A systematic review of the prevalence and risk factors of depression among iranian adolescents

Risk and protective factors associated with adolescent depression in Singapore: a systematic review

INTRODUCTION

Adolescent depression is prevalent, and teen suicide rates are on the rise locally. A systemic review to understand associated risk and protective factors is important to strengthen measures for the prevention and early detection of adolescent depression and suicide in Singapore. This systematic review aims to identify the factors associated with adolescent depression in Singapore.

METHODS

A systematic search on the following databases was performed on 21 May 2020: PubMed, EMBASE and PsycINFO. Full texts were reviewed for eligibility, and the included studies were appraised for quality using the Newcastle Ottawa Scale. Narrative synthesis of the finalised articles was performed through thematic analysis.

RESULTS

In total, eight studies were included in this review. The four factors associated with adolescent depression identified were: (1) sociodemographic factors (gender, ethnicity); (2) psychological factors, including childhood maltreatment exposure and psychological constructs (hope, optimism); (3) coexisting chronic medical conditions (asthma); and (4) lifestyle factors (sleep inadequacy, excessive internet use and pathological gaming).

CONCLUSION

The identified factors were largely similar to those reported in the global literature, except for sleep inadequacy along with conspicuously absent factors such as academic stress and strict parenting, which should prompt further research in these areas. Further research should focus on current and prospective interventions to improve mental health literacy, targeting sleep duration, internet use and gaming, and mitigating the risk of depression in patients with chronic disease in the primary care and community setting.

Association Between Different Dietary Carbohydrate and Risk of Depression, Anxiety, and Stress Among Female Adolescents

Purpose

Mental disorders account for a large part of the burden of disease in young population. The present study aimed to investigate the relationship between carbohydrate intakes and the risk of depression, anxiety, and stress among female adolescents.

Methods

In this cross-sectional study, 263 female adolescents aged 15-18 years participated. Depression, anxiety, and stress scores were determined by DASS-21 (Depression Anxiety Stress Score-21 items) questionnaire, and dietary intakes were assessed using a validated 168-item food frequency questionnaire. Crude and multivariable-adjusted odds ratios (OR) and 95% confidence intervals (CIs) were estimated through logistic regression analysis.

Results

Adolescents with depression consumed more glucose and sucrose and less lactose compared to adolescents without depression. After adjustment for all confounders, higher intakes of glucose and sucrose were significantly associated with increased risk of depression (OR glu = 1.3, P = 0.035 and OR suc = 1.41, P = 0.034), anxiety (OR glu = 1.3, P = 0.019 and OR suc = 1.81, P = 0.027), and stress (OR glu = 1.41, P = 0.046 and OR suc = 1.8, P = 0.044). In addition, increasing lactose intake was significantly associated with reducing the risk of depression (OR = 0.96, P = 0.013) and stress (OR = 0.96, P = 0.015).

Conclusions

This study found significant associations between dietary carbohydrate intake and mental disorders among female adolescent.

Effects of socio-demographical characteristics of high school students on smartphone addiction and depression

This study was conducted to determine the smartphone addiction and severity of depressive symptoms of high school students. In this descriptive cross-sectional and correlational study, the sample consisted of 1744 high school students. In the study, data were collected using a Descriptive Questionnaire, the Smartphone Addiction Scale-Short Form, and the Depression Scale for Children. Data were analyzed in independent groups Student's t test, One-way ANOVA, Pearson correlation analysis, and a multiple regression model. It was determined that the students' mean smartphone addiction score was affected by gender, grade level, school success, having problems with the family, relationship with family, relationship with friends, and social self-evaluation. The mean depression score was affected by family type, economic status, social self-evaluation. According to the multiple regression analysis, effects of socio-demographic variables on smartphone addiction were 25%. It was concluded that the socio-demographic characteristics of high school students have an effect on smartphone addiction and depression.

Role of Branched and Aromatic Amino Acids, Diet Inflammatory Index, and Anthropometric Indices on Mental Health

Background

Mental health disorders are one of the most important and increasing health problems in the youth of today's societies. Some dietary intake and body mass status are factors that affect mental health. This study aimed to investigate the relationship between the intake of branched-chain amino acids (BCAAs) and aromatic amino acids (AAAs) and anthropometric and dietary inflammatory indices with mental health, including depression, anxiety, and stress.

Methods

In this case-control study, the data of 138 teenage girls aged 13-18 years were collected. Three-day 24-hour food recall and standard anthropometric methods were used to calculate the dietary inflammation intake score of normal and energy-adjusted diets. Mental health disorders were diagnosed by the DASS-21 questionnaire. Statistical analysis used Student's t-test, correlation, and multiple regression were used to analyze the data based on the study's statistical requirements.

Results

Based on the findings, 59 (42%) of the girls had mental disorders, and 79 (58%) were healthy. The average weight of stressed people was significantly higher than that of healthy people, and the BMI of anxious people was significantly higher than that of nonanxious people (P < 0.05). A significant positive correlation was found between stress and weight and energy intake. Additionally, there was a significant negative correlation between BCAAs and mental health. The average intake of BCAAs was significantly lower in patients (P = 0.01). The trend analysis showed significantly lower BCAA levels among the 4th quartile of mental disorders. No significant relationship was observed between DII, AAA, and anthropometric indices. After adjustment of the results, no relationship was observed between mental health and the studied factors.

Conclusions

BCAA might be related to mental health. Further studies in different age and sex groups are highly recommended.

Change Score and Subscore Precision and Reliability of the Children's Depression Inventory

The Child Depression Inventory (CDI) is often used to assess change in depression over time, but no studies estimate the reliability of CDI change scores nor its five subscores. Our study investigated the reliability of change scores for both the total score on the CDI as well as its five subscores. We examined CDI responses from 186 maltreated children and estimated change score reliability for relative (e.g., comparison) and absolute (e.g., diagnosis) purposes. We also conducted subscore utility analysis, which determines if subscores have adequate reliability and provide information beyond the total score. We found that the total change score had acceptable reliability of .70 for our sample for both relative and absolute interpretations. In addition, the total score was a better predictor of true subscore values than the observed subscores-suggesting subscores did not add value over the total score, and that the reliability of changes in subscores was too low to be useful for any purpose. In summary, we found that the total CDI change scores were useful for assessing change in studies that examine relative or absolute change, and we advise caution when interpreting CDI subscores based on our analysis.

Comparison of Dutch healthy eating and healthy eating indexes and anthropometry in patients with major depression with health subjects: a case-control study

Background

Diseases and disorders related to mental health are spreading like other chronic diseases all around the world. Considering the role of food in the prevention and treatment of these disorders, including major depression, investigating the relationship between different food patterns and this disorder is of particular importance. The aim of this study was to compare Dutch healthy eating and healthy eating indexes and anthropometry in patients with major depression with healthy individuals.

Methods

In this case-control study, the final analysis was performed on 67 men and 111 women with an age range of 20-30 years. Height (cm), weight (kg), food frequency questionnaire (FFQ), physical activity (MET-min/week), demographic and PHQ-9 questionnaires were taken from all participants. In the following, all the food ingredients and their components were extracted and used to calculate HEI-2015 and DHD. Statistical analysis was performed using SPSS software with independent t-test, logistic regression and chi-square.

Results

It was found that people with major depression in this study were mostly women and occupied. The average HEI-2015 in healthy people and those with major depression was 58 and 54.3, respectively. Also, the average DHD in these people was 60.5 and 55, respectively. HEI-2015 and DHD had a significant negative correlation with depression score (r = -0.16, p-value = 0.03) (r = -0.19, p-value = 0.01). Also, in the logistic regression model, before and even after adjusting confounders, HEI-2015 and DHD had a reduced odds ratio in people suffering from major depression. The two groups did not differ significantly in terms of the average factors of height, weight and body mass index (BMI).

Conclusion

It seems that HEI2015 and DHD have a significant relationship in reducing major depression. However, due to the small number of studies in this regard, especially in the field of DHD, the need for more studies seems necessary.

The association between lifelines diet score (LLDS) with depression and quality of life in Iranian adolescent girls

BACKGROUND

It has been proposed that a greater degree of adherence to a healthy dietary pattern is associated with a lower risk of depression and a poor quality of life (QoL). The Lifelines diet score (LLDS) is a new, evidence-base scoring system to define the quality of diet. We designed a cross-sectional study to investigate the association between LLDS with depression and QoL in Iranian adolescent girls.

METHODS

A total of 733 female adolescents were recruited from Mashhad and Sabzevar cities, Iran. Depression and QoL were assessed utilizing the Beck Depression Inventory (BDI) and SF-12v2 questionnaires, respectively. The LLDS was defined by dividing intakes of 12 food groups with negative or positive health effects into quintiles ranging 12 to 60 points. To explore the association between LLDS with QoL and depression, logistic regression was used in crude and adjusted models.

