents aged 10-18. Finally, the study consisted of 895 participants. The bootstrap method was used to investigate the role of resilience as a mediator in the relationship between different parenting styles and EBPs from a positive psychology perspective. RESULTS The mean score of EBPs was 12.71 (SD = 5.77). After controlling for variables such as gender, age, left-behind children, family type and family income, resilience partially played a mediating role in the associations of paternal rejection (a × b = 0.051 BCa95%CI:0.023,0.080), maternal rejection (a × b = 0.055 BCa95%CI: 0.024, 0.086), paternal emotional warmth (a × b = -0.139 BCa95%CI: -0.182, -0.099) and maternal emotional warmth (a × b = -0.140 BCa95%CI: -0.182, -0.102), with EBPs. The effect sizes were11.28%, 11.51%, 40.76%, and 38.78%, respectively. CONCLUSIONS Resilience could partially mediate the relationship between parenting style and EBPs, highlighting that parents should adopt a positive parenting style and that resilience improvement could be effective in reducing EBPs among Chinese adolescents.
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Affiliation(s)
- Jiana Wang
- School of Public Health, Health Science Center, Ningbo University, No.818 Fenghua Road, Ningbo, Zhejiang, 315211, People's Republic of China.
- Department of Social Medicine, School of Public Health, China Medical University, No. 77 Puhe Road, Shenyang North New Area, Shenyang, Liaoning, 110122, People's Republic of China.
| | - Xinyuan Huang
- Department of Social Medicine, School of Public Health, China Medical University, No. 77 Puhe Road, Shenyang North New Area, Shenyang, Liaoning, 110122, People's Republic of China
| | - Zhe Li
- Anesthesiology department, The Fourth Affiliated Hospital of China Medical University, , Shenyang, Liaoning, People's Republic of China
| | - Kun Chen
- Department of Social Medicine, School of Public Health, China Medical University, No. 77 Puhe Road, Shenyang North New Area, Shenyang, Liaoning, 110122, People's Republic of China
| | - Zhiyu Jin
- Department of Social Medicine, School of Public Health, China Medical University, No. 77 Puhe Road, Shenyang North New Area, Shenyang, Liaoning, 110122, People's Republic of China
| | - Jing He
- Department of Social Medicine, School of Public Health, China Medical University, No. 77 Puhe Road, Shenyang North New Area, Shenyang, Liaoning, 110122, People's Republic of China
| | - Bingsong Han
- Department of Social Medicine, School of Public Health, China Medical University, No. 77 Puhe Road, Shenyang North New Area, Shenyang, Liaoning, 110122, People's Republic of China
| | - Lin Feng
- Department of Social Medicine, School of Public Health, China Medical University, No. 77 Puhe Road, Shenyang North New Area, Shenyang, Liaoning, 110122, People's Republic of China
| | - Nana Meng
- Department of Social Medicine, School of Public Health, China Medical University, No. 77 Puhe Road, Shenyang North New Area, Shenyang, Liaoning, 110122, People's Republic of China
| | - Cong Yang
- Department of Social Medicine, School of Public Health, China Medical University, No. 77 Puhe Road, Shenyang North New Area, Shenyang, Liaoning, 110122, People's Republic of China
| | - Zhuang Liu
- Journal Center of China Medical University, China Medical University, No. 77 Puhe Road, Shenyang North New Area, Shenyang, Liaoning, 110001, People's Republic of China.
