Cognitions and depressive symptoms among ethnic minority adolescents

Reciprocal developmental pathways between future-related thinking and symptoms of adolescent depression and anxiety: A systematic review and meta-analysis of longitudinal studies

Adolescence is a time when important decisions about the future are made and vulnerability to mental health problems increases. We reviewed longitudinal studies examining the reciprocal pathways between future-related thinking (hopelessness, hope, optimism/positive future expectations) and adolescent depression and anxiety symptoms. Evidence from 22 studies (N = 10,682) found that negative future-related thinking predicted subsequent depression (r = 0.27, p < .001), an effect still significant after controlling for baseline depression (r = 0.23, p < .001). Higher hopelessness (r = 0.34, p < .001), lower hope (r = 0.16, p < .001), and reduced optimism/positive future expectations (r = 0.18, p < .001) were associated with subsequently increased depressive symptoms. Negative future-related thinking also predicted later increased anxiety symptoms (r = 0.15, p = .021). Concerning the reciprocal pathway, depressive symptoms were associated with later negative future-related thinking (r = 0.32, p < .001), which remained after baseline levels of future-related thinking were controlled (r = 0.07, p = .02). There were insufficient studies to infer reciprocal links between anxiety and future-related thinking. Our analyses provided evidence of a reciprocal developmental relationship between depressive symptoms and future-related thinking, implying a negative cycle. Identifying precursors of this cycle could provide the basis for depression prevention in adolescents and promote better decision-making about the future.

Links between mental health problems and future thinking from the perspective of adolescents with experience of depression and anxiety: a qualitative study

BACKGROUND

Depression and anxiety are common during adolescence and could have detrimental impacts on young people's ability to make and implement plans for their future. However, to the best of our knowledge, no other study has adopted a qualitative approach in investigating these effects from the perspective of adolescents with lived experiences of depression and anxiety. We sought to understand how young people perceive and interpret the impact of mental health conditions on their thinking about the future.

METHODS

We conducted semi-structured interviews with 19 adolescents aged 16-19 years in the UK (median age = 19, IQR = 1.5), who had a history of protracted periods of clinical or subclinical depression and/or anxiety. They were asked to reflect on how their ability to think about the future and the content of the future-related thinking was impacted during periods of poor mental health, compared with periods of feeling well. Interviews were transcribed verbatim and subjected to thematic content analysis.

RESULTS

Five domains were identified. First, the impact of mood on future thinking capability focuses on reduced ability and motivation to engage in future thinking. Second, the impact of mood on images, thoughts, and feelings about the future includes the emotional valence of future-related thoughts, their vividness, structure, and the extent to which they intimated subjective feelings of control (i.e., agency). Third, social influences focuses on social factors that might ameliorate or exacerbate future thinking. Fourth, reflections on personal worries and expectations about the future captures personal interpretations of past worries and hopes and how future thinking affected mood. Finally, personal coping refers to how young people cope with the negative emotions that come with future thinking.

CONCLUSIONS

This study provided a nuanced and granular account of how depression and anxiety impacted young people's future thinking based on their lived experiences. By highlighting the different ways that variations in future thinking were experienced as a function of depression and anxiety, our analysis highlighted new factors that should be considered in studies of adolescent mental health risk, which could inform the development of new therapeutic approaches.

Racial/ethnic differences in parenting behaviors as protective factors in adolescent internalizing problems

The current study explores variations among racially/ethnically diverse adolescents regarding parents' role in mitigating internalizing problems. Adolescents with a higher level of parental awareness, ease of talking to parents, and parental support were less likely to show internalizing problems. Parental awareness was negatively associated with internalizing problems among Whites and Hispanics. The ease of talking to parents was significant for all groups except for American Indians/Alaska Natives. These findings can inform culturally relevant treatments.