RESULTS

The prevalence of depression and poor QoL was 24% and 49%, respectively. After adjusting for confounding factors, adolescent girls in the highest quartile of LLDS compared with the participants in the lowest quartile had a 42% lower probability of reporting depressive symptoms (OR: 0.58; 95% CI: 0.35-0.97, P = 0.03). In addition, the participants in the highest quartile of LLDS had lower odds of poor QoL compared with the subjects in the lowest quartile (OR: 0.65; 95% CI: 0.42-0.92, P = 0.04).

CONCLUSIONS

There is an inverse relationship between LLDS with risk of depression and poor QoL. Prospective and interventional investigations are needed to reach a clear vision.

Cumulative ecological risk and nonsuicidal self-injury in adolescents: The mediation of depression and the moderation of impulsiveness

BACKGROUND

This study is based on the biosocial model of nonsuicidal self-injury (NSSI), to explore the effects of cumulative ecological risk on adolescents' NSSI, the mediating effect of depression between cumulative ecological risk and adolescents' NSSI, and the moderating role of impulsiveness in this mediating pathway.

METHODS

A total of 16 508 adolescents, with 7903 males (47.9%), participated in the study and completed the Cumulative Ecological Risk Questionnaire, the Short Form of the Center for Epidemiological Studies Depression Scale, the Impulsiveness assessment, and the Nonsuicidal Self-Injury Scale.

RESULTS

(1) There was a significant positive correlation between cumulative ecological risk, depression, impulsiveness, and NSSI; (2) cumulative ecological risk significantly predicted adolescents' NSSI; (3) depression had a mediating effect between cumulative ecological risk and adolescents' NSSI; and (4) impulsiveness moderated both the effects of cumulative ecological risk on adolescents' depression and NSSI and the effects of depression on NSSI in adolescents.

CONCLUSIONS

Impulsiveness and depression are risk factors for adolescent NSSI and play a crucial role between cumulative ecological risk and NSSI in adolescents.

Characterizing the profiles of patients with acute concussion versus prolonged post-concussion symptoms in Ontario

Identifying vulnerability factors for developing persisting concussion symptoms is imperative for determining which patients may require specialized treatment. Using cross-sectional questionnaire data from an Ontario-wide observational concussion study, we compared patients with acute concussion (≤ 14 days) and prolonged post-concussion symptoms (PPCS) (≥ 90 days) on four factors of interest: sex, history of mental health disorders, history of headaches/migraines, and past concussions. Differences in profile between the two groups were also explored. 110 patients with acute concussion and 96 patients with PPCS were included in our study. The groups did not differ on the four factors of interest. Interestingly, both groups had greater proportions of females (acute concussion: 61.1% F; PPCS: 66.3% F). Patient profiles, however, differed wherein patients with PPCS were significantly older, more symptomatic, more likely to have been injured in a transportation-related incident, and more likely to live outside a Metropolitan city. These novel risk factors for persisting concussion symptoms require replication and highlight the need to re-evaluate previously identified risk factors as more and more concussions occur in non-athletes and different risk factors may be at play.

Prevalence Rates of Depression and Anxiety among Young Rural and Urban Australians: A Systematic Review and Meta-Analysis

Globally, depression and anxiety are major public health concerns with onset during adolescence. While rural Australia experiences overall lower health outcomes, variation in mental health prevalence rates between rural and urban Australia is unclear. The aim of this paper was to estimate the pooled prevalence rates for depression and anxiety among young Australians aged between 10 and 24 years. Selected studies from a systematic literature search were assessed for risk of bias. Random effects model using DerSimonian and Laird method with Freeman-Tukey Double Arcsine Transformation was fitted. Sensitivity analyses were performed. Prevalence estimates were stratified by region and disorder. The overall pooled prevalence of depression and anxiety was 25.3% (95% CI, 19.9-31.0%). In subgroup analysis, anxiety prevalence was 29.9% (95% CI, 21.6-39.0%); depression: 21.3% (95% CI, 14.9-28.5%); and depression or anxiety: 27.2% (95% CI, 20.3-34.6%). Depression and anxiety prevalence were higher in urban 26.1% (95% CI, 17.3-35.9%) compared to rural areas 24.9% (95% CI, 17.5-33%), although the difference was not statistically significant. The heterogeneity was high with an I2 score of 95.8%. There is need for further research on healthcare access, mental health literacy and help-seeking attitude in Australia.

Do social phobia and depression go hand in hand? A cross-sectional study among school-going adolescents of Northern region of India

BACKGROUND

The preeminent mental health conditions, namely social phobia and depression among adolescents, usually remain incognito. The transition period from childhood to adulthood makes adolescents more liable for low amour-propre, loneliness, and even increases the suicidal tendencies among them. To burgeon the knowledge regarding social phobia and depression among adolescents, the present study was put forward with the objective to assess the prevalence of social anxiety disorders (social phobia) and depression among adolescents.

MATERIALS AND METHODS

A cross-sectional study was conducted for 2 months on 600 students aged 10-19 years belonging to classes VIII-XII of government and private schools in the Dehradun district recruited through multistage random sampling technique. A pre-tested semi-structured questionnaire having sociodemographic details, validated self-administered tools, Social Phobia Inventory tool, and Kutchers Adolescent Depression Scale (Cronbach's alpha: 0.77 and 0.79) were used. Statistical package for social sciences, version 23 was used for data analysis. Chi-square test, Fisher exact test, and Pearson correlation analysis were used for analysis.

RESULTS

Prevalence of social phobia was found to be 37% among school-going adolescents. Further, 23.7% of the study participants had mild social phobia, while moderate and severe phobia was seen among 11.5% and 2.3%, respectively. Females had more moderate and severe social phobia than males. Adolescents of government schools had more moderate affective distress and somatic distress as compared to adolescents of private schools.

CONCLUSION

Social phobia and depression among school-going adolescents are on the upsurge. The present study shows that social phobia and depression have a strong correlation among themselves, which needs to be addressed as expeditiously as possible. Coping strategies and social skill therapy and programs are pressing priorities for the fulgent future of adolescents.

Association between dietary behaviors and depression in adolescent girls

Background

The growing prevalence of depression has become a major public health problem. There is limited evidence regarding the relationship between dietary behaviors and depression. The present study was designed to evaluate the association between dietary behaviors and depression score.

Methods

A total of 933 Iranian adolescent girls aged 12 to 18 years were included in this cross-sectional study. Depression severity score was assessed using a validated Persian version of Beck’s depression inventory. Dietary behaviors were pre-defined and assessed in ten domains using a standard questionnaire. To investigate the association between dietary behaviors and depression score, the linear regression analysis in crude and adjusted models was used.

Results

67.7% of participants had no or minimal depression symptoms and 32.3% of participants were categorized with mild-to-severe depression symptoms. There were significant inverse relationships between main meal consumption (Beta: -0.141; 95% CI: − 3.644 to − 1.000; P = 0.001), snack consumption (Beta: -0.100; 95% CI: − 2.400 to − 0.317; P = 0.002), regular meal consumption (Beta: 0.23; 95% CI: 0.13–0.42; P = 0.001) and food chewing (Beta: -0.152; 95% CI: − 2.279 to − 0.753; P = 0.03) with depression score. These associations remained significant after adjustment for confounding variables. In addition, frequency of intra-meal fluid intake (Beta: 0.096; 95% CI: 0.288 to 1.535; P = 0.004) and spicy foods consumption (Beta: 0.076; 95% CI: 0.098 to 1.508; P = 0.02) were directly associated with depression score in the crude model. These significant relations were disappeared in full adjusted model. No significant association was found between breakfast consumption, intake of fried foods, chewing ability, and tooth loss with depression score (P > 0.05).

Conclusions

Significant associations were observed between specific eating behaviors with depression score. Prospective studies are needed to confirm these findings.

