Relationship of Beck Depression Inventory factors to depression among adolescents

Systematic Review: Measurement Properties of Patient-Reported Outcome Measures Used to Measure Depression Symptom Severity in Adolescents With Depression

OBJECTIVE

To systematically evaluate the measurement properties of 12 patient-reported outcome measures (PROMs) used to measure depression symptom severity in adolescents with depression. Depression symptom severity was chosen as the outcome of focus given its importance as an outcome to measure in adolescents with depression across clinical trials and/or care.

METHOD

MEDLINE, PsycInfo, Embase, Scopus, CINAHL, and Cochrane were searched from year of inception up to December 7, 2023. Study appraisal (ie, risk of bias), evaluation of measurement properties, and evidence synthesis followed the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines. Included studies evaluated at least 1 of 9 measurement properties as detailed in the COSMIN taxonomy within a reported sample or subgroup of youth ages 12 to 24 years, with at least 40% meeting criteria for any depressive disorder.

RESULTS

Of the 15,560 records identified, 31 studies for 7 PROMs were included in the COSMIN appraisal. Although several PROMs have the potential to accurately measure depression symptom severity in adolescents with depression, at this time none of the PROMs can be recommended for use without further evaluative work. High-quality evidence was generally lacking, largely due to few or inconsistent findings, small sample sizes, and other methodological concerns.

CONCLUSION

This systematic review of the measurement properties of 12 PROMs used to measure depression symptom severity in adolescents with depression found that none of the PROMs can be recommended for use until further evaluative work is conducted. Clinicians and researchers should proceed with caution when using these PROMs.

PLAIN LANGUAGE SUMMARY

This systematic review evaluated 12 patient report outcome measures (PROMs) commonly used to measure depression symptom severity in adolescents with depression. Only 7 of these PROMs had studies to evaluate; none of them had the necessary measurement properties to indicate that they could be recommended for use or that results could be trusted. The authors suggest that more evaluative work is required to ensure the validity of the measurement properties of the tools utilized to measure depression symptom severity in adolescents with depression. This work should include engagement of youth and caregivers in evaluation of the content validity (eg, the relevance, comprehensibility, and comprehensiveness) of these PROMs.

DIVERSITY AND INCLUSION STATEMENT

One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. We actively worked to promote sex and gender balance in our author group. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work.

Childhood Physical Fitness as a Predictor of Cognition and Mental Health in Adolescence: The PANIC Study

BACKGROUND

Cognitive and mental health problems are highly prevalent in adolescence. While higher levels of physical fitness may mitigate these problems, there is a lack of long-term follow-up studies on the associations of physical fitness from childhood with cognition and mental health in adolescence.

OBJECTIVE

We investigated the associations of physical fitness from childhood to adolescence over an 8-year follow-up with cognition and mental health in adolescence.

METHODS

The participants were 241 adolescents (112 girls), who were 6-9 years at baseline and 15-17 years at 8-year follow-up. Average and change scores for cardiorespiratory fitness (maximal power output [Wmax]; peak oxygen uptake [VO2peak]), motor fitness (10 × 5-m shuttle run), and muscular fitness (standing long jump; hand grip strength) were calculated. Global cognition score was computed from six individual cognitive tasks, and perceived stress and depressive symptoms were assessed at the 8-year follow-up. The data were analysed using linear regression models adjusted for age, sex, and parental education.

RESULTS

Average motor fitness was positively associated with global cognition score (standardised regression coefficient [β] - 0.164, 95% confidence interval [CI] - 0.318 to - 0.010) and inversely with perceived stress (β = 0.182, 95% CI 0.032-0.333) and depressive symptoms (β = 0.181, 95% CI 0.028-0.333). Average cardiorespiratory fitness was inversely associated with perceived stress (Wmax: β =  - 0.166, 95% CI - 0.296 to - 0.036; VO2peak: β =  - 0.149, 95% CI - 0.295 to - 0.002) and depressive symptoms (Wmax: β =  - 0.276, 95% CI - 0.405 to - 0.147; VO2peak: β =  - 0.247, 95% CI - 0.393 to - 0.102). A larger increase in cardiorespiratory fitness was associated with lower perceived stress (Wmax: β =  - 0.158, 95% CI - 0.312 to - 0.003; VO2peak: β =  - 0.220, 95% CI - 0.395 to - 0.044) and depressive symptoms (Wmax: β =  - 0.216, 95% CI - 0.371 to - 0.061; VO2peak: β =  - 0.257, 95% CI - 0.433 to - 0.080).

CONCLUSIONS

Higher levels of motor fitness in childhood and adolescence were associated with better cognition in adolescence. Higher levels of and larger increases in cardiorespiratory fitness from childhood to adolescence were associated with better mental health in adolescence.

Comprehensive investigation of factor structure and gender equivalence of the Beck Depression Inventory-II among nonclinical adolescents

The Beck Depression Inventory-II (BDI-II) is a widely used tool for rating the severity of depressive symptoms. Studies on the factor structure of the BDI-II in adolescents have yielded controversial findings. Most studies have reported an oblique two-factor model that describes the 'cognitive' and 'somatic-affective' dimensions. However, there is variation in the item composition of each factor across studies. Alternative factor structures have been proposed, including one-factor, three-factor, hierarchical, and bifactor models. Additionally, there is limited data on measurement invariance across genders. This study aimed to examine hypothetical factor structures and gender equivalence of the BDI-II in a sample of Brazilian nonclinical adolescents (N = 1,184, aged 13-18 years, 59.1% females). Cross-validation of the BDI-II was performed through exploratory (EFA) and confirmatory factor analysis (CFA). Measurement invariance was evaluated using multigroup-CFA (MG-CFA). EFA suggested an oblique two-factor model depicting "affective-cognitive" and "somatic" dimensions. CFA tested competing models for the structure of BDI-II, including the simple one- and two-factor models, a bifactor model, and the EFA model along with its corresponding bifactor model. All models demonstrated adequate and similar fitness, well-defined factors, and good reliability. Bifactor analyses indicated a robust general factor with low reliable variance in total scores attributed to multidimensionality caused by the group factors in bifactor models. MG-CFA supported invariance across gender, suggesting that the same BDI-II construct could be applied to both female and male adolescents. This study provides evidence that the BDI-II could be used as a unidimensional measure of depressive symptoms in adolescents by researchers and clinicians.

Determinants of binge eating and its impact on indicators of obesity among Finnish adolescents - a cohort study

BACKGROUND

Binge eating, a type of disordered eating, is relatively common among youth and predisposes them to many adverse health outcomes. Diverse psychological and social factors may be associated with binge eating. The aim of this study was to examine child and parental psychosocial determinants of binge eating and its impact on indicators of obesity.

METHODS

The sample consisted of 10 679 Finnish adolescents who participated in the Fin-HIT cohort study. The participants were 9-12 years at baseline, and they were followed-up for 2.6 years on average. At baseline, children's anthropometry was measured, and they reported binge eating, disordered eating attitudes and behaviors, self-esteem, and body shape satisfaction with validated questionnaires. Parents reported their own weight satisfaction, dieting, and depressive symptoms at baseline. Adjusted logistic and linear regressions were used in the analyses.

RESULTS

Self-esteem was associated with lower odds (OR 0.88, 95% CI 0.85-0.91), and overall disordered eating attitudes and behaviors were associated with higher odds (OR 1.08, 95% CI 1.06-1.10) of binge eating. Additionally, child and parent body dissatisfaction were associated with binge eating but not in the fully adjusted model where the child's BMI was additionally considered. None of the parental factors were associated with binge eating in the fully adjusted model. Binge eating was associated with higher BMI z-scores and waist circumferences both cross-sectionally and longitudinally.

CONCLUSIONS

In support of previous findings, we found that low self-esteem, body dissatisfaction and other disordered eating attitudes and behaviors are associated with binge eating, but our results also highlight the impact of weight status as a potential moderator when the determinants of binge eating are examined. More studies on the role of parental factors in adolescent binge eating are needed.

