The public health impact of socioeconomic status on adolescent depression and obesity

Could a Growth Mindset Attenuate the Link Between Family Socioeconomic Status and Depressive Symptoms? Evidence from Chinese Adolescents

Purpose

The alleviating effects of a growth mindset on depression are promising. However, whether a growth mindset can attenuate the effect of low family socioeconomic status (SES) on depressive symptoms among adolescents remains unknown. Based on the Family Stress Model, the current study explores whether a growth mindset could moderate the associations between family SES, interparental conflict, and adolescent depressive symptoms.

Methods

The participants were 1572 Chinese adolescents (Mage = 13.35 years, SD = 1.16, 51.84% female). They completed the family SES questionnaire, Children's Perceptions of Interparental Conflict scale, Growth Mindset scale, and Center for Epidemiologic Studies Depression scale. We tested the moderation, mediation, and moderated mediation models using the SPSS macro program PROCESS.

Results

A growth mindset moderated the association between family SES and depressive symptoms. Family SES was significantly related to depressive symptoms in adolescents with a lower growth mindset, but not in those with a higher growth mindset. After incorporating the mediating effect of interparental conflict, the growth mindset did not exert a significant moderating influence on the direct path; however, it significantly moderated the mediating effect of interparental conflict on depressive symptoms. Specifically, while a lower growth mindset in adolescents was associated with an increased risk of depressive symptoms due to interparental conflict, those with a higher growth mindset showed a less pronounced effect.

Conclusion

A growth mindset attenuates the link between family SES and depressive symptoms among adolescents. These findings highlight the benefits of a growth mindset on mental health, especially for low-SES adolescents.

Depression in youths with early life adversity: a systematic review and meta-analysis

Background

Globally, early-life adversity (ELA) is linked to an increased risk of developing depression in adulthood; however, only a few studies have examined the specific effects of various types of ELA on depression in children and adolescents. This meta-analysis explores the association between the subtypes of ELA and the risk for youth-onset depression.

Methods

We searched three electronic databases for reporting types of ELA, namely, emotional abuse, physical abuse, sexual abuse, emotional neglect, physical neglect, family conflict/violence, divorce, low socioeconomic status, and left-behind experience, associated with depression before the age of 18 years. Our meta-analysis utilized the odds ratio (OR) and relied on a random effects model. Large heterogeneous effects were detected. Some factors moderated the association between ELA and depression in youths. The homogeneity of variance test and meta-regression analysis were used to detect these relationships.

Results

A total of 87 studies with 213,006 participants were ultimately identified via several strategies in this meta-analysis. Individuals who experienced ELA were more likely to develop depression before the age of 18 years old than those without a history of ELA (OR=2.14; 95% CI [1.93, 2.37]). The results of the subgroup analysis revealed a strong association between ELA and depression in youth, both in terms of specific types and dimensions. Specifically, emotional abuse (OR = 4.25, 95% CI [3.04, 5.94]) was more strongly related to depression in children and adolescents than other forms of ELA were. For both dimensions, threat (OR = 2.60, 95% CI [2.23, 3.02]) was more closely related to depression than deprivation was (OR = 1.76, 95% CI [1.55, 1.99]).

Conclusion

This meta-analysis revealed that the adverse effects of a broader consideration of ELA on the risk of youth-onset depression vary according to the subtypes of ELA.

Systematic review registation

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023405803, identifier 42023405803.

Associations of Longitudinal BMI-Percentile Classification Patterns in Early Childhood with Neighborhood-Level Social Determinants of Health

Background: Understanding social determinants of health (SDOH) that may be risk factors for childhood obesity is important to developing targeted interventions to prevent obesity. Prior studies have examined these risk factors, mostly examining obesity as a static outcome variable. Methods: We extracted electronic health record data from 2012 to 2019 for a children's health system that includes two hospitals and wide network of outpatient clinics spanning five East Coast states in the United States. Using data-driven and algorithmic clustering, we have identified distinct BMI-percentile classification groups in children from 0 to 7 years of age. We used two separate algorithmic clustering methods to confirm the robustness of the identified clusters. We used multinomial logistic regression to examine the associations between clusters and 27 neighborhood SDOHs and compared positive and negative SDOH characteristics separately. Results: From the cohort of 36,910 children, five BMI-percentile classification groups emerged: always having obesity (n = 429; 1.16%), overweight most of the time (n = 15,006; 40.65%), increasing BMI percentile (n = 9,060; 24.54%), decreasing BMI percentile (n = 5,058; 13.70%), and always normal weight (n = 7,357; 19.89%). Compared to children in the decreasing BMI percentile and always normal weight groups, children in the other three groups were more likely to live in neighborhoods with higher poverty, unemployment, crowded households, single-parent households, and lower preschool enrollment. Conclusions: Neighborhood-level SDOH factors have significant associations with children's BMI-percentile classification and changes in classification. This highlights the need to develop tailored obesity interventions for different groups to address the barriers faced by communities that can impact the weight and health of children living within them.

Associations of longitudinal BMI percentile classification patterns in early childhood with neighborhood-level social determinants of health

Background

Understanding social determinants of health (SDOH) that may be risk factors for childhood obesity is important to developing targeted interventions to prevent obesity. Prior studies have examined these risk factors, mostly examining obesity as a static outcome variable.

Methods

We extracted EHR data from 2012-2019 for a children's health system that includes 2 hospitals and wide network of outpatient clinics spanning 5 East Coast states in the US. Using data-driven and algorithmic clustering, we have identified distinct BMI-percentile classification groups in children from 0 to 7 years of age. We used two separate algorithmic clustering methods to confirm the robustness of the identified clusters. We used multinomial logistic regression to examine the associations between clusters and 27 neighborhood SDOHs and compared positive and negative SDOH characteristics separately.

Results

From the cohort of 36,910 children, five BMI-percentile classification groups emerged: always having obesity (n=429; 1.16%), overweight most of the time (n=15,006; 40.65%), increasing BMI-percentile (n=9,060; 24.54%), decreasing BMI-percentile (n=5,058; 13.70%), and always normal weight (n=7,357; 19.89%). Compared to children in the decreasing BMI-percentile and always normal weight groups, children in the other three groups were more likely to live in neighborhoods with higher poverty, unemployment, crowded households, single-parent households, and lower preschool enrollment.

Conclusions

Neighborhood-level SDOH factors have significant associations with children's BMI-percentile classification and changes in classification. This highlights the need to develop tailored obesity interventions for different groups to address the barriers faced by communities that can impact the weight and health of children living within them.

Impact Statement

This study demonstrates the association between longitudinal BMI-percentile patterns and SDOH in early childhood. Five distinct clusters with different BMI-percentile trajectories are found and a strong association between these clusters and SDOH is observed. Our findings highlight the importance of targeted prevention and treatment interventions based on children's SDOH.

Emerging Risk of Adolescent Depression and Suicide Detected Through Pediatric Primary Care Screening

OBJECTIVE

The goal of the current study was to document patterns of stability and change in adolescent depression and suicide risk detected via universal depression screening in pediatric primary care and to determine who may go on to experience emerging risk.

METHODS

Retrospective electronic health record information (sociodemographic data and depression screening results for 2 timepoints) was extracted for adolescents aged 12-17 who attended well-visits between November 15, 2017, and February 1, 2020, in a large pediatric primary care network. A total of 27,335 adolescents with 2 completed depression screeners were included in the current study.

RESULTS

While most adolescents remained at low risk for depression and suicide across the 2 timepoints, others experienced emerging risk (i.e., low risk at time 1 but elevated risk at time 2), decreasing risk (i.e., high risk at time 1 but low risk at time 2) or stable high risk for depression or suicide. Odds of experiencing emerging depression and suicide risk were higher among adolescents who were female (compared to males), Black (compared to White), and had Medicaid insurance (compared to private insurance). Odds of experiencing emerging depression risk were also higher among older adolescents (compared to younger adolescents) as well as adolescents who identified as Hispanic/Latino (compared to non-Hispanic/Latino).

CONCLUSIONS

Findings can inform symptom monitoring and opportunities for prevention in primary care.

Impact of Parental Mental Health and Poverty on the Health of the Next Generation: A Multi-Trajectory Analysis Using the UK Millennium Cohort Study

PURPOSE

Exposure to parental mental ill-health and poverty in childhood impact health across the lifecourse. Both maternal and paternal mental health may be important influences, but few studies have unpicked the complex interrelationships between these exposures and family poverty for later health.