Mental health problems of black and white children in a nationally representative epidemiologic survey

Black children face more numerous socio-economic disadvantages than White children, but whether they have more adverse mental health problems remains understudied. Using nationally-representative data from the 2018-2019 National Survey of Children's Health, we examined differences in mental health problems between non-Hispanic Black (n = 2,890) and White (n = 30,015) children aged 6-17. Multivariate analyses were used to determine whether differences in mental health conditions could be accounted for by other factors. We found Black children were significantly less likely than White children to have clinically-identified internalizing conditions (especially anxiety) and more likely to be identified with conduct problems. Black children were also substantially more likely to have greater exposure to adverse childhood experiences (ACEs), to be uninsured, experience poverty, and less likely to receive needed mental health services. After adjusting for these potential confounders, Black children remained half as likely to have clinically-recognized internalizing conditions, but were no longer more likely to have clinically-identified conduct problems. Differences in ACEs alone fully accounted for the racial difference in conduct problems. These results point to the potential impact of assessment bias by clinicians and underscore the potential benefit of routine screening for depression/anxiety in racial/ethnic minority children, especially in light of rising suicide rates among Black youth.

Anxiety and Depression Correlates at Age 10 in Children Born Extremely Preterm

Objective  Anxiety and depression rates are known to be elevated in prematurely-born children and adolescents. This prospective study examines demographic, academic, and physical health correlates of anxiety and depression symptoms in a sample of 10-year-old children who were born extremely preterm. Methods  Participants were 889 (51.2% male; 62.3% White) children who were born <28 weeks gestation. Child and family demographic data were collected at birth. When the children were 10, parents (n = 871) and teachers (n = 640) rated the level of anxiety and depression in children through the Child Symptom Inventory-4. Child academic functioning was assessed via the Wechsler Individual Achievement Test-III. Parents completed questionnaires about child academic functioning and physical health issues. Data analyses were conducted with multivariate linear modeling. Results  Level of prematurity was significantly related to both parent and teacher reports of anxiety. Public health insurance and individualized education program (IEP) status were associated with both parent and teacher reports of depression. Hispanic ethnicity, public insurance, IEP status, and asthma were significantly associated with both parent-reported anxiety and depression. Gross motor impairment was associated with parent-reported anxiety and teacher-reported depression. Child obesity was associated with teacher reports of anxiety, while male sex was significantly related to teacher reports of depression. Conclusion  This pattern of findings may suggest hypotheses for future research on models of the development and persistence of anxiety and depression within this particularly vulnerable group of children.

Depressive symptoms among adolescents in Georgia: the role of ethnicity, low self-control, parents, and peers

OBJECTIVES

The present study tested the role of low self-control, positive parental and peer relationships, and ethnic minority status (Armenian or Azeri), in explaining variability in depressive symptoms in Georgian youth.

METHODS

Self-report data were collected from N = 8254 adolescents in Georgia (55.5% female, M age = 15.57, SD 1.03). Hypotheses were tested using structural equation modeling (SEM) with latent constructs.

RESULTS

Low self-control significantly and positively predicted depressive symptoms, while perceived parental warmth did so negatively; peer friendship quality was unrelated. Ethnic minority status explained a very small amount of unique variance in depressive symptoms for Azeri youth only, not for Armenian adolescents. Multi-group SEM moderation tests provided evidence that the links between constructs were invariant across ethnic groups. The model explained 15.6% of variance in depressive symptoms.

CONCLUSIONS

Findings support the salience of the tested depressive symptom correlates among Georgian adolescents, consistent with previous evidence from other countries. Adolescent ethnic minority status did not increase risk of depressive symptoms. Self-control emerged as the strongest correlate.

Self-reported depression and anxiety symptoms in school-aged Singaporean children

INTRODUCTION

Few studies have examined anxiety and depression experiences of primary (middle) school-aged children from ethnically diverse backgrounds, and most have relied on parents or others as informants. The present study aimed to investigate self-reported anxiety and depression symptoms in Singaporean primary school-aged children. Age, gender, and ethnic differences and interactions were explored as well as similarities and differences between Singaporean children and US norms.

METHODS

A large representative community sample of 1655 8- to 12-year-old Singaporean children (Chinese, Malay, and Indian) completed the Multidimensional Anxiety Scale for Children (MASC) and the Children's Depression Inventory (CDI) as part of a larger epidemiological study of mental health in Singaporean children.