A latent profile analysis of sleep disturbance in relation to mental health among college students in China

Aims

This study aimed to examine the subtype classification characteristics of sleep disturbance (SD) in college students and their associations with sample characteristic factors and mental health outcomes.

Methods

The sample comprised 4,302 college students (Mean age = 19.92 ± 1.42 years, 58.6% females). The Youth Self-Rating Insomnia Scale, Beck Depression Inventory, 8-item Positive Subscale of the Community Assessment of Psychic Experiences, and 10-item Connor-Davidson Resilience Scale were used to assess adolescents' sleep disturbance, depressive symptoms, psychotic-like experiences (PLEs), and resilience. Latent profile analysis, logistic regression, and liner regression analysis were used to analyze the data.

Results

Three subtypes of SD in college students were identified: the high SD profile (10.6%), the mild SD profile (37.5%), and the no SD profile (51.9%). Compared with college students in the "no SD" profile, risk factors for "high SD" include being male and poor parental marital status. Sophomores were found to predict the "high SD" profile or "mild SD" profile relative to the "no SD" profile. College students in the "mild SD" profile or "high SD" profile were more likely to have a higher level of depressive symptoms and PLEs, while a lower level of resilience.

Conclusion

The findings highlighted that target intervention is urgently needed for male college students, sophomores, and those with poor parental marital status in the "mild SD" profile or "high SD" profile.

Transgender identity is associated with severe suicidal ideation among Finnish adolescents

OBJECTIVES

Emerging evidence reveals disparities in suicidal behaviour and ideation exist between transgender and cisgender youth. It has been hypothesized that certain gender minority specific risk factors, such as experiences of victimization, could partially explain the mental health disparities between transgender and cisgender youth. We set out to explore whether transgender identity is associated with severe suicidal ideation among Finnish adolescents and whether the possible association persist when a range of covariates is controlled for.

METHODS

The study included 1,425 pupils (mean age (SD) = 15.59 (0.41)) who participated in the study during a school lesson. Logistic regression was used to study associations between transgender identity and severe suicidal ideation.

RESULTS

Four models, each adding more covariates, were created. The final model revealed a statistically significant association between transgender identity and severe suicidal ideation, even though the association grew weaker as more covariates were added and controlled for.

CONCLUSIONS

The results indicate that transgender identity is associated with severe suicidal ideation even after prominent covariates or risk factors of suicidal behaviour and ideation have been taken into account.

Factor structure of the patient health questionnaire-9 and measurement invariance across gender and age among Chinese university students

The Patient Health Questionnaire-9 (PHQ-9) has been widely used to screen depression symptoms. The present research aimed to assess the reliability and validity of PHQ-9, besides measurement invariance of the PHQ-9 across gender and age among Chinese university students. A total of 12,957 Chinese college students from 2 universities in Henan and Hainan provinces (China) completed the questionnaires via WeChat. This research reported the psychometric properties of PHQ-9 and measurement invariance of the PHQ-9 across gender and age among Chinese university students. Compared with 1-factor model, the 2-factor (affective factor and somatic factor) model of PHQ-9 showed a better fit index in Chinese university students. Without the last 2 items, the 2-factor model of the PHQ-9 showed satisfactory reliability, validity, and good fit index (e.g., Root mean square error of approximation = 0.060, Goodness-of-fit index = 0.982, Comparative fit index = 0.986, and Tucker-Lewis index = 0.974). The Cronbach's alpha of PHQ-9 was 0.874. Multi-group analysis across gender and age demonstrated that measurement equivalency for the 2-factor model of the PHQ-9 was established (e.g., Root mean square error of approximation < 0.08, Comparative fit index > 0.90 and Tucker-Lewis index > 0.90). The 2-factor model of the PHQ-9 without the items of "movement" and "desire to die" showed a better fit index in Chinese university students. The measurement equivalence across gender and age for the 2-factor model of the PHQ-9 can be established among Chinese university students.

Diagnostic Test Accuracy of the Beck Depression Inventory for Detecting Major Depression in Adolescents: A Systematic Review and Meta-Analysis

Major depressive disorder in adolescents is closely linked to poor social, cognitive, and academic outcomes, including suicidality. The Beck Depression Inventory (BDI), a screening tool, is one of the most widely used instruments for detecting depression; however, its diagnostic test accuracy has not yet been thoroughly examined. This study, therefore, aimed to systematically review and perform a meta-analysis to evaluate the accuracy of the BDI for detecting depression in adolescents. In August 2020, a search was conducted in the EMBASE, MEDLINE, CINAHL, and PsycArticles databases, and following a review against predefined eligibility criteria, 22 studies were finally included. The quality of the included articles was evaluated, and a hierarchical regression model was used to calculate the pooled estimates of sensitivity and specificity; 73.0% (95% CI; 62.0%, 81.8%) and 80.3% (72.8%, 86.1%) in cutoff 16, respectively. The findings indicated the BDI is a reliable and useful tool to screen adolescents' depression.

Atypical anorexia nervosa: Rethinking the association between target weight and rehospitalization

OBJECTIVE

Bodyweight restoration is one of the most important targets in adolescent inpatient treatment of anorexia nervosa (AN). This study examined the association between achieving target weight and rehospitalization in two groups of adolescents with AN and atypical anorexia nervosa (AAN) admitted to a specialized inpatient unit.

METHOD

Included were 202 adolescent patients hospitalized in a specialized eating disorder unit, 10-18 years old. One hundred fifty-four adolescents were diagnosed with AN, and 48 with AAN. We examined the patients' demographic and clinical characteristics, the achievement of treatment goals, and their rehospitalization history within a year of discharge from the unit.

RESULTS

Log-linear regression indicated a significant association between achieving target weight during the inpatient program and rehospitalization at one-year follow-up in the AN group; this association was not significant in the AAN group.

DISCUSSION

This study emphasizes the importance of differentiating patients with AAN from those with classical AN. Specifically, it raises questions about the predictive power of target weight at discharge in preventing relapse and its centrality in determining AAN patients' treatment plans.

Self-evaluation as an active ingredient in the experience and treatment of adolescent depression; an integrated scoping review with expert advisory input

BACKGROUND

Negative self-perceptions is one of the most common symptoms of depression in young people, and has been found to be strongly associated with severity of depression symptoms. Psychological treatments for adolescent depression are only moderately effective. Understanding the role and importance of these self-perceptions may help to inform and improve treatments. The aim of this review was to examine self-evaluation as a characteristic of adolescent depression, and as an active ingredient in treatment for adolescent depression.

METHODS

We conducted a scoping review which included quantitative and qualitative studies of any design that reported on self-evaluation as a characteristic of, or focus of treatment for, adolescent depression. Participants were required to be 11-24 years and experiencing elevated symptoms of depression or a diagnosis. We also met with 14 expert advisory groups of young people with lived experience, clinicians, and researchers, for their input. Findings from 46 peer-reviewed research studies are presented alongside views of 64 expert advisors, to identify what is known and what is missing in the literature.

RESULTS

Three overarching topics were identified following the review and reflections from advisors: 1) What does it look like? 2) Where does it come from? and 3) How can we change it? The literature identified that young people view themselves more negatively and less positively when depressed, however expert advisors explained that view of self is complex and varies for each individual. Literature identified preliminary evidence of a bidirectional relationship between self-evaluation and depression, however, advisors raised questions regarding the influences and mechanisms involved, such as being influenced by the social environment, and by the cognitive capacity of the individual. Finally, there was a consensus from the literature and expert advisors that self-evaluation can improve across treatment. However, research literature was limited, with only 11 identified studies covering a diverse range of interventions and self-evaluation measures. Various barriers and facilitators to working on self-evaluation in treatment were highlighted by advisors, as well as suggestions for treatment approaches.

CONCLUSIONS

Findings indicate the importance of self-evaluation in adolescent depression, but highlight the need for more research on which treatments and treatment components are most effective in changing self-evaluation.