METHODS

We used longitudinal data on 10,500 children from the nationally representative UK millennium cohort study. Trajectories of poverty, maternal mental health, and secondary caregiver mental health were constructed from child age of 9 months through to 14 years. We assessed the associations of these trajectories with mental health outcomes at the age of 17 years. Population-attributable fractions were calculated to quantify the contribution of caregivers' mental health problems and poverty to adverse outcomes at the country level.

RESULTS

We identified five distinct trajectories. Compared with children with low poverty and good parental mental health, those who experienced poverty and poor primary or secondary caregiver mental health (53%) had worse outcomes. Children exposed to both persistent poverty and poor caregiver mental health were at markedly increased risk of socioemotional behavioural problems (aOR 4.2; 95% CI 2.7-6.7), mental health problems (aOR 2.5; CI 1.6-3.9), and cognitive disability (aOR 1.7; CI 1.1-2.5). We estimate that 40% of socioemotional behavioural problems at the age of 17 were attributable to persistent parental caregivers' mental health problems and poverty.

DISCUSSION

More than half of children growing up in the UK are persistently exposed to either one or both of poor caregiver mental health and family poverty. The combination of these exposures is strongly associated with adverse health outcomes in the next generation.

Racial differences in associations between adverse childhood experiences and physical, mental, and behavioral health

Purpose

Adverse childhood experiences (ACEs) are associated with poor adulthood health. Multiracial people have elevated mean ACEs scores and risk of several outcomes. We aimed to determine whether this group should be targeted for prevention efforts.

Methods

We analyzed three waves (1994-2009) of the National Longitudinal Study of Adolescent to Adult Health (n = 12,372) in 2023, estimating associations between four or more ACEs and physical (metabolic syndrome, hypertension, asthma), mental (anxiety, depression), and behavioral (suicidal ideation, drug use) outcomes. We estimated adjusted risk ratios for each outcome in modified Poisson models interacting race and ACEs. We used the interaction contrast to estimate race-specific excess cases per 1000 relative to Multiracial participants.

Results

Excess case estimates of asthma were smaller for White (-123 cases, 95% CI: -251, -4), Black (-141, 95% CI: -285, -6), and Asian (-169, 95% CI: -334, -7) participants compared to Multiracial participants. Black (-100, 95% CI: -189, -10), Asian (-163, 95% CI: -247, -79) and Indigenous (-144, 95% CI: -252, -42) participants had fewer excess cases of and weaker relative scale association with anxiety compared to Multiracial participants.

Conclusions

Adjusted associations with asthma and anxiety appear stronger for Multiracial people. Existing ACEs prevention strategies should be tailored to support Multiracial youth and families.

Patterns of Social Determinants of Health and Child Mental Health, Cognition, and Physical Health

Importance

Social determinants of health (SDOH) influence child health. However, most previous studies have used individual, small-set, or cherry-picked SDOH variables without examining unbiased computed SDOH patterns from high-dimensional SDOH factors to investigate associations with child mental health, cognition, and physical health.

Objective

To identify SDOH patterns and estimate their associations with children's mental, cognitive, and physical developmental outcomes.

Design, Setting, and Participants

This population-based cohort study included children aged 9 to 10 years at baseline and their caregivers enrolled in the Adolescent Brain Cognitive Development (ABCD) Study between 2016 and 2021. The ABCD Study includes 21 sites across 17 states.

Exposures

Eighty-four neighborhood-level, geocoded variables spanning 7 domains of SDOH, including bias, education, physical and health infrastructure, natural environment, socioeconomic status, social context, and crime and drugs, were studied. Hierarchical agglomerative clustering was used to identify SDOH patterns.

Main Outcomes and Measures

Associations of SDOH and child mental health (internalizing and externalizing behaviors) and suicidal behaviors, cognitive function (performance, reading skills), and physical health (body mass index, exercise, sleep disorder) were estimated using mixed-effects linear and logistic regression models.

Results

Among 10 504 children (baseline median [SD] age, 9.9 [0.6] years; 5510 boys [52.5%] and 4994 girls [47.5%]; 229 Asian [2.2%], 1468 Black [14.0%], 2128 Hispanic [20.3%], 5565 White [53.0%], and 1108 multiracial [10.5%]), 4 SDOH patterns were identified: pattern 1, affluence (4078 children [38.8%]); pattern 2, high-stigma environment (2661 children [25.3%]); pattern 3, high socioeconomic deprivation (2653 children [25.3%]); and pattern 4, high crime and drug sales, low education, and high population density (1112 children [10.6%]). The SDOH patterns were distinctly associated with child health outcomes. Children exposed to socioeconomic deprivation (SDOH pattern 3) showed the worst health profiles, manifesting more internalizing (β = 0.75; 95% CI, 0.14-1.37) and externalizing (β = 1.43; 95% CI, 0.83-2.02) mental health problems, lower cognitive performance, and adverse physical health.

Conclusions

This study shows that an unbiased quantitative analysis of multidimensional SDOH can permit the determination of how SDOH patterns are associated with child developmental outcomes. Children exposed to socioeconomic deprivation showed the worst outcomes relative to other SDOH categories. These findings suggest the need to determine whether improvement in socioeconomic conditions can enhance child developmental outcomes.

Adolescents' internalizing symptoms predict dating violence victimization and perpetration 2 years later

The aim of this longitudinal study was to examine bidirectional associations of adolescents' internalizing symptoms with dating violence victimization and perpetration. We conducted secondary analyses of the Québec Longitudinal Study of Child Development data (n = 974). Each adolescent completed items from the Conflict Tactics Scale (at ages 15 and 17 years) to assess psychological, physical, and sexual dating violence victimization and perpetration in the past 12 months. Adolescents' symptoms of depression and general anxiety in the past 12 months were self-reported (at ages 15 and 17 years) using The Mental Health and Social Inadaptation Assessment for Adolescents. There were concurrent associations of adolescents' internalizing symptoms with dating violence victimization and perpetration. Internalizing symptoms at age 15 years were positively associated with dating violence victimization and perpetration 2 years later in both males and females, even after adjusting for baseline characteristics. However, neither dating violence victimization nor perpetration at age 15 years was associated with internalizing symptoms 2 years later. For males and females, internalizing symptoms put adolescents at risk for future dating violence victimization and perpetration. Interventions that target internalizing symptoms may have the potential to decrease subsequent dating violence.

A Review of the Relationship between Socioeconomic Status Change and Health

OBJECTIVES

This review aimed to identify and synthesize the existing literature on the effects of socioeconomic status (SES) changes on health.

METHODS

A review was conducted using Medline, Cochrane library, and CINAHL (Cumulative Index to Nursing and Allied Health Literature). All longitudinal or cross-sectional studies that examined links between changes to SES across different time periods and measured health outcomes were included. Screening was conducted using select inclusion and exclusion criteria in order of title, abstract, and full text. Two independent reviewers assessed the quality of the full text articles using the Downs and Black checklist.

RESULTS

Our literature search led to 2719 peer reviewed articles, 2639 of which were title screened after duplicates were removed. A total of 117 abstracts and 12 full text articles were screened. Overall, findings from 11 articles form the basis of this review. Eight different types of measures of changes to SES were identified. These include education, occupation, economic security, income sufficiency, home ownership, car ownership, health insurance, and marital status. Assessed outcomes included measures related to physical health, cardiovascular disease, mental health, and oral health. A large proportion of studies found that an SES change impacts health. Evidence suggests that those with consistently high SES have the best health outcomes, followed by those who report their SES change from low to high (upward social mobility). Evidence on the relative health effects for those who report their SES change from high to low (downward social mobility) compared to those who report consistently low SES is inconsistent.

CONCLUSION

Current evidence suggests that an SES change has an impact on an individual's health. More research on the effects of SES changes on health outcomes in adulthood is needed and can inform various areas of health research including health resiliency and development. Future studies should focus on individual SES indicators and their effects on health outcomes at multiple points throughout life.