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Kerry MJ, Robin D, Albermann K, Dratva J. Measuring mental health action competencies in school teachers: internal and external validity evidence. Front Digit Health 2024; 6:1257392. [PMID: 38414714 PMCID: PMC10896949 DOI: 10.3389/fdgth.2024.1257392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 01/25/2024] [Indexed: 02/29/2024] Open
Abstract
Introduction Mental health literacy is receiving increasing research attention due to growing concerns for mental health globally. Among children, teachers have recently been recognized as playing a vital role in the recognition and reporting of potential mental health issues. Methods A nationally sampled cross-section of teachers was surveyed to examine the discriminant validity of the mental health literacy measure across levels of teaching. A survey collected a total of n = 369 teacher responses in Switzerland (Kindergarten = 76, Primary = 210, Secondary = 83). Item response theory (IRT) analyses were conducted. Results Inspection of psychometric properties indicated removal of two weak performing items. The 15-item measure exhibited a significant mean difference, such that class-responsibility function scored higher (M = 2.86, SD = .45) than non-responsible function (M = 2.68, SD = .45) teachers [t(309) = -2.20, p = .01]. It also exhibited a significant mean difference, such that more subjective experienced scored higher (M = 2.86, SD = .45) than less subjective experienced (M = 2.68, SD = .45) teachers [t(210) = -8.66, p < .01]. Discussion Hypotheses regarding age and role tenure were in the expected direction, but non-significant. The MHL measure for teachers demonstrated sound measurement properties supporting usage across teaching levels.
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Affiliation(s)
- Matthew J. Kerry
- Institute of Public Health, ZHAW Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Dominik Robin
- Institute of Public Health, ZHAW Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Kurt Albermann
- Centre of Social Paediatrics, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Julia Dratva
- Institute of Public Health, ZHAW Zurich University of Applied Sciences, Winterthur, Switzerland
- Medical Faculty, University of Basel, Basel, Switzerland
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Hunduma G, Dessie Y, Geda B, Yadeta TA, Deyessa N. Prevalence and correlates of internalizing and externalizing mental health problems among in-school adolescents in eastern Ethiopia: a cross-sectional study. Sci Rep 2024; 14:3574. [PMID: 38347112 PMCID: PMC10861546 DOI: 10.1038/s41598-024-54145-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 02/08/2024] [Indexed: 02/15/2024] Open
Abstract
Adolescent's mental health issues are a major social burden and a significant public health issue, but they have not received enough attention in Ethiopia. Therefore, this study aimed to determine the prevalence and correlates of internalizing and externalizing mental health problems among in-school adolescents in the Harari region, eastern Ethiopia. A cross-sectional study was conducted among 3227 in-school adolescents. Multistage sampling was used to select schools and eligible students to participate in the study. A guided, self-administered strength and difficulty questionnaire measured mental health problems. Data were double-entered, validated, and cleaned using EpiData 3.1 and analyzed using STATA version 17. Ordinal logistic regression analysis was performed to estimate the adjusted odds ratio between mental health problems and their correlates. Statistical significance was set at p-value < 0.05. The magnitudes of mental health problems among in-school adolescents by subscale was 24.17% (95% CI 22.72; 25.67) for internalizing and 11.93% (95% CI 10.85; 13.09) for externalizing problems. A high internalizing problem score was associated with females, rural residents, alcohol users, attending public schools, those bullied at school, and those in the lowest wealth index. Likewise, the likelihood of a high externalizing problem score was high among alcohol users, adolescents whose fathers are uneducated, rural, and bullied at school. The study suggests that mental health problems are prevalent among in-school adolescents in Ethiopia, especially internalizing problems. The study also identifies several risk factors associated with internalizing and externalizing problems, such as wealth index, school types, alcohol use, bullying, and rural residence. These factors may indicate the need for more mental health awareness and support programs for adolescents in Ethiopia. This highlights that schools and communities should prioritize mental health awareness and support programs for adolescents. These programs should be tailored to address the specific needs of the population, such as rural residents, those in the lowest wealth index, and those who have experienced bullying.