Joint Waterpipe and Cigarette Smoking as Key Correlate of History of Depression in Iranian Population: A Cross-Sectional Study

Research on the association between waterpipe smoking and depression is limited. This study aimed to explore the prevalence and adjusted associated correlates of depression among Iranian adult. We analyzed data from 974 participants of a population-based cross-sectional study enrolling 18-50-year-old residents of Tehran, Iran in 2015. Data on lifetime self-reported history of depression, smoking behaviors, socioeconomic status, self-rated health, physical activity, stressful life events as well as a number of relevant confounders was obtained. Logistic regression models were employed for estimating adjusted odds ratios (ORs) and their 95% confidence intervals (CI). The mean (SD) age of the study sample was 32.55 (8.58) years. Of 974 recruited adults, 52.36% were female. The lifetime prevalence of depression in the general population was 17.0%. In general, 21.77% and 24.79% of participant reported lifetime history of cigarette and waterpipe smoking, respectively. While only cigarette smoking (OR = 1.94, 95% CI: (1.04-3.61) and only waterpipe smoking (OR = 1.65, 95% CI: (.95-2.86) were significantly associated with depression, joint cigarette and waterpipe smoking (OR= 3.76, 95% CI: (1.99-6.08) was the strongest correlate of depression followed by female gender (OR = 3.28, 95% CI: (2.08-5.15) and poor self-rated health (OR = 2.47, 95% CI: (1.73-3.53). The prevalence of self-reported depression in general population of Tehran is considerably higher than its global mean. We reported joint cigarette and waterpipe smoking as a significant correlate with depression in the general population. Future health promotion interventions should highlight the disadvantages of joint cigarette and waterpipe smoking targeting adults and especially females.

Smartphone addiction and victimization predicts sleep problems and depression among children

BACKGROUND

In this study we examined the phenomena of smartphone addiction, online harassment, and school bullying/victimization to predict the prospective influence these could have on the onset and persistence of sleep problems and depression among children.

METHODS

Responses from 2155 fifth-grade children recruited from 30 primary schools in Taipei were assessed, and a follow-up was performed in the 6th grade. Self-administered questionnaires were collected for each year.

FINDINGS

Children who reported smartphone addictions, online harassment, and school bullying/victimization coupled with an increase in those factors were more likely to experience the onset and persistence of sleep problems. In addition, children who reported smartphone addiction, online harassment, school bullying/victimization, and poor sleep quality were more likely to experience the onset and persistence of depression.

IMPLICATIONS

School nurses or pediatric nurses should be able to assess children's Internet use and risks to understand potential influences on sleep quality and mental status and provide recommendations for children, parents and schools.

Satisfaction with life, depression, anxiety, and stress among adolescent girls in Tehran: a cross sectional study

OBJECTIVE AND BACKGROUND

Mental health is a widespread field that entails variables such as the presence of positive feelings like satisfaction with life and lack of negative emotions like depression, anxiety, and stress. This research aimed to study the prevalence of depression, anxiety, stress, and satisfaction with life as dimensions of adolescent girls' mental health in Tehran.

METHODOLOGY

The population considered in this cross-sectional study consisted of adolescent girls in the last grade of high school in Tehran. Research samples were selected using multi-stage sampling. The sample size in this study was 491 and the research tools used were standardized questionnaires. Descriptive and inferential statistics included Spearman, ANOVA, and regression tests were used.

FINDINGS

More than half of the adolescents experienced common symptoms of depression, anxiety, and stress. About 30% of adolescents were dissatisfied with life to some extent. Satisfaction with life was negatively correlated with age, depression, anxiety, and stress. Age and depression were predictor variables of life satisfaction based on the regression model.

CONCLUSION

A considerable percentage of adolescents suffered some form of depression, anxiety, and stress symptoms and were notably dissatisfied with life. Regarding the importance of satisfaction with life in having a joyful life and its role in initiating depression, anxiety, and stress, our findings highlight the need for interventions to prevent depression, anxiety, and stress and enhance life satisfaction among adolescents.

The association between dietary phytochemical index with depression and quality of life in iranian adolescent girls

BACKGROUND

There is increasing evidence that the dietary intake of phytochemicals is inversely associated with severity of depression and positively associated with quality of life (QoL). The present study investigated the relationship between dietary phytochemical index (DPI) with depression and QoL scores in Iranian adolescent girls.

METHODS

A total of 733 adolescent girls from Mashhad and Sabzevar cities in northeastern Iran were entered into this cross-sectional study. Assessment of depression and QoL was performed utilizing the Beck Depression Inventory (BDI) and SF-12v2 questionnaire, respectively. Assessment of dietary intake was undertaken by a qualified dietitian, using a validated food-frequency questionnaire (FFQ) containing 168 food items. To explore the association between DPI with QoL and depression, logistic regression was used in crude and adjusted models.

RESULTS

The participants in the fourth quartile of DPI compared with the first quartile had a 50% lower odds of depression (OR: 0.50; 95% CI: 0.30-0.84, P = 0.009) This relation remained significant in all adjusted models. The adolescents in highest quartile of DPI compared with the first quartile had 38% lower odds of poor QoL (OR: 0.62; 95% CI: 0.41-0.94, P = 0.02). This association remained significant in adjusted models I and II, but not after adjusting for all confounding variables (OR: 0.67; 95% CI: 0.43-1.02, P = 0.06) (Model III).

CONCLUSIONS

DPI was inversely associated with risk of depression. The association between DPI score and QoL remained unclear. Further prospective and interventional studies are required.

Perceived Academic Stress and Depression: The Mediation Role of Mobile Phone Addiction and Sleep Quality

BACKGROUND

Although academic stress is a well-known risk factor for students' depression, little is known about the possible psychological mechanisms underlying this association. In this study, we investigated the prevalence of depression and sleep disturbance among Chinese students, examined the relationship between perceived academic stress and depression, considered if mobile phone addiction and sleep quality is a mediator of this relationship, and tested if mobile phone addiction and sleep quality together play a serial mediating role in the influence of perceived academic stress on depression.

METHOD

A cross-sectional survey was conducted among students from September to December 2018 in Heilongjiang Province, China. The final analysis included 5,109 students. Mobile phone addiction, sleep quality, and depressive symptoms were assessed using the Mobile Phone Addiction Index, Pittsburgh Sleep Quality Index, and Center for Epidemiologic Studies-Depression scales, respectively. The serial mediation model was used to analyse the relationship between perceived academic stress, mobile phone addiction, sleep quality, and depression.

RESULTS

Among all participants, the prevalence of depressive symptoms and sleep disturbance was 28.69 and 27.95%, respectively. High school students showed the highest scores of perceived academic stress (2.68 ± 1.06), and the highest prevalence of depressive symptoms (33.14%) and sleep disturbance (36.47%). The serial mediation model indicated that perceived academic stress was a significant predictor of depression (B = 0.10, SE = 0.02, 95% CI = 0.06 - 0.13). Additionally, mobile phone addiction (B = 0.08, 95% boot CI = 0.06-0.11) and sleep quality (B = 0.27, 95% boot CI = 0.22-0.33) played a mediating role between perceived academic stress and depression. Mobile phone addiction and sleep quality together played a serial mediating role in the influence of perceived academic stress on depression (B = 0.11, 95% boot CI = 0.08-0.14). Furthermore, the indirect effect (i.e., the mediating effect of mobile phone addiction and sleep quality) was significant and accounted for 64.01% of the total effect.

CONCLUSIONS

Our research results underscore the need for stakeholders-including family members, educators, and policy makers-to take preventative intervention measures to address depression among Chinese students, especially high school students.

The association between dietary patterns and depression in adolescents: A cross-sectional study

INTRODUCTION AND PURPOSE

So far, few studies have examined the relationship between dietary patterns and depression in adolescents. The aim of the present study was to determine this relationship in a sample of adolescent Iranian girls.

MATERIALS AND METHODS

347 female high school students aged 14-17 years living in Shiraz, Iran participated in this cross-sectional study. General and physical activity questionnaires, 3-d dietary recalls, and Beck Depression Inventory-Second Edition (BDI-II) were completed for all individuals and their anthropometric characteristics were measured. The major dietary patterns were then identified using principal component factor analysis.

FINDINGS

In total, 2 major dietary patterns were identified. After adjusting for potential confounders in multivariate linear regression analysis, the Western pattern (characterized by high consumption of French fries, hydrogenated fats, mayonnaise, sweets and desserts, high-fat dairy, refined grains, red or processed meats, pickles, organ meats and soft drinks and low consumption of low-fat dairy) was positively (standardized β coefficient: 0.510, P < 0.001) and the healthy pattern (characterized by high intake of vegetables, legumes, boiled potatoes, poultry, fish, vegetable oils, olives, fruits and fruit juices and low-fat dairy and low intake of refined grains) was inversely associated (standardized β coefficient: -0.508, P < 0.001) with BDI-II score.

CONCLUSION

Overall, findings of this study indicate that certain dietary patterns are associated with depression in adolescent Iranian girls. However, more studies are needed to further confirm these findings.

Efficacy and Moderators of Internet-Based Interventions in Adults with Subthreshold Depression: An Individual Participant Data Meta-Analysis of Randomized Controlled Trials

INTRODUCTION

Evidence on effects of Internet-based interventions to treat subthreshold depression (sD) and prevent the onset of major depression (MDD) is inconsistent.

