城市哮喘儿童抑郁障碍及相关因素分析

目的 了解哮喘儿童抑郁障碍现状,探讨其相关影响因素,为健康教育提供理论依据.方法 使用哮喘儿童一般情况调查表、儿童抑郁障碍自评量表(DSRSC)对408名8～16岁哮喘儿童进行抑郁障碍调查,并分析其相关影响因素.结果 哮喘儿童抑郁障碍检出率为22.3％,抑郁障碍评分高于全国正常儿童常模,不同年龄组间的哮喘儿童抑郁障碍差异有显著意义(P＜0.01).抑郁障碍评分的影响因素经多元逐步回归分析,父母对哮喘的认识程度、母亲文化程度、患儿性别、家庭结构、患儿文化程度5个变量进入了回归方程,其中,患儿父母对哮喘的认识程度和母亲文化程度对抑郁障碍影响最显著,患儿文化影响最小,余下两个影响因素从大到小分别为患儿性别和家庭结构.结论 哮喘儿童抑郁情绪高于全国正常儿童,受多种因素影响,应引起医护人员及家长、社会的高度重视.     

Attention-deficit/hyperactivity disorder: diagnostic assessment methods used by advanced practice registered nurses

BACKGROUND: Children presenting with symptoms of attention-deficit/hyperactivity disorder (ADHD) have become highly prevalent in primary care practice; however, advanced practice registered nurses (APRNs) diagnostic methods used to identify and diagnose this disorder are greatly understudied. AIM: This study aimed to identify APRNs recognition and diagnostic practices of children who were suspected of having an ADHD diagnosis. It also addressed APRNs comfort levels with treating and diagnosing ADHD, along with certain diagnostic methods and their perceived accuracy of these methods. METHODS: This nonexperimental exploratory research study used a self-administered questionnaire to gather information about diagnostic methods used by APRNs who diagnose children with ADHD, treat the disorder, or did both. RESULTS AND DISCUSSION: The questionnaires identified that the APRNs were following the American Academy of Pediatrics diagnostic guidelines for diagnosing ADHD in children more closely than other health care providers (pediatricians and family physicians). The results of this study also indicated that most APRNs were very comfortable to comfortable making an ADHD diagnosis (52.5%), and 64.4% reported the same level of comfort with treating ADHD. These findings indicate that the majority of APRNs surveyed who works with children are comfortable with diagnosing and treating ADHD.     

Depression in Adults with Attention-Deficit/Hyperactivity Disorder (ADHD): The Mediating Role of Cognitive-Behavioral Factors

Adults with Attention-Deficit/Hyperactivity Disorder (ADHD) are at increased risk for depressive disorders but little is known about the potential cognitive and behavioral mechanisms of risk that could shape treatment. This study evaluated the degree to which cognitive-behavioral constructs associated with depression and its treatment—dysfunctional attitudes and cognitive-behavioral avoidance—accounted for variance in depressive symptoms and disorder in adults with ADHD. 77 adults clinically diagnosed with ADHD completed self-report questionnaires, diagnostic interviews, and clinician-administered symptom rating scales. Statistical mediation analysis was employed and indirect effects assessed using bootstrap analysis and bias-corrected confidence intervals. Controlling for recent negative life events, dysfunctional attitudes and cognitive-behavioral avoidance fully accounted for the variance between ADHD symptoms and depressive symptoms. Each independent variable partially mediated the other in accounting for depression symptoms suggesting overlapping and unique variance. Cognitive-behavioral avoidance, however, was more strongly related to meeting diagnostic criteria for a depressive disorder than were dysfunctional attitudes. Processes that are targeted in cognitive behavior therapy (CBT) for depression were associated with symptoms in adults with ADHD. Current CBT approaches for ADHD incorporate active coping skills and cognitive restructuring and such approaches could be further tailored to address the ADHD-depression comorbidity.     