Racial Differences in Associations Between Adverse Childhood Experiences and Physical, Mental, and Behavioral Health

Introduction

Adverse childhood experiences (ACEs) are associated with poor adulthood health, with individuals experiencing multiple ACEs at greatest risk. Multiracial people have high mean ACEs scores and elevated risk of several outcomes, but are infrequently the focus of health equity research. This study aimed to determine whether this group should be targeted for prevention efforts.

Methods

We analyzed Waves 1 (1994-95), 3 (2001-02), and 4 (2008-09) of the National Longitudinal Study of Adolescent to Adult Health (n = 12,372) in 2023, estimating associations between four or more ACEs and physical (metabolic syndrome, hypertension, asthma), mental (anxiety, depression), and behavioral (suicidal ideation, drug use) outcomes. We estimated risk ratios for each outcome in modified Poisson models with a race × ACEs interaction, adjusted for hypothesized confounders of the ACE-outcome relationships. We used the interaction contrast to estimate excess cases per 1,000 individuals for each group relative to Multiracial participants.

Results

Excess case estimates of asthma were significantly smaller for White (-123 cases, 95% CI: -251, -4), Black (-141, 95% CI: -285, -6), and Asian (-169, 95% CI: -334, -7) participants compared to Multiracial participants. Black (-100, 95% CI: -189, -10), Asian (-163, 95% CI: -247, -79) and Indigenous (-144, 95% CI: -252, -42) participants had significantly fewer excess cases of and weaker (p < 0.001) relative scale association with anxiety compared to Multiracial participants.

Conclusions

Adjusted associations between ACEs and asthma or anxiety appear stronger for Multiracial people than other groups. ACEs are universally harmful but may contribute disproportionately to morbidity in this population.

Bulimia symptoms and anger and aggression among adolescents

BACKGROUND

Previous research has indicated that anger and aggression may be elevated in adolescents with a bulimia nervosa (BN) diagnosis. However, as yet, little is known about whether bulimia symptoms are linked to anger and aggression in adolescents in the general population. To address this deficit this study aimed to explore the associations between a clinical level of bulimia symptoms (CLBS) and anger, anger rumination and aggression in community-based adolescents, and determine whether gender is important in this context.

METHODS

This study was conducted on a representative sample of youth from northwestern Russia (n = 2613, age 13-17 years old, 59.5% female) using self-report scales. A proxy variable for a CLBS was created using the Eating Disorder Diagnostic Scale. Aggression, anger and anger rumination were assessed by the Trait Anger Scale of the State Trait Anger Expression Inventory, the Anger Rumination Scale, and scales created to assess physically and verbally aggressive behavior. Multivariate analysis of covariance was used to examine the associations between the study variables.

RESULTS

A CLBS was more prevalent in girls than in boys (13.4% vs. 3.5%). The association with anger and aggression was stronger in both genders with a CLBS, compared to those adolescents without a CLBS. In the CLBS group, boys as compared to girls scored higher on verbal and physical aggression, anger rumination and social aggression. In both the CLBS and Non-CLBS groups higher anger and aggression scores were associated with increasing age.

CONCLUSIONS

Findings suggest that aggression and anger rumination are elevated in adolescents with BN symptoms, and that the associations between anger, aggression and BN symptoms may be stronger in boys. As previous research has indicated that the presence of aggressive behaviors may affect the prognosis of BN and complicate management of the disorder, clinician screening for these behaviors in adolescents with BN symptoms may facilitate the provision of more effective treatment, especially among boys.

Risk of depression mediates the association between cardiorespiratory fitness and academic performance in adolescent boys and girls: DADOS study

This study aims to analyze the mediating role of risk of depression in the association between cardiorespiratory fitness and academic performance in a sample of adolescents and to test the moderation effect of sex. A total of 263 adolescents (125 girls, 13.9 ± 0.3 years) from the DADOS (Deporte, ADOlescencia y Salud) study were included in the analysis. Cardiorespiratory fitness was assessed by the 20-m shuttle run test. Academic performance was assessed through the final academic grades and the test of educational abilities. Risk of depression was evaluated through the Behavior Assessment System for Children and Adolescents. Mediation analyses were performed to determine the direct and indirect associations between cardiorespiratory fitness, risk of depression, and academic performance. Indirect effects with confidence intervals not including zero were interpreted as statistically significant, and percentages of mediation were calculated in order to know how much of the association was explained by the mediation. Our findings indicated a significant mediating effect of risk of depression in the association between cardiorespiratory fitness with final grades in math, language, and grade point average (percentages of mediation: 26%, 53%, and 29%, respectively). These analyses were not moderated by sex (all confidence intervals included 0).

CONCLUSION

Risk of depression acts as a possible underlying mechanism in the association between cardiorespiratory fitness and academic grades in adolescents. Educational and health institutions could benefit from our findings since the promotion of higher cardiorespiratory fitness levels might reduce the risk of depression with potential benefits on adolescents' academic performance.

WHAT IS KNOWN

• Cardiorespiratory fitness is positively associated with academic performance in adolescents. Nevertheless, the psychological mechanisms underlying this association are poorly understood.

WHAT IS NEW

• Risk of depression mediates the association between cardiorespiratory fitness and academic performance in adolescents, independently of sex. • Our findings may improve the efficacy of mental health and educational programs by promoting the enhancement of cardiorespiratory fitness levels, which may reduce risk of depression with potential benefits on academic performance.

Adolescent Emotion Regulation and Future Psychopathology: A Prospective Transdiagnostic Analysis

Transdiagnostic frameworks posit a causal link between emotion regulation (ER) ability and psychopathology. However, there is little supporting longitudinal evidence for such frameworks. Among N = 1,262 adolescents, we examined the prospective bidirectional relationship between ER and future pathological anxiety, depression, and substance dependence symptoms in 10 assessment waves over 7 years. In Random-intercept cross-lagged panel models, within-person results do not reveal prospective lag-1 effects of either ER or symptoms. However, between-person analyses showed that dispositional ER ability at baseline predicted greater risk for developing clinically significant depression, anxiety, and substance dependence over the 7-year follow-up period. These findings provide some of the first direct evidence of prospective effects of ER on future symptom risk across affect-related disorders, and should strengthen existing claims that ER ability represents a key transdiagnostic risk factor.

Anxiety, Depression, and PTSD among College Students in the Post-COVID-19 Era: A Cross-Sectional Study

In the post-COVID-19 era, significant changes have taken place regarding the epidemic, the economy, family and social life. However, it remains unclear how these changes encompass the psychological symptoms of college students. We carried out a cross-sectional study to investigate anxiety, depression, and post-traumatic stress disorder (PTSD) symptoms among college students from 10 November 2020, to 16 November 2020. The questionnaire included a self-designed canvas, Generalized Anxiety Disorder 7 (GAD-7), Patient Health Questionnaire 9 (PHQ-9), and Impact of Event Scale (IES-R). Factors associated with psychological symptoms were estimated by ordered and non-conditional logistic regression analysis. Of 4754 participants, 25.0%, 29.7%, 3.4%, 15.3%, 17.1%, and 2.9% reported anxiety, depression, PTSD symptoms, one, any two, and all three, respectively. In cases with anxiety or depression symptoms, there was a 9.11% comorbidity with PTSD. Factors associated with fears of being infected, social, family, and economic changes increased the risk of psychological symptoms in college students caused by COVID-19. Female college students, identified with anxiety or depression symptoms, were at a lower risk of developing PTSD symptoms (OR, 0.61, 95% CI: 0.43-0.86). Non-medical majors at university, rural residence, higher educational background, fear of taking public transport, and deterioration of family relationships increased the risk for PTSD symptoms among male respondents with anxiety or depression symptoms due to COVID-19. Factors correlated with psychological symptoms had expanded from the fear of being infected to extensive social, family, and economic changes caused by COVID-19. Therefore, screening and interventions for psychological symptoms should be consistently strengthened and more targeted to college students in the post-COVID-19 era.

The relationship between subjective socioeconomic status and health in adults with and without intellectual disability

BACKGROUND

This study investigated if subjective socioeconomic status (SSS) is related to self-rated health (SRH) and objective indicators of health in people with and without intellectual disability.

METHODS

Participants were 217 adults with, and 2350 adults without intellectual disability in Jersey. In the intellectual disability sample, 85 (39.2%) participants consented independently, while 132 (60.8%) participants consented through proxy procedures. The MacArthur Scale of Subjective Social Status was used to measure SSS. The Euro-Qol EQ-5D-5L and a five-point scale ranging from poor to excellent health were used to measure SRH.