OBJECTIVE

We conducted an individual participant data meta-analysis to determine differences between intervention and control groups (IG, CG) in depressive symptom severity (DSS), treatment response, close to symptom-free status, symptom deterioration and MDD onset as well as moderators of intervention outcomes.

METHODS

Randomized controlled trials were identified through systematic searches via PubMed, PsycINFO, Embase and Cochrane Library. Multilevel regression analyses were used to examine efficacy and moderators.

RESULTS

Seven trials (2,186 participants) were included. The IG was superior in DSS at all measurement points (posttreatment: 6-12 weeks; Hedges' g = 0.39 [95% CI: 0.25-0.53]; follow-up 1: 3-6 months; g = 0.30 [95% CI: 0.15-0.45]; follow-up 2: 12 months, g = 0.27 [95% CI: 0.07-0.47], compared with the CG. Significantly more participants in the IG than in the CG reached response and close to symptom-free status at all measurement points. A significant difference in symptom deterioration between the groups was found at the posttreatment assessment and follow-up 2. Incidence rates for MDD onset within 12 months were lower in the IG (19%) than in the CG (26%). Higher initial DSS and older age were identified as moderators of intervention effect on DSS.

CONCLUSIONS

Our findings provide evidence for Internet-based interventions to be a suitable low-threshold intervention to treat individuals with sD and to reduce the incidence of MDD. This might be particularly true for older people with a substantial symptom burden.

Multiple Mediating Effects of Conflicts With Parents and Self-Esteem on the Relationship Between Economic Status and Depression Among Middle School Students Since COVID-19

This study explores associations between perceived economic status and depression among middle school students during COVID-19 in the context of conflict with parents and self-esteem. Data were collected in South Korea in the fall of 2020. A total of 328 middle school students were included, and a multiple mediator model was employed to examine the multiple mediating effects. Middle schoolers' household economic status was negatively associated with their conflict with parents. Conflict with parents was negatively related to middle school students' self-esteem. Indirect effects of perceived economic status via conflict with parents were significantly associated with depression. The indirect effect of perceived economic status via both conflict with parents and self-esteem was related to depression. Government subsidies should temporarily be expanded to improve households' economic status to potentially improve middle school students' depression and to enhance relationships between children and their parents during the COVID-19 pandemic. Further, extra financial support from the government should be focused on poor households with children in order to address family conflict, self-esteem, and depression among middle school students.

Trends in the prevalence and incidence of anxiety and depressive symptoms in Iran: findings from KERCADRS

OBJECTIVES

Anxiety and depression (A&D) are common mental disorders with high economical and health burdens. This study aimed to investigate the prevalence and the incidence rate of A&D symptoms and their relationship with sociodemographic and other risk factors and comorbidities in adults living in southeastern Iran.

DESIGN

A population-based cohort study with random cluster household survey sampling method.

SETTING

Second round of Kerman Coronary Artery Disease Risk Factors Study (KERCADRS) (2014-2018) performed in Southeastern, Iran.

PARTICIPANTS

We recruited 9997 participants (15-80 years) in the second round of the study, from whom 2820 persons were the people who also participated in the first round of KERCADRS in 2009-2012. The age-standardised A&D prevalence was measured among all participants, and the 5-year A&D incidence rate was measured in those who were free from A&D in the first round in 2009-2012 and were at risk of A&D in the follow-up. The relationship between A&D and demographic characteristics, smoking, opium use, obesity and physical activity was assessed by logistic regression models.

RESULTS

Overall, the prevalence of anxiety (48.1% to 16.4%, p<0.001) and depression (5.9% to 1.3%, p<0.001) decreased between the two rounds. The highest prevalence of anxiety was among widowed (31.4%), unemployed (21.3%), obese (19.4%), and opium users (17.4%). Young adults, women, those divorced or widowed, and those with obesity and low physical activity had a higher chance of developing anxiety. The 5-year incidence rate (person/1000 person-years) was 15.0 for anxiety and 3.9 for depression.

CONCLUSION

Despite the overall decrease in the prevalence of A&D symptoms in last 5 years in the area, young adults, women, unemployed, opium users, people with low physical activity and those with obesity had a higher chance of developing anxiety and are in need of more targeted interventions.

Depression and its determinants among adolescents in Jimma town, Southwest Ethiopia

OBJECTIVES

To determine the prevalence and socio-demographic and parental-related factors of depression among school adolescents in Jimma town, southwest Ethiopia.

METHODS

Using a cross-sectional survey, 546 school adolescents were screened for depression using the patient health questionnaire (PHQ-9) from five randomly selected public and private schools. Oslo social support scale, adverse childhood experience tool, and socio-demographic questionnaire were used to gather data on risk factors. Linear regression analysis was used, and unstandardized beta (β) coefficients with 95% confidence intervals (CI) were reported to declare statistical significance.

RESULTS

A total of 546 adolescents participated in the study, with a response rate of 97.3%. The mean (±SD) age of participants was 16.8 ± 1.3 years. The majority (81%) of the adolescents were attending day classes at public schools. The prevalence of depression was found to be 28% using the patient health questionnaire. Based on the PHQ-9 depression severity scale, 18.5% and 8.2% of the adolescent had moderate and moderate to severe depression while 1.3% had severe depression. In the final multivariate linear regression analysis, it was found that sex, rural residence, low social support, being in higher grade level, and adverse childhood experience were found to be independently associated with a higher score of depression.

CONCLUSION

One in three adolescents was found to have a depressive syndrome. We recommend schools to integrate school mental health service that contains routine screening and intervention services. Moreover, efforts are needed to sensitize and educate the communities on child protection, social support, and safeguarding to effectively tackle the magnitude of adolescent depression.

Psychometric properties of the Thai Mood and Feelings Questionnaire (MFQ) for adolescent depression

BACKGROUND

The Mood and Feelings Questionnaire (MFQ) is a widely used screening tool for child and adolescence depression but has not been validated with young people in Thailand. This study aimed to assess the reliability and validity and to determine the optimal clinical cut-off of the Thai MFQ.

METHODS

The Thai MFQ was evaluated in two parts. In part 1, The MFQ was translated and back translated into the Thai language and piloted on a small number of Thai adolescents. Then 1275 young people aged 12-18 years from three secondary schools in Thailand completed the MFQ and related measures of depression. In part 2, 138 students were invited to take part in a structured diagnostic interview (the Thai translation of the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children -Present and Lifetime Version (the K-SADS-PL). Of those, 103 students were interviewed and completed the Thai MFQ a second time to assess test-retest reliability. Receiver Operating Characteristics (ROC) analyses were conducted to evaluate diagnosis accuracy and examine the optimal cut-off score of the Thai MFQ.

RESULTS

The Thai MFQ had excellent internal consistency (α = 0.92) and good to moderate test-retest reliability in 2-week and 4-week intervals. The Thai MFQ also had good convergent validity with related measures of depression. The ROC analyses demonstrated that the Thai MFQ also had excellent accuracy distinguishing between depressed and non-depressed adolescents [AUC = 0.95, 95% CI [0.92, 0.99]. A total score of 28 on the Thai MFQ was the optimal cut-off score (sensitivity was 0.97 and specificity was 0.83).

DISCUSSION

The Thai MFQ demonstrated excellent psychometric properties and accurately distinguished between depressed and non-depressed adolescents. It is appropriate to use as a screening measure to identify adolescents with depression in community settings in Thailand.

The prevalence of depression in Iranian children: A systematic review and meta-analysis

INTRODUCTION

The present study was conducted to evaluate the prevalence of depression in Iranian children.

METHOD

This meta-analysis was registered in PROSPERO with code (CRD42020216632) and performed based on the MOOSE protocol and PRISMA guidelines. Title and abstract of articles were searched without time limit until April 2020 in international databases PubMed/Medline, Scopus, Embase, Science Direct, Cochrane Library, CINAHL, EBSCO, Web of Science, Google Scholar, and Iranian databases.

RESULTS

In 34 studies with a sample size of 23,779 Iranian children, the prevalence of depression was estimated 42.3 % (95 %CI: 34.9-50.0). Prevalence of depression in girls in 20 studies with a sample size of 11,170 was estimated 42.1 % (95 %CI: 32.7-52.1) and the prevalence of depression in males in 20 studies with a sample size of 4678 was estimated 29.6 % (95 %CI: 21.2-39.7). The odds ratio of female to male depression was 1.33 (95 %CI: 1.07-1.65, P < 0.011). Prevalence of mild, moderate, major and deep depression was 20.3 % (95 %CI: 16.4-24.9), 15.0 % (95 %CI: 11.3-19.7), 14.5 % (95 %CI: 10.8-19.1), and 4.3 % (95 %CI: 1.8-9.8), respectively. In subgroup analysis for prevalence of depression in Iranian children, the variables of geographical area (P = 0.258), quality of studies (P = 0.186), type of questionnaire (P = 0.907), sample size (P = 0.500) and year of studies (P = 0.538) were not significant, but subgroup analysis of province (P < 0.001) and school grade (P < 0.001) were significant.

