Relationships Between Adolescent Stress, Depressive Symptoms, and Sexual Risk Behavior in Young Adulthood: A Structural Equation Modeling Analysis

Determinants of adolescents' depression, anxiety, and somatic symptoms in Northwest Ethiopia: A non-recursive structural equation modeling

INTRODUCTION

In low and middle-income countries, adolescent mental health is not only a major public health challenge but also a development concern. Depression and anxiety are the most common mental health disorders and somatic symptoms often co-exist with them. Adolescents with common mental health problems are associated with an increased risk of suicide, future unemployment, and poor quality of life. However, little is known about the mental health of adolescents in Ethiopia. Thus, this study aimed to assess the determinants of depression, anxiety, and somatic symptoms among adolescents in Northwest Ethiopia, in 2022.

METHODS

An institution-based cross-sectional study was conducted from June 8 to 24, 2022. Two-stage stratified random sampling was used to select 1407 adolescents in Northwest Ethiopia. Structured and standardized self-administered questionnaires were used to collect the data. Non-recursive structural equation modeling was employed to assess the direct, indirect, and total effects of predictors. Adjusted regression coefficients and corresponding 95% confidence intervals were used to interpret the strength of the association.

RESULTS

The prevalence of depression, anxiety, and somatic symptoms were 28.21% (95% CI: 25.8, 31%), 25.05% (95%CI: 22.8, 27.5), and 25.24(95% CI: 23, 27.6%) respectively. Alcohol use had a significant positive effect on depression [β = 0.14, 95% CI: 0.073, 0.201], anxiety [β = 0.11, 95% CI: 0.041, 0.188], and somatic symptoms [β = 0.12, 95% CI: 0.062, 0.211]. Stress had a significant positive effect on depression [β = 0.76, 95% CI: 0.642, 0.900], anxiety [β = 1.10, 95% CI: 0.955, 1.264], and somatic symptoms [β = 086, 95% C: 0.700, 1.025]. Depression had a direct positive effect on anxiety [β = 0.74, 95% CI: 0.508, 1.010].

CONCLUSION

In this study, the prevalence of depression, anxiety, and somatic symptoms was moderate. Alcohol use and stress were significantly related to depression, anxiety, and somatic symptoms. The bidirectional relationship between anxiety and depression was significant. Therefore, public health interventions should focus on the bidirectional relationship between depression and anxiety, as well as on identified factors to reduce the burden of mental illness in adolescents.

Lifestyles and Sexual Behaviour Among School-Going Adolescents: A Mediational Role of Mental Health

Sexual behaviour and mental health among adolescents are major public health issues. This study examines how lifestyles affect sexual behaviour among school-going adolescents in Malaysia, and the potential mediational role of mental health. It is the first to our knowledge to explore the mediating effect of mental health on sexual behaviour with a focus on a fast-growing developing country. Data were obtained from the National Health and Morbidity Survey 2017 (n = 27,497). Structural equation modelling was utilized to examine depression and anxiety as mediators of the relationships between sexual behaviour and smoking, alcohol drinking and illicit drug use, controlling for sociodemographic factors. Results showed that adolescents who smoked, consumed alcohol, used illicit drugs, and had depression and anxiety were more likely to engage in sexual behaviour than others. Depression and anxiety partially mediated the relationships between sexual behaviour and smoking, and illicit drug use. The association between alcohol drinking and sexual behaviour was fully mediated by depression and anxiety. In conclusion, lifestyles may affect sexual behaviour through mediation of mental health. Therefore, policymakers should take mental health factors into consideration when designing adolescent sexual behaviour preventative interventions.

Alienation: A useful concept for health inequality research

AIMS

While Marxist class analysis has strongly influenced the development of health inequality research, other aspects of Marx's theory have received less attention. Among the most relevant of Marx's theoretical contributions for social inequalities in health is the theory of alienation. As empirical applications of the theory of alienation are currently scarce, the purpose of this commentary is to invigorate interest in alienation theory within the field of health inequality research by demonstrating its potential to illuminate the relationship between social inequality, psycho-social affects and health outcomes.