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Affiliation(s)
- Gari Hunduma
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.
| | - Yadeta Dessie
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Biftu Geda
- School of Nursing and Midwifery, College of Health and Medical Sciences, Madda Walabu University, Shashamene, Ethiopia
| | - Tesfaye Assebe Yadeta
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Negussie Deyessa
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Hurel C, Ehlinger V, Molcho M, Cohen JF, Falissard B, Sentenac M, Godeau E. Life satisfaction in the context of the COVID-19 pandemic among middle school adolescents in France: findings from a repeated cross-sectional survey (EnCLASS, 2012-2021). Front Pediatr 2023; 11:1204171. [PMID: 37614904 PMCID: PMC10443644 DOI: 10.3389/fped.2023.1204171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 07/07/2023] [Indexed: 08/25/2023] Open
Abstract
Background and aims Since the COVID-19 pandemic, several studies have reported a decrease in adolescents' well-being. We aim to describe life satisfaction over the last decade and examine the factors associated with its variations between 2020 and 2021 among French students in their last year of middle school (around 14-15 years old). Methods Data were drawn from a repeated biennial cross-sectional national survey conducted in French schools over the last decade (EnCLASS study), using a self-administered questionnaire. After describing life satisfaction trends between 2012 and 2021 using the Cantril ladder, we examined individual changes in life satisfaction between 2020 and 2021 and their associations with housing and studying conditions during the COVID-19 lockdown, using multinomial logistic regression analysis (decrease, increase, no change as reference). Results Among the 17,686 survey respondents, an overall slight decrease in the prevalence of adolescents reporting high life satisfaction (i.e., Cantril score ≥6) was observed since 2012 with the lowest proportion reported in 2021 (77.4%). Between 2020 and 2021, 16.3% of French adolescents experienced an improvement in life satisfaction, while 17.7% experienced the opposite. Decrease in life satisfaction between 2020 and 2021 was more likely experienced by adolescents living in reconstructed families [aOR 2.09 (95%CI, 1.58-2.77)], those who did not have their own room [aOR 1.58 (1.16-2.15)], nor access to the Internet to interact with their friends during the lockdown [aOR 1.47 (1.09-1.98)]. Interestingly, more girls than boys were represented in both those reporting increase and decrease in life satisfaction [aOR 1.82 (1.40-2.37) and 1.43 (1.14-1.79), respectively]. Conclusions This study shows that the way adolescents experienced the first 2020 lockdown in France was not uniform, and that one must consider sex as well as housing and studying conditions when interpreting adolescents' life satisfaction decrease during the COVID-19 pandemic.
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Affiliation(s)
- Cynthia Hurel
- Department of Human and Social Sciences, EHESP School of Public Health, Rennes, France
- Rennes University, Centre Hospitalier Universitaire (CHU) de Rennes, Department of Epidemiology and Public Health, Rennes, France
| | - Virginie Ehlinger
- UMR 1295 CERPOP, Inserm, Université Toulouse III - Paul Sabatier, Team SPHERE, Toulouse, France
| | - Michal Molcho
- Department of Children’s Studies, School of Education, University of Galway, Galway, Ireland
| | - Jérémie F. Cohen
- Department of General Pediatrics and Pediatric Infectious Diseases, Hôpital Necker-Enfants malades, AP-HP, Université Paris Cité, Paris, France
- Université Paris Cité, Inserm, INRAE, Centre for Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Paris, France
| | - Bruno Falissard
- Paris-Saclay University, UVSQ, CESP, Inserm U1018, Paris, France
- Public Health and Epidemiology Department, AP-HP, Hôpital du Kremlin Bicêtre, Le Kremlin Bicêtre, France
| | - Mariane Sentenac
- Université Paris Cité, Inserm, INRAE, Centre for Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Paris, France
| | - Emmanuelle Godeau
- Department of Human and Social Sciences, EHESP School of Public Health, Rennes, France
- UMR 1295 CERPOP, Inserm, Université Toulouse III - Paul Sabatier, Team SPHERE, Toulouse, France
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Irwin CE. Developing Solid Measures for Mental Health Will Improve the Health and Well-Being of Young People Throughout the World. J Adolesc Health 2023; 72:7-8. [PMID: 36528363 DOI: 10.1016/j.jadohealth.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 10/06/2022] [Indexed: 12/23/2022]