RESULTS

Higher SSS and younger age were predictors of better SRH for the proxy-report intellectual disability group. Being employed was associated with higher EQ-5D-5L index values for all intellectual disability groups.

CONCLUSION

As SSS was only related to SRH in the proxy intellectual disability group, further research with a larger intellectual disability sample is needed to explore its utility further.

Using Boosted Machine Learning to Predict Suicidal Ideation by Socioeconomic Status among Adolescents

(1) Background: This study aimed to use machine learning techniques to identify risk factors for suicidal ideation among adolescents and understand the association between these risk factors and socioeconomic status (SES); (2) Methods: Data from 54,948 participants were analyzed. Risk factors were identified by dividing groups by suicidal ideation and 3 SES levels. The influence of risk factors was confirmed using the synthetic minority over-sampling technique and XGBoost; (3) Results: Adolescents with suicidal thoughts experienced more sadness, higher stress levels, less happiness, and higher anxiety than those without. In the high SES group, academic achievement was a major risk factor for suicidal ideation; in the low SES group, only emotional factors such as stress and anxiety significantly contributed to suicidal ideation; (4) Conclusions: SES plays an important role in the mental health of adolescents. Improvements in SES in adolescence may resolve their negative emotions and reduce the risk of suicide.

Family Socioeconomic Status and Internalizing Problem Behavior Among Chinese Adolescents: The Chain Mediation Effect of Academic Performance and Peer Conflict

This study aims to provide a new perspective on the relationship between family socioeconomic status (SES) and internalizing problem behavior (IPB) among adolescents. Many studies have focused on the relationship between family SES and IPB among adolescents; however, research on the underlying mechanism is still insufficient, and peer conflict has been ignored as a crucial social relationship factor for adolescents. This study identifies two new mediating variables and a chain mediating mechanism model between them. Using national longitudinal data from 2,467 adolescents aged 10–15 published in the China Family Panel Studies of wave 2018, this study found the following: (1) higher family SES can significantly reduce peer conflict and IPB among adolescents; (2) adolescents with better academic performance were less likely to be involved in peer conflict; (3) peer conflict mediated 30.41% of the relationship between family SES and adolescent’s IPB; and (4) there was a chain mediating mechanism, and the mediating effect of peer conflict was much stronger than the mediating effect of both academic performance and the chain mediation pathways. This is the first study to develop a chain mediation model to examine the roles of academic achievement and peer conflict in the relationship between family SES and IPB. These findings are significant in that they highlight the importance of providing adolescents with proper emotional de-escalation and peer conflict resolution strategies, contributing to the management of adolescent mental health in urban governance and rural development.

School Discrimination, Discipline Inequities, and Adjustment Among Black Adolescent Girls and Boys: An Intersectionality-Informed Approach: Dismantling Systems of Racism and Oppression during Adolescence

Employing an intersectionality-informed approach, this investigation examines how school discrimination and disciplinary inequities shape Black adolescent boys' and girls' adjustment. One hundred and twenty-six adolescents (M = 11.88 years; SD = 1.02) residing in the Southeastern United States comprised the study sample. Results indicated that school discrimination was associated with greater depressive symptoms, lower academic persistence, and lower school satisfaction (at 1-year follow-up). In a counterintuitive pattern, adolescents' perceptions of disciplinary inequities were associated with greater persistence. This investigation provided partial support for gender variation. Perceptions of school disciplinary inequities were associated with lower educational aspirations for girls, whereas systemic school discrimination was more strongly associated with boys' educational aspirations. Overall, our study suggests that school-specific systemic discrimination and disciplinary practices shape Black adolescents' adjustment.

Adolescent depression screening in primary care: Who is screened and who is at risk?

BACKGROUND

Limited research has simultaneously focused on sociodemographic differences in who receives recommended adolescent depression screening in primary care and who endorses elevated depression and suicide risk on these screeners. We describe screening and risk rates in a large pediatric primary care network in the United States after the network expanded its universal depression screening guideline to cover all well-visits (i.e., annual medical checkups) for adolescents ages 12 and older.

METHODS

Between November 15, 2017 and February 1, 2020, there were 122,682 well-visits for adolescents ages 12-17 (82,531 unique patients). The Patient Health Questionnaire - Modified for Teens (PHQ-9-M) was administered to screen for depression.

RESULTS

A total of 99,961 PHQ-9-Ms were administered (screening rate=81.48%). The likelihood of screening was higher among adolescents who were female, 12-14 years of age at their first well-visit during the study, White, Hispanic/Latino, or publicly-insured (i.e., Medicaid-insured). Additionally, 5.92% of adolescents scored in the threshold range for depression symptoms and 7.19% endorsed suicidality. Heightened depression and suicide risk were observed among adolescents who were female, 15-17 years of age at their first well-visit during the study, Black, Hispanic/Latino, attending urban primary care practices, or Medicaid-insured. Odds of endorsing suicidality were also higher among teens who identified as other races.

LIMITATIONS

Limitations related to data available in the electronic health record and reliance on data from a single hospital system are noted.

CONCLUSIONS

Findings highlight misalignments in screening and risk status that are important to address to ensure more equitable screening implementation and health outcomes.

High Parental Education Protects Against Changes in Adolescent Stress and Mood Early in the COVID-19 Pandemic

PURPOSE

The COVID-19 pandemic has brought dramatic changes to the daily lives of U.S. adolescents, including isolation from friends and extended family, transition to remote learning, potential illness and death of loved ones, and economic distress. This study's purpose is to measure changes in adolescents' perceived stress and mood early in the pandemic.

METHODS

The present study drew from a racially and ethnically diverse sample of high school student participants in an ongoing intervention study in the Midwestern U.S., 128 of whom provided reports of their daily stress and mood both before (December 2017 to March 2020) and during (March-July 2020) the COVID-19 pandemic. We expected to see increases in perceived stress, declines in positive mood states, and increases in negative mood states, with larger impacts on individuals from households with lower parental education levels.

RESULTS

Multilevel models revealed increases in perceived stress primarily for adolescents from low/moderate education families during the pandemic. Impacts on mood states also diverged by education: adolescents from low/moderate education households reported feeling more ashamed, caring, and excited than before the pandemic, changes that were not shared by their peers from high education households. Although changes in mood that arose with the onset of the pandemic became less pronounced over time, increased levels of home- and health-related stress stayed high for low/moderate education adolescents.

CONCLUSIONS

During the COVID-19 period, we observed disparate impacts on adolescents according to household education level, with more dramatic and negative changes in the emotional well-being of adolescents from low/moderate education households.

No associations in preregistered study of youth depression and functional connectivity of fronto-parietal and default mode networks

Adolescence is characterized by vulnerability to the onset of major depressive disorder (MDD). The goal of this preregistered study was to assess neural correlates of depression symptoms in young adolescents, both cross-sectionally and longitudinally. The default mode network (DMN) is believed to support internal attention towards self-referential thoughts, while the fronto-parietal network (FPN) is theorized to support cognitive control and regulation of attention. As MDD diagnosis has been associated with heightened connectivity within DMN regions and diminished connectivity within FPN regions relative to healthy controls, our study builds upon group-difference analyses by using dimensional measures of depression severity. Our preregistered hypotheses were that within-DMN functional connectivity would be positively associated with concurrent depression severity, while within-FPN functional connectivity would be negatively associated with concurrent depression severity. Preregistered analyses also examined between DMN-FPN connectivity as an alternative predictor variable, and assessed the longitudinal associations between all three functional connectivity measures and change in depression severity over three subsequent waves. Multiple regression models tested cross-sectional analyses and hierarchical linear models tested longitudinal analyses. One hundred and twenty-four youth completed a resting state functional MRI. Their depression severity was assessed at the time of the scan and at three follow-up sessions. None of the predictor variables were associated with concurrent depression severity, nor with the slope of depression symptom trajectories in longitudinal analyses. These negative results add to extant cross-sectional studies, and may inform future investigations of brain correlates of depression psychopathology in youth.

The influence of childhood adversities on mid to late cognitive function: From the perspective of life course

Background

The effects of childhood adversities on cognitive function in later life are well reported. However, few studies have examined the cumulative mechanism, especially in Chinese population. This study aims to explore this cumulative effects of childhood adversities on mid to late cognitive decline in China.