CONCLUSION

The results of the present meta-analysis showed that depression is common in Iranian children and is much higher than global estimates. These findings emphasize the importance of identifying and providing treatment to children who are most in need.

Children and adolescents' mental health in Iran's primary care: Perspectives of general practitioners, school staff and help seekers

BACKGROUND

Iran has well-established networks for primary care staffed by general practitioners who provide services to patients across the lifespan. Iran recently established collaborative care networks to build general practitioners' capacity to provide adult mental health services. In an NIH-funded study, we are designing and evaluating a training program for general practitioners (GPs) to extend this collaboration to include services for children and adolescents. In the formative phase of this project, we conducted a qualitative study to obtain information relevant to the design of the training program.

METHODS

We conducted semi-structured individual interviews with 28 stakeholders; including 15 GPs working in a collaborative care network, 6 parents and 4 adolescents who had received child mental health care from a GP, and 3 policymakers. We also held a focus group discussion with 8 school teachers and counselors. All interviews were transcribed during the interviews' sessions and then were thematically analyzed.

RESULTS

GPs reported seeing a range of child emotional and behavioral problems but felt the need for additional training in diagnosis and management, especially in skills for interviewing and communicating with children. GPs also expressed the need to understand legal issues involved in treating children, including cases of possible child abuse. School staff agreed that GPs could help with children's educational and emotional problems but also believed GPs would need extra training. Parents indicated a preference for GPs over psychiatrists (as did adolescents) as a source of mental health care, and for psychological over pharmacological interventions. Adolescents expressed a preference not to speak about private issues in the presence of their parents, and expressed concern that the GPs did not respect their preference. They also desired a more active role during visits.

CONCLUSIONS

Before expanding the scope of practice of Iranian GPs to provide management of common emotional and behavioral problems in children and adolescents, the concerns and specific needs of these practitioners need to be addressed. Parents and youth in the study expressed a preference for mental health care from a GP rather than a specialist. However, they also commented on the need for restructuring the current GP visits to facilitate youth participation. These findings provide directions for expanding the scope of practice of adult collaborative care networks to meet the mental health care needs of children and adolescents more expeditiously and effectively.

Childhood socioeconomic status and adulthood mental health: results from the survey on employees of Tehran University of Medical Sciences

BACKGROUND

Socioeconomic status, especially during childhood, is known as one of the key factors affecting health. This study's objective was to investigate the association between childhood socioeconomic and mental health status in adulthood.

METHODS

This cross-sectional study was conducted on 2062 employees of Tehran University of Medical Sciences. Depression, stress and anxiety were measured using the validated DASS-42 questionnaire. A self-rated question was used to assess childhood socioeconomic status. Other variables including age, sex, marital status, and also wealth index, were measured. Linear regression models were used to analyze the data.

RESULTS

24.6% of men and 33.8% of women had degrees of depression (mild, moderate, severe or very severe). 32.9% of men and 29.4% of women had mild, moderate, severe or very severe anxiety. 36.3% of men and 45.2% of women also exhibited mild, moderate, severe or very severe stress. Results showed after adjusting for the current socioeconomic status, childhood socioeconomic status has a relationship with the mental health of individuals.

CONCLUSION

People with a suboptimal childhood socioeconomic status seem to be a high-risk group for depression, stress and anxiety in adulthood. Strategies need to put into practice to improve the mental health of these people.

Risk and resource factors for depressive symptoms during adolescence and emerging adulthood - A 5-year follow-up using population-based data of the BELLA study

INTRODUCTION

Depression is one of the most common mental disorders in adolescents and young adults worldwide, and causes a high burden for both individuals and society. The present study aims to investigate the role of risk and resource factors for depressive symptoms during adolescence and emerging adulthood in a German population-based cohort.

METHODS

Within the longitudinal BELLA study, data on risk and resource factors were collected among n = 632 children and adolescents aged 11 to 17 years. Depressive symptoms were measured five years later. Multivariate linear regression models served to investigate effects of risk and resource factors on depressive symptoms. Regression models were stratified by gender. Moreover, we explored potential interaction effects.

RESULTS

A negative mother-child relationship predicted depressive symptoms in girls, whereas school stress served as a risk factor in boys. Peer competence was associated with fewer depressive symptoms in girls, and family cohesion was identified as a resource factor in boys. In addition, few moderating effects of resource factors on the association between risk factors and depressive symptoms were found.

LIMITATIONS

As the BELLA study is a population-based observational study, we only identified associations between risk and resource factors and no cause-effect relationships.

CONCLUSIONS

Findings provide evidence of gender-specific risk and resource factors for depression. Individuals who are exposed to risk factors must be monitored during the transition into adulthood. Gender-sensitive prevention and early intervention programs are needed.

Dietary antioxidants and fibre intake and depressive symptoms in Iranian adolescent girls

OBJECTIVE

To investigate the cross-sectional association between dietary intakes of antioxidants and fibre and depressive symptoms among Iranian adolescent girls.

DESIGN

A cross-sectional population-based study.

SETTING

Primary schools in two different cities located in northeastern Iran (Mashhad and Sabzevar).

PARTICIPANTS

A total of 988 adolescent girls aged 12-18 years were included in the study.

RESULTS

Subjects with no or minimal depression symptoms had significantly higher dietary intakes of α-carotene (P = 0·01), β-carotene (P = 0·006), lutein (P = 0·03) and vitamin C (P = 0·04) when compared with subjects with mild-to-severe depression symptoms. Soluble dietary fibre and insoluble dietary fibre intakes were also significantly higher in healthy adolescents compared with those with depression symptoms (P < 0·001). In multivariate-adjusted model 2, the OR (95 % CI) of depressive symptoms were 0·61 (95 % CI 0·37, 1·01), 0·42 (95 % CI 0·26, 0·69), 0·50 (95 % CI 0·31, 0·79), 0·71 (95 % CI 0·44, 1·15), 0·51 (95 % CI 0·32, 0·82) and 0·42 (95 % CI 0·25, 0·68) for the highest v. lowest quartile of vitamin C, β-carotene, α-carotene, lutein, soluble dietary fibre and insoluble dietary fibre cereal intakes, respectively.

CONCLUSIONS

Dietary intake of some antioxidants and dietary fibre intake was inversely associated with depression symptoms among Iranian adolescent girls.

Depressive symptoms and suicidal ideation among Vietnamese students aged 13-17: Results from a cross-sectional study throughout four geographical regions of Vietnam

We conducted a cross-sectional study in four provinces located in four different geographical areas in Vietnam to examine the prevalence and associated factors of depression and suicide ideation among school students aged 13-17. A sample of 6407 students from secondary school and high school participated in our survey to complete self-reported questionnaires. Depressive symptoms were measured by the Center for Epidemiologic Studies Depression scale (CES-D). Suicidal ideation and associated factors were measured by the Global School Student Health Survey (GSHS) questionnaire. We found that 31.7% of students had depressive symptoms, and 11% reported suicidal ideation during the last year. Female students and older students were more at risk of experiencing depressive symptoms and suicidal ideation than male students and younger students. Bullying, violence, smoking, and alcohol consumption appear as risk factors, while a good relationship with parents/guardians may protect school students from having depressive symptoms and suicidal ideation.

Perceived learning difficulty associates with depressive symptoms and substance use among students of higher educational institutions in North Western Ethiopia: A cross sectional study

Background

The potential role of perceived learning difficulty on depressive symptoms and substance use in the context of student population was seldom studied. This study aimed to investigate the association of perceived learning difficulty with depressive symptoms and substance use among university students in northwest Ethiopia.

Methods

A cross sectional study was conducted on 710 pre-engineering students. A locally validated version of Patient Health Questionnaire (PHQ-9) was used to assess depressive symptoms at a cut off 5–9 indicating mild depressive symptoms and at a cut off 10 for major depressive symptoms. Perceived difficulty in school work was assessed by items dealing about difficulties in areas of course work. The response alternatives of these items were 0 = not at all, 1 = not so much, 2 = quite much, 3 = very much. The types of substances that students had used in their life and in the last three months were assessed. Negative binomial regression and multinomial regressions were employed to investigate the predictors of number of substance use and depressive symptoms respectively.