Feasibility of Delivering a Cognitive Behavioural Therapy-Based Resilience Curriculum to Young Mothers by Public Health Nurses

Background:

Young mothers have higher rates of mental health problems, yet can be difficult to engage in care. Few interventions exist targeting the full range of mental health problems these women face. While transdiagnostic psychotherapies have been utilized in adolescent groups, they have not been tested in young mothers.

Objective:

Our objective was to examine the feasibility and acceptability of a public health nurse-delivered transdiagnostic CBT-based resilience curriculum for young mothers in a supported school setting, and to determine preliminary estimates of the program’s effects.

Methods:

56 mothers, 21 years of age or younger were recruited from a supported high school program in Canada. Using a pretest/post-test design with no control group, measures of maternal depression, anxiety, emotion regulation, and offspring behaviour were collected immediately before and after the completion of the weekly 10-session intervention.

Results:

The intervention was feasible and acceptable to young mothers. While few statistically significant changes were noted in the complete sample, for those with moderate-severe depression at baseline, program participation resulted in clinically meaningful improvements in depression, anxiety, and emotion regulation.

Conclusion:

Provision of a transdiagnostic CBT-based resilience-building program delivered by public health nurses in a supported school setting was both feasible and well-tolerated. Given the preliminary nature of this study, its clinical utility is unclear, though it may have benefits for young mothers with more significant mental health problems at baseline.

Peculiarities of health literacy in people with mental disorders: A cross-sectional study

BACKGROUND

Health literacy (HL) is considered a key concept to positively address relevant decisions concerning physical and mental health. According to an integrated model of a European Consortium, the process to access, understand, appraise and apply health information is at the centre of practising HL.

AIM

In this study, we examine HL in a population with an early onset of a mental disorder (MD).

METHODS

Results are based on a cross-sectional survey among people with MD (n = 310) who sought help at an early detection centre for MD in Cologne, Dresden or Munich. Help-seekers filled out the European Health Literacy Survey questionnaire (HLS-EU-Q) on perception-based HL, socio-demographic data and general health status. Psychopathology was assessed separately by trained specialists. Data are compared with a representative sample of the German population.

RESULTS

Overall, HL was lower in a sample with MD compared with the general population. Disease-specific limitations were present in accessing, appraising and applying health information, whereas understanding was perceived fairly easy. Statistical analysis of limited HL revealed correlations with the diagnosis of affective disorders and anxiety disorders, an increase of depressive symptoms as well as the presence of more than one MD. In line with these findings, low levels of HL were associated with a worse general health status.

CONCLUSION

In a population with MD, accessing, appraising and applying health information seemed to be particularly challenging. Therefore, educational programmes that mainly focus on increasing knowledge might not be sufficient for improving the HL in people with MD. Further research should concentrate on context-specific HL to foster behavioural change and improve overall health.

Longitudinal bidirectional relations between body dissatisfaction and depressive symptoms among Black adolescents: A cross-lagged panel analysis

Objective

To assess the variation in body dissatisfaction and depressive symptoms by weight status and the bi-directional relations between body dissatisfaction and depressive symptoms by weight status among Black adolescents.

Methods

A sample of 153 Black adolescents aged 12–13 years, either overweight/obese (n = 57, 37%) or healthy weight (n = 96, 63%), were recruited and evaluated three times over two years (T1, T2 and T3). Measured weight and height were converted to age and sex-specific BMI z-score; body dissatisfaction was measured with silhouettes, and depressive symptoms were measured with the Beck Depression Inventory (BDI-I). Bidirectional relations were assessed with cross-lagged panel analyses, accounting for stability over time and contemporary correlations.

Results

Body dissatisfaction was higher among the overweight/obese group than the healthy weight group. No significant differences were found for depressive symptoms by weight status. Among the overweight/obese group, there were bidirectional relations: antecedent body dissatisfaction predicted subsequent depressive symptoms (T1-T2: β = 0.42, SE = 0.11, p<0.001; T2-T3: β = 0.36, SE = 0.09, p<0.001) and antecedent depressive symptoms predicted subsequent body dissatisfaction (T1-T2: β = 0.25, SE = 0.10, p = 0.012; T2-T3: β = 0.17, SE = 0.08, p = 0.045). Among the healthy weight group, there was no relation in either direction.

Conclusions

Elevated body dissatisfaction among the overweight/obese group supports weight-based stigma as a stressor among Black adolescents. The bidirectional relations between body dissatisfaction and depressive symptoms among the overweight/obese group support the internalization of thinness idea and negative self-appraisal associated with depressive symptoms. Prevention of both body dissatisfaction and depressive symptoms may be mutually beneficial among Black adolescents with overweight/obesity.

Sleeve gastrectomy vs gastric bypass in improvement of depressive symptoms following one year from bariatric surgery, Tehran Obesity Treatment Study (TOTS)

BACKGROUND

The Beck Depression Inventory (BDI) has been frequently employed as a measure of depression in studies of obesity, with the majority of studies reporting an improvement in scores following weight loss after bariatric surgery. However, the effects of different bariatric techniques on depression score improvement is uncertain.

METHOD

The study included 685 obese patients who underwent laparoscopic sleeve gastrectomy (SG) (n = 443) or gastric bypass (GB) (n = 242) and completed BDIs at baseline and 1 year after surgery.

RESULTS

Mean age of the patients was 38.7 ± 10.9 (84.8% female), and mean body mass index (BMI) was 45.1 ± 6.0 kg/m². One year after surgery, excess weight loss (EWL %) in the GB group was more than the SG group (65.4% vs 62.8% P = 0.02). At baseline, 29.9% of patients had BDI scores in the normal range (0-9), and respectively 32.4 %, 28.3 % and 9.3 % had mild (10-18), moderate (19-29) and sever (+30) depression score; these corresponding values after 1 year were 60.6, 23.2, 11.8 and 4.4%. Overall, BDI scores fell in both surgery groups after 1 year, in the GB group it was 17.2 ± 10.5 vs 11.1 ± 9.6, and for the SG group 16.1 ± 10.2 vs 9.6 ± 8.9. However BDI score change (ΔBDI) was not significantly different between two surgery groups (-6.04 ± 10.6 vs -6.4 ± 9.5, P = 0.149).

CONCLUSION

Bariatric surgery had a beneficial effect on weight reduction and BDI score regardless of its type. Further studies with longer follow-up and more samples are needed to clarify the differences between bariatric procedures.

Does Gender Nonconforming Behavior in Early Childhood Predict Adolescents' Depressive Symptoms?

Gender nonconforming behavior (GNB) is a risk factor for poorer psychological adjustment, but little is known about whether preschool-age children displaying GNB are at risk for depressive symptoms during adolescence. We examined maternal report of GNB at age 4-5 years-old as a predictor of adolescents' depressive symptoms at age 16-17 years-old in a longitudinal study of U.S. children from a predominantly low SES (61% received Aid to Families with Dependent Children) and African American (90%) sample. Youth with GNB in early childhood (n = 10) reported more depressive symptoms during adolescence than did their peers without GNB (n = 115), and this relationship remained after controlling for covariates (environmental risk, prenatal exposure, and neonatal medical problems). Our findings suggest that early GNB may be a risk factor for the development of depressive symptoms in adolescence. Further research is needed to replicate the current findings with a larger sample and to identify the underlying mechanisms by which GNB may increase risk for depressive symptoms. If replicated, the findings further highlight the need for both professionals and parents to become aware of the potential challenges that children with GNB face and to become knowledgeable about ways to facilitate healthy adjustment among gender nonconforming youth.