RESULTS

Rates of clinically elevated symptoms of anxiety and depression were 9.3% and 16.9% on the MASC and the CDI, respectively. Separation and social anxieties were most common. Evidence of a gender difference in levels of emotional symptoms was most evident in Indian children, with girls reporting more symptoms than boys. The relationship between age and internalizing problems was weak.

DISCUSSION

A substantial minority of primary school-aged Singaporean children reported elevated anxious and depressive symptoms. Better understanding of the factors that contribute to the development and maintenance of these problems can help the development of culture-specific interventions and facilitate the planning of community-tailored services and initiatives.

The role of perceived discrimination during childhood and adolescence in understanding racial and socioeconomic influences on depression in young adulthood

OBJECTIVE

To describe levels of perceived lifetime discrimination among young adults and determine its role in understanding this racial/ethnic disparity.

STUDY DESIGN

Data were from the Princeton School District study, a 10-year cohort study in which investigators followed 545 non-Hispanic black (46%) and white initial 5-12 graders. Perceived lifetime racial discrimination was assessed with the General Ethnic Discrimination Scale and depressive symptoms with the Center for Epidemiological Studies Depression Scale. Stepped linear and logistic regression analyses assessed the relationships of race/ethnicity, parental education, and quintiles of discrimination to depressive symptoms. Stratification by race/ethnicity explored differences in the role of discrimination in explaining the relationship between parental education and depressive symptoms.

RESULTS

Black students from professionally educated families had the greatest discrimination scores, 1.8 times greater than among their white peers (meanblack = 42.1 vs meanwhite = 22.8; P < .0001). Greater parental education was associated with lower depressive symptoms in all regression models. Race/ethnicity became predictive of depressive symptoms only after adjusting for discrimination, which was strongly associated with depressive symptoms. Stratified analysis suggested discrimination accounted for the relationship of parental education to depressive symptoms among whites. Among black subjects, accounting for discrimination unmasked a buffering effect of parental education.

CONCLUSIONS

Greater levels of parent education are protective against depression for white youth. However, for black youth, greater parent education confers both risk and protective effects. The high discrimination among black youth from families with college or professionally educated parents overwhelms the protective effect of greater levels of parent education.

Depressive symptoms in low-income, urban adolescents: cognitive and contextual factors

This study examined the relationships among cognitive variables, family immigration history, negative life events, and depressive symptoms in a sample of 306 low-income, urban fifth- and sixth-grade children. Explanatory style and negative automatic thoughts were the cognitive variables examined. There were three key findings. First, children who were immigrants reported significantly more depressive symptoms, more negative life events, and more negative automatic thoughts than children who were not immigrants. Second, both explanatory style and negative automatic thoughts were significantly associated with depressive symptoms above and beyond the effects of child immigration history and negative life events. Finally, negative automatic thoughts mediated the relationship between child immigration history and depressive symptoms. We discuss the clinical and research implications of these findings.

Children of treated substance-abusing mothers: a 10-year prospective study

This study examined children of substance-abusing mothers approximately 10 years after mothers' admission to drug abuse treatment, and identified maternal characteristics that may be risk factors for child behavior problems on the Child Behavior Checklist. Data were obtained from 396 mothers who were included in a sample consecutively admitted to 44 treatment programs in 13 California counties during 2000-2002. The Addiction Severity Index was administered at both intake and follow-up. Each mother reported on one child 6-17 years of age. All of the children had been exposed to drugs, either in utero or postnatally. At follow-up about 22% of the children demonstrated borderline or clinical range problem behaviors. Child behavior problems were related significantly to the mothers' ethnicity (lower among Hispanics relative to white), and problem severity in family/social relationship and mental health, marginally related to her prior medical/health problem, and not related to severity of alcohol, drug, legal and employment problems. Assisting mothers to address their family/social relationship and psychological problems may have an added value to prevent or reduce behavioral problems of their children.

Prevalence and determinants of gastroesophageal reflux symptoms in adolescents

BACKGROUND AND AIMS

Gastroesophageal reflux disease (GERD) is common in adults, and there are increasing secular trends in adult GERD morbidity in many countries. However, population-based study on adolescent GERD was very limited. The specific aims of the study were to explore the prevalence and determinant of GERD symptoms in adolescents.

