Self-image and depressive symptoms among adolescents in a non-clinical sample

Fecal incontinence was associated with depression of any severity: insights from a large cross-sectional study

OBJECTIVE

Current studies on the association between fecal incontinence (FI) and depression are very limited, and most of them are restricted to women or elderly patients. This study aims to evaluate in detail the association between FI and depression among US adults.

METHODS

13,480 adults aged 20 years and older were selected from the National Health and Nutrition Examination Survey 2005-2010. Monthly loss of solid, liquid, or mucous stool was defined as FI. Clinical depression and depression severity were assessed by the validated Patient Health Questionnaide-9 (PHQ-9). Models of multivariate logistic regression were used to calculate adjusted odds ratios (ORs). A subgroup analysis was carried out to ensure that the results were stable.

RESULTS

After adjusting for covariates such as demographics, risk behaviors and associated comorbidities, the PHQ-9 score and clinical depression were both significantly associated with FI, with ORs and 95%CIs of 1.11 (1.10-1.13) and 3.01 (2.53-3.57). Depression of all severities was also significantly associated with FI. The ORs and 95%CIs of FI with mild depression, moderate depression, and moderately severe to severe depression were 2.29 (1.96-2.68), 3.44 (2.77-4.27) and 4.65 (3.61-6.00), respectively. Subgroup analyses showed no statistically significant interactions (P > 0.05).

CONCLUSIONS

In conclusion, FI significantly associated with depression of any severity. Like the elderly or female patients with FI, young and middle-aged or men with FI are also at high risk of depression and should also be the focus of depression screening and early intervention.

Association between fecal incontinence and suicidal ideation in adult Americans: Evidence from NHANES 2005-2010

OBJECTIVES

Currently, research on the relationship between fecal incontinence (FI) and suicidal ideation is very limited. This study aims to evaluate whether FI is associated with suicidal ideation among US adults.

METHODS

In this cross-sectional study, 13,480 adults aged 20 years and older were selected from the National Health and Nutrition Examination Survey 2005-2010. Monthly loss of solid, liquid, or mucous stool was defined as FI. As part of the Patient Health Questionnaire-9, item 9 assessed suicidal ideation. Models of multivariate logistic regression were used to calculate adjusted odds ratios. A subgroup analysis was carried out to ensure that the results were stable.

RESULTS

It was found that FI was associated with an increased risk of suicidal ideation after controlling for baseline characteristics, risk behaviors, and comorbid conditions such as depression (OR: 1.60, 95%CI: 1.24-2.08, P < 0.001). In subgroup analyses, FI remained significantly associated with suicidal ideation among participants aged 45 years and older, with odds ratios and 95% confidence intervals of 1.62 (1.11-2.38) and 2.49 (1.51-4.13), respectively. For age category <45 years, the association between FI and suicidal ideation weakened (OR: 1.02, 95%CI: 0.60-1.75, P = 0.932).

CONCLUSIONS

In conclusion, this study showed that FI was significantly associated with suicidal ideation. Patients aged middle-aged and older are at high risk and should be the focus of screening and timely intervention for suicidal ideation.

The Role of Neural Self-Referential Processes Underlying Self-Concept in Adolescent Depression: A Comprehensive Review and Proposed Neurobehavioral Model

There is growing knowledge about how self-concept develops in adolescence and contributes to the onset of depression, but researchers have only recently begun investigating the neural mechanisms that underlie self-referential cognition in adolescents with and without depression. This paper reviews task-related functional neuroimaging (fMRI) research on self-referential neural processing in both healthy and depressed adolescents (M_age range = 12-18 years), with a focus on elucidating brain activation that may subserve adolescent self-perception and related associations with depression. Drawing on conclusions from the affective neuroscience literature and developmental theory, we propose a neurobehavioral model and future research recommendations to address how social factors might shape self-referential neural processes and self-concept in ways that confer risk for depression. We review the operationalization of self-concept, developmental theory (i.e., symbolic interactionism) on self-concept development, and the role of self-concept in adolescent depression. We then review empirical studies assessing neural activation during healthy and depressed adolescents' processing of self-relevant information, and the limited studies assessing links between social factors and neural self-referential processing.