Methods

Data were drawn from the second and third wave of the China Health and Retirement Longitudinal Study (CHARLS). We included 9,942 respondents aged 45 and above and retrospectively collected information on childhood adversities. Cognitive function was measured in three dimensions: orientation and calculation, immediate memory, and delayed memory. A structural equation model was employed for analysis.

Results

Age (β = -0.155, P<0.001) and mid to late depressive symptoms (β = -0.041, P<0.001) showed direct effects on cognitive decline. Low mid to late life socioeconomic status (SES) showed a direct effect on mid-late cognitive impairment (β = 0.603, P<0.001) and an indirect effect through depression (β = 0.007, P<0.001). Low childhood SES (β = 0.310, P<0.001), lack of friends (β = 0.208, P<0.001), parental mental health problems (β = 0.008, P<0.001), and poor relationship with parents (β = 0.001, P<0.001) had an indirect effect on cognitive impairment.

Conclusions

Childhood adversities had negative effects on cognitive function among middle aged and elderly population in China. The findings suggest that early counter measures on childhood adversities may lead to an effective reduction of cognitive impairment.

In Their Own Words: Parents and Key Informants' Views on Nutrition Education and Family Health Behaviors

Parents, health professionals, and communities are integral in the development of nutrition behaviors that reduce children's risk for high body mass index (BMI) and chronic disease. The aim of this study was to conduct formative evaluations with key health informants and parents to understand the specific strategies that families use at mealtimes to promote their family's health, along with the barriers they face in attending current nutrition education programming. Focus groups (in English and Spanish) were conducted with parents (n = 22; 63.64% Black/African American, 13.64% Black but not African American, 18.18% Hispanic/Latinx) whose household was located in a community where 50% of residents' gross income was ≤185% of the federal poverty level. Semi-structured interviews were conducted with six key informants with expertise in family health and nutrition. Inductive thematic analysis was used to identify themes across interviews. Six general themes emerged from the interviews including perceptions of health, relationships, health behaviors, facilitators, barriers, and desired changes. Across the six themes, participants responded with suggestions for community-based health promotion programs such as incorporating a broader definition of health to better address the individual and systemic barriers that perpetuate health inequities and make healthy eating difficult. Participants identified stress reduction, health literacy, and cooking knowledge as areas of interest for future programming.

An examination of the association between risk of depression and academic performance according to weight status in adolescents: DADOS study

BACKGROUND

The early identification of emotional and psychological problems during adolescence seems helpful to improve academic performance (AP). However, the association between risk of depression and AP, as well as the role of health-related factors in this association remain to be elucidated. Therefore, the aims of this study were to analyze the association between risk of depression and AP in adolescents; to examine this association according to weight status; and to test the mediating role of weight status in this association.

METHODS

A sample of 265 adolescents (125 girls) aged 13.9 ± 0.3 years old from the DADOS (Deporte, ADOlescencia y Salud) study was included in the analyses. Risk of depression was self-reported through the Behavior Assessment System for Children and Adolescents. AP was assessed through academic grades and the Spanish version of the Science Research Associates Test of Educational Ability. Weight status was assessed by body mass index (BMI) (kg/m²) and dichotomized according to the international age- and sex-specific BMI cut-offs (non-overweight vs. overweight).

RESULTS

Linear regression analyses showed an inverse association between risk of depression and academic grades (all p<0.05). Further linear regressions analyzing risk of depression and AP (dependent variable) stratified by weight status showed stronger associations among overweight adolescents. Additionally, mediation analyses revealed that weight status acted as a mediator of this association.

LIMITATIONS

The cross-sectional design prevents from interfering causal relationships.

CONCLUSIONS

Educational institutions should promote the early identification of depression as well as the promotion of healthy weight status as strategies to enhance AP in adolescents.

Concentrated Poverty in U.S. Schools and Adolescents' Risk of Being Overweight

The economic segregation of U.S. schools undermines the academic performance of students, particularly students from low-income families who are often concentrated in high-poverty schools. Yet it also fuels the reproduction of inequality by harming their physical health. Integrating research on school effects with social psychological and ecological theories on how local contexts shape life course outcomes, we examined a conceptual model linking school poverty and adolescent students' weight. Applying multilevel modeling techniques to the first wave of data (1994-1995) from the National Longitudinal Study of Adolescent to Adult Health (Add Health; n = 18,924), the results revealed that individual students' likelihood of being overweight increased as the concentration of students from low-income families in their schools increased, net of their own background characteristics. This linkage was connected to a key contextual factor: the exposure of students in high-poverty schools to other overweight students. This exposure may partly matter because of the lower prevalence of dieting norms in such schools, although future research should continue to examine potential mechanisms.

Longitudinal Relationships among Cybervictimization, Peer pressure, and Adolescents' Depressive Symptoms

BACKGROUND

Most studies have used cross-sectional designs, very few of which have examined the bidirectional relationship between cybervictimization and depressive symptoms. This study examined bidirectional relationships among adolescents' cybervictimization, peer pressure, and depressive symptoms, and the mediating effect of peer pressure. As a further expansion of the present study, we examined whether these relationships would vary as the roles of gender and economic stress.

METHODS

Participants were 2,407 adolescents (M_age = 12.75, SD = 0.58; n_male = 1191). They provided data in two waves (12 months apart).

RESULTS

Results showed that there were significant bidirectional relationships between cybervictimization and depressive symptoms and peer pressure. Peer pressure significantly mediated the relationship between cybervictimization at Time 1 and depressive symptoms at Time2. For males, the relationship between cybervictimization at Time 1 and depressive symptoms at Time2 became stronger. For females, there was no significant bidirectional relationship between cybervictimization and depressive symptoms. In addition, family socioeconomic status and adolescents perceived economic stress did not moderate the longitudinal relationships among cybervictimization, peer pressure, and depressive symptoms.

LIMITATIONS

Different types of victimization needed to be included. In addition, more waves data served to explore the mediating effects.

CONCLUSIONS

The increase of cybervictimization predicts higher levels of adolescents' depressive symptoms, but only for males and not for females. Peer pressure mediates the relationship between cybervictimization and depressive symptoms.

Intelligence and academic achievement in inpatient adolescents with comorbid anxiety and depression

Few studies have investigated the relationship between comorbid depression and anxiety and cognitive and academic functioning. To understand this relationship, this study used a retrospective chart review from an inpatient facility for 42 adolescents diagnosed with a comorbid anxiety and depressive disorder. Multiple regression was used to determine whether anxiety and depression predicted academic achievement, as well as whether intelligence predicted current levels of anxiety and depression. Results indicated that higher severity of depression was associated with lower reading (β = -0.39) and writing (β = -0.40) achievement, while higher severity of anxiety was associated with higher scores on reading (β = 0.41) and writing (β = 0.36). Full-scale IQ was not significantly predictive of anxiety severity (β = 0.08) or depression severity (β = -0.24). Results are discussed in terms of identifying risk factors and improving outcomes for adolescents with severe comorbid anxiety and depression psychopathology.

Parental Education and Left Lateral Orbitofrontal Cortical Activity during N-Back Task: An fMRI Study of American Adolescents

Introduction. The Orbitofrontal Cortex (OFC) is a cortical structure that has implications in cognition, memory, reward anticipation, outcome evaluation, decision making, and learning. As such, OFC activity correlates with these cognitive brain abilities. Despite research suggesting race and socioeconomic status (SES) indicators such as parental education may be associated with OFC activity, limited knowledge exists on multiplicative effects of race and parental education on OFC activity and associated cognitive ability. Purpose. Using functional brain imaging data from the Adolescent Brain Cognitive Development (ABCD) study, we tested the multiplicative effects of race and parental education on left lateral OFC activity during an N-Back task. In our study, we used a sociological rather than biological theory that conceptualizes race and SES as proxies of access to the opportunity structure and exposure to social adversities rather than innate and non-modifiable brain differences. We explored racial variation in the effect of parental educational attainment, a primary indicator of SES, on left lateral OFC activity during an N-Back task between Black and White 9–10 years old adolescents. Methods. The ABCD study is a national, landmark, multi-center brain imaging investigation of American adolescents. The total sample was 4290 9–10 years old Black or White adolescents. The independent variables were SES indicators, namely family income, parental education, and neighborhood income. The primary outcome was the average beta weight for N-Back (2 back versus 0 back contrast) in ASEG ROI left OFC activity, measured by functional Magnetic Resonance Imaging (fMRI) during an N-Back task. Ethnicity, age, sex, subjective SES, and family structure were the study covariates. For data analysis, we used linear regression models. Results. In White but not Black adolescents, parental education was associated with higher left lateral OFC activity during the N-Back task. In the pooled sample, we found a significant interaction between race and parental education on the outcome, suggesting that high parental education is associated with a larger increase in left OFC activity of White than Black adolescents. Conclusions. For American adolescents, race and SES jointly influence left lateral OFC activity correlated with cognition, memory, decision making, and learning. Given the central role of left lateral OFC activity in learning and memory, our finding calls for additional research on contextual factors that reduce the gain of SES for Black adolescents. Cognitive inequalities are not merely due to the additive effects of race and SES but also its multiplicative effects.