Results

The prevalence of depressive symptoms was 71.4% (Mild: 30% and Major 41.4%). About 24.6% of participants had the experience of using at least one substance. Increment in perceived difficulties in learning score was associated with more use of substances (aRRR = 1.03, 95% CI: 1.01–1.06), mild level depressive symptoms (aOR = 1.10, 95% CI: 1.04, 1.56 and major depressive symptoms (aOR = 1.19, 95% CI: 1.13, 1.26). Every increment in anxiety score was associated with increased risk of mild level of depressive symptoms (aOR = 1.09, 95% CI: 1.01, 1.17) and major depressive symptoms (aOR = 1.28, 95% CI: 1.18, 1.37). Being male (aRRR = 5.54, 95% CI: 3.28, 9.36), urban residence (aRRR = 2.46, 95% CI: 1.62, 3.72) and increment in number of life threatening events (aRRR = 1.143, 95% CI: 1.08, 1.22) were associated with increased risk of substance use.

Conclusion

Perceived difficulties in learning independently predicted increased depressive symptoms as well as substance use among participants.

Antioxidant vitamin intakes and risk of depression, anxiety and stress among female adolescents

BACKGROUND AND AIM

The relation of some antioxidant nutrients with psychological disorders has been studied previously. The aim of this study was to examine the association between antioxidant vitamin intakes and the risk of depression, anxiety, and stress.

METHODS

This cross-sectional study was conducted on 263 Tehranian female adolescents. Dietary intakes of vitamin E, C, and β-Carotene were determined using a valid and reliable food-frequency questionnaire. Depression, anxiety, and stress scores were characterized by DASS-21 (Depression Anxiety Stress Score-21 items) questionnaire. The multivariable logistic regression models were used to determine the odds ratios (ORs) and 95% confidence intervals (95%CIs) of depression, anxiety, and stress across tertiles of antioxidant vitamin intakes.

RESULTS

The mean ± SD age of participants was 16.20 ± 0.97 years. Also, the mean ± SD depression, anxiety and stress scores of participants were 9.89 ± 4.15, 8.43 ± 4.39 and 14.00 ± 6.45, respectively. In the fully adjusted model, subjects in the highest tertile of β-Carotene had a lower prevalence of depression (OR:0.46, 95%CI:0.23-0.95), anxiety (OR:0.40, 95%CI:0.20-0.81), and stress (OR:0.35, 95%CI:0.17-0.73) compared to the lowest tertile (P for trend<0.05). Moreover, individuals in the top tertile of vitamin E had a lower prevalence of stress, in comparison to the bottom tertile (OR:0.34, 95% CI:0.13-0.89), (P for trend<0.05). However, no significant associations were found between the intakes of vitamin E and C and other psychological disorders.

CONCLUSION

In this study, higher intake of β-Carotene was associated with lower prevalence of depression, anxiety and stress. Also, we found an inverse relationship between vitamin E intake and the risk of stress.

Mediators in psychological and psychoeducational interventions for the prevention of depression and anxiety. A systematic review

Although efforts have been undertaken to determine how psychological interventions exert their effects, research on mediators and mechanisms of change remains limited, especially in the field of prevention. We aimed to assess available evidence on mediators of psychological and psychoeducational interventions for the prevention of depression and anxiety in varied populations. A systematic review using PubMed, PsycINFO, Web of Science, Embase, OpenGrey, and the Cochrane Central Register of Controlled Trials was performed. Two independent reviewers assessed the eligibility criteria of all articles, extracted data, determined the risk of bias in randomized controlled trials, and the requirements for mediators. The outcomes were mediators of the incidence of depression or anxiety and/or the reduction of symptoms of depression or anxiety. We identified 28 nested mediator studies within randomized controlled trials involving 7442 participants. Potential cognitive, behavioral, emotional and interpersonal mediators were evaluated in different psychological and psychoeducational interventions to prevent depression and anxiety. The effects were mediated mainly by cognitive variables, which were the most commonly assessed factors. For depression, the mediator with the strongest empirical support was negative thinking in adults. Cognitive change is an important mediator in preventive psychological and psychoeducational interventions for both anxiety and depression. REGISTRATION DETAILS: Registration number (PROSPERO): CRD42018092393.

Prevalence and correlates of depressive symptoms in secondary school children in Dhaka city, Bangladesh

Objectives: Depression is a leading contributor to the global burden of disease, and often starts at a young age. Depression in young people can increase the risk of unhealthy lifestyle behaviour and can lead to substantial disability, social problems, poor health, and suicide. Other research has examined depressive symptoms among adult populations in Bangladesh, but little is known about other age groups. The aim of this study was to assess the prevalence and socio-demographic correlates of depressive symptoms among secondary school children of Dhaka city, Bangladesh.Design: A self-completed questionnaire was administered to 898 students from eight secondary schools of Dhaka, the capital City of Bangladesh. Of the respondents, 755 (372 males, 383 females; average age 14.26 years; SD 1.15) completed the 10-item Center for Epidemiological Studies Depression Scale (CESD-10). A score of 10 or more was used to indicate depressive symptoms. Parents completed a separate questionnaire to provide individual and household/family-level data. Generalized Estimating Equations (GEE) was used to assess sociodemographic and lifestyle factors associated with adolescent depressive symptoms.Results: Among the responding adolescents, 25% reported depressive symptoms with prevalence more common among females than males (30% vs. 19%). Factors significantly associated with symptoms of depression included being female, aged 15-16 years, self-perception of non-normal weight, feeling unsafe at school, sleep disturbance, low life satisfaction, high intake of sugary drinks, and regularly skipping breakfast.Conclusion: Depressive symptoms are prevalent among secondary school children in urban Bangladesh. Interventions for adolescents with depressive symptoms could focus on lifestyle practices such as weight management, personal safety, sleep hygiene and healthy eating.

Clinical and Cost-Effectiveness of Personalized Tele-Based Coaching for Farmers, Foresters and Gardeners to Prevent Depression: Study Protocol of an 18-Month Follow-Up Pragmatic Randomized Controlled Trial (TEC-A)

Background: Farmers show high levels of depressive symptoms and mental health problems in various studies. This study is part of a nationwide prevention project carried out by a German social insurance company for farmers, foresters, and gardeners (SVLFG) to implement internet- and tele-based services among others to improve mental health in this population. The aim of the present study is to evaluate the (cost-)effectiveness of personalized tele-based coaching for reducing depressive symptom severity and preventing the onset of clinical depression, compared to enhanced treatment as usual. Methods: In a two-armed, pragmatic randomized controlled trial (N = 312) with follow-ups at post-treatment (6 months), 12 and 18 months, insured farmers, foresters, and gardeners, collaborating family members and pensioners with elevated depressive symptoms (PHQ-9 ≥ 5) will be randomly allocated to personalized tele-based coaching or enhanced treatment as usual. The coaching is provided by psychologists and consists of up to 34 tele-based sessions for 25-50 min delivered over 6 months. Primary outcome is depressive symptom severity at post-treatment. Secondary outcomes include depression onset, anxiety, stress, and quality of life. A health-economic evaluation will be conducted from a societal perspective. Discussion: This study is the first pragmatic randomized controlled trial evaluating the (cost-)effectiveness of a nationwide tele-based preventive service for farmers. If proven effective, the implementation of personalized tele-based coaching has the potential to reduce disease burden and health care costs both at an individual and societal level. Clinical Trial Registration: German Clinical Trial Registration: DRKS00015655.

Examining the Effectiveness of a Web-Based Intervention for Depressive Symptoms in Female Adolescents: Applying Social Cognitive Theory

BACKGROUND

Depression is a serious mental health illness among adolescents especially girls. Web-based treatment can possibly become a solution for reducing mental health problems in adolescents. This study is one of the first trials aimed to evaluate the efficiency of web-based depression improvement program among female adolescents based on the Social Cognitive Theory (SCT).

STUDY DESIGN

Randomized Controlled Trial.

METHODS

A six-month randomized controlled trial based on the SCT was implemented in female schools in Hamadan City, west of Iran in 2018 on 128 female students with mild to moderate depressive symptoms (CES-D =10-45). They were randomly assigned to either intervention or control group (n= 64 in each group). Depression improvement program was implemented through the website via short videos, animations and Power-Point slides. Depression was evaluated using Center for Epidemiologic Depression Scale. A researcher-made questionnaire based on the sheerer and Perceived-Social-Support-Scale-Revised (PSSS-R) questionnaires were used to evaluate the SCT constructs. The data were analyzed using SPSS software.

