Referring students for professional psychological help: A qualitative study of teachers' experience in Hong Kong

Teachers have frequent interaction with students and are well positioned to refer students for mental health assistance when needed. Twelve secondary schoolteachers in Hong Kong were interviewed about their experience referring students to mental health professionals (MHPs). Using consensual qualitative research, multiple factors were found to influence teachers' referral decisions, including problem severity, students' willingness, stigma of help-seeking, parent/guardian's beliefs, teacher-parent/guardian relationship, MHPs' effectiveness and availability, quality of interaction with MHPs, and teachers' self-efficacy in handling student issues. Based on the findings, we propose a conceptual model of factors influencing teachers' referral decisions. Implications for research, practice, and training are discussed.

Risk and protective factors related to changes in mental health among adolescents since COVID-19 in Hong Kong: a cross-sectional study

BACKGROUND

Most research has suggested that children and adolescents had poorer mental health than pre-COVID-19 pandemic status. There have been few investigations into factors associated with pre-peri pandemic differences in young people's mental health status. Our study aimed to investigate the association between sociodemographic factors, attitudes, and daily life experiences and these differences.

METHODS

We used self-reported cross-sectional data from the Youth Sexuality Survey (YSS) by the Family Planning Association of Hong Kong, collected from secondary school students aged 10-16 between the fourth and fifth waves of the pandemic. The study outcome was pre-peri pandemic differences in mental health (better, unchanged, or poorer). Associations between the study outcome with age, sex, satisfaction with academic performance, school life, relationship with classmates and family life, and average sleeping and exercising time in the past month, were assessed through multinomial logistic regression, controlling for depressive/anxiety symptoms and change in physical health status since the pandemic.

RESULTS

There were 6,665 respondents. Compared with pre-pandemic, approximately 30% reported poorer mental health, whilst 20% reported better mental health. Females (OR = 1.355, 95% CI = 1.159-1.585) and those dissatisfied with their academic performance (OR = 1.468, 95% CI = 1.233-1.748) were significantly more likely to report poorer mental health with reference to unchanged status, while those satisfied with family life had improved mental health with reference to unchanged (OR = 1.261, 95% CI = 1.006-1.579) and poorer status (OR = 1.369, 95% CI = 1.085-1.728).

CONCLUSION

Policy and community strategies that promote good family relationships are thus essential for young people's mental health during societal challenges such as the COVID-19 pandemic.

Is subthreshold depression in adolescence clinically relevant?

BACKGROUND

Subthreshold depression is highly prevalent in adolescence, but compared to major depressive disorder, the clinical impact is under-researched. The aim of this review was to compare subthreshold depression and major depressive disorder in adolescents by reviewing available literature on epidemiology, risk factors, illness trajectories, brain anatomy and function, genetics, and treatment response.

METHODS

We conducted a scoping review of papers on subthreshold depression and major depressive disorder in adolescence published in English. Studies in adults were included when research in adolescence was not available.

RESULTS

We found that individuals with subthreshold depression were similar to individuals with major depressive disorder in several regards, including female/male ratio, onset, functional impairment, comorbidity, health care utilization, suicidal ideation, genetic predisposition, brain alterations, and treatment response. Further, subthreshold depression was about two times more common than major depressive disorder.

LIMITATIONS

The definition of subthreshold depression is highly variable across studies. Adolescent-specific data are limited in the areas of neurobiology and treatment.

CONCLUSIONS

The findings of the current review support the idea that subthreshold depression is of clinical importance and provide evidence for a spectrum, versus categorical model, for depressive symptomatology. Given the frequency of subthreshold depression escalating to major depressive disorder, a greater recognition and awareness of the significance of subthreshold depression in research, clinical practice and policy-making may facilitate the development and application of early prevention and intervention.

Age-Related Differences of Rumination on the Loneliness-Depression Relationship: Evidence From a Population-Representative Cohort

Background and Objectives

This study examined the association of loneliness with depressive symptoms across various age groups. Loneliness is a significant risk factor for precipitating depressive symptoms. Rumination, a mechanism that underpins depression, can become intense when a person feels lonely. In addition, age is a major factor associated with changes in mental and physical health. Thus, the importance of rumination and age in moderating the loneliness-depression link were investigated.