METHODS

A population-based association study was performed on 1828 students aged 13-16 years from four public junior high schools in Taiwan. The presences of symptoms of GERD, asthma and food allergy, demographic characteristics, and health behaviors were obtained by structured questionnaires.

RESULTS

Complete information of symptoms of GERD and asthma were available for 1745 (95.5%) students. The cumulative and 3-month prevalence rates of GERD symptoms were 20.5% and 8.9%, respectively. Multivariate-adjusted odds ratio of having experienced GERD symptoms were 1.53 (95% confidence interval [CI]: 1.18-1.98) for ever smoking, 1.52 (95% CI: 1.12-2.26) for bi-ethnicity, 1.70 (95% CI: 1.26-2.29) for food allergy, and 3.59 (95% CI: 2.69-4.82) and 2.43 (95% CI: 1.67-3.53) for having asthma attacks within or more than 1 year before, respectively. Similar results were found for 3-month prevalence.

CONCLUSIONS

The study showed that GERD symptoms were frequent in junior high school students in Taiwan. Food allergy, asthma, and cigarette smoking were independently correlated with the prevalence of GERD symptoms. Psychosocial factors associated with bi-ethnic family may contribute to its development.

Is depression associated with contraceptive motivations, intentions, and use among a sample of low-income Latinas?

BACKGROUND

Latinas in the United States experience high rates of unintended pregnancy and low rates of contraception use, yet reasons are not completely understood. Depression is common among pregnant and nonpregnant Latinas; its influence on contraceptive motivations, intentions, and use is understudied.

OBJECTIVES

We sought to 1) describe Latinas' contraceptive motivations, intentions, and use; 2) use structural equation modeling to test associations between depression and contraceptive self-efficacy/motivations/intentions/use; and 3) determine whether associations differ by pregnancy status.

METHODS

This cross-sectional study included Latinas ages 15 to 45 recruited from an urban Federally Qualified Health Center in Baltimore, Maryland. Structured surveys were used to collect data regarding depressive symptoms measured using the PHQ-9. All other constructs were measured with previously validated questions. Constructs included contraceptive self-efficacy, positive and negative contraceptive motivations (perceived advantages and disadvantages of using contraception), contraceptive intentions to begin or continue contraception use, and contraceptive methods currently used.

RESULTS

Among pregnant Latinas, depression was associated with negative motivations (β = 0.16; p < .05), negative motivations were associated with intentions (β = -0.22; p < .01), and contraceptive self-efficacy was associated with intentions (β = 0.43; p < .001). Among nonpregnant Latinas, contraceptive self-efficacy was associated with intentions (β = 0.78; p < .001) and intentions were associated with use (β = 0.40; p < .05).

CONCLUSIONS

Among pregnant Latinas, negative motivations intervene in the association between depression and contraceptive intentions. For nonpregnant Latinas, intentions intervene in the association between self-efficacy and contraceptive use. This study underscores the importance of depression screening during pregnancy and encourages practitioners to target contraceptive motivations to improve contraceptive use.

Racial differences in suicidal ideation among school going adolescents

BACKGROUND

Young adults are at increased risk for suicidal behavior and there is growing concern about racial differences in suicidal ideation, especially in the younger population.

AIM

The aim of this study is to assess suicidal ideation in school going tribal and nontribal adolescents and to study its relationships with psychological well-being, depression, and anxiety.

MATERIALS AND METHODS

A total of 259 students of Classes X, XI, and XII of three Schools of Ranchi, who fulfilled inclusion and exclusion criteria, were screened for suicidal ideation by Suicidal Ideation Questionnaire (SIQ) and psychological well-being by General Health Questionnaire-12 (GHQ-12). The level of anxiety and depression was assessed by Hospital Anxiety Depression Scale (HADS).