Dampening,Positive Rumination,and Positive Life Events: Associations with Depressive Symptoms in Children at Risk for Depression

Blunted positive affect is characteristic of depression. Altered positive affect regulation may contribute to this blunting, and two regulation strategies, dampening positive affect and positive rumination, have been implicated in depression. However, the conditions under which these strategies impart risk/protective effects prior to onset of depression are unknown. The current study examined 81 healthy children (age 7–10) at low and high risk for depression on the basis of maternal history of depression and tested how dampening and positive rumination interacted with the experience of recent positive life events to predict depressive symptoms. Children at high and low risk did not differ in their use of dampening or positive rumination. However, elevated use of dampening in the context of many positive life events predicted current depressive symptoms, and specifically anhedonic symptoms, in children at low-risk for depression. These findings held when controlling for negative rumination and negative life events. Positive rumination did not interact with positive life events but was associated with higher depressive symptoms in high-risk children. Results indicate that prior to the onset of depression, positive life events may impart risk when dampening positive affect is utilized in this context, while positive rumination may increase risk for depressive symptoms.     

Hopelessness Depression in Children: An Examination of the Symptom Component of the Hopelessness Theory

The goal of the current study was to test the symptom component of the hopelessness theory of depression in a sample of 39 children between the ages of seven and 13 currently exhibiting clinically significant levels of depressive symptoms. Children were categorized into subgroups on the basis of whether or not they (1) possessed a depressogenic attributional style and (2) experienced a negative event prior to the onset of their depressive symptoms. Although children with and without a vulnerability-stress match did not differ in terms of either overall symptom severity or level of non-hopelessness depression symptoms, children with a vulnerability-stress match exhibited higher levels of both hopelessness and hopelessness depression symptoms. In addition, although children in both groups were equally likely to receive a diagnosis of major depressive disorder, minor depressive disorder, dysthymia, and adjustment disorder with depressed mood, children with a vulnerability-stress match were more likely than children without a vulnerability-stress match to receive a diagnosis of hopelessness depression based on criteria set forth by Alloy et al. [J Abnormal Psychol 109:403–418, 2000]. Last, hopelessness depression symptoms exhibited a significantly greater association with hopelessness than did non-hopelessness depression symptoms.

Self-concept in children and adolescents with attention deficit hyperactivity disorder

Children with attention deficit hyperactivity disorder (ADHD) struggle with behavioral symptoms, yet little research has provided information about how behavioral symptoms impact their self-concept, especially in terms of gender, age, and ethnicity. Data were collected from 145 children and adolescents with ADHD and their mothers. African Americans, Hispanic Americans, and Caucasians were nearly equally represented in the sample, with approximately one third each. The Child Behavior Checklist was used to assess ADHD symptom severity, and Piers--Harris Children's Self-Concept Scale was used to measure self-concept. Older ages and more internalizing behavior problems predicted lower self-concept. There were no significant differences between ethnic groups on behavior problem and self-concept scores, although post hoc analyses revealed a trend for Caucasian children with ADHD to have lower self-concept scores than those of African American or Hispanic children. The findings indicate that there is a need to assess self-concept in children and adolescents with ADHD, especially those who are older and have comorbid conditions of anxiety and depression.     

注意缺陷多动障碍患儿家庭环境特征及自我意识的相关分析

目的探讨注意缺陷多动障碍(ADHD)患儿家庭环境特征及其与自我意识之间的相关性。方法采用家庭环境量表中文版(FES-CV)、Piers-Harris儿童自我意识量表(PHCSS)对79例ADHD儿童、71名正常儿童分别进行评估。结果 PHCSS中,AD-HD儿童行为、智力与学习情况、躯体外貌与属性、合群、幸福与满足及总分低于正常儿童(P<0.05);ADHD儿童在FES-CV中亲密度、独立性、知识性、娱乐性、道德宗教观、组织性得分低于正常儿童(P<0.05),矛盾性得分明显高于正常儿童(P<0.01)。回归分析显示,ADHD儿童FES-CV中的道德宗教观是影响PHCSS总分的主要危险因素(P<0.05)。结论 ADHD患儿的家庭存在家庭功能缺陷,并与患儿自我意识水平较低有关。     

Age-dependent relationships among pain, depressive symptoms, and functional disability in youth with recurrent headaches