Research Design and Methods

This cross-sectional study was conducted during the acute phase of the coronavirus disease 2019 pandemic in Hong Kong (February 27 to March 17, 2020). A population-representative sample of 1,972 people (1,107 females; 18-92 years of age) was recruited and interviewed via telephone through random digit dialing. This sample included 394 younger adults (18-30 years), 1,106 middle-aged adults (31-64 years), and 472 older adults (65 years or above). Respondents reported depressive symptoms, subjective loneliness, state rumination, and sociodemographic factors.

Results

Loneliness and rumination were positively associated with depressive symptoms, and they significantly interacted in predicting cognitive-affective symptoms. Further analysis of age showed that the interaction was significant only in middle-aged adults and older adults. Both rumination and age interacted with loneliness, respectively, in predicting cognitive-affective symptoms.

Discussion and Implications

These findings indicate that the strength of the association between loneliness and the cognitive-affective symptoms of depression depends on rumination levels and age. An intervention to regulate rumination offers a feasible direction for health care and social care aimed at improving older adults' mental health.

Subthreshold depression in adolescence: Gender differences in prevalence, clinical features, and associated factors

BACKGROUND

Subthreshold depression (SD) is an important mental health problem in adolescence given its high prevalence, comorbidity, and functional impairment. However, currently little is known about gender differences of SD in adolescence. The aim of this study was to examine gender differences in prevalence, clinical features, and associated factors in adolescents with subthreshold depressive episode (SDE).

METHODS

The participants were 2,022 adolescents between 9^th and 11^th grades (49.5% girls, 15.2 years average age) recruited from eight state-subsidized schools located in the northern part of Santiago, Chile. The Patient Health Questionnaire-9 (PHQ-9) was used to assess depressive symptoms. Descriptive statistics, bivariate and multinomial logistic regression analyses were used.

RESULTS

The prevalence of SDE and major depressive episode were 16.5% (95% CI: 14.9-18.2) and 17.7% (95% CI: 16.1-19.4), respectively. Both mental health problems were more prevalent in females (p < 0.001). With regard to SDE, girls displayed a higher rate of depressive mood and sleep problems, while boys had greater anhedonia, problems related with concentration, and psychomotor retardation/agitation. High levels of dysfunctional thoughts and perceived social support were associated with SDE in females and males. Social problem solving and emotion regulation had a differentiated impact on SDE depending on gender.

CONCLUSION

Depressive symptoms and SDE were found to be common health problems among adolescents in Chile. SDE had major gender differences in terms of prevalence, clinical features, and associated factors. These differences should be considered in the development of preventive and early interventions.

Self-esteem and other risk factors for depressive symptoms among adolescents in United Arab Emirates

BACKGROUND

Little is known about depressive symptoms among adolescents in the United Arab Emirates (UAE). This study aimed to identify the prevalence of depression and its association with self-esteem, individual, parental and family factors among adolescents aged 12 to 18 in UAE.

METHODS

Six hundred adolescents, aged 12 to 18 years were recruited from 4 of 111 schools in a cross-sectional study. We administered Beck Depression Inventory Scale and Rosenberg Self-esteem Scale to measure self-report symptoms of depression and self-esteem. We used multiple linear regression to identify significant predictors of depression.

RESULTS

Over 86% of the identified sample participated to the survey. The mean age of the sample was 14.3 (±1.3) with an excess of girls (61%). Depressive symptoms were detected in 17.2% (95% CI 14.2-20.7). There was an inverse relationship between self-esteem scores and depressive symptoms. Positive predictors of depressive symptoms, having controlled for age, gender, and ethnicity included experiencing neglect, being verbally abused in school, having no monthly allowance to spend in school, a history of physical morbidities requiring treatment, being a current or past smoker and a low family income.

CONCLUSION

The high prevalence of depressive symptoms measured in this survey suggests a significant public health problem among adolescents in the UAE. Public health interventions aimed at facilitating education and early detection and potential treatment of depressive symptoms are a priority in the region.