Experiences of sexual harassment are associated with high self-esteem and social anxiety among adolescent girls

Introduction: Subjection to sexual harassment among adolescents have been associated with negative mental health outcomes, such as depression and social anxiety. Self-esteem and social support may modify these associations. Methods: The Adolescent Mental Health Cohort 10-year replication data were used. It is a cross-sectional classroom survey involving 656 girls and 636 boys aged (mean (sd)) 15.6 (0.4) years and 15.7 (0.4) years, respectively. Subjection to sexual harassment was elicited with five questions. Depression was measured by the Beck's 13-item Depression Inventory, social anxiety by the SPIN-Fin Inventory, self-esteem by Rosenberg's Self-Esteem Scale and social support by the PSSS-R scale. The data were analysed using cross-tabulations with chi-square statistics and logistic regressions. Resutls: Among girls, social anxiety and higher self-esteem were positively associated with experiencing subjection to sexual harassment in multivariate models. No statistically significant associations were detected among boys between experiences of sexual harassment and any of the four variables. Conclusion: Experiences of being sexually harassed correlate among adolescents with high social anxiety but also with high self-esteem. Sexual harassment among adolescents may partly be explained as inept ways of showing interest, but it may nevertheless have detrimental effects on the well-being of the those subjected to it.

Prevalence and correlates of depression among male medical students and interns in Albaha University, Saudi Arabia

Background:

Depression in medical students and interns appear higher than the general population, with evidence of mental health deterioration over a period of medical training.

Objectives:

To estimate the prevalence and evaluate the predictors of depression among male medical students and interns, Albaha University, Saudi Arabia.

Subjects and Methods:

A cross-sectional analytic study was conducted which includes a representative stratified random sample with the proportional allocation of male medical students and interns, College of Medicine, Albaha University (2017–2018). A questionnaire included sociodemographic characteristics of the participants as well as a medical and family history of depression, medical or psychiatric illness, abuse or violence, and the major traumatic event was utilized. In addition, the validated reliable Arabic version of Becks Depression Inventory (BDI) questionnaire was used to screen for depression.

Results:

The study included 161 medical students and 21 interns. Their age ranged between 19 and 26 years with a mean of 22.03 ± 1.94 years. Majority of the participants (98.9%) were Saudis and singles (84.6%). The prevalence of depression, based on the BDI scale, was 53.8%; it was mild in 25.8% and severe or extreme in 4.4% of the participants. No factor was significantly associated with depression. However, severe or extreme depression was more reported among students/interns with a history of domestic abuse or violence and those who had a history of major trauma or psychiatric event, P < 0.001.

Conclusion:

Depression is a common problem among male medical students and interns in AlBaha University, with no difference according to demographics, smoking history, family history of depression, history of chronic medical or psychiatric illness, history of domestic/violence abuse, and history of major trauma or psychiatric event.

Experiences of sexual harassment are associated with the sexual behavior of 14- to 18-year-old adolescents

Subjection to sexual harassment is associated with a number of negative outcomes, such as internalizing and externalizing symptoms and a disinclination to attend school. Among adolescents, sexual harassment may increase with both their emerging sexual desires and increased socializing in mixed-gender peer groups during early adolescence. We set out to study the possible associations between normative and risk-taking sexual behavior and subjection to sexual harassment among adolescents between the ages of 14 and 18 years. The informants included 90,953 boys and 91,746 girls, with a mean (SD) age of 16.3 (1.2) years, who responded to a classroom survey (School Health Promotion Study 2010-2011) in Finland. We found that even early steps in romantic and erotic experiences were associated with experiences of sexual harassment. The more advanced the adolescents' sexual experiences were, the more commonly they reported differing experiences of sexual harassment. These associations were particularly strong among the girls. Among the sexually active adolescents, the more partners the adolescents had for intercourse, the more commonly they reported experiences of sexual harassment. Adolescents actively interested in romantic and sexual relationships may socialize in contexts where sexual harassment is more likely to occur. They may be more sensitive to sexual cues than their non-interested peers, or sexual harassment may be a traumatic experience predisposing adolescents to risk-taking sexual behavior as a form of acting out. A double standard regarding the appropriate expression of sexuality received some support in our data.

Perceived rather than actual overweight is associated with mental health problems in adolescence

BACKGROUND

Overweight and perceived overweight are common among adolescents. The nature of the relationship between overweight/perceived overweight and mental health problems is still unclear.

AIMS

The aim of this study was to examine whether actual overweight, perceived overweight or both are associated with internalizing and externalizing disorders among adolescents.

METHODS

Data were collected by two similar school surveys in all Finnish-speaking secondary schools in Tampere (population 200,000) in the academic years 2002-2003 and 2012-2013. A total of 2775 acceptable responses were received. All the analyses were carried out separately for girls and boys. Mean age of the respondents was 15.6 years.

RESULTS

In multivariate analyses perceived overweight, not actual weight, was significantly associated with higher risk of self-reported depression (OR: 4.3, 95% CI: 2.9-6.3, p < .001) and self-reported conduct disorder (OR: 2.3, 95% CI: 1.6-3.3, p < .001) in girls and with higher risk of self-reported depression (OR: 3.26, 95% CI: 1.65-6.4, p = .001) and self-reported social phobia (OR: 2.4, 95% CI: 1.0-5.6, p = .05) in boys.

CONCLUSION

Perceived overweight rather than actual weight status is associated with both internalizing and externalizing mental health problems in adolescents.

Social phobia, depression and eating disorders during middle adolescence: longitudinal associations and treatment seeking

BACKGROUND

Longitudinal associations between social phobia (SP), depression and eating disorders (EDs), and the impact of antecedent SP and depression on subsequent treatment seeking for EDs have rarely been explored in prospective adolescent population studies.

AIM

We aimed to examine these associations in a large-scale follow-up study among middle adolescents.

METHOD

We surveyed 3278 Finnish adolescents with a mean age of 15 years for these disorders. Two years later, 2070 were reached and again surveyed for psychopathology and treatment seeking. Longitudinal associations between the self-reported disorders and treatment-seeking patterns for self-acknowledged ED symptoms were examined in multivariate analyses, controlling for SP/depression comorbidity and relevant socioeconomic covariates.

RESULTS

Self-reported anorexia nervosa (AN) at age 15 years predicted self-reported depression at age 17 years. Furthermore, self-reported SP at age 15 years predicted not seeking treatment for bulimia nervosa (BN) symptoms, while self-reported depression at age 15 years predicted not seeking treatment for AN symptoms during the follow-up period.

CONCLUSIONS

Adolescents with AN should be monitored for subsequent depression. Barriers caused by SP to help seeking for BN, and by depression for AN, should be acknowledged by healthcare professionals who encounter socially anxious and depressive adolescents, especially when they present with eating problems.

Delinquency and sexual experiences across adolescence: does depression play a role?

PURPOSE

To elucidate a possible connection between delinquency and adolescent sexual behaviours in different age groups from 14 to 20 and the role of depression therein.

MATERIALS AND METHODS

Data were gathered from the cross-sectional Finnish School Health Promotion Study 2010 and 2011 with 186,632 respondents. We first examined the bivariate relationship between delinquency and sexual behaviour, and then proceeded to multivariate models accounting for self-reported depression. Analyses were conducted separately for girls and boys, in seven age groups. The main outcomes were analysed by χ² test and logistic regression.

RESULTS

Delinquency was connected to having experienced sexual intercourse across all age groups, and was related to reporting multiple sexual partners among sexually active adolescents, in both boys and girls, before and after controlling for depression. Delinquency and depression were independently associated with the sexual behaviours studied.

CONCLUSIONS

Being sexually active and engaging in risky sexual behaviours are related to delinquency in the adolescent population throughout the developmental phase, even in late adolescence when being sexually active is developmentally normative. Being sexually active is further connected to depression until middle adolescence, and risky sexual behaviours across adolescence. Clinicians working with adolescents presenting with delinquent behaviour with or without depression need to address their sexual health needs.

Impaired responsibility dimension of self-esteem of Brazilian adolescents with epilepsy

This study aimed to compare the self-esteem of Brazilian adolescents with epilepsy and Brazilian adolescents without this condition and the correlations between self-esteem of these adolescents with depression and anxiety symptoms. Study participants were 101 adolescents of both sexes, aged 10-19years old, from elementary and high school education. Fifty patients diagnosed with uncomplicated epilepsy attending the pediatric epilepsy clinic of University Hospital composed the case group. The other fifty-one adolescents without this diagnosis were attending public schools in Campinas-SP region. The instruments used were: identification card with demographics and epilepsy data, Multidimensional Self-Esteem Scale, Beck Depression Inventory and Inventory of State-Trait Anxiety - IDATE. A statistically significant result was found in the Responsibility Self-esteem Dimension favoring the control group. Significant correlations between self-esteem scores and anxiety and depression symptoms were also found. The development of a chronic disease such as epilepsy leads to a change in the way the individual perceives himself and the social environment he is inserted, influencing his behavior. The way people with epilepsy experience their seizures is a subjective measure that will control his/her well-being. Childhood and adolescence form the basis for a healthy emotional development; thus, our results show the importance of studying how subjective variables relate to the physical aspects of a chronic disease in these life stages.