RESULTS

Overall 33.2% of the adolescents had suicidal ideation out of which 34.2% were tribal-students and 32.8% nontribal-students with no significant intergroup difference. Psychological discomfort (GHQ-12 Score ≥3) was noticed in 59.1% of adolescents, but no racial difference was found. However, the mean HADS depression score was significantly higher in tribal adolescents, more so in tribal boys than nontribal adolescents or boys, respectively. There was a significant positive correlation of SIQ total score in all the adolescents with GHQ-12 total score, HADS total score, HADS anxiety score, and HADS depression score.

CONCLUSION

There were no racial differences in suicidal ideation and psychological discomfort among tribal and nontribal adolescents. Tribal adolescents, and more specifically tribal boys, had more depression than their nontribal counterparts. Suicidal ideation was positively correlated with psychological discomfort, anxiety, and depression.

Early life predictors of adult depression in a community cohort of urban African Americans

Depression among African Americans residing in urban communities is a complex, major public health problem; however, few studies identify early life risk factors for depression among urban African American men and women. To better inform prevention programming, this study uses data from the Woodlawn Study, a well-defined community cohort of urban African Americans followed from age 6 to 42 years, to determine depression prevalence through midlife and identify childhood and adolescent risk factors for adult depression separately by gender. Results indicate that lifetime depression rates do not differ significantly by gender (16.2 % of men, 18.8 % of women) in contrast to findings of a higher prevalence for women in national studies. Furthermore, rates of depression in this urban African American population are higher than those found in national samples of African Americans and more comparable to the higher rates found nationally among Whites. Regarding early predictors, for both men and women, family conflict in adolescence is a risk factor for adult depression in multivariate regression models. For women, vulnerability to depression has roots in early life, specifically, low maternal aspirations for school attainment. Females displaying more aggressive and delinquent behavior and those growing up in a female-headed household and a household with low maternal education have elevated rates of depression. Males growing up in persistent poverty, those engaging in greater delinquent behavior, and those with low parental supervision in adolescence also have elevated rates of depression. Effective prevention programming for urban African Americans must consider both individual characteristics and the family dynamic.

Race/ethnicity and mental health in the first decade of the 21st century

Recent empirical studies on mental health generally report racial/ ethnic differences in depression rates but typically do not control for potential confounding by sample contextual variations in historical epoch, geographical location, and social demography. An empirical study of race/ethnicity differences in psychological distress is reported as an attempt to control these contexts by using a sample that is homogeneous in age, historical epoch, geography, and social demography (954 youth ages 18-19 living in a single, large urban community). No mean differences in psychological distress were observed among four racial/ethnic groups: Asians, African Americans, Latinos, and non-Hispanic Whites. A second analysis compared 17 different racial/ethnic groups defined in terms of family national origin. No differences in psychological distress were found among these groups. The findings are consistent with the view that race/ethnicity itself is not related to disparities in mental health.

Cultural stressors and the hopelessness model of depressive symptoms in Latino adolescents

Depressive symptoms in Latino youth have been related to both culturally-universal and culturally-based stressors. However, few studies have examined the unique contributions of culturally-based stressors above and beyond other types of stressors. Moreover, no past studies with Latinos have examined the role of culturally-based stressors within a hopelessness model of depressive symptoms, a cognitive model with the strongest empirical support in adolescence. The current study examined these issues in a sample of 171 Latino adolescents (7th-10th grades; mean age = 14; 46 % male). The Latino adolescents were primarily Mexican-American (78 %) and born in the United States (60 %). Students completed measures during a school period on their experiences of parent-child conflict, economic stress, discrimination from peers, and acculturative stress as well as depressive symptoms and attributional style. The results indicated that culturally-based stressors (e.g., acculturative stress and discrimination) predicted greater depressive symptoms even when controlling for culturally-universal stressors (e.g., parent-child conflict, economic stress). Moreover, a negative attributional style moderated the relationship between culturally-universal stressors and depressive symptoms, but this was not the case for culturally-based stressors. Culturally-based stressors play an important role in depressive symptoms among Latino youth. These stressors predicted greater symptomatology even when controlling for other types of stressors and a negative attributional style. These findings suggest that there may be other cognitive risk factors associated with culturally-based stressors.