Adolescent Mental Health Problems in Hong Kong: A Critical Review on Prevalence, Psychosocial Correlates, and Prevention

PURPOSE

Adolescent mental health problems are a public health issue in Hong Kong and a review of the situation can have implications for intervention and prevention. This paper aims to review the available prevalence rates of mental health problems among adolescents in Hong Kong and examines the correlates of these conditions through a positive youth development (PYD) framework.

METHODS

Local studies published in English between January 1995 and September 2017 were searched in ERIC, PsycArticles, PsycInfo, and PubMed. Data were selected and extracted by two reviewers. The primary outcome was the prevalence or the scores of mental health problems among adolescents. The secondary outcome was the correlates associated with the problems identified in the studies.

RESULTS

Twenty-three studies were identified. The prevalence of depression was between 0.55% and 2.2% (three studies), whereas the prevalence for anxiety (one study) and generalized anxiety disorder (two studies) were 6.9% and 2.6%, respectively. Comparatively higher levels of depressive symptoms and lower levels of general mental health among Hong Kong adolescents than adolescents in other regions. The protective factors examined in these studies were categorized into PYD constructs, namely: cognitive competence, behavioral competence, emotional competence, resilience, and bonding with family, which were associated with better mental health.

CONCLUSIONS

This review contends that future mental health research and intervention for adolescents should focus more on PYD constructs and family factors.

Support for Autonomy at School Predicts Immigrant Adolescents' Psychological Well-being

We investigated the relationship between teacher support at school intended to promote students' autonomy and immigrant adolescents' psychological well-being. A structural equation model was tested on 3130 immigrant adolescents who attended a representative sample of 654 Italian high schools. Gender, socioeconomic status, previous school achievement and immigrant generation were included in the analysis as control variables. Results showed that when teachers are perceived as adopting an approach that is supportive of autonomy, immigrant adolescents report significantly higher levels of psychological well-being. Gender appears to be the most relevant background factor, with girls being more at risk than boys as regards mental health. Overall, our findings suggest that interventions of enacted support by teachers at school that aim to foster students' autonomy would be an effective approach for protecting against mental illness in immigrant adolescents.

Behavioral problem trajectories and self-esteem changes in relation with adolescent depressive symptoms: a longitudinal study

PURPOSE

Prospectively childhood behavioral problems and low self-esteem are associated with depression. However, these mental health changes over time have never been examined. This study assessed the association of childhood behavioral trajectories and self-esteem changes over time with adolescent depressive symptoms.

METHODS

Parent-reported Rutter behavioral assessments and self-reported Culture-Free Self-Esteem Inventories (SEI) were obtained via record linkage from the Student Health Service, Department of Health (Hong Kong), and the Patient Health Questionnaire-9 (PHQ-9) depressive symptom scores were obtained via active follow-up of the Hong Kong's Children of 1997" Chinese birth cohort. Partitional clustering was used to generate homogenous trajectories between ~ 7 and ~ 11 years for Rutter scores. Changes in low self-esteem between ~ 10 and ~ 12 years were obtained from the SEI. Multiple linear regression was used to estimate their associations with depressive symptom scores at ~ 13 years.

RESULTS

Four trajectories/groups (stable low, declining, rising, and stable high) of Rutter score and self-esteem groups were created. The stable low behavioral trajectory was associated with the fewest depressive symptoms while the stable high trajectory had 1.23 more depressive symptoms [95% confidence interval (CI) 0.84 to 1.61] than the stable low trajectory. Consistently low self-esteem (stable low) was associated with 2.96 more depressive symptoms (95% CI 2.35-3.57) compared to consistently high self-esteem (stable high).

CONCLUSIONS

Sustained or worsening childhood behavioral problems and low self-esteem were precursors of adolescent depressive symptoms, and as such could be an early indicator of the need for intervention.