Can Child Self-Report Measures of Depression and Anxiety Be Used in College Samples?

Depression and anxiety are typically measured in college samples using adult scales. However, some child and adolescent versions of internalizing symptoms may be appropriate for use with college samples. Child versions may be appropriate to use with college samples when multi-sample designs are utilized, e.g., both children and adults are assessed. To explore this possibility, 149 college students ( M age = 21.9 yr., SD = 6.3; 43 men, 106 women) were assessed on child and adolescent versions and adult scales of anxiety, i.e., the Revised Children's Manifest Anxiety Scale and the Beck Anxiety Inventory, and depression, i.e., the Children's Depression Inventory and the Beck Depression Inventory. Both sets of depression scores were highly correlated ( r = .81), which suggests that the children's measure can be used in college samples. Although scores on the two anxiety scales were also significantly correlated, these scales shared less common variance. An exploratory factor analysis provided evidence that a single factor composed of all items for depression was an optimal solution. It was concluded that the Children's Depression Inventory can be used with college samples; however, the Revised Children's Manifest Anxiety Scale should not.

Social Phobia and Educational and Interpersonal Impairments in Adolescence: A Prospective Study

We examined longitudinal associations between social phobia (SP) and educational and interpersonal impairments among Finnish adolescents. Participants were 3278 adolescents (9th grade; M age = 15.5 years) who completed measures of SP and depressive symptoms; 2070 participated in follow-up two years later. Indicators for educational and interpersonal functioning were assessed for each sex separately. Multivariate analyses, controlling for depression and relevant socioeconomic covariates, indicated that for boys, age 15 SP predicted slow academic progression, being without a close friend or not having a romantic relationship, and poor support from friends and significant others at age 17. However, for girls, age 15 SP only predicted not having been involved in a romantic relationship by age 17. In conclusion, we found striking sex differences for adolescent SP as a predictor for subsequent educational and interpersonal impairments in late adolescence. SP may have a more devastating effect on boys' social and academic functioning relative to that of girls.

Sexual harassment and emotional and behavioural symptoms in adolescence: stronger associations among boys than girls

PURPOSE

To study the associations between subjection to sexual harassment and emotional (depression) and behavioural (delinquency) symptoms among 14-to-18-year-old adolescents, and gender differences within these associations.

METHODS

90,953 boys and 91,746 girls aged 14-18 participated in the School Health Promotion Study (SHPS), a school-based survey designed to examine the health, health behaviours, and school experiences of teenagers. Experiences of sexual harassment were elicited with five questions addressing five separate forms of harassment. Depression was measured by the 13-item Beck Depression Inventory and delinquency with a modified version of the International Self-Report Delinquency Study (ISRD) instrument. Data were analysed using cross-tabulations with Chi-square statistics and logistic regression.

RESULTS

All sexual harassment experiences studied were associated with both depression (adjusted odds ratios varied from 2.2 to 2.7 in girls and from 2.0 to 5.1 in boys) and delinquency (adjusted odds ratios 3.1-5.0 in girls and 1.7-6.9 in boys). Sexual name-calling had a stronger association with depression and with delinquency in girls (adjusted odds ratios, respectively, 2.4 and 4.2), than in boys (adjusted odds ratios, respectively, 2.0 and 1.7), but otherwise stronger associations with emotional and behavioural symptoms were seen in boys.

CONCLUSIONS

Subjection to sexual harassment is associated with both emotional and behavioural symptoms in both girls and boys. The associations are mostly stronger for boys. Boys subjected to sexual harassment may feel particularly threatened regarding their masculinity, and there may be less support available for boys traumatised due to sexual harassment.

Poor sleep quality is responsible for the nondipper pattern in hypertensive but not in normotensive chronic kidney disease patients

AIM

This study was designed to evaluate the relationship between sleep quality and hypertension and to determine if there was an association between nondipper blood pressure (BP) and sleep quality in chronic kidney disease (CKD) patients.

METHODS

A total of 775 pre-dialysis CKD patients (314 normal BP patients, 461 hypertension patients) defined as dippers or nondippers by ambulatory BP monitoring were recruited for this study. Demographics and clinical correlates were collected, including body mass index, estimated glomerular filtration rate (eGFR) and other measures. Sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI).

RESULTS

A total of 185 (58.9%) patients with normal BP and 341 (74.0%) hypertensive patients had a nondipper BP pattern. The hypertension group had a higher prevalence of the nondipper BP pattern, smoking, alcohol intake and diabetes mellitus (DM) and lower eGFR levels and poorer sleep quality than the normal BP group. Patients with the nondipper BP pattern had lower haemoglobin, worse renal function and poorer sleep quality when compared with hypertensive CKD patients with the dipping BP pattern. PSQI scores were significantly associated with the rate of nocturnal BP decline (P < 0.05) in the hypertension group but not in the normal BP group. Poor sleep quality was an independent factor affecting BP pattern in hypertensive CKD patients using multivariate linear and logistic regression analyses. There was no association between sleep quality and hypertension in CKD patients after multivariate logistic regression analyses.

CONCLUSION

Poor sleep quality, which is commonly observed in pre-dialysis CKD patients, is an independent associated factor of the nondipper BP pattern in hypertensive CKD patients. No association was found between poor sleep and nondipper BP in normotensive patients.

Prevalence of depressive symptoms and its correlates among medical students in China: a national survey in 33 universities

We conducted a national survey among medical students in China to estimate the prevalence of depressive symptoms and explore associated risk factors based on an established questionnaire composed of demographic information, life events in the past four weeks before survey, and the validated Chinese version of the 21-item Beck's Depression Inventory (BDI). The mean age of enrolled 9010 students was 20.7 (standard deviation: 1.6) years. BDI scores indicated that 19.9% had depressive symptoms based on the cut-off score of 14. Socioeconomic factors and student characteristics such as male sex, low monthly income per capita, father's poor education background, and higher year of study were associated with higher prevalence of depressive symptoms among medical students. Students who studied in comprehensive universities were more likely to have depressive symptoms compared with those from medical universities. Habitual smoking and alcohol drinking, sleep deprivation, and hospitalization or medication for one week or more in the last four weeks also predisposed students to higher risk of depressive symptoms. Our results indicate that depressive symptoms are becoming a highly prevalent health problem among Chinese medical students. Primary and secondary prevention should be prioritized to tackle this issue based on potential risk factors.

In adolescents with epilepsy, high scores of anxiety and depression are associated with occurrence of seizures in public places

OBJECTIVE

To assess depression and anxiety symptoms of adolescents with epilepsy compared with adolescents without epilepsy.

METHOD

The study sample consisted of: case participants (50 subjects) attending the pediatric epilepsy clinic of a tertiary hospital and control participants (51 subjects) from public schools. The instruments utilized were: identification card with demographic and epilepsy data, Beck Depression Inventory and State-Trait Anxiety Inventory.

RESULTS

No significant differences were founded between the groups regarding scores for depression and anxiety symptoms but both groups presented moderate scores of anxiety. A correlation was found between low scores anxiety and not frequent seizures, low scores anxiety and perception of seizure control, high scores of anxiety and depression and occurrence of seizures in public places.

CONCLUSION

Low scores of anxiety are associated with not frequent seizures; high scores of anxiety and depression are associated with occurrence of seizures in public places.