Does a lower self-concept contribute to mental health disparities of diverse immigrant youth from middle childhood to late adolescence?

BACKGROUND

Three out of ten children in Germany have immigrant backgrounds and this proportion is expected to further increase in subsequent years. While immigrant youth have been found more vulnerable to developing symptoms of depression and anxiety, the underlying mechanisms of how such disparities unfold during youth development are still understudied. Some previous research has found that immigrant youth are at risk of experiencing a less positive self-concept compared to non-immigrant youth. We investigated whether the self-concept mediates mental health disparities and explored variability in such associations from middle childhood to late adolescence.

METHODS

Overall 1839 children and adolescents aged 6-21 years (M = 14.05 years, SD = 3.03, 49.8% female, n = 782 with immigrant status) participated in a cross-sectional self-report survey in classroom settings using scales from the Beck Youth Inventories II (Beck et al. in Beck Youth Inventories - Second Edition, Psychological Corporation, San Antonio, 2005) to assess self-concept and symptoms of depression and anxiety. Links between immigrant status, age, self-concept and symptom levels of depression as well as anxiety were examined using hierarchical regression and moderated mediation models.

RESULTS

Immigrant youth reported higher symptom levels of depression and anxiety than their non-immigrant peers but did not differ in their self-concepts. Hypothesized moderated mediation models were not fully supported and self-concept neither mediated the link between immigrant status and depression nor immigrant status and anxiety. However, self-concept was a significant predictor for symptom levels of depression as well as anxiety, with stronger associations in adolescents.

CONCLUSIONS

Our study substantiates previous findings that immigrant youth in Germany have overall increased symptom levels of depression and anxiety compared to non-immigrant youth. Our study however does not support that immigrant youth have a more negative self-concept and that the self-concept mediates such internalizing mental health disparities. Findings match previous evidence that developing a positive attitude towards the self is linked to better mental health. Beyond that, our findings suggest that mental health interventions addressing the self-concept could be especially relevant when targeting adolescents. Further research is needed to deepen the understanding of the mediating processes between migration status and mental health variables.

Adolescent Inpatients with Depression: Comparison to Inpatients without Depression and to Peers without Psychiatric Disorders

Background:

Family background, social support and psychological characteristics are known to be associated with depression in adolescence, but scientific data in complex, naturalistic settings are scarce.

Objective:

To investigate the characteristics of adolescent psychiatric inpatients with depressive disorders compared to peers without psychiatric disorders and to adolescent psychiatric inpatients without depression.

Methods:

The study population of 206 inpatients (13-17 years old) and 203 age and gendermatched non-referred adolescents was evaluated using the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL) interview, and clinical interview and clinical records when available. Structured self-reports provided information on family background, defense styles, self-image and perceived social support. We compared firstly subjects with current depressive disorders (n=120) to subjects without any psychiatric disorder (n=159) and secondly within the inpatient population, those with depressive disorders (n=117) to those with any other psychiatric diagnoses (n=89).

Results:

Current depressive disorders were characterized by worse self-image, less mature defenses and less perceived social support particularly from the family. Adversities in the family were more prevalent in subjects with depression compared to subjects without any psychiatric diagnosis, while among inpatients, no significant differences were observed. Psychiatric comorbidity was common in all inpatients, whereas suicidality was more prevalent among inpatients with depression.

Conclusions:

Negative self-image, less mature defense style and low perceived social support particularly from the family were characteristics of depression in adolescents.