Depression Symptom Patterns and Social Correlates among Chinese Americans

The aim of this study is to examine and compare the depression symptoms pattern and social correlates in three groups: foreign-born Chinese Americans, US-born Chinese Americans, and non-Hispanic whites. This study used data from the Collaborative Psychiatric Epidemiology Surveys (CPES). The study sample consists of 599 Chinese Americans (468 for the foreign-born and 121 for the US-born) and 4032 non-Hispanic whites. Factor analysis was used to examine the depression symptom patterns by each subgroup. Four depression symptoms dimensions were examined: negative affect, somatic symptoms, cognitive symptoms, and suicidality. Logistic regression was used to investigate the effects of sociodemographic (age, gender, marital status, and education), physical health condition, and social relational factors (supports from and conflict with family and friends) on specific types of depression symptoms separately for the three subgroups. The findings showed little differences in depression symptom patterns but clear variation in the social correlates to the four depression dimensions across the three ethnocultural groups, foreign-born Chinese Americans, US-born Chinese Americans, and non-Hispanic whites. Clinicians should take into account the sociocultural factors of patients when making diagnosis and suggesting treatments. In addition, psychiatrists, psychologists, or other mental health service providers should offer treatment and coping suggestions based on the specific symptom dimensions of patients, and patients’ ethnocultural backgrounds.

Patient-Reported Adverse Effects Associated with Combination Antiretroviral Therapy and Coadministered Enzyme-Inducing Antiepileptic Drugs

AbstractConcurrent treatment with combination antiretroviral therapy (cART) and an enzyme-inducing antiepileptic drug (EI-AED) is common in resource-limited settings; however, the incidence and impact of adverse effects in cotreated patients is largely unknown. Symptoms of adverse effects were assessed by both spontaneous report and checklist for 145 human immunodeficiency virus (HIV)-infected Zambian adults initiating various treatment combinations, such as cART with an EI-AED (N = 20), cART only (N = 43), or neither drug (untreated; N = 82). At study baseline, the cART + EI-AED group reported more headache, generalized fatigue, problems with concentration, and depression than the untreated group (P < 0.01 for all). At 2 weeks, a greater proportion of cART + EI-AED participants reported increased nausea or vomiting compared with baseline (P < 0.05). Adverse effects did not appear to impact self-reported adherence at 2 weeks as 100% cART adherence was reported in 19 of 20 (95%) and 42 of 43 (98%) cART + EI-AED and cART-only participants, respectively; 100% EI-AED adherence was reported in 19 of 20 (95%) participants. However, adherence at 6 months was suboptimal in both groups with 18 of 33 (56%) participants on cART experiencing greater than 1-week lapse in pharmacy-reported medication supply. Our results highlight the need to educate patients about the increased potential for nausea and vomiting with cART + EI-AED cotreatment. Although adherence was high early during treatment, adherence should be reinforced overtime to minimize the potential for HIV and/or epilepsy treatment failure.

Associations between Social Support from Family, Friends, and Teachers and depressive Symptoms in Adolescents

Approximately 20% of adolescents develop depressive symptoms. Family, friends, and teachers are crucial sources of social support for adolescents, but it is unclear whether social support impacts adolescents directly (principle-effect model) or by moderating the effect of stress (stress-buffer model) and whether each source of social support remains meaningful when their influence is studied simultaneously. To help fill this gap, we followed 1452 Australian students (average age at enrollment = 13.1, SD = 0.5; range: 11-16 years; 51.9% female) for 5 years. Based on our findings, each source of support is negatively related to depressive symptoms one year later when studied independently but when combined, only family and teacher support predicted depressive symptoms. Family support in all grades and teacher support in grade 8 to 10 but not in grade 11 directly impacted adolescent depressive symptoms 1 year later. Family support in grades 8 and 11 also buffered against the negative impact of stress on depressive symptoms one year later. Based on the unexpected findings, the most important limitations seem to be that the used instruments do not allow for a separation of different groups of friends (e.g., classmates, same-gender peers, romantic partners), types of social support, and stress. In addition, the high, nonrandom attrition rate with adolescents reporting less social support, more stressful events, a higher frequency of depressive symptoms, and/or being of Torres Strait Islander or Aboriginal background limits the generalizability of our findings. Summarized, our findings demonstrate that adolescents facing stress might benefit more from family support compared to their peers without stressful life events and that friends may have a weaker presence in adolescent lives than expected.