RESULTS

The intervention program resulted in the improvement of depression in 12 wk based on Intent-to-treat analyses. Nevertheless, these achievements seem to have decreased by 24 wk in intervention group. The intervention increased the mean scores of the constructs of social support and self-regulation from baseline to 12 wk in the intervention group (P<0.05). The intervention had no effect on outcome expectations and self-efficacy. There were no statistically significant associated between theory constructs changes and changes in depression (P>0.05).

CONCLUSION

The web-based intervention improved depression in female students. Future training using strategies for the sustainable improvement of depression in female students are needed.

Prevalence of depression and its associated sociodemographic factors among Iranian female adolescents in secondary schools

Background

Across the globe, depression is a common psychiatric disorder and is the main cause of disability among adolescents. To this end, this study was conducted to screen for the prevalence of depression among secondary school female students in the city of Hamadan, in western Iran.

Methods

In this cross-sectional study, a total of 670 secondary school female students, within the age range of 15–18 years were investigated using multistage random sampling method. Moreover, the Persian version of Center for Epidemiologic Studies Depression Scale (CES-D) and a researcher-designed questionnaire containing demographic variables were employed as research instruments. Analyses of the findings were made using SPSS version 16 software followed by stratified logistic regression model, which was performed for correlation analysis.

Results

The mean (standard deviation) age of students was 16.2 (0.68) years. The prevalence of severe depression in female students estimated by the Center for Epidemiologic Studies Depression Scale (CES-D) was equal to 52.6%. A statistically significant relationship was also observed to exist between prevalence of depression and type of school (P < 0.001), family income (P < 0.001), living in the suburbs (P < 0.001), and field of study at school (P < 0.001). However, no statistically significant correlation was found between depression among students and school grade, type of living with parents, father’s education and occupation, mother’s education and occupation, and family size.

Conclusion

Depression was prevalent among the secondary school female students examined and it significantly correlated with socioeconomic status. Therefore, periodic screening, psychological training programs, proper diagnosis of high-risk individuals in secondary schools, and early intervention among secondary school female students are urgently needed.

Adherence to a healthy dietary pattern is associated with less severe depressive symptoms among adolescent girls

There is growing interest on the impact of diet on depressive disorders. However, there are limited data on the association between dietary patterns and depression symptoms among Iranian adolescents. The aim of this study was to evaluate the association between dietary patterns and depression score among Iranian adolescent girls. Data were obtained from 750 adolescent girls, who were recruited from several schools using a random cluster sampling. Dietary data were collected using a valid and reliable food frequency questionnaire (FFQ). Beck's depression inventory (BDI-II) was used to assess depression severity score. The prevalence of girls diagnosed with depression was 29.1%. Three major dietary patterns were identified in the study based on factor analysis: "Healthy", "Traditional" and "Western". The multivariate-adjusted odds ratio of having depressive symptoms was 0.55 (95% confidence intervals, 0.34-0.89) for the highest versus lowest quartile of the healthy dietary pattern score. However, there were no significant associations between the Traditional and Western dietary patterns and depression symptoms. Our results indicate that adherence to a Healthy dietary pattern characterized by high intakes of fruits, vegetables, fish and dairy products is associated with a lower probability of having depressive symptoms among Iranian adolescent girls.

The Effect of Eye Movement Desensitization and Reprocessing (EMDR) on the severity of suicidal thoughts in patients with major depressive disorder: a randomized controlled trial

OBJECTIVE

Depression is a major risk factor for suicide and more than 90% of people who attempt suicide suffer from depression. The present study aimed to investigate the effect of eye movement desensitization and reprocessing (EMDR) therapy on the severity of suicidal thoughts in patients with major depressive disorder.

STUDY DESIGN

Randomized Clinical Trial.

METHODS

This clinical trial was performed on 70 people with major depressive disorder who exhibited suicidal thoughts. The patients were selected via convenience sampling and were randomly divided into control (n=35) and experimental (n=35) groups. EMDR was performed individually in the experimental group for 45-90 min, 3 days per week, on alternate days, for 3 weeks (9 sessions in total), whereas the controls group received routine treatment without intervention. Both groups completed the Beck Scale for Suicide Ideation (BSSI) at pre- and post-test. The obtained data were analyzed with descriptive and inferential statistics using SPSS 22 (α=0.05).

RESULTS

Mean BSSI score for the experimental group was reduced significantly at post-test (11.11±4.15) compared to pre-test (26.48±5.74) (p<0.001). Although the control group's mean BSSI score was also reduced at post-test (24.93±4.42) compared to pre-test (26.68±5.05), this difference was not statistically significant (p>0.05).

CONCLUSION

EMDR therapy has been shown in this study to reduce the severity of suicidal feelings. Therefore, it can be recommended as an alternative treatment method for reducing the severity of suicidal thoughts in patients with major depressive disorder.

Academic stress from the viewpoint of Iranian adolescents: A qualitative study

BACKGROUND

Academic stress is one of the major affecting factors on adolescent health. This study investigates adolescents' view about the sources of academic stress, with which their identification could be used for the reduction of adolescent academic stress.

MATERIALS AND METHODS

This qualitative study was conducted with Directional Content Analysis methodology. Semi-structured interview methods were used for data collection. Participants were students aged 12-18 years old. Purposeful sampling with Opportunistic Maximum Variation Method was performed in terms of type of schools, socioeconomic classes, and gender of students. A total of 43 interviews and were conducted by two interviewers.

RESULTS

A total of 173 codes, 11 subcategories, and 5 categories were extracted as academic stressors. The categories included family factors (32 codes); peers (18 codes); teachers, school supervisors, and educational system (72 codes); homework and test scores (32 codes); and educational assistance classes (19 codes).

CONCLUSION

This study showed that students have different sources of academic stress. Awareness of their source of stress can help parents and teachers to revise their treat about students' function and policymaker to provide better planning and management for students.

Gender Differences in the Prevalence of Depression among the Working Population of Nepal

Objective

To estimate the prevalence of depression in the working population; to examine if any gender disparity prevails; and to determine the sociodemographic mediators of depression.

Methods

Data from previous research was retrieved for this study. Only paid workers were selected (n=160). Sociodemographic variables including prevalence of moderate depression were compared between the genders using Chi square test. Significant variables were subject to logistic regression. Validated Nepali version of the Beck Depression Inventory scale (BDI-Ia) was used to determine depressive symptoms with a cutoff score of ≥20 considered as moderate depression.

Result

The overall prevalence of moderate depression was 15%, with higher prevalence among working women compared to men [χ² (df) = 6.7(1), P=0.01], those practicing religions other than Hinduism [χ² (df) = 5.5(1), P=0.01], those educated up to primary school compared to other education criteria [χ² (df) = 9.4(4), P=0.03], those having vitamin D deficiency compared to others [χ² (df) = 8.5(3), P=0.03], and sedentary lifestyle compared to active lifestyle [χ² (df) = 6.7(1), P=0.009]. The OR (95% CI) for moderate depression was significantly higher in women than in men [3.2 (1.1-9.6), P= 0.03] and sedentary lifestyle [2.9(1.1-8.2), P= 0.04] even after adjusting for confounding variables.

Conclusion

Working women have increased odds of depression compared to men. Among various characteristics, sedentary lifestyle was the most important causative factor for depression among women.

Risk-Taking Behaviors in Iranian Children and Adolescents: A Latent Class Analysis Approach: Caspian IV Study

BACKGROUND

Risk taking behaviors have several negative consequences. This study aimed to identify the subgroups of students based on risk-taking behaviors and to assess the role of demographic characteristics, depression, anxiety, socioeconomic status (SES), physical inactivity and screen time on membership of specific subgroup.

STUDY DESIGN

Cross-sectional study.

METHODS

This nationwide survey was conducted in 2011-2012 among 14880 students, aged 6-18 yr, selected by multistage, cluster-sampling method from 30 provinces of Iran. The students completed two sets of anonymous and validated questionnaires, obtained from the World Health Organization-Global School Health Survey questionnaires. Latent class analysis was performed to achieve the study objectives.

RESULTS

Overall, 13486 children and adolescents participated were enrolled (response rate 90.6%). They consisted of 50.8% boys, with a mean age of 12.47 ±3.36 year. The prevalence of physical fight, bullying, victimization, active smoking, passive hookah and passive cigarette smoking was 39.7%, 17.4%, 27.2%, 5.9%, 21.1 and 33.8%, respectively. Five latent classes were identified: (a) low risk (46.7%), (b) passive smoker (25.2%), (c violence and aggression taker with passive smoking (13.5%), (d) violence and aggression taker without passive smoking (10.8%) and (e) high risk (3.8%). Higher age (OR=1.41), being male (OR=5.21), depression (OR=4.58), anxiety (OR=3.38) and screen time (OR=3.11) were associated with high-risk class.

