Adolescents coping with mood disorder: a grounded theory study

Symptoms of depression and anxiety in Chinese adolescents: heterogeneity and associations with executive function

BACKGROUND

Depression and anxiety are common symptoms associated with significant morbidity in adolescents. Few studies have explored the relationship between latent profiles of adolescent depression-anxiety symptoms and executive function (EF), which is also a major pediatric public health concern.

METHODS

The sample included 1,306 participants who were recruited from two schools in Ningxia. The Depression Self-Rating Scale for Children (DSRSC) and the Screen for Child Anxiety Related Emotional Disorders (SCARED) were used to assess the level of depression-anxiety symptoms in adolescents, and their executive function state was assessed using the Behavior Rating Inventory of Executive Function-Self-Report version (BRIEF-SR). Latent profile analysis (LPA) was carried out using Mplus 7.0 to explore the most likely number of profiles based on the subscales of DSRSC and SCARED. The relationship between adolescents' executive function and depression-anxiety symptoms were analyzed by multivariable logistic regression, and the odds ratio were used to test the impact of this relationship.

RESULTS

The LPA results show that the three-profile model was the best-fitting model for adolescent depression and anxiety symptoms. The proportions of Profile-1 ("Healthy Group"), Profile-2 ("Anxiety Disorder Group"), and Profile-3 ("Depression-Anxiety Disorder Group") were 61.4%, 23.9%, and 14.7%, respectively. Additional analyses using multivariable logistic regression suggested that poor shifting capacity and emotional control were significantly more likely to be classified into the depression and/or anxiety groups, and worse working memory, task completion, and better inhibition were significantly more likely to be classified into the anxiety group.

CONCLUSIONS

The findings contribute to our understanding of the heterogeneity of adolescents' depression-anxiety symptoms and highlight the important role of executive function in influencing mental health outcomes. These findings will guide the improvement and delivery of interventions for the treatment of anxiety and depression in adolescents, mitigating functional impairments in patients and reducing disease risk.

A Scale Measuring Academic-Related Anxiety Following Concussion

Does academic-related anxiety contribute to an adolescent’s recovery process and return to activity after experiencing a concussion? The authors created a novel measure of academic-related anxiety (Mularoni Measure of Academic Anxiety following Concussion [MMAAC]) and administered it to adolescents following concussion in outpatient pediatric sports medicine clinics. Two previously validated measures of anxiety were also administered, and results were compared with the MMAAC scores as well as the lengths of time for return to school and sports. Results show that higher MMAAC scores positively correlate with the length of time an adolescent needs to return to school. Study results indicate that the MMAAC reliably measures academic-related anxiety in adolescents suffering from concussions and can be helpful in predicting a basic timetable for return to school. The authors believe that this brief survey can be used by physicians in clinic to evaluate anxiety and assist with return to school expectations to provide comprehensive recovery support.

Stressors and Coping Methods of Turkish Adolescents With High and Low Risk of Depression: A Qualitative Study

BACKGROUND

Stress and coping skills are essential factors in the etiology of depression. Understanding the stressors and coping strategies of adolescents in Turkey may help determine the content of the country-specific depression prevention program.

AIMS

The purpose of this study was to understand the stressors of adolescents with a high or low risk of depression and how they coped with these stressors.

METHOD

This descriptive qualitative study was conducted in a high school in western Turkey. The data were collected via semistructured individual interviews. Eleven adolescents with high risk of depression and 10 adolescents with low risk of depression were included in the study. Content analysis technique was used to analyze the data.

RESULTS

The stressors of adolescents and their coping were grouped into three themes: stressors, factors affecting coping strategies of adolescents, and coping. Stressors theme consists of three subthemes: family relationship, peer relationship, and telephone/internet usage. The factors affecting coping strategies of adolescents theme consists of four subthemes: cognitive distortions, self-perception, family relationships, and peer relationships. The coping theme consists of two subthemes: engagement coping and disengagement coping.