Impact of depressive/anxiety symptoms on the quality of life of adolescents with ADHD: a community-based 1-year prospective follow-up study

Adolescents with attention-deficit/hyperactivity disorder (ADHD) often exhibit functional impairment even those having less visible symptoms. Therefore, it is of great clinical importance to identify ADHD symptoms among adolescents in the community. Furthermore, little is known regarding the role of internalizing symptoms in their quality of life. Thus, this study aimed to screen ADHD in a sample of high school students using the Adult ADHD Self-report Scale (ASRS) and to investigate the impact of internalizing symptoms on their well-being. In the first year, adolescents aged 15-17 years old from a senior high school (N = 1947) completed the Adult ADHD Self-rating Scale (ASRS), Wender Utah Rating Scale, Impulsiveness Scale, Beck's Depression Inventory and Beck's Anxiety Inventory. In the second year, the World Health Organization Quality of Life-BREF was applied for the measurement of their psychosocial outcomes. Results showed that adolescents with higher ASRS scores manifested more severe concurrent depressive and anxiety symptoms. ADHD symptoms among these adolescents were significantly associated with poorer quality of life 1 year later (p < 0.001). And both depressive and anxiety symptoms were mediators in the relationship between ADHD symptoms and quality of life. The finding of this study supports that the concurrent internalizing symptoms may underlie the negative relations between ADHD symptoms and quality of life in adolescents in the community. The application of ASRS in adolescents may help clinicians in early intervention for their ADHD problems as well as emotional symptoms.

Does Worrying Mean Caring Too Much? Interpersonal Prototypicality of Dimensional Worry Controlling for Social Anxiety and Depressive Symptoms

Worry, social anxiety, and depressive symptoms are dimensions that have each been linked to heterogeneous problems in interpersonal functioning. However, the relationships between these symptoms and interpersonal difficulties remain unclear given that most studies have examined diagnostic categories, not accounted for symptoms' shared variability due to general distress, and investigated only interpersonal problems (neglecting interpersonal traits, interpersonal goals, social behavior in daily life, and reports of significant others). To address these issues, students (Study 1; N=282) endorsed symptoms and interpersonal circumplex measures of traits and problems, as well as event-contingent social behaviors during one week of naturalistic daily interactions (N=184; 7,036 records). Additionally, depressed and anxious patients (N=47) reported symptoms and interpersonal goals in a dyadic relationship, and significant others rated patients' interpersonal goals and impact (Study 2). We derived hypotheses about prototypical interpersonal features from theories about the functions of particular symptoms and social behaviors. As expected, worry was uniquely associated with prototypically affiliative tendencies across all self-report measures in both samples, but predicted impacting significant others in unaffiliative ways. As also hypothesized, social anxiety was uniquely and prototypically associated with low dominance across measures, and general distress was associated with cold-submissive tendencies. Findings for depressive symptoms provided less consistent evidence for unique prototypical interpersonal features. Overall, results suggest the importance of multimethod assessment and accounting for general distress in interpersonal models of worry, social anxiety, and depressive symptoms.

Evaluation of the Psychometric Properties of the Asian Adolescent Depression Scale and Construction of a Short Form: An Item Response Theory Analysis

The present study applied item response theory to examine the psychometric properties of the Asian Adolescent Depression Scale and to construct a short form among 1,084 teenagers recruited from secondary schools in Hong Kong. Findings suggested that some items of the full form reflected higher levels of severity and were more discriminating than others, and the Asian Adolescent Depression Scale was useful in measuring a broad range of depressive severity in community youths. Differential item functioning emerged in several items where females reported higher depressive severity than males. In the short form construction, preliminary validation suggested that, relative to the 20-item full form, our derived short form offered significantly greater diagnostic performance and stronger discriminatory ability in differentiating depressed and nondepressed groups, and simultaneously maintained adequate measurement precision with a reduced response burden in assessing depression in the Asian adolescents. Cultural variance in depressive symptomatology and clinical implications are discussed.