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Pedersen GA, Lam C, Hoffmann M, Zajkowska Z, Walsh A, Kieling C, Mondelli V, Fisher HL, Gautam K, Kohrt BA. Psychological and contextual risk factors for first-onset depression among adolescents and young people around the globe: A systematic review and meta-analysis. Early Interv Psychiatry 2023; 17:5-20. [PMID: 35388612 PMCID: PMC10084304 DOI: 10.1111/eip.13300] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 02/28/2022] [Accepted: 03/13/2022] [Indexed: 01/21/2023]
Abstract
AIM Identifying predictors for future onset of depression is crucial to effectively developing preventive interventions. We conducted a systematic review and meta-analysis to identify risk factors for first-onset depression among adolescents and young people. METHODS We searched MEDLINE (Ovid), PsycINFO, Cochrane Database, Web of Science, Lilacs, African Journals Online and Global Health (July 2009 to December 2020) for longitudinal studies assessing risk factors for first-onset depression among adolescents and young people aged 10-25 years. Meta-analyses generated summary odds ratio (OR) estimates. REGISTRATION PROSPERO CRD42018103973. RESULTS Nineteen studies representing 21 unique populations were included in the meta-analysis. Among studies reporting race/ethnicity, 79% of participants were of White/European descent. Seventeen studies were from high-income countries, with only two from an upper-middle-income country (China). Odds for first-onset depression were significantly greater for girls compared to boys (n = 13; OR = 1.78 [1.78, 2.28], p < 0.001) and for youth with other mental health problems at baseline (n = 4; OR = 3.20 [1.95, 5.23], p < 0.001). There were non-significant associations for negative family environment (n = 8; OR = 1.60 [0.82, 3.10], p = 0.16) and parental depression (n = 3; OR = 2.30 [0.73, 7.24], p = 0.16). CONCLUSIONS Most longitudinal studies do not report risk factors specifically for first-onset depression. Moreover, predictive data are limited to predominantly White populations in high-income countries. Future research must be more ethnically and geographically representative. Recommendations are provided for consistent and comprehensive reporting of study designs and analyses of risk factors for first-onset depression.
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Affiliation(s)
- Gloria A Pedersen
- Division of Global Mental Health, Department of Psychiatry, School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia, USA
| | - Crystal Lam
- Division of Global Mental Health, Department of Psychiatry, School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia, USA
| | - Megan Hoffmann
- Division of Global Mental Health, Department of Psychiatry, School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia, USA
| | - Zuzanna Zajkowska
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Annabel Walsh
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Christian Kieling
- Child & Adolescent Psychiatry Division, Department of Psychiatry, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Valeria Mondelli
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,National Institute for Health Research (NIHR) Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, King's College London, London, UK
| | - Helen L Fisher
- Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,ESRC Centre for Society and Mental Health, King's College London, London, UK
| | - Kamal Gautam
- Transcultural Psychosocial Organization Nepal (TPO Nepal), Kathmandu, Nepal
| | - Brandon A Kohrt
- Division of Global Mental Health, Department of Psychiatry, School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia, USA
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Carvajal-Velez L, Ahs JW, Lundin A, van den Broek M, Simmons J, Wade P, Chorpita B, Requejo JH, Kohrt BA. Validation of the Kriol and Belizean English Adaptation of the Revised Children's Anxiety and Depression Scale for Use With Adolescents in Belize. J Adolesc Health 2023; 72:S40-S51. [PMID: 36400635 DOI: 10.1016/j.jadohealth.2022.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 09/28/2022] [Accepted: 10/05/2022] [Indexed: 11/17/2022]
Abstract