CONCLUSIONS

It was determined that adolescents with a high risk of depression had more stressors and used more disengagement-coping techniques. It is recommended that to prevent depression among adolescents, school nurses should take initiatives to strengthen the coping strategies of adolescents with high risk of depression.

The experience of loneliness among young people with depression: a qualitative meta-synthesis of the literature

BACKGROUND

Young people have a higher prevalence of loneliness than other age groups, and they are also at risk of depression. Quantitative studies describe a bidirectional association between loneliness and depression, but there is limited understanding of how these influence each other. Little is known about the experience of loneliness among young people with depression. Qualitative approaches may help understand the relationship between loneliness and depression among young people, and how to intervene to improve outcomes. We aimed to conduct a meta-synthesis to understand the complex inter-relationship between loneliness and depression among young depressed people by synthesising evidence from a systematic review of qualitative studies.

METHODS

We conducted a meta-synthesis of qualitative studies capturing experiences of loneliness among young people with depression. We systematically searched six electronic databases for selected search terms, critically appraised eligible studies, and analysed the data from included studies using the approach of thematic synthesis. We used feedback from an inter-disciplinary research workshop to improve reflexivity.

RESULTS

Our inclusion criteria identified fourteen studies. Our analysis identified four themes: (1) social withdrawal due to poor mental health, (2) non-disclosure of depression contributing to social distance, (3) the desire to connect, and (4) paradoxes of loneliness and depression. These themes illustrated a range of pathways between depression and loneliness, and a sense of how these might be mutually reinforcing. Our findings suggest that where depressed individuals engage in certain behaviours (withdrawing; not confiding) for a range of reasons, this can lead to feelings of loneliness, an awareness of which worsens their mood, thus perpetuating their depression.

CONCLUSIONS

Young people with depression experience loneliness as an insurmountable distance between themselves and others. Our findings identified non-disclosure of depression, and the debilitating nature of the depressive symptomatology, as factors perpetuating a vicious cycle of loneliness and depression. They suggest that approaches to tackling the problem might include helping young people communicate about their depression to trusted friends and educating their social networks in how to support them. The wider research literature suggests that cognitive interventions may have a role in shifting maladaptive cognitions about their social world.

Children and young people's conceptualizations of depression: a systematic review and narrative meta-synthesis

BACKGROUND

There is an increasing research interest in conceptualizations of mental illness, examined in association with help-seeking, stigma and treatment preferences. A recent focus on young people's concepts has been identified, with depression being one of the most examined conditions.

METHODS

The purpose of this systematic review is to synthesize evidence on children and adolescents' conceptualizations of depression, adopting the model of illness representations. The review further aims to examine developmental trends, gender differences and the role of experience. A systematic review and narrative meta-synthesis were conducted, reviewing 36 studies identified through a systematic search of six databases in March 2016.

RESULTS

Thirty-six quantitative and qualitative studies were included. Half of the young people are able to recognize depression, and recognition increases when symptoms are more severe (e.g. suicidality). Young people are able to name a variety of causes for depression. Mental health professionals are considered the appropriate source of help by half of the young people, followed by family and peers. However, stigma constitutes a major barrier to help-seeking. There are developmental trends and gender differences in young people's conceptualization of depression, while experience with depression is associated with a broader conceptualization.

CONCLUSIONS

Young people's concepts of depression resemble aspects of adult conceptualizations, however are sometimes incomplete. Further research on younger children and clinical populations is needed. Research on young people's conceptualizations informs both clinical practice and mental health literacy interventions.

The meanings young people assign to living with mental illness and their experiences in managing their health and lives: a systematic review of qualitative evidence

BACKGROUND

It is estimated that less than 25% of young people in need of treatment for mental illness receive specialized services, and even fewer receive a diagnosis by their doctor. These findings are troubling given that living with a mental illness can have a significant impact on a young person's life, the lives of his/her family members, the young person's community and society generally.

OBJECTIVE

The objective of this systematic review was to synthesize the best available qualitative evidence on the meanings young people assign to living with mental illness and their experiences in managing their health and lives.