Estimation of national stress index using socioeconomic antecedents - a case of MIMIC model

Developed economies are at the forefront of facing the brunt of non-communicable diseases (NCD). The majority of the health expenditures are routed in managing obesity and mental disorder-related patients, and there is a fall in the productivity of the distressed and NCD prone labour. Several indicators of stress are used in literature to assess its implications. However, empirically no database has maintained the longitudinal data of national stress level. This study focused on constructing the socioeconomic antecedent of non-communicable stress which is leading to several NCDs. For this Multiple Indicator and Multiple Causes (MIMIC) model is utilized for 151 countries between 2008 and 2018. The results show that macroeconomic conditions, trade, and environmental quality follow fundamentals in explaining stress. While, national stress index is a significant source of smoking and mental disorder prevalence.

Do funding sources influence long-term patient survival in pediatric liver transplantation?

BACKGROUND

Socioeconomic status has been associated with inferior outcomes after multiple surgical procedures, but has not been well studied with respect to pediatric liver transplantation. This study evaluated the impact of insurance status (as a proxy for socioeconomic status) on patient and allograft survival in pediatric first-time liver transplant recipients.

METHODS

Our retrospective analysis of the UNOS data base from January 2002 through September 2017 revealed 6997 pediatric patients undergoing first-time isolated liver transplantation. A mixed Cox proportional hazards model adjusted for donor, recipient, and program characteristics determined the RR of insurance status on allograft and patient survival. All results were considered significant at P < .05. All statistical results were obtained using R version 3.5.1 and coxme version 2.2-10.

RESULTS

Medicaid status had a significant negative impact on long-term survival after controlling for multiple covariates. Pediatric patients undergoing first-time isolated liver transplantation with Medicaid insurance had a RR of 1.42 [confidence interval: 1.18-1.60] of post-transplant death.

CONCLUSION

Pediatric patients undergoing first-time isolated liver transplantation have multiple risk factors that may impact long-term survival. Having Medicaid insurance almost doubles the chances of dying post-liver transplant. This patient population may require more global support post-transplant to improve long-term survival.

Socioeconomic status and child psychopathology in the United States: A meta-analysis of population-based studies

Children raised in families with low socioeconomic status (SES) are more likely to exhibit symptoms of psychopathology. However, the strength of this association, the specific indices of SES most strongly associated with childhood psychopathology, and factors moderating the association are strikingly inconsistent across studies. We conducted a meta-analysis of 120 estimates of the association between family SES and child psychopathology in 13 population-representative cohorts of children studied in the US since 1980. Among 26,715 participants aged 3-19 years, we observed small to moderate associations of low family income (g = 0.19), low Hollingshead index (g = 0.21), low subjective SES (g = 0.24), low parental education (g = 0.25), poverty status (g = 0.25), and receipt of public assistance (g = 0.32) with higher levels of childhood psychopathology. Moderator testing revealed that receipt of public assistance showed an especially strong association with psychopathology and that SES was more strongly related to externalizing than internalizing psychopathology. Dispersion in our final, random effects, model suggested that the relation between SES and child psychopathology is likely to vary in different populations of children and in different communities. These findings highlight the need for additional research on the mechanisms of SES-related psychopathology risk in children in order to identify targets for potential intervention.

Parental Education, Household Income, Race, and Children's Working Memory: Complexity of the Effects

Background. Considerable research has linked social determinants of health (SDoHs) such as race, parental education, and household income to school performance, and these effects may be in part due to working memory. However, a growing literature shows that these effects may be complex: while the effects of parental education may be diminished for Blacks than Whites, household income may explain such effects. Purpose. Considering race as sociological rather than a biological construct (race as a proxy of racism) and built on Minorities' Diminished Returns (MDRs), this study explored complexities of the effects of SDoHs on children's working memory. Methods. We borrowed data from the Adolescent Brain Cognitive Development (ABCD) study. The total sample was 10,418, 9- and 10-year-old children. The independent variables were race, parental education, and household income. The primary outcome was working memory measured by the NIH Toolbox Card Sorting Test. Age, sex, ethnicity, and parental marital status were the covariates. To analyze the data, we used mixed-effect regression models. Results. High parental education and household income were associated with higher and Black race was associated with lower working memory. The association between high parental education but not household income was less pronounced for Black than White children. This differential effect of parental education on working memory was explained by household income. Conclusions. For American children, parental education generates unequal working memory, depending on race. This means parental education loses some of its expected effects for Black families. It also suggests that while White children with highly educated parents have the highest working memory, Black children report lower working memory, regardless of their parental education. This inequality is mainly because of differential income in highly educated White and Black families. This finding has significant public policy and economic implications and suggests we need to do far more than equalizing education to eliminate racial inequalities in children's cognitive outcomes. While there is a need for multilevel policies that reduce the effect of racism and social stratification for middle-class Black families, equalizing income may have more returns than equalizing education.

The persistence of child and adolescence mental healthcare: results from registry data

Background

Previous studies on the persistence of child and adolescent mental healthcare do not consider the role of time-invariant individual characteristics. Estimating persistence of healthcare using standard linear models yields biased estimates due to unobserved heterogeneity and the autoregressive structure of the model. This study provides estimates of the persistence of child and adolescent mental healthcare taking these statistical issues into account.

Methods

We use registry data of more than 80,000 Dutch children and adolescents between 2000 and 2012 from the Psychiatric Case Registry Northern Netherlands (PCR-NN). In order to account for autocorrelation due to the presence of a lagged dependent variable and to distinguish between persistence caused by time-invariant individual characteristics and a direct care effect we use difference GMM-IV estimation. In further analyses we assess the robustness of our results to policy reforms, different definitions of care and diagnosis decomposition.

Results

All estimation results for the direct care effect (true state-dependence) show a positive coefficient smaller than unity with a main effect of 0.215 (p<0.01), which indicates that the process is stable. Persistence of care is found to be 0.065 (p<0.05) higher for females. Additionally, the majority of persistence of care appears to be associated with time-invariant characteristics. Further analyses indicate that (1) results are robust to different definitions of care and (2) persistence of care does not differ significantly across subgroups.

Conclusions

The results indicate that the majority of mental healthcare persistence for children and adolescents is due to time-invariant individuals characteristics. Additionally, we find that in the absence of further shocks a sudden increase of 10 care contacts in the present year is associated with an average of less than 3 additional care contacts at some point in the future. This result provides essential information about the necessity of budget increases for future years in the case of exogenous increases in healthcare use.

Effect of one year krill oil supplementation on depressive symptoms and self-esteem of Dutch adolescents: A randomized controlled trial

INTRODUCTION

Observational studies have shown a relationship between omega-3 long-chain polyunsaturated fatty acids (n-3 LCPUFA) and depression in adolescents. However, n-3 LCPUFA supplementation studies investigating the potential improvement in depressive feelings in adolescents from the general population are missing.

METHODS

A one-year double-blind, randomized, placebo controlled krill oil supplementation trial was conducted in two cohorts. Cohort I started with 400 mg eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) or placebo, after three months this increased to 800 mg EPA and DHA per day, whilst cohort II started with this higher dose. Omega-3 Index (O3I) was monitored via finger-prick blood measurements. At baseline, six and 12 months participants completed the Centre for Epidemiologic Studies Depression Scale (CES-D) and the Rosenberg Self Esteem questionnaire (RSE). Adjusted mixed models were run with treatment allocation/O3I as predictor of CES-D and RSE scores.