OBJECTIVE: To assess age differences associated with depressive symptoms and functional disability in children and adolescents with recurrent headache. BACKGROUND: Research has indicated that psychological factors, especially depression, are related to the extent and nature of functional disability experienced from headaches. There is a lack of research examining how age impacts the relationship between pain, psychological factors, and activity restriction in children and adolescents with recurrent headache. METHODS: Seventy-seven participants from a pediatric neurology clinic completed self-report measures of pain intensity, depressive symptoms, and functional disability. RESULTS: Findings demonstrated a significant positive correlation between pain and functional disability, and depressive symptoms and functional disability for children. Correlations for adolescents failed to reach significance. Functional disability emerged as a mediator between headache pain and depressive symptoms for children but not for adolescents. CONCLUSIONS: Results indicate potentially important age differences when examining the impact of functional disability on depressive symptoms in this sample. Findings suggest that functional disability may contribute to depressive symptoms differently for children versus adolescents with recurrent headache. Age-specific interventions that differentially focus on the specific roles that pain, depressive symptoms, and disability have for children and adolescents with recurrent headache may be warranted.     

Patterns of Depressive Symptoms in Children

PROBLEM: Depressive symptoms in children have been linked to recurrent problems with depression, school problems, and risky health behaviors. Adolescent girls report depressive symptoms three to four times more frequently than adolescent boys. Few studies, however, have examined gender-related depressive symptoms in younger, school-aged children. METHODS: In the present study, gender differences in depressive symptoms in children ages 10-12 years were explored using the Children's Depression Inventory (CDI) with a convenience sample of 122 suburban middle-class public school fifth and sixth graders. FINDINGS: A distinct pattern of depressive symptom expression was found with girls reporting more internalizing and more negative self-esteem, and boys reporting more externalizing and more school problems. CONCLUSION: These findings suggest that despite similarities on a total depressive symptom score, there are distinct gender differences in depressive symptom expression that are identifiable before adolescence and may be associated with normative development.     

Investigation of the Rates of Comorbid Symptoms in Children with ADHD Compared to Children with ASD

There is a scarcity of research looking at how comorbid psychological disorders impact the assessment of children with autism spectrum disorders (ASD). The present study aimed to extend the literature in this area by evaluating rates of comorbid symptoms in both children with ASD and those with attention-deficit/hyperactivity disorder (ADHD). Children with ASD, ADHD, or no psychological diagnosis participated in this study. Internalizing and externalizing symptoms were assessed with the Autism Spectrum Disorders - Comorbidity for Children (ASD-CC). Multivariate and univariate main effect analyses with post-hoc comparisons were then conducted. Children with ASD evinced higher rates of comorbid symptoms than children with ADHD. Additionally, both children with ASD and those with ADHD exhibited more comorbid symptoms than children without a psychological disorder. These findings are in accordance with previous research and support the need for broadband assessment of psychiatric conditions in children presenting with developmental delays or externalizing behaviors. Other implications of these findings are discussed.     

Identifying Risk Factors for Maternal Depression in Families of Adolescents With Epilepsy

ISSUES AND PURPOSE. To investigate factors associated with depressive symptoms in mothers of children with chronic seizure disorders.
DESIGN AND METHODS. A cross-sectional correlational design was used with a sample of 115 mother-child dyads in families where the child had chronic epilepsy.
RESULTS. A three-factor model consisting of family income, satisfaction with family relationships, and presence of child behavior problems explained 32% of the variance in maternal depressive symptoms.
PRACTICE IMPLICATIONS. Childhood epilepsy has a negative effect on the mother's mood in many families. Child behavior problems were found to be the strongest predictor of maternal depressive symptoms. Assessing for behavior problems and maternal depression should become a routine part of the family nursing assessment.     