PURPOSE To validate a culturally-adapted Kriol and Belizean English version of the Revised Children's Anxiety and Depression Scale (RCADS) through comparison with clinical diagnoses made using the Kiddie Schedule of Affective Disorders and Schizophrenia. METHODS Participants comprised of 256 adolescents aged 10-14 years and 15-19 years, who completed the adapted RCADS (10 depression items, 12 anxiety items) in one-on-one interviews, followed by a diagnostic assessment using Kiddie Schedule of Affective Disorders and Schizophrenia administered by trained clinicians. Sensitivity, specificity, positive predictive value, negative predictive value, diagnostic odds ratios, area under the curve (AUC), and Youden's Index were calculated for RCADS cutoffs and scores on the total scale and anxiety and depression subscales. RESULTS For adolescents aged 10-14 years (n = 161), the AUC was 0.72 for the full scale, 0.67 for anxiety subscale, and 0.76 for depression subscale. For adolescents aged 15-19 years (n = 95), the AUCs were 0.82, 0.77, and 0.83. Most depression items performed well in discriminating those with and without diagnoses. Separation anxiety items performed poorly. "Thoughts of death" were common even among adolescents not meeting diagnostic criteria. The RCADS depression subscale presented the strongest psychometric properties with adolescents aged 15-19 years (at cutoff of 13, sensitivity = 0.83, specificity = 0.77, positive predictive value = 0.47, negative predictive value = 0.95, odds ratio = 15.96). CONCLUSION The adapted RCADS-22 had acceptable categorization for adolescents aged 10-14 years and excellent categorization for adolescents aged 15-19 years; therefore, the tool is recommended for use among the latter age group. Based on sensitivity and specificity values at different cutoffs, guidance is provided to select different thresholds to suit clinical, public health, or other uses to detect and quantify adolescent depression and anxiety in Belize.
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Affiliation(s)
- Liliana Carvajal-Velez
- Division of Data, Analytics, Planning and Monitoring, Data and Analytics Section, UNICEF, New York; Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
| | - Jill W Ahs
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Department of Health Sciences, Swedish Red Cross University, Stockholm, Sweden
| | - Andreas Lundin
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Myrthe van den Broek
- War Child Holland and Amsterdam Institute of Social Science Research, University of Amsterdam, Amsterdam, Netherlands
| | - Juliet Simmons
- Department of Mental Health, Ministry of Health and Wellness, Belize City, Belize
| | | | - Bruce Chorpita
- Department of Psychology, University of California, Los Angeles, California
| | - Jennifer Harris Requejo
- Division of Data, Analytics, Planning and Monitoring, Data and Analytics Section, UNICEF, New York
| | - Brandon A Kohrt
- Department of Psychiatry, George Washington University, Washington, District of Columbia
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9
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Marlow M, Skeen S, Grieve CM, Carvajal-Velez L, Åhs JW, Kohrt BA, Requejo J, Stewart J, Henry J, Goldstone D, Kara T, Tomlinson M. Detecting Depression and Anxiety Among Adolescents in South Africa: Validity of the isiXhosa Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7. J Adolesc Health 2023; 72:S52-S60. [PMID: 36274021 DOI: 10.1016/j.jadohealth.2022.09.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 08/09/2022] [Accepted: 09/27/2022] [Indexed: 11/07/2022]
Abstract
PURPOSE Screening tools such as the Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder-7 (GAD-7) could potentially be used in resource-limited settings to identify adolescents who need mental health support. We examined the criterion validity of the isiXhosa versions of the PHQ-9 and GAD-7 in detecting depression and anxiety among adolescents (10-19 years) in South Africa. METHODS Adolescents were recruited from the general population and from nongovernmental organizations working with adolescents in need of mental health support. The PHQ-9 and GAD-7 were culturally adapted and translated into isiXhosa and administered to 302 adolescents (56.9% female). The Kiddie Schedule for Affective Disorders and Schizophrenia was administered by trained clinicians as the gold standard diagnostic measure for depression and anxiety. RESULTS For the PHQ-9, the area under the curve was 0.88 for the full sample of adolescents (10-19 years old). A score of ≥10 had 91% sensitivity and 76% specificity for detecting adolescents with depression. For the GAD-7, the area under the curve was 0.78, and cutoff scores with an optimal sensitivity-specificity balance were low (≥6). A score of ≥6 had 67% sensitivity and 75% specificity for detecting adolescents with anxiety. DISCUSSION The culturally adapted isiXhosa version of the PHQ-9 can be used as a valid measure for depression in adolescents. Further research on the GAD-7 for use with adolescents is recommended.