RESULTS

Both intention-to-treat and assessing the change in O3I analyses did not show significant effects on CES-D or RSE scores.

CONCLUSION

There is no evidence for less depressive feelings, or higher self-esteem after one year of krill oil supplementation. However, due to a lack of adherence and drop-out issues, these results should be interpreted with caution.

Association between Weight Status and Mental Health Service Utilization in Children and Adolescents

BACKGROUND

Previous literature reports inconsistent associations between obesity and mental health. The objective of this study was to determine the association between weight status and mental health service utilization in Ontario children and youth.

METHODS

A cross-sectional study of children 0 to 18 years, identified using primary care electronic medical records from the EMRPC database in Ontario, Canada was conducted. Height and weight data were extracted to calculate BMI and linked to administrative data on mental health related outpatient visits, emergency department visits, and hospitalizations. Multivariable logistic regression models were performed.

RESULTS

A total of 50,565 children were included. Overall, 2.2% were underweight, 70.4% had a normal weight, 18.3% were overweight, 6.9% had obesity and 2.2% had severe obesity. 28.2% of all children had at least one mental health visit. Multivariable analyses showed children with overweight, obesity, and severe obesity were 1.11 (95% CI 1.05-1.17), 1.18 (95% CI 1.08-1.27) and 1.39 (95% CI 1.22-1.59) times more likely to have an outpatient mental health visit compared to children with normal weight.

CONCLUSION

Increased weight status was associated with mental health related outpatient visits and emergency department visits. This study may inform policy makers' planning of mental health resources for children with obesity and severe obesity.

Subjective Socioeconomic Status and Children's Amygdala Volume: Minorities' Diminish Returns

Considerable research has suggested that low socioeconomic status (SES) negatively influences brain structure, including but not limited to decreased amygdala volume. Considering race and ethnicity as sociological rather than biological constructs, this study was built on minorities' diminished returns (MDRs) to test if the effects of family SES on the total amygdala volume is weaker for black and Latino children than white and non-Latino children. We borrowed data from the Adolescent Brain Cognitive Development (ABCD) study, a national multi-center brain imaging investigation of childhood brain development in the US. The total sample was 9380 9-10-year-old children. The independent variables were subjective family SES and parental education. The primary outcome was total amygdala volume. High subjective SES and parental education were independently associated with larger total amygdala size. The association between high subjective SES and larger total amygdala volume was less pronounced for black and Latino children than white and non-Latino children. For American children, family SES has unequal effects on amygdala size and function, a pattern that is consistent with MDRs. This result suggests that SES loses some of its expected effects for racial and ethnic minority families.

Family Income Mediates the Effect of Parental Education on Adolescents' Hippocampus Activation During an N-Back Memory Task

Introduction: Hippocampus, a medial temporal lobe structure, has significant implications in memory formation and learning. Although hippocampus activity is believed to be affected by socioeconomic status (SES), limited knowledge exists on which SES indicators influence hippocampus function. Purpose: This study explored the separate and combined effects of three SES indicators, namely parental education, family income, and neighborhood income, on adolescents’ hippocampus activation during an N-Back memory task. As some of the effects of parental education may be through income, we also tested if the effect of parental education on hippocampus activation during our N-Back memory task is mediated by family or neighborhood income. Methods: The Adolescent Brain Cognitive Development (ABCD) study is a national multi-center investigation of American adolescents’ brain development. Functional magnetic resonance imaging (fMRI) data of a total sample of 3067 9–10-year-old adolescents were used. The primary outcome was left- hippocampus activation during the N-Back memory task (mean beta weight for N-Back run 1 2 back versus 0 back contrast in left hippocampus). The independent variable was parental education. Family income and neighborhood income were two possible mediators. Age, sex, and marital status were the covariates. To test mediation, we used hierarchical linear regression models first without and then with our mediators. Full mediation was defined according to Kenny. The Sobel test was used to confirm statistical mediation. Results: In the absence of family and neighborhood income in the model, higher parental educational attainment was associated with lower level of left hippocampus activation during the N-Back memory task. This effect was significant while age, sex, and marital status were controlled. The association between parental educational attainment and hippocampus activation during the N-Back memory task was no more significant when we controlled for family and neighborhood income. Instead, family income was associated with hippocampus activation during the N-Back memory task. These findings suggested that family income fully mediates the effect of parental educational attainment on left hippocampus activation during the N-Back memory task. Conclusions: The effect of parental educational attainment on adolescents’ hippocampus activation during an N-Back memory task is fully explained by family income. That means low family income is why adolescents with low-educated parents show highlighted hippocampus activation during an N-Back memory task. Given the central role of the hippocampus in learning and memory and as income is a modifiable factor by tax and economic policies, income-redistribution policies, fair taxation, and higher minimum wage may have implications for promotion of adolescent equality and social justice. There is a need to focus on family-level economic needs across all levels of neighborhood income.

Evidence for skin-deep resilience using a co-twin control design: Effects on low-grade inflammation in a longitudinal study of youth

This study tested the skin-deep resilience hypothesis - that low socioeconomic status (SES) youth who are working hard to succeed in life experience good psychological and educational outcomes but at a cost to their physical health - in a sample of monozygotic (MZ) twins. The National Longitudinal Study of Adolescent Health (Add Health) contained a sample of 226 MZ twin pairs at Wave 1 (M age = 16 years), of whom 141 pairs completed the Wave 4 assessment 13 years later (M age = 29 years). Family SES was measured at Wave 1 via income, education, and occupation. Conscientiousness was measured at Wave 4 as an indicator of those who were working hard to succeed in life. Outcomes measured at Wave 4 included low-grade inflammation (C-reactive protein, CRP), mental health (depression, problematic alcohol use), and academic success (educational attainment). A co-twin control design was utilized which directly compared within-twin differences in the association between conscientiousness and life outcomes. Main effects of between-twin conscientiousness were found such that higher levels of conscientiousness were associated with higher educational attainment, fewer symptoms of depression, and less problematic alcohol use, across all SES groups. An interaction between family SES and within-twin difference in conscientiousness was found for CRP, such that, among twins growing up in lower SES households, the twin with higher levels of conscientiousness had higher levels of CRP. These patterns provide support for the phenomenon of skin-deep resilience using a twin methodology that reduces the possibility of confounding by shared genetic and environmental factors.

Demographic, Social, and Economic Factors of Internalizing Problems in Referred and Non-Referred Adolescents

Depressive symptoms and suicidal ideation are common internalizing problems during adolescence. Numerous studies have explored the role of certain demographic, social, and economic factors in their development in referred or non-referred adolescents, but not simultaneously in both groups. In this study, we examined the association between age, gender, parents’ educational level, and socioeconomic status (SES) and depressive symptoms and suicidal ideation in a referred group (n = 211) and a non-referred (n = 1401) group of adolescents. We also examined the moderating role that these factors play in the relationships between both internalizing problems. The results showed: higher levels of depressive symptoms and suicidal ideation in the referred group; an increase in both problems during early-to-middle adolescence in the non-referred group; an association between low SES and suicidal ideation in both groups; an association between low father’s education level and depressive symptoms in the non-referred group; and no gender differences in either of these two internalizing problems. The moderation analyses showed that age, in referred adolescents, and SES, in non-referred adolescents, moderated the relationship between depressive symptoms and suicidal ideation. This study contributes to the identification of groups of vulnerable adolescents that could constitute the target populations of preventive programs.