Oxytocin facilitates valence-dependent valuation of social evaluation of the self

People are eager to know the self in other’s eyes even with personal costs. However, what drives people costly to know evaluations remains unknown. Here we tested the hypothesis of placing subjective value on knowing social evaluations. To quantify the subjective value, we developed a pay-to-know choice task where individuals trade off profits against knowing social evaluations. Individuals computed independent unknown aversion towards positive and negative social evaluations and placed higher values on knowing social evaluation on positive than negative aspects. Such a valence-dependent valuation of social evaluation was facilitated by oxytocin, a neuropeptide linked to feedback learning and valuation processes, by decreasing values of negative social evaluation. Moreover, individuals scoring high in depression undervalued positive social evaluation, which was normalized by oxytocin. We reveal the psychological and computational processes underlying self-image formation/update and suggest a role of oxytocin in normalizing hypo-valuation of positive social evaluation in depression.

Danyang Wang and Yina Ma measure the amount of money participants are willing to forgo for the opportunity to access social or non-social evaluations of the self. They show that subjective values on knowing social evaluation is valence-dependent whereas that on non-social evaluation is valence-insensitive. Moreover, oxytocin contributes to valence-dependent valuation on social evaluation.

Democratic Policing and Officer Well-Being

Efforts to improve police–community relationships have increased initiatives that aim to build trust and mutual respect between officers and the communities they serve. Existing literature examines the impact of internal departmental dynamics and individual-level characteristics on officers’ endorsement of community-oriented policing strategies. Research has indicated that when officers feel fairly treated within their agencies and when they are less psychologically and emotionally distressed, they report stronger support for policing tactics that increase fairness in police processes and decision making. This mixed-method study is the first to examine the reciprocal relationship by asking: How do procedurally just and community-oriented policing strategies impact officer well-being and occupational stress? Sworn officers in a medium-sized California department completed a survey assessing their views on their agency, various police tactics, the communities they serve, and their physical and mental health. Results showed that officers’ increased support for community-oriented and procedurally just police strategies are significantly associated with decreased job stress, depression, anxiety, and negative affect, controlling for race, gender, perceived job dangerousness, cynicism, and how many years they had served as a police officer. In-depth interviews with officers in the department revealed three explanatory mechanisms for these statistical relationships. First, the tenets of procedural justice provided officers with tactics that reduce the threat and stress of intergroup interactions. Second, community-oriented policing activities increased opportunities for officers to have positive interactions with the communities they work in, mitigating the distrust, cynicism, and detachment fostered by enforcement activities. Last, procedural justice and community-oriented police strategies empowered officers to counter negative stereotypes about police and reaffirm their self-image. Taken together, these survey and interview findings highlight the mutuality of democratic policing and officer wellness.

Self-image and psychological distress in treatment-seeking adolescents

BACKGROUND

Adolescence has been recognized as a critical period for mental health during which it is fundamental to the well-being of adolescents to provide early and appropriate mental health interventions. Self-image perceptions play a particularly relevant role during adolescence since individuals are extensively involved in reorganizing their identity and relationships. Although the self-image development implies adaptive outcomes for most adolescents, some age-related tasks can be difficult to deal with and lead to psychological suffering for a minority of them.

METHOD

This study examined how domain-specific self-image was associated with psychological distress in 128 treatment-seeking adolescents aged 13-18 (60.9% female). The adolescents completed the Offer Self-Image Questionnaire to measure their global and domain-specific self-image and the Youth-Outcome Questionnaire to assess their psychological distress.

RESULTS

Regression analyses indicated that impulse control, emotional tone, family, and social functioning significantly predict worse psychological functioning in the entire group. Moreover, significant gender differences emerged showing a more complex set of risk factors among adolescent females, thus suggesting the need for gender-targeted preventive and treatment strategies.

CONCLUSIONS

The findings highlight that adolescents' feelings and concerns about their self-image may be key factors to consider in planning, developing, and delivering effective public mental health services for adolescents.