Symptom screening scales for detecting major depressive disorder in children and adolescents: a systematic review and meta-analysis of reliability, validity and diagnostic utility

BACKGROUND

Depression symptom screening scales are often used to determine a clinical diagnosis of major depressive disorder (MDD) in prevention research. The aim of this review is to systematically examine the reliability, validity and diagnostic utility of commonly used screening scales in depression prevention research among children and adolescents.

METHODS

We conducted a systematic review of the electronic databases PsycINFO, PsycEXTRA and Medline examining the reliability, validity and diagnostic utility of four commonly used depression symptom rating scales among children and adolescents: the Children׳s Depression Inventory (CDI), Beck Depression Inventory (BDI), Center for Epidemiologic Studies - Depression Scale (CES-D) and the Reynolds Adolescent Depression Scale (RADS). We used univariate and bivariate random effects models to pool data and conducted metaregression to identify and explain causes of heterogeneity.

RESULTS

We identified 54 studies (66 data points, 34,542 participants). Across the four scales, internal reliability was 'good' (pooled estimate: 0.89, 95% Confidence Interval (CI): 0.86-0.92). Sensitivity and specificity were 'moderate' (sensitivity: 0.80, 95% CI: 0.76-0.84; specificity: 0.78, 95% CI: 0.74-0.83). For studies that used a diagnostic interview to determine a diagnosis of MDD, positive predictive power for identifying true cases was mostly poor. Psychometric properties did not differ on the basis of study quality, sample type (clinical vs. nonclinical) or sample age (child vs. adolescent).

LIMITATIONS

Some analyses may have been underpowered to identify conditions in which test performance may vary, due to low numbers of studies with adequate data.

CONCLUSIONS

Commonly used depression symptom rating scales are reliable measures of depressive symptoms among adolescents; however, using cutoff scores to indicate clinical levels of depression may result in many false positives.

Craving is associated with amygdala volumes in adolescent marijuana users during abstinence

BACKGROUND

Amygdala volume abnormalities have been reported in relation to craving in substance-dependent adults, but it remains unclear if these effects are seen in adolescent marijuana (MJ) users, particularly following abstinence.

OBJECTIVES

The aim of this study was to examine the relationship between amygdala volume and craving during 28 days of abstinence in adolescent MJ users.

METHODS

MJ-using adolescents (n = 22) aged 16-19 were recruited as part of a larger study on brain function in teen drug users. Craving measures were collected twice per week throughout a 28-day abstinence period. High-resolution anatomical magnetic resonance imaging data were collected at the end of the 28 days of confirmed abstinence. Left and right amygdala volumes were traced by hand (ICC > 0.86). Composite scores for self-reported craving and withdrawal symptoms throughout the 28-day abstinence period were calculated to provide four composite measures of total craving, mood, sleep, and somatic complaints.

RESULTS

Results revealed that greater craving during abstinence was significantly associated with smaller left and right amygdala volumes, after controlling for age and gender. Other measures of withdrawal, including mood, somatic complaints and sleep problems, were not related to amygdala morphometry.

CONCLUSION

These results are consistent with previous findings in adult alcohol- and cocaine-dependent individuals, who demonstrated a relationship between reduced amygdala volumes and increased craving. Future studies are needed to determine if these brain-behavior relationships are attributable to MJ use or predate the onset of substance use.

Low perceived social support predicts later depression but not social phobia in middle adolescence

Social phobia and depression are common and highly comorbid disorders in adolescence. There is a lack of studies on possible psychosocial shared risk factors for these disorders. The current study examined if low social support is a shared risk factor for both disorders among adolescent girls and boys. This study is a part of the Adolescent Mental Health Cohort Study's two-year follow-up. We studied cross-sectional and longitudinal associations of perceived social support with social phobia, depression, and comorbid social phobia and depression among girls and boys. The study sample consisted of 2070 15-year-old adolescents at baseline. Depression was measured by the 13-item Beck Depression Inventory, social phobia by the Social Phobia Inventory (SPIN), and perceived social support by the Perceived Social Support Scale-Revised (PSSS-R). Girls reported higher scores on the PSSS-R than boys in total scores and in friend and significant other subscales. Cross-sectional PSSS-R scores were lower among adolescents with social phobia, depression, and comorbid disorder than among those without these disorders. Low PSSS-R total score and significant other subscale were risk factors for depression among both genders, and low support from friends among girls only. Low perceived social support from any source was not a risk factor for social phobia or comorbid social phobia and depression. As conclusion of the study, low perceived social support was a risk factor for depression, but not a shared risk factor for depression and social phobia. Interventions enhancing perceived social support should be an important issue in treatment of depression.

Association between sleep quality and cardiovascular damage in pre-dialysis patients with chronic kidney disease

Background

Poor sleep quality, a novel risk factor of cardiovascular diseases (CVD), is highly prevalent in patients with chronic kidney disease (CKD). The association between poor sleep quality and cardiovascular damage in patients with CKD is unclear. This study is aimed to assess the prevalence and related risk factors of sleep disturbance and determine the relationship between sleep quality and cardiovascular damage in Chinese patients with pre-dialysis CKD.

Methods

A total of 427 pre-dialysis CKD patients (mean age = 39 ± 15 years, 260 male/167 female) were recruited in this study. The demographics and clinical correlates were collected. The sleep quality was measured by the Pittsburgh Sleep Quality Index (PSQI), whereas the cardiovascular damage indicators (the Early/late diastolic peak flow velocity (E/A) ratio and left ventricular mass index (LVMI)) were determined by an echocardiographic examination.

Results

Of the CKD patients, 77.8% were poor sleepers as defined by a PSQI score > 5. Median estimated glomerular filtration rate (eGFR) was 69.4(15.8-110.9) ml/min/1.73 m². Logistic regression analysis revealed that left ventricular hypertrophy (LVH) was independently associated with the PSQI score (OR = 1.092, 95% CI = 1.011-1.179, p = 0.025), after adjustment for age, sex and clinical systolic blood pressure, diastolic blood pressure, Phosphate, Intact parathyroid hormone (iPTH), Hemoglobin and eGFR. The linear regression analysis showed that the E/A ratios were independently associated with the PSQI score (β = -0.115, P = 0.028) after adjustment for a series of potential confounding factors.

Conclusions

Poor sleep quality, which is commonly found in pre-dialysis CKD patients, is an independent factor associated with cardiovascular damage in CKD patients. Our finding implies that the association between poor sleep and CVD might be mediated by cardiac remodeling.

Associations between impulsivity, aggression, and suicide in Chinese college students

Background

Although there are accumulating data regarding the epidemiology of suicide in China, there are meager data on suicidal ideation and attempts among college students. Interestingly, elevated impulsivity is thought to facilitate the transition from suicidal thoughts to suicidal behavior. Therefore, the objective of this research was to identify the associations between suicide and the personality factors of impulsivity and aggression.

Methods

This study’s sampling method employed stratified random cluster sampling. A multi-stage stratified sampling procedure was used to select participants (n = 5,245). We conducted structured interviews regarding a range of socio-demographic characteristics and suicidal morbidity. The Patient Health Questionnaire depression module (PHQ-9) was used to acquire the information about thoughts of being better off dead or hurting themselves in some ways during the past two weeks. The impulsivity symptoms in this study were assessed with the BIS-11-CH (i.e., the Chinese version of the BIS-11), and the Aggressive symptoms were assessed with the BAQ. The statistical package for social science (SPSS) v.13.0 program (SPSS Inc., Chicago, IL, USA) was used for statistical analysis. Socio-demographic variables such as ethnic and gender were compared between groups, through the use of χ² tests. The nonparametric test (k Independent Sample test, Kruskal-Wallis H) was performed to determine differences between the personality factors of impulsivity and aggression and suicide.

Results

In total, 9.1% (n = 479) of the 5,245 students reported they have ever thought about committing suicide; and 1% (n = 51) reported a history of attempted suicide (attempters). The analyses detected significant differences in scores on cognitive impulsivity (p < 0.01), when comparing individuals who only had suicidal ideation and individuals who had attempted suicide. Moreover, significant differences were found between ideators only and attempters on scores of self-oriented attack (p < .001).