INCLUSION CRITERIA

The current review considered both interpretive and critical research studies that drew on the experiences of young people with mental illness.

SEARCH STRATEGY

The search for published studies included the following databases: MEDLINE, CINAHL, Social Sciences Full Text, PsycINFO, Social Work Abstracts, Sociological Abstracts, Embase, Social Services Abstracts, Child Development and Adolescent Studies, Scopus, Web of Science and Academic Search Complete. The search for unpublished studies included conference proceedings and ProQuest Dissertations and Theses Database.

METHODOLOGICAL QUALITY

Each paper was assessed independently by two reviewers for methodological quality. The Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI) was used to appraise the methodological quality of the articles.

DATA EXTRACTION

Qualitative data were extracted from papers included in the review using the standardized data extraction tool from JBI-QARI.

DATA SYNTHESIS

JBI-QARI was used to pool findings based on their similarity of meaning and developed into four synthesized findings.

RESULTS

Fifty-four research papers generated 304 study findings that were aggregated into nine categories. The nine categories were further aggregated into four synthesis statements: (1) A different way of being, (2) Getting through the difficult times, (3) Yearning for acceptance and (4) Room for improvement.

CONCLUSION

Young people with mental illness experienced a range of feelings and thoughts that at times left them feeling uncomfortable in their body and world. Rejection by family and friends was a common fear. The changes experienced by young people required them to use a variety of strategies that were both negative and positive. The challenges young people faced in seeking and receiving care reinforce that there is a need for improvement in mental health services for youth living with mental illness.

The Effectiveness of Assertiveness Training on the Levels of Stress, Anxiety, and Depression of High School Students

BACKGROUND

Adolescence is a transition period from childhood to early adulthood. Because of the immense pressure imposed on adolescents due to the complications and ambiguities of this transition, their level of excitement increases and sometimes it appears in the form of sensitivity and intense excitement.

OBJECTIVES

This study aimed at determining the effectiveness of assertiveness training on the levels of stress, anxiety, and depression of high school students.

MATERIALS AND METHODS

This quasi-experimental study was conducted on high school students of Isfahan in academic year 2012 - 13. A total of 126 second grade high school students were collected according to simple random sampling method and divided into two groups: experimental with 63 participants and control with the same number. Data gathering instruments included a demographic questionnaire, Gambill-Richey assertiveness scale, and depression anxiety stress scales (DASS-21). Assertiveness training was carried out on the experimental group in 8 sessions; after 8 weeks, posttest was carried out on both groups. Statistical tests such as independent t test, repeated measures ANOVA, Chi-square test, and the Mann-Whitney test were used to interpret and analyze the data.

RESULTS

The Chi-square and Mann-Whitney tests did not show significant statistical differences between the two groups in terms of demographic variables (P ≥ 0.05). Repeated measures ANOVA showed no significant difference between the mean scores for assertiveness before (100.23 ± 7.37), immediately after (101.57 ± 16.06), and 2 months after (100.77 ± 12.50) the intervention in the control group. However, the same test found a significant difference between the mean score for assertiveness in the experimental group before (101.6 ± 9.1), immediately after (96.47 ± 10.84), and 2 months after (95.41 ± 8.37) implementing the training program (P = 0.002). The independent t test showed no significant difference in the mean score for anxiety and stress between two groups before the assertiveness training program; however, 2 months after the intervention, the mean score for anxiety in the experimental group was found significantly lower than the control group. As for the mean score for depression, the independent t test showed no significant difference between two groups before training; however, despite the decrease in the mean scores for depression in the experimental group following the intervention, the difference was not significant (P = 0.09).

CONCLUSIONS

The results of the current study show that conducting assertive training in high school students decreases their anxiety, stress, and depression. Given that high school years are among the most sensitive stages of one's life plus the fact that conducting such training programs besides their safe and low cost nature are effective and practical, it is highly recommended that such programs be carried out among high school adolescents.