Protective factors for youth confronting economic hardship: Current challenges and future avenues in resilience research

Economic hardship during childhood is associated with worse mental and physical health across the life span. Over the past decade, interdisciplinary research has started to elucidate the behavioral and biological pathways that underlie these disparities and identify protective factors that mitigate against their occurrence. In this integrative review we describe these advances, highlight remaining gaps in knowledge, and outline a research agenda for psychologists. This article has 3 aims. First, we consider the evolving psychobiological literature on protective factors and conclude that supportive relationships can mitigate against the physical health problems often associated with economic hardship. Second, we discuss recent empirical developments in health psychology, public health, and the biological sciences, which reveal trade-offs associated with adaptation and challenge the conception of what it means to be resilient. Finally, we outline a research agenda that attempts to integrate existing knowledge on health disparities with these newer challenges to inform both policy and practice for youth experiencing economic hardship. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The Politics of Health Care: Health Disparities, the Affordable Care Act, and Solutions for Success

This article explores why racial and income health disparities continue to exist in the United States. Poverty and racism are the primary drivers of the social problem which impact social determinants of health for vulnerable populations. The theoretical frameworks of conflict theory and critical race theory contextualize the causes and provide direction for overhauling public health policy in general and the Patient Protection and Affordable Care Act (Affordable Care Act) in particular. Although the Affordable Care Act was implemented to increase health coverage, economic and racial health inequities still exist in the United States. Policy recommendations for improving the health and welfare of low-income minorities include: 1) impacting poverty itself by desegregating urban areas of concentrated poverty, and 2) impacting racial discrimination in health care by putting the voices of African-American patients in the forefront to inform culturally relevant policy and practice.

Anxiety and depression in children and adolescents with obesity: a nationwide study in Sweden

BACKGROUND

Anxiety and depression are more common in children with obesity than in children of normal weight, but it is unclear whether this association is independent of other known risk factors. Interpretation of results from previous studies is hampered by methodological limitations, including self-reported assessment of anxiety, depression, and anthropometry. The aim of this study was to investigate whether obesity increases the risk of anxiety or depression independently of other risk factors in a large cohort of children and adolescents, using robust measures with regard to exposure and outcome.

METHODS

Children aged 6-17 years in the Swedish Childhood Obesity Treatment Register (BORIS, 2005-2015) were included (n = 12,507) and compared with a matched group (sex, year of birth, and area of residence) from the general population (n = 60,063). The main outcome was a diagnosis of anxiety or depression identified through ICD codes or dispensed prescribed medication within 3 years after the end of obesity treatment. Hazard ratios (HRs) with 95% confidence intervals (CIs) from Cox proportional models were adjusted for several known confounders.

RESULTS

Obesity remained a significant risk factor for anxiety and depression in children and adolescents after adjusting for Nordic background, neuropsychiatric disorders, family history of anxiety/depression, and socioeconomic status. Girls in the obesity cohort had a 43% higher risk of anxiety and depression compared to girls in the general population (adjusted HR 1.43, 95% CI 1.31-1.57; p < 0.0001). The risk in boys with obesity was similar (adjusted HR 1.33, 95% CI 1.20-1.48; p < 0.0001). In sensitivity analyses, excluding subjects with neuropsychiatric disorders and a family history of anxiety/depression, the estimated risks in individuals with obesity were even higher compared with results from the main analyses (adjusted HR [95% CI]: girls = 1.56 [1.31-1.87], boys = 2.04 [1.64-2.54]).

CONCLUSIONS

Results from this study support the hypothesis that obesity per se is associated with risk of both anxiety and depression in children and adolescents.

Adolescents' Subjective Social Status Predicts Day-to-Day Mental Health and Future Substance Use

Adolescents' subjective social status (SSS) is associated with mental and behavioral health outcomes, independent of socioeconomic status (SES). Many previous findings, however, come from cross-sectional studies. We report results from a longitudinal study with 151 adolescents identified as at risk for early substance use and behavioral problems sampled from low-SES neighborhoods. We examined whether adolescent's SSS predicted mental health (depression, anxiety, and inattention/impulsivity) measured over 30 days via ecological momentary assessment and risk for substance use at an 18-month follow-up. Results showed that with each perceived step "up" the SSS ladder, adolescents experienced fewer mental health symptoms in daily life and lower future substance use risk after adjusting for objective SES and previous psychopathology. Implications of these findings are discussed.

Epigenetics, Gender, and Sex in the Diagnosis of Depression

Background :

A marked sexual dimorphism exists in psychiatric diagnoses. Culture derived gender bias in diagnostic criteria is one explanation. Adverse childhood events, including sexual and physical abuse, are more reliable and consistent predictors of later psychiatric diagnoses, including depression and post-traumatic stress disorder. Some interesting interactions between genes and experience have been uncovered, but the primary effect appears to be epigenetic with life experience altering gene expression and being transmitted to subsequent generations.

Objectives :

To determine if reconceptualizing depression as encompassing both internalizing and externalizing strategies would eliminate gender differences in the diagnosis of depression

Methods :

We reviewed 74 life stories of patients, collected during a study of the effect of physicians’ knowing patients’ life stories on the quality of the doctor-patient relationship. Looking at diagnoses, the prevalence of women to men was 2.9 to 1. We redefined depression as a response to being in a seemingly hopeless situation accompanied by despair, either externalizing ((more often diagnosed as substance use disorders, impulse control disorders, antisocial personality disorder, or bipolar disorder) or internalizing (the more standard diagnosis of depression). Then we reviewed these life stories from that perspective to determine how many would be diagnosed as depressed.

Results :

With this reconceptualization of depression, the sex ratio changed to 1.2 to 1.

Conclusions:

From this perspective, men and women are equally likely to respond to hopelessness, though men are more socialized to externalize and women to internalize. Considering depression in this way may help to better identify men at risk for suicide.

Neighborhood Poverty and Amygdala Response to Negative Face

Introduction

Considerable research has established a link between socioeconomic status (SES) and brain function. While studies have shown a link between poverty status and amygdala response to negative stimuli, a paucity of knowledge exists on whether neighborhood poverty is also independently associated with amygdala hyperactive response to negative stimuli.

Purpose

Using functional brain imaging data, this study tested the association between neighborhood SES and the amygdala's response to negative stimuli. Considering race as a sociological rather than a biological construct, we also explored racial heterogeneity in this association between non-Hispanic Black and non-Hispanic White youth.

Methods

We borrowed the functional Magnetic Resonance Imaging (fMRI) data of the Adolescent Brain Cognitive Development (ABCD) study. The sample was 2,490 nine to ten year old non-Hispanic Black and non-Hispanic White adolescents. The independent variable was neighborhood income which was treated as a continuous measure. The primary outcomes were the right and left amygdala response to negative face during an N-Back task. Age, sex, race, marital status, and family SES were the covariates. To analyze the data, we used linear regression models.

Results

Low neighborhood income was independently associated with a higher level of amygdala response to negative face. Similar results were seen for the right and left amygdala. These effects were significant net of race, age, sex, marital status, and family SES. An association between low neighborhood SES and higher left but not right amygdala response to negative face could be observed for non-Hispanic Black youth. No association between neighborhood SES and left or right amygdala response to negative face could be observed for non-Hispanic White youth.

Conclusions

For American youth, particularly non-Hispanic Black youth, living in a poor neighborhood predicts the left amygdala reaction to negative face. This result suggested that Black youth who live in poor neighborhoods are at a high risk of poor emotion regulation. This finding has implications for policy making to reduce inequalities in undesired behavioral and emotional outcomes. Policy solutions to health inequalities should address inequalities in neighborhood SES.

Parental Education and Nucleus Accumbens Response to Reward Anticipation: Minorities' Diminished Returns

Background

Considerable research has documented the effects of race and socioeconomic status (SES) on reward-seeking behaviors; however, less is known about the multiplicative effects of race and family SES on brain response to reward anticipation. Marginalization-related Diminished Returns (MDRs) suggest that family SES would show weaker effects on brain development of children in non-White families than in White families.

Objective

To test race by SES variation in Nucleus Accumbens (NAcc) response to reward anticipation (NAcc-RA) among American children.

Methods

For this cross-sectional analysis, data came from the Adolescent Brain Cognitive Development (ABCD) study which included 6,419, 9-10 year old children. The independent variable was parental education. The moderator was race. The primary outcome was the right NAcc-RA. Age, sex, ethnicity, household income, and family structure were the covariates. We used mixed effects regression models that adjusted for the nested nature of the ABCD data.

Results

While high parental education was associated with a higher amount of right NAcc-RA, this effect was stronger for White than non-White children. This finding was evident in the observed interactions between race and parental education on the right NAcc-RA.

Discussion

For American children, NAcc-RA is not shaped by race or family SES, but by their intersection. As a result of the interaction between race and SES (diminished return of SES for non-Whites), middle-class racial minority children may remain susceptible to high-risk behaviors. Disparities in high-risk behaviors in children should not be reduced to economic disparities. Structural inequalities may reduce the return of SES resources for non-White families.