Treatment of culturally diverse children and adolescents with depression

This article is written for the practitioners treating depression in ethnic minority youth. It will review the context in which services are delivered to these youth: Researchers have recognized persistent ethnic differences in terms of utilization of services and unmet need. Furthermore, when ethnic minority youth do receive pediatric mental health care, the services that they receive may differ from those given to White patients. The reasons for these discrepancies have been examined in numerous studies, and have included contextual variables (economics, availability, and accessibility of services), patient variables (differences in prevalence or manifestation of the disorder, cultural beliefs and attitudes, preferential use of alternative or informal services, health literacy, and adherence), and provider variables (referral bias and patient-provider communication). Information about the differences between White and minority youth in the pharmacodynamics and pharmacokinetics of the antidepressant response is still limited. There are significant challenges for developing evidence-based guidelines that inform practice with these youth, hinging on both the underrepresentation of ethnic minority groups in clinical trials, and the great variability in biological and cultural characteristics of individuals in ethnic minority categories. Awareness on the part of the practitioner of the cultural variables that influence help-seeking and ongoing utilization of mental health services may aid in the engagement, effective treatment, and retention of ethnic minority children and adolescents with depression. However, given the great heterogeneity that exists within any cultural grouping, clinicians will need to integrate information about cultural patterns with that obtained from the individual patient and family to inform optimal practices for each patient. This article is written to enhance awareness on the part of the practitioner as to the variables that influence psychiatric care for depression in culturally diverse youth. The mental health needs of minority youth are not well served: They are treated less frequently, and when they are treated, the services they receive are less frequently adequate. The reasons that have been proposed for the disparities in their care, particularly with regard to diagnosis and treatment for depression, will be reviewed. They include contextual factors (such as economics, insurance, and other variables affecting the availability of services) patient and family factors (such as prevalence, symptom presentation, and values and beliefs that influence whether patients are referred to and avail themselves of services), and provider factors (such as referral bias and patient-provider communication, which affect whether patients engage and stay in treatment). The implications for the practitioner treating ethnic minority youth with depression will be discussed. Culture, as used in this article, refers to the common values, beliefs, and social behaviors of individuals with a shared heritage. Some aspects of culture that are likely to influence service utilization include health beliefs, particularly regarding models of mental illness, and level of stigma toward mental health treatment, which are frequently shared by individuals in a cultural group. However, some caveats for the explanatory potential of "culture" should be kept in mind. Conventions for naming groups vary between investigators and over time (e.g., the restriction of the category "White" into "White NonHispanic," is quite recent). Although heterogeneity is assumed within a named cultural or racial group, the terms Hispanic, Asian, and African-American incorporate subgroups can be very different in linguistic, historical, and geographical ancestry (e.g., Stewart 2008 ), and each group incorporates individuals who may not share any components of their historical heritage. Even among those with historical ties, values, beliefs, and social behaviors can vary according to the extent to which they identify with the mainstream culture. Social class frequently creates a "culture" of its own, with individuals in the same social class across traditional cultural groupings sharing disparities in care, and many beliefs and values. Individuals are likely to belong to numerous "cultures," and may not share specific typical behaviors or beliefs with any of them.

Disentangling the prospective relations between maladaptive cognitions and depressive symptoms

In a four-wave, cohort-longitudinal design with a community sample of 515 children and adolescents (grades 2 through 9), this study examined the longitudinal structure of and prospective interrelations between maladaptive cognitions and depressive symptoms. Multigroup structural equation modeling generated four major findings. First, the longitudinal structures of maladaptive cognitions and depressive symptoms consist of a single time-invariant factor and a series of time-varying factors. Second, evidence supported a model in which depressive symptoms predicted negative cognitions but not the reverse. Third, the time-invariant components of cognition and depression were highly correlated. Fourth, the strength of the depression-to-cognition relation increased with age. Implications regarding the mechanisms underlying clinical interventions with depressed children are discussed.