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Affiliation(s)
- Marguerite Marlow
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - Sarah Skeen
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; Amsterdam Institute for Social Science Research, University of Amsterdam, Amsterdam, Netherlands
| | - Caitlin M Grieve
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Liliana Carvajal-Velez
- Division of Data, Analytics, Planning and Monitoring, Data and Analytics Section, UNICEF, New York, New York; Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Jill W Åhs
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Department of Health Sciences, Swedish Red Cross University College, Stockholm, Sweden
| | - Brandon A Kohrt
- Department of Psychiatry, George Washington University, Washington, District of Columbia
| | - Jennifer Requejo
- Division of Data, Analytics, Planning and Monitoring, Data and Analytics Section, UNICEF, New York, New York
| | - Jackie Stewart
- Division of Global Surgery, University of Cape Town, Cape Town, South Africa
| | - Junita Henry
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Daniel Goldstone
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Tashmira Kara
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Mark Tomlinson
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; School of Nursing and Midwifery, Queens University, Belfast, United Kingdom
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10
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Carvajal-Velez L, Ahs JW, Requejo JH, Kieling C, Lundin A, Kumar M, Luitel NP, Marlow M, Skeen S, Tomlinson M, Kohrt BA. Measurement of Mental Health Among Adolescents at the Population Level: A Multicountry Protocol for Adaptation and Validation of Mental Health Measures. J Adolesc Health 2023; 72:S27-S33. [PMID: 36528384 DOI: 10.1016/j.jadohealth.2021.11.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 11/19/2021] [Accepted: 11/19/2021] [Indexed: 11/20/2022]
Abstract
PURPOSE Mental disorders are among the leading causes of disability among adolescents aged 10-19 years. However, data on prevalence of mental health conditions are extremely sparse across low- and middle-income countries, even though most adolescents live in these settings. This data gap is further exacerbated because few brief instruments for adolescent mental health are validated in these settings, making population-level measurement of adolescent mental health especially cumbersome to carry out. In response, the UNICEF has undertaken the Measurement of Mental Health Among Adolescents at the Population Level (MMAP) initiative, validating open-access brief measures and encouraging data collection in this area. METHODS This protocol presents the MMAP mixed-methods approach for cultural adaptation and clinical validation of adolescent mental health data collection tools across settings. Qualitative activities include an initial translation and adaptation, review by mental health experts, focus-group discussions with adolescents, cognitive interviews, synthesis of findings, and back-translation. An enriched sample of adolescents with mental health problems is then interviewed with the adapted tool, followed by gold-standard semistructured diagnostic interviews. RESULTS The study protocol is being implemented in Belize, Kenya, Nepal, and South Africa and includes measures for anxiety, depression, functional limitations, suicidality, care-seeking, and connectedness. Analyses, including psychometrics, will be conducted individually by country and combined across settings to assess the MMAP methodological process. DISCUSSION This protocol contributes to closing the data gap on adolescent mental health conditions by providing a rigorous process of cross-cultural adaptation and validation of data collection approaches.