CONCLUSION

The prevalence of some risk-taking behaviors among Iranian students is high. Our findings emphasize the importance of planning and evaluating preventive interventions by considering different high-risk behaviors simultaneously.

Adherence to Mediterranean dietary pattern and depression, anxiety and stress among high-school female adolescents

BACKGROUND: Few studies have shown the protective effects of Mediterranean Dietary Pattern (MDP) in psychological disorders. OBJECTIVE: This cross-sectional study was designed to determine the association between adherence to MDP and depression, anxiety and stress among female adolescents aged 16.20±0.97 in Tehran, Iran. METHODS: Data from 263 participants were analyzed. Adherence to MDP was determined using Mediterranean-Style Dietary Pattern Score (MSDPS). Depression, anxiety and stress scores were characterized by DASS-21 (Depression Anxiety Stress Score-21 items) questionnaire. RESULTS: Multivariable logistic regression was used to determine the prevalence of depression, anxiety, and stress across quintiles of MSDPS. After adjustment for age, the odds ratio (OR) for depression in the highest quintile of MSDPS was 0.44 (95% confidence interval [95%CI], 0.19–0.95), (P for trend = 0.009) compared to the lowest quintile. After additional adjustment for BMI, energy intake, physical activity, ethnicity, parents education level and total family income, subjects in the highest quintile had a 59% lower prevalence of depression compared to those in the lowest quintile of MSDPS (OR = 0.41;95% CI, 0.17–0.97), (P for trend = 0.010). However, the MSDPS was not significantly associated with the presence of anxiety and stress. CONCLUSION: Adherence to MDP is associated with a reduced presence of depressive symptoms in female adolescents.

Efficacy and moderators of psychological interventions in treating subclinical symptoms of depression and preventing major depressive disorder onsets: protocol for an individual patient data meta-analysis of randomised controlled trials

INTRODUCTION

The long-term effectiveness of psychological interventions for the treatment of subthreshold depression and the prevention of depression is unclear and effects vary among subgroups of patients, indicating that not all patients profit from such interventions. Randomised clinical trials are mostly underpowered to examine adequately subgroups and moderator effects. The aim of the present study is, therefore, to examine the short-term and long-term as well as moderator effects of psychological interventions compared with control groups in adults with subthreshold depression on depressive symptom severity, treatment response, remission, symptom deterioration, quality of life, anxiety and the prevention of major depressive disorder (MDD) onsets on individual patient level and study level using an individual patient data meta-analysis approach.

METHODS AND ANALYSIS

Systematic searches in PubMed, PsycINFO, Embase and the Cochrane Central Register of Controlled Trials were conducted. We will use the following types of outcome criteria: (A) onset of major depression; (B) time to major depression onset; (C) observer-reported and self-reported depressive symptom severity; (D) response; (E) remission; (F) symptom deterioration; (G) quality of life, (H) anxiety; and (I) suicidal thoughts and behaviours. Multilevel models with participants nested within studies will be used. Missing data will be handled using a joint modelling approach to multiple imputation. A number of sensitivity analyses will be conducted in order test the robustness of our findings.

ETHICS AND DISSEMINATION

The investigators of the primary trials have obtained ethical approval for the data used in the present study and for sharing the data, if this was necessary, according to local requirements and was not covered from the initial ethic assessment.This study will summarise the available evidence on the short-term and long-term effectiveness of preventive psychological interventions for the treatment of subthreshold depression and prevention of MDD onset. Identification of subgroups of patients in which those interventions are most effective will guide the development of evidence-based personalised interventions for patients with subthreshold depression.

PROSPERO REGISTRATION NUMBER

CRD42017058585.

Association between HIV status and depressive symptoms among children and adolescents in the Southern Highlands Zone, Tanzania: A case-control study

BACKGROUND

Children and adolescents continue to have HIV/AIDS in southern Saharan Africa. Scaling up of HIV services has significantly improved access to ARV and consequently improved on morbidity and mortality related to HIV/AIDS including opportunistic infection. Despite the above efforts, non-communicable conditions including mental disorders such as depression have been observed to contribute to the burden of disabilities about which little is documented. This study, therefore, aimed to determine the magnitude of depressive symptoms and the associated factors among HIV-infected children and adolescents.

METHODS

The study was a matched case-control design involving 300 cases of HIV-infected children matched by age and sex against 600 uninfected controls. Systematic sampling technique was used to select the cases while multistage sampling technique was employed to identify villages/ streets purposive and sampling technique was employed to obtain participants from households.

RESULTS

The overall prevalence of depressive symptoms among the cohort of 900 participants was found to be 12.9%, with 27% of HIV-infected and 5.8% of HIV-uninfected children and adolescents screened positive for depressive symptoms. Multiple logistic regression revealed that being HIV-infected (AOR 1.96(1.11-3.45)), residing in a rural setting (AOR 0.61(0.39-0.96)) and history of childhood deprivation (AOR 4.76 (2.79-8.13)) were significantly associated with depressive symptoms.

CONCLUSION

HIV infected adolescents are more affected by depression compared to non-infected counterparts. Childhood deprivation was significantly associated with presence of depressive symptoms. Integration of mental health evaluation and treatment into the HIV care provided for adolescents can be beneficial. More studies to delineate factors associated with depressed adolescents with HIV may add value to the body of knowledge and overall improvement of care.

Prevalence of depression and anxiety among children in rural and suburban areas of Eastern Uttar Pradesh: A cross-sectional study

Background:

Psychiatric morbidity in children and adolescents is a major concern as they become more complex and intense with children's transition into adolescence.

Aim:

The aim of this study is to assess and compare the prevalence of depression and anxiety among children residing in rural and suburban area of eastern Uttar Pradesh and understand the burden of these problems in our society.

Materials and Methods:

Children, in the age group 11–18 years, were divided into 2 groups: Group I – 100 children from rural area Tikri; Group II – 100 children from suburban area Sunderpur. Their sociodemographic details were recorded. Children's Depression Inventory and Revised Children's Manifest Anxiety Scale were used to screen for depression and anxiety in children, respectively. The final diagnosis was done using present state examination in accordance with International Classification of Mental and Behavioral Disorders 10. Data were statistically analyzed using Chi-square test.

Results:

The prevalence of depression was found to be 14.5% while that of anxiety disorder was found to be 15%. There was no significant difference in the prevalence of depression or anxiety in rural and suburban areas (P > 0.05). Depression and anxiety were more prevalent in middle adolescence, in females, and in lower-middle socioeconomic group. Depression was more prevalent in the students of class 9^th –12^th, whereas anxiety was more in students of lower classes. Depression was more prevalent in joint families. These differences show some important trends regarding factors affecting these problems.

Conclusion:

This study yields useful information which could be of use in early management of psychiatric disorders present in the community and prevent their development into chronic disorders.

Depression among medical students in Saudi medical colleges: a cross-sectional study

INTRODUCTION

Major depressive disorder is a common mental disorder worldwide that has many clinical presentations and is associated with many diseases. The aim of this study is to assess the levels of depression among medical students in Saudi medical colleges.

METHODS

A cross-sectional study with a convenience sample conducted in Saudi medical colleges. Patient Health Questionnaire-9 (PHQ-9) was used for screening and associated with sociodemographic characteristics.

RESULTS

A total of 2,562 medical students from 20 universities were recruited into this study, and 1,572 (61.4%) of the participants were females and 990 (38.6%) were males. Depression symptoms are found to be associated with college years, living conditions and smoking status (P<0.05).

CONCLUSION

High levels of depression symptoms were found among Saudi medical students (83.4%). Students in the first years of college should be screened for depression, while education and support for medical students in these years are essential.

Adherence to a Dash-style diet in relation to depression and aggression in adolescent girls

The aim of this study was to assess adherence to the Dietary Approach to Stop Hypertension (DASH) dietary pattern in relation to depression and aggression in adolescent girls. The study was carried out among 580 girls aged between 12 and 18 years of age. DASH scores were determined according to the method of Fung et al. A Persian version of the Beck Depression Inventory and Buss-Perry questionnaire were used for the assessment of depression and aggression. We analysed our data using crude and adjusted models. Adjustments were made for age, energy intake, mother's job status, passive smoking, start of menstruation, parental death, parental divorce, physical activity level and body mass index, using three different models. A high adherence to a Dash-style diet (for individuals in the upper quartile) was associated with a lower odds of depression compared with subjects with lower adherence (those in the lowest quartile) (OR 0.47; 95% CI 0.26-0.84, P-value = 0.009); these associations remained significant after adjustments. However, we did not obtain any significant relationship between a DASH-style diet and aggression. We observed a significant inverse relationship between greater adherence to a DASH diet and lower odds of depression. Further prospective studies are needed to confirm these findings.