Subthreshold depression in adolescence: a systematic review

In adolescence, the number of depressive symptoms is rising notably. Individuals may have relevant depressive symptoms without meeting the full criteria of a major depressive episode (MDE), a condition referred to as subthreshold depression (sD). This article presents a review on adolescent sD examining the prevalence, the quality of life (QoL), the risk of developing MDE, and preventive programs available for adolescents living with sD. A systematic literature search from the year of the introduction of Diagnostic and Statistic Manual for Mental Disorders Fourth Edition (DSM-IV) until 2012 (18 years) was conducted with a special focus on adolescent sD. Data from 27 studies were included into this review. The results show high prevalence of sD among adolescents, with a negative impact on QoL, and provide evidence that sD is a significant risk indicator of later MDE; therefore, individuals with sD represent good targets for preventive interventions. Our review highlights the fact that sD is a significant health problem among adolescents indeed, and adolescents with sD could be a subgroup of youth, who need further help to reduce their clinically significant depressive symptoms for the successful prevention of a later MDE.

Depression in China: integrating developmental psychopathology and cultural-clinical psychology

With a starting point in John Abela's groundbreaking developmental psychopathology research on adolescent depression in China, we aimed to review the state of the literature on Chinese depression across the lifespan. We began with Dr. Abela's published studies relevant to depression in China and our own research with adults before turning to the reference lists of these articles to find additional sources. Then we conducted literature searches using PsycINFO and PubMed to find other relevant studies published between April 2001 and April 2011 . There are two distinct literatures on depression in China. Developmental psychopathology research has emphasized adolescent samples and cognitive models of causation; cultural-clinical psychology and cultural psychiatry research have emphasized adult samples and the meanings associated with emotions, symptoms, and syndromes. Both approaches to the study of depression in China have yielded important findings but have also highlighted issues that could be better addressed by incorporating the other approach. Beyond depression in China, the psychological study of culture and mental health more generally would benefit from greater exchange between developmental psychopathology and cultural-clinical psychology.

Rumination as a vulnerability factor to depression in adolescents in mainland China: lifetime history of clinically significant depressive episodes

The current study tested the vulnerability and sex differences hypotheses of the response styles theory of depression (Nolen-Hoeksema, 1991). Participants included 494 tenth-grade students (M = 15.25 years, SD = 0.47) recruited from two secondary schools in Beijing, China. Participants completed self-report measures assessing rumination and neuroticism as well as a semistructured clinical interview assessing current and past clinically significant depressive episodes. Higher levels of rumination were associated with a greater likelihood of exhibiting both a current depressive episode and a past history of depressive episodes even after controlling for neuroticism. Higher levels of rumination were also associated with greater severity and duration of current depressive episodes and greater severity of past depressive episodes even after controlling for neuroticism. Contrary to the sex differences hypothesis of the response styles theory, girls and boys did not differ in levels of rumination.

Dinosaur girls, candy girls, and Trinity: voices of Taiwanese club drug users

Research among Asian users of methylenedioxy methamphetamine (MDMA), also known as Ecstasy, is rare. To evaluate the feasibility of a study on the abuse of and dependence on Ecstasy, two focus groups of users (n= 12) and health professionals (n=7) were conducted in Taiwan. Major results included blatant human testing with "candy and dinosaur girls" and a specific sequence of drugs called a "Trinity" (Ecstasy, ketamine, and marijuana). "Head-shaked bars" and "KTVs" were public places where illegal behaviors were implicitly allowed. Depression after Ecstasy use was not reported. For future studies, participants suggested that magnetic resonance imaging could be a strong incentive for young users to enhance willingness to participate. Cultural issues of Ecstasy use are also discussed.

Factor structure of the Center for Epidemiological Studies Depression Scale in Hong Kong adolescents

We present data from the Center for Epidemiological Studies-Depression Scale (CES-D; Radloff, 1977) for 2 samples of Hong Kong community adolescents (combined N = 1,385). The 4 positive affect items related poorly to the remainder of the scale. Using 16 items, the data were consistent with 2 models with highly correlated factors: (a) a 2-factor model, 1 of which merged somatic and affective items, and (b) a 3-factor model separating somatic, depressed, and interpersonal items. Correlations with related constructs provide preliminary support of validity. Hong Kong adolescents are influenced both by traditional concepts of mind-body holism and Western psychological models separating psychological and somatic symptoms.

Measurement matters in the association between early adolescent depressive symptoms and body mass index

OBJECTIVE

The objectives of this study were to examine associations between depressive symptoms and body mass over 1 year during early adolescence and to assess how the associations might differ depending upon whether self-reported or directly measured height and weight were used.