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Affiliation(s)
- Liliana Carvajal-Velez
- Division of Data, Analytics, Planning and Monitoring, Data and Analytics Section, UNICEF, New York; Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
| | - Jill W Ahs
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Department of Health Sciences, Swedish Red Cross University College, Stockholm, Sweden
| | - Jennifer Harris Requejo
- Division of Data, Analytics, Planning and Monitoring, Data and Analytics Section, UNICEF, New York
| | - Christian Kieling
- Division of Child & Adolescent Psychiatry, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Andreas Lundin
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Manasi Kumar
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
| | - Nagendra P Luitel
- Research Department, Transcultural Psychosocial Organization (TPO) Nepal, Baluwatar, Kathmandu, Nepal
| | - Marguerite Marlow
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Belfast, United Kingdom
| | - Sarah Skeen
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Belfast, United Kingdom
| | - Mark Tomlinson
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Belfast, United Kingdom; School of Nursing and Midwifery, Queens University, Belfast, United Kingdom
| | - Brandon A Kohrt
- Department of Psychiatry, George Washington University, Washington, District of Columbia
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11
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Nyongesa V, Kathono J, Mwaniga S, Yator O, Madeghe B, Kanana S, Amugune B, Anyango N, Nyamai D, Wambua GN, Chorpita B, Kohrt BA, Ahs JW, Idele P, Carvajal L, Kumar M. Cultural and contextual adaptation of mental health measures in Kenya: An adolescent-centered transcultural adaptation of measures study. PLoS One 2022; 17:e0277619. [PMID: 36520943 PMCID: PMC9754261 DOI: 10.1371/journal.pone.0277619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 10/31/2022] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION There is paucity of culturally adapted tools for assessing depression and anxiety in children and adolescents in low-and middle-income countries. This hinders early detection, provision of appropriate and culturally acceptable interventions. In a partnership with the University of Nairobi, Nairobi County, Kenyatta National Hospital, and UNICEF, a rapid cultural adaptation of three adolescent mental health scales was done, i.e., Revised Children's Anxiety and Depression Scale, Patient Health Questionnaire-9 and additional scales in the UNICEF mental health module for adolescents. MATERIALS AND METHODS Using a qualitative approach, we explored adolescent participants' views on cultural acceptability, comprehensibility, relevance, and completeness of specific items in these tools through an adolescent-centered approach to understand their psychosocial needs, focusing on gender and age-differentiated nuances around expression of distress. Forty-two adolescents and 20 caregivers participated in the study carried out in two primary care centers where we conducted cognitive interviews and focused group discussions assessing mental health knowledge, literacy, access to services, community, and family-level stigma. RESULTS We reflect on process and findings of adaptations of the tools, including systematic identification of words adolescents did not understand in English and Kiswahili translations of these scales. Some translated words could not be understood and were not used in routine conversations. Response options were changed to increase comprehensibility; some statements were qualified by adding extra words to avoid ambiguity. Participants suggested alternative words that replaced difficult ones and arrived at culturally adapted tools. DISCUSSION Study noted difficult words, phrases, dynamics in understanding words translated from one language to another, and differences in comprehension in adolescents ages 10-19 years. There is a critical need to consider cultural adaptation of depression and anxiety tools for adolescents. CONCLUSION Results informed a set of culturally adapted scales. The process was community-driven and adhered to the principles of cultural adaptation for assessment tools.
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Affiliation(s)
| | - Joseph Kathono
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
- Nairobi Metropolitan Services, Nairobi, Kenya
| | - Shillah Mwaniga
- Nairobi Metropolitan Services, Nairobi, Kenya
- Vrije University, Amsterdam, Netherlands
| | - Obadia Yator
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
| | - Beatrice Madeghe
- Department of Food and Nutrition Sciences, University of Nairobi, Nairobi, Kenya
| | | | | | - Naomi Anyango
- Department of Mental Health, Ministry of Health, Kenya
| | | | - Grace Nduku Wambua
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Bruce Chorpita
- University of California, Los Angeles, United States of America
| | - Brandon A. Kohrt
- Division of Global Mental Health, Department of Psychiatry and Behavioral Science, The George Washington University, Washington, District of Columbia, United States of America
| | - Jill W. Ahs
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
- Department of Health Care Sciences, Swedish Red Cross University College, Huddinge, Sweden
| | - Priscilla Idele
- UN Secretariat, New York, New York, United States of America
| | - Liliana Carvajal
- Division of Data, Analytics, Planning and Monitoring, Data and Analytics Section, UNICEF, New York, New York, United States of America
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Manasi Kumar
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
- Brain and Mind Institute, Aga Khan University, Nairobi, Kenyau
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12
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The Measurement of Mental Health Problems Among Adolescents and Young Adults Throughout the World. J Adolesc Health 2021; 69:361-362. [PMID: 34452726 DOI: 10.1016/j.jadohealth.2021.06.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 06/09/2021] [Indexed: 11/21/2022]
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