High Beck Depression Inventory 21 scores in adolescents without depression are associated with negative self-image and immature defense style

Beck Depression Inventory (BDI) is widely used in assessing adolescents' psychological wellbeing, but occasionally the result diverges from diagnostics. Our aim was to identify factors associated with discrepancies between BDI scores and diagnostic assessment in adolescent psychiatric patients and general population. The study comprised 206 inpatients (13-17 years old) and 203 age and gender matched non-referred adolescents. Study subjects filled self-reports on depression symptoms (BDI-21), alcohol use (AUDIT), defense styles (DSQ-40) and self-image (OSIQ-R), and on background information and adverse life events. Diagnostics was based on K-SADS-PL interview, and/or clinical interview and clinical records when available. We compared subjects who scored in BDI-21 either 0-15 points or 16-63 points firstly among subjects without current unipolar depression (n = 284), secondly among those with unipolar depression (n = 105). High BDI-21 scores in subjects without depression diagnosis (n = 48) were associated with female sex, adverse life events, parents' psychiatric problems, higher comorbidity, higher AUDIT scores, worse self-image and more immature defense styles. Low BDI-21 scores among subjects with depression diagnosis (n = 23) were associated with male sex, more positive self-image and less immature defense style. In conclusion, high BDI-21 scores in the absence of depression may reflect a broad range of challenges in an adolescent's psychological development.

The relationship between self-Image and social anxiety in adolescence

BACKGROUND

Self-image is the subjective perception about one's own self, body, mental functioning, social attitudes, and adjustment in different aspects of life. Research has linked negative self-image with a number of problem behaviors and psychiatric symptoms in adolescence; however, studies of the relationship between self-image and anxiety disorders are still scarce.

METHOD

This study involved a community sample of 1305 high-school students (51.4% female) who ranged in age from 14 to 19 years old. They completed self-report measures of self-image and social anxiety disorder (SAD).

RESULTS

A quarter of the students reported high levels of social anxiety. Statistical analyses showed significant differences between these students and the other students in all the self-image subscales. Several dimensions of impaired self-image (emotional tone, social attitudes, vocational and educational goals, family relationships, external mastery, and psychological health) were associated with high levels of social anxiety, with some gender differences underpinning these relationships.

CONCLUSIONS

Clinicians treating SAD in youth may wish to consider that a negative self-image may play a critical role in the onset and retention of social anxiety symptoms.

Psychopathological Symptoms, Social Skills, and Personality Traits: A Study with Adolescents

The purpose of this study is two-fold: (a) to study the concomitant relationships between psychopathological symptoms, cooperation, social skills, and other personality traits; and (b) to identify the predictive variables of psychopathological symptoms. The sample consists of 322 adolescents aged 14 to 17 years old. This study uses correlational methodology. In order to assess psychopathological symptoms, cooperation, social skills, and personality traits, the following scales are used: the Symptom Checklist (SCL-90-R; Derogatis, 1983), the Cooperativeness Scale (CS; Rigby, Cox, & Black, 1997), the MESSY social skills scale (Matson, Rotatori, & Helsel, 1983), and the TPT Personality Test (Corral, Pamos, Pereña, & Seisdedos, 2002). Pearson coefficients suggest that adolescents with many psychopathological symptoms have low levels of cooperative behaviors and social skills. They also score high in inappropriate assertiveness, impulsiveness, overconfidence, and jealousy-withdrawal and have low levels of emotional stability, sociability, and responsibility. Through multiple regression analyses, the following variables were identified as predictors of psychopathological symptoms: jealousy-withdrawal, low social integration, impulsiveness, and low self-concept. The role played by intervention programs promoting socio-emotional development to prevent psychopathological symptoms and enhance mental health is discussed.

Trajectories of depressive symptoms from adolescence to young adulthood: Chinese Americans versus non-Hispanic whites

We examined age, sex, and race/ethnicity differences in trajectories of depressive symptom from adolescence to early adulthood; we also tested whether socioeconomic status and acculturation were associated with the differences. The findings suggest that adolescents over age 15 had a higher level and faster decline in depressive symptoms than their younger counterparts; females had higher level and a faster decline in depressive symptoms than males. Chinese American females had the highest depressive symptoms sustained across 7 years; Chinese American males over age 15 had higher depressive symptoms than their White male counterparts. Neither socioeconomic status nor acculturation was significantly associated with the differences in the trajectories. Our findings suggest a need for greater attention to Chinese American adolescents' psychological well-being.