METHOD

Participants were 446 sixth-grade Seattle students. Depressive symptoms were assessed using the Mood and Feelings Questionnaire. Regression models were used to examine whether baseline depression status was associated with 12-month body mass index (BMI; using self-reported height and weight) and whether baseline overweight status was associated with 12-month depressive symptom score. Analyses were rerun among a subsample (n=165) who had height and weight directly measured.

RESULTS

Using BMI derived from self-reported values, depressed males had a significantly lower BMI than nondepressed males, while depressed females had a significantly higher BMI than nondepressed females, after adjusting for covariates. Among a subsample using measured height and weight values, however, depression was no longer associated with BMI in either gender. Baseline overweight status did not predict 12-month depression score.

CONCLUSIONS

Observed associations between depression and subsequent BMI were explained by differential misclassification of self-reported height and weight by depression status and gender. Direct measurement of height and weight may be necessary to ensure validity in studies of adolescent depression and weight-related outcomes.

Symptomatic expression of depression among Jewish adolescents: effects of gender and age

BACKGROUND

Depression symptomatology was assessed with the Beck Depression Inventory (BDI) in a sample of Jewish adolescents, in order to compare the frequency and severity of depression with non-Jewish adolescents as well as examine gender difference of the expression of depressive symptomatology.

METHOD

Subjects comprised 475 students from Jewish private schools, aged 13-17 years, who were compared with an age-matched non-Jewish sample (n=899). Kendall's definition was adopted to classify these adolescents according to level of depressive symptoms. The frequency of depression was calculated for ethnicity, gender and age strata. Discriminant analysis and principal component analysis were performed to assess the importance of depression-specific and non-specific items, along with the factor structure of the BDI, respectively.

RESULTS

The overall mean score on the BDI in the Jewish and the non-Jewish sample was 9.0 (SD=6.4) and 8.6 (SD=7.2), respectively. Jewish girls and boys had comparable mean BDI scores, contrasting with non-Jewish sample, where girls complained more of depressive symptoms than boys (p<0.001). The frequency of depression, adopting a BDI cutoff of 20, was 5.1% for the Jewish sample and 6.3% for the non-Jewish sample. The frequency of depression for Jewish girls and boys was 5.5% (SE=1.4) and 4.6% (SE=1.5), respectively. On the other hand, the frequency of depression for non-Jewish girls and boys was 8.4% (SE=1.2) and 4.0% (SE=1.0), respectively. The female/male ratio of frequency of BDI-depression was 1.2 in the Jewish sample, but non-Jewish girls were twice (2.1) as likely to report depression as boys. Discriminant analysis showed that the BDI highly discriminates depressive symptomatology among Jewish adolescents, and measured specific aspects of depression. Factor analysis revealed two meaningful factors for the total sample and each gender (cognitive-affective dimension and somatic dimension), evidencing a difference between Jewish boys and Jewish girls in the symptomatic expression of depression akin to non-Jewish counterparts.

CONCLUSIONS

Ethnic-cultural factor might play a role in the frequency, severity and symptomatic expression of depressive symptoms in Jewish adolescents. The lack of gender effect on depression, which might persist from adolescence to adulthood among Jewish people, should be investigated in prospective studies.

Repeat suicide attempts in Hong Kong community adolescents

It has been well documented that a history of suicide attempts confers risk for subsequent attempts; however, efforts to explain how variables may change after a previous attempt and in turn relate to future suicide attempts are rare in the literature. This study presents longitudinal data on adolescent suicide attempts in Hong Kong, and examines whether the data support the "crescendo" model to explain repeat suicide attempts. One thousand and ninety-nine community adolescents aged 12-18 years were evaluated at two assessment points 12 months apart (T1 and T2). The study assessed (1) risk factors at T1 for a suicide attempt between T1 and T2, (2) whether a suicide attempt during the 12 months prior to T1 predicted an attempt between the two assessment points, and (3) whether the indicators of distress worsened from T1 to T2 if an attempt had taken place in the interim. The results indicated that: (1) depressive symptoms, substance use, and suicidal ideation measured at T1 were independent predictors of a suicide attempt between T1 and T2; (2) suicide attempt in the year prior to T1 predicted suicide attempt between T1 and T2 after controlling for other predictors; and (3) suicide attempt between T1 and T2 was a predictive factor for a negative change from T1 to T2 in substance use, suicidal ideation, family relationships, depression, anxiety, and life stress. These findings are consistent with the "crescendo" model proposing that the risk of repeat attempts is enhanced following a previous suicide attempt.