RESULTS

Alienation theory describes how the class structure of capitalist societies creates experiences of powerlessness, estrangement and isolation. These experiences are further posited as emerging from the exploitation of labour, thus connecting social inequality to psychological wellbeing. Alienation theory is particularly compatible with psycho-social explanations of health inequalities, which similarly posits that social inequality affects health through psychological mechanisms. We argue that alienation theory contributes in three ways to health inequality research: a) by suggesting potential mechanisms and offering predictions that may be put to use in empirical research, b) by providing a potential explanation of the welfare state paradox, and c) by situating the psycho-social determinants of health within a critical analysis of the sources of social inequality in capitalist society.

CONCLUSIONS

Alienation theory may provide a more textured understanding of the relationship between inequality and psycho-social health, while also foregrounding issues of class, power and exploitation that are often absent from psycho-social explanations.

The Association Between Family Function and Adolescents' Depressive Symptoms in China: A Longitudinal Cross-Lagged Analysis

The complex interrelationships between family function and adolescents' depressive symptoms are not yet fully clarified, especially in China. Based on the family systems theory, this study explored the relationships between family function and Chinese adolescents' depressive symptoms by a 3-year longitudinal study design. Three waves of data were collected from 1,301 Chinese middle school students in Grade 7 to Grade 9. All participants completed the Chinese Family Assessment Instrument (CFAI) and the Center for Epidemiologic Studies Depression Scale (CES-D) once a year during the junior middle school period. Our results showed that both family function and adolescent depressive symptoms were stable in Grade 7 and Grade 8, but in Grade 9, family function increased and depressive symptoms declined. Furthermore, we found that the family function in Grade 7 negatively influenced depressive symptoms of adolescents in Grade 8, while adolescent depressive symptoms in Grade 8 negatively impacted subsequent family function in Grade 9, namely there was a circular effect between family function and adolescent depressive symptoms. These findings suggest that the associations between family function and adolescents' depressive symptoms are dynamic and time-dependent. Our study contributes to the intervention aimed at the reduction of adolescent depressive symptoms from the family perspective.

Longitudinal influence of COVID-19-related stress on sexual compulsivity symptoms in Chinese undergraduates

BACKGROUND

The coping theory shows that stressful life events are associated with individuals' psychology/behaviors; meanwhile, the coronavirus disease of 2019 (COVID-19) pandemic is known to have impacted individuals' physical and mental health. Prior studies revealed that undergraduates have many sexual behavior and emotion disorders, which may be impacted during an isolation period, such as the one brought by COVID-19. However, few studies have explored the longitudinal associations between COVID-19-related stress and sexual compulsivity symptoms (SCS), and the mediating effect of emotions (i.e., depression and anxiety) on this relationship. This longitudinal study aimed to investigate these associations.

METHODS

We employed a cross-lagged design (2020/2/12: Time 1, 3219 participants; 2020/6/6: Time 2, 2998 participants) and recruited Chinese undergraduates through an online system to respond to a survey.

RESULTS

Our results showed that COVID-19-related stress at Time 1 directly influenced SCS at Time 1, and there was an indirect influence via depression and anxiety at Time 1. COVID-19-related stress at Time 1 positively correlated with depression, anxiety, and SCS at Time 2, and the first could directly and positively predict SCS at Time 2. Moreover, albeit depression at Time 2 was negatively linked to SCS at Time 2, anxiety at Time 2 enhanced the effect of COVID-19-related stress on SCS.

CONCLUSIONS

Our findings extend the literature on SCS, showing that the higher the COVID-19-related stress, the higher the SCS, and the longer-lasting effect was associated with anxiety in undergraduates. Furthermore, depression does not mediate the relationship between COVID-19-related stress and SCS.