Psychological vulnerability among overweight/obese minority adolescents

Depression is associated with obesity among adolescents, with racial/ethnic variability noted. Psychological correlates that may influence this relationship have not been adequately explored. The primary objective of this secondary analysis was to compare levels of stress, self-esteem, coping, social support, and depressive mood between normal weight and overweight/obese minority adolescents (as defined using Centers for Disease Control and Prevention standards). Adolescents (n = 101) aged 14-18 years who were largely minority (87%) were recruited from two Midwestern-area high schools. Using a descriptive comparative design, individuals were grouped into normal weight (>5th to <85th percentile) and overweight/obese (≥ 85 th percentile) for comparison on measures. Self-reported levels of stress, coping, self-esteem, social support, depressive mood, and body mass index were obtained. Obese/overweight adolescents reported significantly lower self-esteem than did those with normal weight (p < .05). Although stress was a significant predictor of depressive mood in both groups (p < .001), low self-esteem was also a significant predictor of depressive mood in the overweight/obese group (p = .001). Strategies to manage stress and improve self-esteem may help alleviate depressive mood in high school adolescents.

Relationships Between Physical and Non-Physical Forms of Intimate Partner Violence and Depression among Urban Minority Adolescent Females

BACKGROUND: Little is known about intimate partner violence (IPV) and depression among low income, urban African American and Hispanic adolescent females. METHOD: Interviews with 102 urban African American and Hispanic adolescent females examined physical abuse, emotional/verbal abuse, and threats, and their unique and combined associations with depression. RESULTS: One-quarter of the sample experienced all three types of abuse. Non-physical forms of IPV were significantly associated with depression. CONCLUSIONS: Some urban adolescent females from lower income households experience high rates of IPV. Physical and non-physical forms of IPV are important in understanding and responding to depression in this population.

Effects of an indicated cognitive-behavioral depression prevention program are similar for Asian American, Latino, and European American adolescents

The authors tested whether a brief indicated cognitive-behavioral depression prevention program produced similar effects for Asian American, Latino, and European American adolescents (M age = 17.3, SD = 1.6) with elevated depressive symptoms using data from two randomized trials. The first trial involved 37 Asian-American/Pacific Islanders, 32 Latinos, and 98 European Americans and the second trial involved 61 Latinos and 72 European Americans. Reductions in depressive symptoms from pre- to post-intervention and from pre to 6-month follow-up for intervention participants versus assessment-only controls did not differ significantly for the various ethnic groups in either trial, despite sufficient power to detect clinically meaningful differences. These findings suggest that this indicated depression prevention intervention is similarly efficacious for Asian American, Latino and European American adolescents.

Race/ethnicity and internalizing disorders in youth: a review

This review examines the impact of race/ethnicity and cultural differences in the presentation and prevalence rates of internalizing disorders in youth, as well as a variety of associated factors. There is robust support for higher prevalence rates of depression and anxiety in ethnic minority youth living in the United States. Gender differences are consistent across ethnicity, but symptom presentation, biological factors, and family processes vary somewhat by ethnic group. Environmental factors and acculturation are considered in relation to internalizing disorders in ethnic minority youth. Several problems with the literature are outlined. Several recommendations are made including better operationalization of internalizing disorders in the DSM and key issues that warrant being added to background text in the DSM. A research agenda is outlined to address possible mechanisms by which culture and race/ethnicity impact internalizing symptomatology.

Problem perception in Dutch university students using tobacco, alcohol and drugs

When communicating about health behaviour with students, insight is needed in perceptions students have about their (un)healthy behaviour. We aimed to investigate associations between problem perception and perceived health, academic functioning in students using tobacco, alcohol or drugs. Students who were enrolled fulltime in Medicine, Economics, Occupational Therapy, History, Psychology or Information Studies in Amsterdam, the Netherlands (n = 8258), were invited for an internet-based questionnaire about perceived health, social support, study delay, and problem perception regarding tobacco, alcohol and drug use in October 2005 (response: 44%). Students using tobacco, alcohol and drugs with and without problem perception and non-users were compared (logistic regression). Problem perception in students using tobacco, alcohol or drugs was associated with worse health outcomes.

Exploring patient and provider level variables that may impact depression outcomes among African American adolescents

TOPIC

Optimizing development outcomes among African American adolescents with depression.