Anxiety and depression are risk factors rather than consequences of functional somatic symptoms in a general population of adolescents: the TRAILS study

BACKGROUND

It is well known that functional somatic symptoms (FSS) are associated with anxiety and depression. However, evidence is lacking about how they are related to FSS. The aim of this study was to clarify these relationships and examine whether anxiety and depression are distinctly related to FSS. We hypothesized that anxiety contributes to the development of FSS and that depression is a consequence of FSS.

METHODS

FSS, anxiety, and depression were measured in adolescents (N = 2230, 51% women) by subscales of the Youth Self-Report during three assessment waves (adolescents successively aged: 10-12, 12-14, and 14-17) and by corresponding subscales of the Child Behavior Checklist. Using structural equation models, we combined trait and state models of FSS with those of anxiety and depression, respectively. We identified which relationships (contemporaneous and two-year lagged) significantly connected the states of FSS with the states of anxiety and depression.

RESULTS

Trait variables were all highly interrelated (r = .54-.63). Contrary to our hypothesis, both state anxiety (beta = .35) and state depression (beta = .45) had a strong contemporaneous effect on state FSS. In turn, state FSS had a weak two-year lagged effect on state anxiety (beta = .11) and an even weaker effect on state depression (beta = .06).

CONCLUSIONS

While the effect of anxiety and depression on FSS is strong and immediate, FSS exert a weaker and delayed influence on anxiety and depression. Further research should be done to detect the exact ways in which anxiety and depression lead to FSS, and FSS lead to anxiety and depression.

The relation between self-concept and social functioning in adolescence

A model of the relation between self-concept and internalizing and externalizing problem behaviours in adolescence, with the self-concept influencing problem behaviours (S-->IE), was assessed using a sample of 277 Swedish adolescents. The model was tested in a path analysis with data from Youth Self Report (YSR) and Structural Analysis of Social Behaviour (SASB) questionnaires. Consistent with the model, a positive self-concept was found to be the most important factor for adjustment and for protection against common problem behaviour. A negative self-concept combined with female gender were risk factors for internalized problems. Self-control had only a direct effect on externalizing behaviour for boys. Adolescents of 15, 16 years of age had a stronger relationship between a negative self-concept and externalizing problem behaviour than younger and older adolescents. Internalizing problem behaviours such as anxiety and depression predicted aggressive and delinquent behaviour. These findings highlight the importance of promoting of a positive self-concept in every adolescent in various psychosocial contexts.

Atopic dermatitis in adolescent boys is associated with greater psychological morbidity compared with girls of the same age: the Young-HUNT study

BACKGROUND

Having atopic dermatitis (AD) as well as other chronic diseases is often associated with reduced mental health. Adolescents with AD are thought to be especially vulnerable, but few studies have included an ample number of young people.

OBJECTIVES

To study self-reported mental distress among boys and girls 13-19 years of age with AD compared with mental distress among healthy adolescents as well as mental distress among adolescents with other chronic diseases or complaints, such as headache, neck or shoulder pain, asthma, allergy and rhinitis.

METHODS

The Young-HUNT study was conducted as a cross-sectional, population-based survey in 1995-97. All students in Nord-Trondelag County, Norway, aged 13-19 years were invited, and some 89% participated. A questionnaire on mental and somatic health, life-style and social conditions was completed during one school hour.

RESULTS

A total of 4384 girls and 4433 boys participated. The prevalence of mental distress was higher among older teenagers, and more than every fourth girl aged 17-19 reported mental distress. Although more girls than boys reported mental distress, AD, headache and neck or shoulder pain, the odds for reporting both AD and mental distress were higher for boys [odds ratio (OR) = 2.1 (1.6-2.9)] compared with girls [OR = 1.3 (1.1-1.6)]. A corresponding sex difference in reporting mental distress was also seen for some other chronic diseases or complaints.

CONCLUSIONS

In adolescents aged 13-19 years there was a strong and significant association between self-reported mental distress and AD as well as headache and neck or shoulder pain for both sexes. Although boys reported fewer complaints as AD, they perceived the complaints a heavier burden than did the girls.