Dimensions of Masculine Norms, Depression, and Mental Health Service Utilization: Results From a Prospective Cohort Study Among Emerging Adult Men in the United States

The purpose of this study was to examine the role of multidimensional masculine norms (“status,” “toughness,” “anti-femininity”) on depression and mental health service utilization among emerging adult men in the Northeast United States. This study examines substance use and hostility as secondary outcomes and depression status as an effect moderator on the relationship between masculine norms and mental health service utilization. This study used data from a prospective cohort study that followed 18- to 25-year-old heterosexual men over 6 months. At baseline and 6 months, approximately 29% and 25% of the sample met the criteria for depression. The results of multivariate linear and logistic regression models found that greater endorsement of masculine status was associated with less depressive symptoms at baseline and 6 months, masculine toughness was associated with more substance use at baseline, and masculine anti-femininity was associated with greater hostility at baseline and 6 months. The multivariate Poisson model found that greater endorsement of status was associated with greater mental health service utilization in the prior year, especially for men not meeting the criteria for depression. In contrast, greater endorsement of anti-femininity and toughness norms was associated with less mental health service utilization; for men endorsing toughness norms, this effect was greater for those who were depressed. This study sheds light on the harmful and protective effects of masculine norms on depression, related mental health outcomes, and mental health service utilization, with implications for gender-tailored approaches to engage and retain young men in mental health services.

"Physical Sex Is Over for Now": Impact of COVID-19 on the Well-Being and Sexual Health of Adolescent Sexual Minority Males in the U.S

PURPOSE

This study aimed to explore how the COVID-19 pandemic and physical distancing measures have impacted the well-being and sexual health among adolescent sexual minority males (ASMM) during the initial phase of physical distancing mandates in the U.S.

METHODS

From March 27, 2020, to May 8, 2020, U.S. ASMM (N = 151; aged 14-17 years) completed the online baseline survey of a sexual health intervention trial. COVID-19-related closed- and open-ended questions were included. A mixed-methods approach assessed COVID-19-related changes in well-being and sexual health by outness with an accepting guardian.

RESULTS

The majority (57%) of participants reported being worried about COVID-19. Almost all (91%) were physically distancing. Participants noted that COVID-19 changed school, home, work, and family life. Participants highlighted that COVID-19 reduced their ability to socialize and had a deleterious effect on their mental health. In the past 3 months, participants reported seeing sexual partners in person less often, masturbating and viewing pornography more often, and sexting and messaging on men-seeking-men websites/phone applications about the same amount. Many described being physically distanced from sexual partners, and some noted an increase in their use of virtual ways to connect with partners (e.g., video chatting). There were no differences by outness with an accepting guardian in quantitative or qualitative responses.

CONCLUSIONS

These findings provide a snapshot of the initial effects of the COVID-19 pandemic among a convenience sample of U.S. ASMM and underscore the need to provide access to resources sensitive to their social, developmental, and sexual health needs during this crisis.

Family SES, family social capital, and general health in Chinese adults: exploring their relationships and the gender-based differences

BACKGROUND

Numerous studies have clarified that family socioeconomic status (SES) is positively associated with health. However, the mechanism of family SES on health needs to be further investigated from a social epidemiological perspective. This study aims to analyze the relationships among family SES, family social capital, and adult general health and tests whether gender-based differences exist in the relationship between family social capital and general health.

METHODS

A cross-sectional survey was used to collect data from 4187 representative households in six Chinese provinces. Family SES was conceptualized based on household income, family education, and family occupational status. Family social capital was measured by using family cohesion and health-related family support. General health was assessed by using five general health perception items of the Health Survey Short Form. Structural equation modeling (SEM) was applied to examine the relationships among family SES, family social capital, and general health, and a linear regression model was used to test gender-based differences.

RESULTS

The SEM showed that the direct effects of family SES, family cohesion, and health-related family support on health were 0.08 (P < 0.001), 0.17 (P < 0.001), and 0.10 (P < 0.001), respectively. Family SES had indirect effect (β = 0.05, P < 0.01) on general health via health-related family support. The total effect of family social capital (β = 0.27, P < 0.001) on general health was greater than that of family SES (β = 0.13, P < 0.001). Besides, the regression showed that the effect of health-related family support on general health was greater for women (β = 0.13, P < 0.001) than men (β = 0.04, P > 0.05).

CONCLUSIONS

The results provide strong support for the positive association between family SES, family social capital, and adult health. Family intervention programs should focus on establishing a harmonious family relationship to mobilize family support, particularly for the families with low cohesion and low SES.