Conclusions

Suicidal ideation is prevalent among Chinese university students. Students with high aggression scores were more susceptible to committing suicide. Scores on self-oriented attack and cognitive impulsivity may be important factors for differentially predicting suicide ideation and suicide attempts.

Comorbidity of anxiety and depression in children and adolescents: 20 years after

Brady and Kendall (1992) concluded that although anxiety and depression in youths are meaningfully linked, there are important distinctions, and additional research is needed. Since then, studies of anxiety-depression comorbidity in youths have increased exponentially. Following a discussion of comorbidity, we review existing conceptual models and propose a multiple pathways model to anxiety-depression comorbidity. Pathway 1 describes youths with a diathesis for anxiety, with subsequent comorbid depression resulting from anxiety-related impairment. Pathway 2 refers to youths with a shared diathesis for anxiety and depression, who may experience both disorders simultaneously. Pathway 3 describes youths with a diathesis for depression, with subsequent comorbid anxiety resulting from depression-related impairment. Additionally, shared and stratified risk factors contribute to the development of the comorbid disorder, either by interacting with disorder-related impairment or by predicting the simultaneous development of the disorders. Our review addresses descriptive and developmental factors, gender differences, suicidality, assessments, and treatment-outcome research as they relate to comorbid anxiety and depression and to our proposed pathways. Research since 1992 indicates that comorbidity varies depending on the specific anxiety disorder, with Pathway 1 describing youths with either social phobia or separation anxiety disorder and subsequent depression, Pathway 2 applying to youths with coprimary generalized anxiety disorder and depression, and Pathway 3 including depressed youths with subsequent social phobia. The need to test the proposed multiple pathways model and to examine (a) developmental change and (b) specific anxiety disorders is highlighted.

Decrease in self-esteem mediates the association between symptoms of social phobia and depression in middle adolescence in a sex-specific manner: a 2-year follow-up of a prospective population cohort study

BACKGROUND

Social phobia and depression are common, highly comorbid disorders in middle adolescence. The mechanism underlying this comorbidity, however, is unclear. Decrease in self-esteem caused by the initial disorder might play a decisive role in the development of the subsequent disorder. The present study aimed to determine whether the association between symptoms of social phobia and depression is mediated by decrease in self-esteem in mid-adolescent girls and boys.

METHODS

As a part of the prospective Adolescent Mental Health Cohort (AMCH), subjects of this study were 9th grade pupils (mean age, 15.5) responding to a survey conducted in 2002-2003 (T1) and to a 2-year follow-up survey in 2004-2005 (T2) (N = 2070, mean age 17.6 years, 54.5% girls).

RESULTS

Symptoms of social phobia without symptoms of depression at age 15 and symptoms of depression at age 17 were associated only among boys, and this association was mediated by decrease in self-esteem. Symptoms of depression without symptoms of social phobia at age 15 and symptoms of social phobia at age 17 were associated only among girls, and this association was partially mediated by decrease in self-esteem.

CONCLUSIONS

Decrease in self-esteem plays a decisive role in the association between social phobia and depression. Self-esteem should be a key focus in interventions for adolescents suffering from social phobia or depression. Efficient intervention for the first disorder might help to prevent the decline in self-esteem and thus the incidence of the subsequent disorder. These findings are based on a sample of Finnish adolescents and should be confirmed in other jurisdictions or in more ethnically diverse samples.

The relationship between depressive symptoms and obstructive sleep apnea in pediatric populations: a meta-analysis

BACKGROUND

A higher incidence of depressive disorders and symptoms has been suggested among children suffering from obstructive sleep apnea (OSA). Yet, the extent to which OSA is related to increased depression is unclear.

OBJECTIVES

To evaluate (a) the relationship between depressive symptoms and OSA in pediatric populations, and (b) the efficacy of adenotonsillectomy (AT) for decreasing depressive symptoms among children with OSA.

METHODS

A meta-analysis was conducted to assess the relationship between depressive symptoms and OSA, and the efficacy of AT for decreasing depressive symptoms. Studies reporting depressive symptoms of children with OSA through January 2013 were included.

RESULTS

Eleven studies assessed depressive symptoms in both children diagnosed with OSA (n = 894) and a comparison group (n = 1,096). A medium relationship was found between depressive symptoms and OSA (Hedges' g = 0.43, 95% CI: 0.22-0.64; p = 0.0005). Addressing the second question, 9 studies (n = 379 children) examined depressive symptoms pre- and post-AT. A medium improvement in depressive symptoms was found at follow-up (Hedge's g = 0.41, 95% CI: 0.20-0.62; p ≤ 0.001).

CONCLUSION

Our findings suggest that depressive symptoms are higher among children with OSA. Therefore, patients with depressive symptomatology should receive screening for sleep disordered breathing. Treatment of OSA with AT might decrease clinical symptoms of depression, reduce pharmacotherapy, improve sleep patterns, and promote better health.

Peer victimization and social phobia: a follow-up study among adolescents

OBJECTIVE

This study examined longitudinal associations between direct and relational peer victimization (DV/RV) and self-reported social phobia (SP) among adolescents from 15 to 17 years of age, controlling for depression and family socioeconomic covariates.

METHODS

A total of 3,278 Finnish adolescents with a mean age of 15.5 years were surveyed at baseline (T1), and followed up 2 years afterwards (T2) their mean age being 17.6 years. In all, 2,070 adolescents were reached for the follow-up. Both types of victimization were assessed with structured questions, SP with the Social Phobia Inventory, and depression with the 13-item Beck Depression Inventory. Socioeconomic covariates were assessed with items from the Life Events Checklist. Frequency of victimization and SP were assessed at T1 and T2, and incidence and persistence from T1 to T2. Longitudinal associations between victimization and SP were examined with three logistic regression analyses with depression and socioeconomic covariates controlled for, with SP, DV, and RV in turn as the dependent endpoint (T2) variables.

RESULTS

Among boys a bidirectional association between DV and SP was found with DV both predicting SP [Odds Ratio (OR) 2.6] and being predicted by SP (OR 3.9). Among girls RV predicted SP (OR 2.8), but not vice versa, while depression in turn predicted DV (OR 4.3).

CONCLUSIONS

Direct victimization and SP have a bidirectional association among boys, while among girls RV increases the risk of subsequent SP.

Depression among Chinese university students: prevalence and socio-demographic correlates

The purpose of the present study was to estimate the prevalence of depression in Chinese university students, and to identify the socio-demographic factors associated with depression in this population. A multi-stage stratified sampling procedure was used to select university students (N = 5245) in Harbin (Heilongjiang Province, Northeastern China), who were aged 16–35 years. The Beck Depression Inventory (BDI) was used to determine depressive symptoms of the participants. BDI scores of 14 or higher were categorized as depressive for logistic regression analysis. Depression was diagnosed by the Structured Clinical Interview (SCID) for the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV). 11.7% of the participants had a BDI score 14 or higher. Major Depressive Disorder was seen in 4.0% of Chinese university students. There were no statistical differences in the incidence of depression when gender, ethnicity, and university classification were analyzed. Multivariate analysis showed that age, study year, satisfaction with major, family income situation, parental relationship and mother's education were significantly associated with depression. Moderate depression is prevalent in Chinese university students. The students who were older, dissatisfied with their major, had a lower family income, poor parental relationships, and a lower level of mother's education were susceptible to depression.

Impersistence of Depression in Youth: Implications for Drug Study Design

Food and Drug Administration data show that most anti-depressant studies in youth do not show drug effect. The few positive studies used rigorous diagnostic screening procedures, suggesting major depressive disorder (MDD) may not be a persistent condition in a subgroup of youth. To investigate persistence of MDD, we serially assessed a cohort of inpatients admitted to the hospital with a clinical diagnosis of MDD. Assessments included a structured diagnostic interview, the Diagnostic Interview for Children and Adolescents-Revised (DICA-R), and measures of depressive symptomatology. Of 66 subjects (40 girls; mean age, 14.4 +/- 2.2 years), 34 (51.5%) met DICA-R criteria for MDD at the initial postadmission assessment. Of these, only 8 (23.5%) met DICA-R criteria for MDD at any subsequent assessment. Similar reductions were found on other ratings of depression. In conclusion, MDD did not persist in this sample. The findings suggest a multigated assessment procedure should be employed before randomization in antidepressant clinical trials.