Fatores associados aos problemas de saúde mental em adolescentes

O objetivo do artigo foi investigar os problemas de saúde mental de adolescentes escolares e identificar alguns aspectos individuais, sociais e familiares associados ao seu desenvolvimento. Baseia-se num inquérito epidemiológico com 1.923 alunos de 7ª/8ª séries e de 1º/2º anos de escolas públicas e privadas do município de São Gonçalo, RJ. Para aferir os transtornos psiquiátricos menores utilizou-se a escala Self-Reported Questionnarie. Foram avaliadas questões relativas aos aspectos individuais, familiares e sociais. Utilizou-se a Regressão Logística Simples, tendo a razão de chances como medida para interpretação dos resultados. Constatou-se que violência psicológica, eventos difíceis do relacionamento familiar, auto-estima, satisfação com a vida, sexo e competência na escola se mantiveram no modelo final, indicando seu potencial em comprometer a saúde mental. A apresentação dos dados pode subsidiar o desenvolvimento de políticas públicas para o atendimento do adolescente, especialmente em termos preventivo e de promoção à saúde na área de saúde mental.

Characteristics of adolescent depression

Depression is a common psychiatric disorder that is acknowledged to be increasing in disease burden. The rates of adolescent depression is particularly concerning as they continue to increase. The seriousness and pervasive effects of depression on young people's lives supports the view that research that extends the knowledge in this area is vital. This is a descriptive study of the characteristics of depression in a sample of 121 adolescents attending an outpatient specialist adolescent mental health service in New Zealand. The adolescents were required to complete two self-report measures to assess presence of depressive symptoms, severity of depression, and particular characteristics of the depression. The findings revealed that irritability was the most common characteristic along with other interpersonal and thought processing symptoms. It is important that mental health nurses are able to identify the specific characteristics of adolescent depression that may differ from adult depression in order to manage this patient population effectively.

Hopelessness and suicidal ideation among adolescents in two cultures

BACKGROUND

This study examines the cross-sectional and longitudinal associations among cognitive variables, depressive symptoms and suicidal ideation in Hong Kong Chinese and Caucasian American adolescents.

METHODS

Community adolescents (n = 2,044) ages 14-18 years from Hong Kong and the United States provided information regarding their suicidal ideation, depressive symptoms, and cognitions (self-efficacy, cognitive errors and hopelessness), at two surveys, six months apart.

RESULTS

Self-efficacy was a weak unique predictor of suicidal ideation in both cultures. Hopelessness was the strongest of cognitive variables in concurrent associations with suicidal ideation in bivariate and multivariate models, in both cultures, and in both boys and girls. Hopelessness continued to offer unique prediction when depressive symptoms were controlled, both concurrently and prospectively.

CONCLUSIONS

Our results support hopelessness theories of suicidal ideation and behavior in Hong Kong, and extend the cognitive theory of suicidality to a modernized Asian culture.

A Cross-Cultural Investigation of Cognitions and Depressive Symptoms in Adolescents

Adolescents (N=2,272) from Hong Kong and the United States provided information regarding their depressive symptoms, cognitions (self-efficacy, negative cognitive errors, and hopelessness), and stressful events between 2 surveys 6 months apart. Depressive symptoms and hopelessness were higher, and self-efficacy and negative cognitive errors were lower in Hong Kong than in the United States. Cognitions were associated with concurrent depressive symptoms and predicted depressive symptoms 6 months later in both cultures. The "reverse" model was also supported with more variance predicted by depressive symptoms to later cognitions than from cognitions to depressive symptoms. There was some support for the hypothesis that self-efficacy is less salient in collective compared with individualistic cultures. These findings extend cognitive theories of depression to a non-Western culture.