PURPOSE

This paper aims to explore patient and/or provider level variables that may impact the assessment, detection, and diagnosis of depression among African American adolescents.

SOURCES

Multidisciplinary literature specific to depression among African American adolescents and clinical experience.

CONCLUSION

Nurses are in a position to advocate for the appropriate detection of depression among African American adolescents. Both patient- and provider-level variables (i.e., potential attitudes toward mental health care, ethnocultural variations in the manifestation of depression, and individual provider biases) must be sensitively addressed to affect much needed change and minimize disparate health outcomes.

Home-based, peer-led chronic illness self-management training: findings from a 1-year randomized controlled trial

PURPOSE

Studies suggest peer-led self-management training improves chronic illness outcomes by enhancing illness management self-efficacy. Limitations of most studies, however, include use of multiple outcome measures without predesignated primary outcomes and lack of randomized follow-up beyond 6 months. We conducted a 1-year randomized controlled trial of Homing in on Health (HIOH), a Chronic Disease Self-Management Program variant, addressing these limitations.

METHODS

We randomized outpatients (N = 415) aged 40 years and older and who had 1 or more of 6 common chronic illnesses, plus functional impairment, to HIOH delivered in homes or by telephone for 6 weeks or to usual care. Primary outcomes were the Medical Outcomes Study 36-ltem short-form health survey's physical component (PCS-36) and mental component (MCS-36) summary scores. Secondary outcomes included the EuroQol EQ-5D and visual analog scale (EQ VAS), hospitalizations, and health care expenditures.

RESULTS

Compared with usual care, HIOH delivered in the home led to significantly higher illness management self-efficacy at 6 weeks (effect size = 0.27; 95% CI, 0.10-0.43) and at 6 months (0.17; 95% CI, 0.01-0.33), but not at 1 year. In-home HIOH had no significant effects on PCS-36 or MCS-36 scores and led to improvement in only 1 secondary outcome, the EQ VAS (1-year effect size = 0.40; CI, 0.14-0.66). HIOH delivered by telephone had no significant effects on any outcomes.

CONCLUSIONS

Despite leading to improvements in self-efficacy comparable to those in other CDSMP studies, in-home HIOH had a limited sustained effect on only 1 secondary health status measure and no effect on utilization. These findings question the cost-effectiveness of peer-led illness self-management training from the health system perspective.

Depressive symptoms moderated the effect of chronic illness self-management training on self-efficacy

BACKGROUND

Identifying moderators of the effects of self-efficacy enhancing interventions could facilitate their refinement and more targeted, cost-effective delivery. Current theories and data concerning the potential moderating effect of depressive symptoms on interventions to enhance patient chronic illness self-management self-efficacy are conflicting.

OBJECTIVES

To explore the moderating effect of depressive symptoms on the effect of an intervention to enhance patient self-efficacy for self-managing chronic illness.

RESEARCH DESIGN

Regression analyses using baseline and postintervention (6 weeks) data from an ongoing randomized controlled trial.

SUBJECTS

Patients (N = 415) aged >or=40 years recruited from a primary care network in Northern California with arthritis, asthma, chronic obstructive pulmonary disease, congestive heart failure, depression, and/or diabetes mellitus, plus impairment in >or=1 basic activity, and/or a score of >or=4 on the 10-item Center for Epidemiologic Studies Depression Scale (CES-D).

MEASURES

Stanford self-efficacy scale, self-reported depression, CES-D, and Medical Outcomes Study Short Form health status questionnaire (SF-36) Mental Component Summary score.

RESULTS

Regression analyses revealed the intervention was effective primarily in those with self-reported depression (interaction effect F = 8.24, P = 0.0003), highest CES-D score category (F = 5.68, P = 0.0037), and lowest (most depressed) Mental Component Summary-36 tercile (F = 4.36, P = 0.0135).

CONCLUSIONS

Individuals with more depressive symptoms seem more likely to experience self-efficacy gains from chronic illness self-management training than individuals with less depressive symptoms. Future self-management training studies should stratify subjects within study groups by depressive symptom level to further explore its potential moderating effect.