Prevalence and clinical features of Thought-Perception-Sensitivity Symptoms: results from a community survey of Korean high school students

Epidemiologic research indicates that psychosis and depression most frequently develop during adolescence. Hence, an efficient strategy for improving youth mental health would be to focus on detection of early-stage psychosis and depression in adolescence. In this study, 1461 high school students were surveyed using self-report scales. Students who scored equal to or above the cut-off value on any of the scales and who agreed to a further examination proceeded to a second assessment, using the Kiddie Schedule for Affective Disorders and Schizophrenia and Comprehensive Assessment of At-Risk Mental States along with self-reporting scales. The estimated prevalence of adolescents at ultra-high risk (UHR) for psychosis and of depression-spectrum disorders was 1.26 and 3.69% respectively. Compared with the normal group, experiences of bullying, suicidal ideation, and suicide attempts were significantly higher in these two groups; the subjects at UHR for psychosis were found to have significantly lower academic performance and lower ratings on SCRS; and submissive behavior was more prevalent in the depression-spectrum group. Our results reveal several clinical features of adolescents at UHR for psychosis and with depression-spectrum disorder and underscore the importance of accurate assessment of and early appropriate care for these adolescents.

How low is low? Low self-esteem as an indicator of internalizing psychopathology in adolescence

Schools are among the most important setting for preventive interventions among adolescents. There are evidence-based intervention programs for adolescents at risk for and with early signs of mental health problems but one demanding task is to detect the ones who are in need of an intervention. The aim of the present study was to analyze associations between self-esteem, depressive symptoms, and social anxiety in order to determine clinically relevant cut-points for male and female adolescents' self-esteem as measured with the Rosenberg Self-Esteem Scale (RSES). The participants of the present prospective study, started in 2002-2003, were 2070 adolescents aged 15 years (1,167 girls and 903 boys) at two study sites in Finland who participated at both baseline and 2-year follow-up. Self-esteem was related to depressive symptoms and social anxiety, and the RSES was able to discriminate between cases of depression and social phobia. The present study suggests a cutoff of 25 points to classify low self-esteem in both girls and boys. Low self-esteem may function as an indicator of various forms of internalizing psychopathology. The RSES is worth further examination as a potential screening tool for adolescents in risk of psychopathology.

Social Anxiety Scale for Adolescents (SAS-A): measuring social anxiety among Finnish adolescents

The aim of this study was to investigate symptoms of social anxiety and the psychometric properties of the Social Anxiety Scale for Adolescents (SAS-A) among Finnish adolescents, 13-16 years of age. Study 1 (n = 867) examined the distribution of SAS-A scores according to gender and age, and the internal consistency and factor structure of the SAS-A. In a subsample (n = 563; Study 2) concurrent and discriminant validity of the SAS-A were examined relative to the Social Phobia Inventory and the Beck Depression Inventory. Test-retest stability was examined over a 30-month period by repeated measures every 6 months in another subsample (n = 377; Study 3). Results mostly revealed no gender differences in social anxiety, except that boys reported more general social avoidance and distress than girls. Older adolescents (14-16-year-olds) reported higher social anxiety than younger adolescents (12-13-year-olds). Internal consistency for the SAS-A was acceptable for both genders and for all three SAS-A subscales. Confirmatory factor analysis replicated the original 18-item three-factor structure of the SAS-A, accounting for 61% of the variance between items. Evidence for concurrent and discriminant validity was found. Test-retest stability over 6 months was satisfactory. Results support the reliability and validity of the Finnish adaptation of the SAS-A, and further indicate that gender differences in adolescents' social anxiety may vary across Western countries.

The Beck Depression Inventory and General Health Questionnaire as measures of depression in the general population: a validation study using the Composite International Diagnostic Interview as the gold standard

The Beck Depression Inventory (BDI) and the General Health Questionnaire (GHQ) are commonly used in population studies as measures of depression. We examined in a population sample the validity of four scales for depressive symptoms, the GHQ-12, the 21- and 13-item versions of the BDI, and a new 6-item version of the BDI developed for this study. A total of 5561 participants in the "Health 2000" survey (30-79 years) completed the four scales and were assessed with the Composite International Diagnostic Interview (CIDI), which was used as the validation criterion. We selected items for the BDI-6 through an exploratory factor analysis for the BDI-21. The accuracy of the scales, including the BDI-6, was satisfactory (c-statistics 0.88-0.92 for depression within the past 2 weeks and 0.80-0.83 within the past 12 months) and slightly better for men (0.92-0.96 and 0.85-0.87) than for women (0.86-0.88 and 0.78-0.79). Higher scores in all the scales were associated with more severe depression and more recent depressive episodes. This study suggests that various versions of the BDI and the GHQ-12 are useful in detecting depressive disorders in the general population. Even the 6-item version of the BDI showed acceptable criterion validity, although replication in an independent dataset is needed to confirm its validity.

Exploratory factor analytical study of depressive symptomatology: an Arab experience with a sample comprising college students, using the revised Beck Depression Inventory

BACKGROUND AND OBJECTIVES

An understanding of the domains of depressive symptomatology could facilitate valid and interpretable comparisons across cultures. The objective of the present study was to assess the factor structure of the Beck Depression Inventory-II (BDI-II) in an Arab sample comprising college students, in comparison to the international data.

DESIGN AND SETTING

Cross-sectional questionnaire survey of Arab college students in their classrooms over a 1-year period.

PATIENTS AND METHODS

Participants (n=624) who completed the questionnaire, which had been translated into Arabic, during the 2007-2008 academic session. Exploratory factor analysis was done by principal axis factoring with oblique rotation.

RESULTS

Factor 1 consisted of psychological symptoms. Factor 2 mainly comprised somatic symptoms, but with some affective symptoms (loss of interest, irritability). Factor 3 also belonged to a purely psychological domain, whereas factor 4 was another mixture of somatic and psychological symptoms (41.8% of variance explained). Thus the four domains were as follows: cognitive I, somatic-affective I, cognitive II, and somatic-affective II. These domains were similar in construct to the original subscales on which the BDI-II was validated for students in North America. Our four-factor solution fulfilled the recommended criteria, namely, a strong first factor, simple structure (parsimony), and stable factors with construct meanings that are in line with theory.

CONCLUSION

Our factor structure defined depression in a manner consistent with theory, in that sadness, self-dislike, and guilt feelings defined the cognitive domain. whereas irritability and changes in sleep pattern and appetite mostly defined the somatic-affective domain. The BDI-II has construct validity across cultures.

Organizational justice at school and its associations with pupils' psychosocial school environment, health, and wellbeing

It has been shown that the psychosocial environment perceived by school staff is associated with children's academic performance and wellbeing. In this study we examined the associations between organizational justice (procedural and relational justice) as reported by school staff and pupils' perceptions of their school environment, health problems, academic performance, and absenteeism. We combined data from two surveys: for the staff (the Finnish Public Sector Study, n = 1946) and pupils (the Finnish school health promotion survey, n = 11,781 boys and 12,842 girls) of 136 secondary schools, collected during 2004-2005. Multilevel cumulative logistic regression analyses showed that after adjustment for potential individual and school-level confounding factors, low procedural justice was associated with pupils' dissatisfaction with school-going. Low relational justice was associated with a 1.30 times higher risk of poor academic performance, 1.15 times higher risk of psychosomatic symptoms and 1.13 times higher risk of depressive symptoms among pupils. Both organizational justice components were associated with truancy. We concluded that staff perceptions of organizational justice at school are associated with pupils' reports of their psychosocial school environment, health, performance, and absenteeism due to truancy. Improving managerial and decision making procedures among school personnel may be an important factor for protecting pupils' academic performance and wellbeing.