伴有对立违抗障碍注意缺陷多动障碍患儿智力和行为特征及与血清 5- 羟色胺水平的关系

背景对立违抗障碍( ODD)以对抗等行为为特征,常与注意缺陷多动障碍( ADHD)并存.有研究报道 ADHD合并 ODD比单纯 ADHD有更广泛的损害;有研究认为血清低 5 羟色胺水平可能与 ADHD的攻击性行为有关,国内报道较少. 目的探讨 ADHD合并 ODD的临床特征及与 5 羟色胺的关系. 设计 2002- 06/2003- 05以伴有和不伴有 ODD的 ADHD患儿为研究对象的对照性研究. 单位湘雅二医院精神卫生研究所. 对象研究对象来源于 2002- 06/2003- 05在中南大学儿童精神卫生专科门诊就诊的 7 14岁 ADHD患儿共 61例(男 53例,女 8例),按 DSM Ⅳ关于对立违抗障碍的症状学标准,将 ADHD儿童分为不伴 ODD组( n=33, ADHD组)和伴 ODD组( n=28, ADHD+ ODD组). 方法由患儿父母( n=61)填写 Achenbach儿童行为量表( CBCL),由班主任 (n=31)填写教师报告表( TRF),检测当日早餐被试者进不含巧克力、牛奶的正常饮食,空腹采静脉血 2 mL,用外标法定量测定 5 HT浓度,采用 LD 10AD高效液相色谱仪测定. 主要观察指标伴有和不伴有 ADHD儿童 CBCL, TRF、中国韦氏儿童智力量表 (C WISC),以及血清 5 羟色胺水平差异. 结果经父母和教师评定, ADHD+ ODD组在 CBCL和 TRF攻击性行为分量表、外向性行为问题及行为问题总分显著高于单纯 ADHD组,差异有显著性意义( t=2.28～ 3.76, P< 0.05～ 0.01); ADHD+ ODD组 CBCL的焦虑 /抑郁及内向性行为问题也明显高于 ADHD组,差异有显著性意义( t=2.27～ 2.35, P< 0.05). ADHD+ ODD组的血清 5 羟色胺水平 [(327.01± 164.84)μ g/L]低于 ADHD组 [(451.11± 250.89)μ g/L], 差异有显著性意义( t=2.32, P< 0.05). 结论 ADHD+ ODD儿童在内、外向性问题和适应能力、注意力诸方面均有损害;攻击性行为和 5 羟色胺降低可能是 ADHD+ ODD儿童冲动行为的生物学标记.     

Depressive symptoms and history of depression predict rehabilitation efficiency in stroke patients

OBJECTIVE: To examine how depressive symptoms, a history of depression, and cognitive functioning contribute to the prediction of rehabilitation efficiency in stroke patients. DESIGN: Consecutive admissions to an acute inpatient rehabilitation program were screened for cognitive functioning and level of depressive symptoms. History of depression was determined by family member interview. Functional status was evaluated at time of admission and discharge. Depressive symptoms, depression history, and cognitive functioning were examined as predictors of length of stay (LOS) and efficiency of utilization of rehabilitation services. SETTING: Acute inpatient rehabilitation hospital. PATIENTS: A total of 348 consecutive stroke admissions to an inpatient program were evaluated for depression and cognitive functioning, of whom 243 patients completed all aspects of the screening. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Rehabilitation progress, measured with the LOS efficiency measure (LOS-EFF) of the FIM instrument, and length of rehabilitation hospital stay. RESULTS: Patients with higher levels of depressive symptoms used rehabilitation services less efficiently than those with lower symptom levels but did not have longer LOSs. History of depression was associated with longer LOS and less efficient use of rehabilitation services. Cognitive impairment did not predict rehabilitation efficiency. CONCLUSIONS: The present study lends further support to the benefits of screening stroke patients at the time of rehabilitation admission for depression and history of depression. Identifying patients who have high levels of depressive symptoms and/or a previous depressive episode will allow more comprehensive assessment and rapid intervention.     

Sociodemographic factors of families related to postnatal depressive symptoms of mothers

Postnatal depression in mothers is commonplace as it affects 10-15% of recent mothers. Postnatal depression is still an under-diagnosed illness and if unidentified, is often left untreated. If left untreated, the depression can have an adverse effect not only on the mother, but also on the child's development and on the well-being of the whole family. The aim of this survey was to investigate the prevalence of postnatal depressive symptoms among Finnish mothers and to ascertain the relationship with sociodemographic factors in mothers. A sample of 1000 families at 2 months postnatal was studied by mailing the Edinburgh Postnatal Depression Scale to mothers and a questionnaire on demographic characteristics to mothers and fathers. The response rate was 39%. The data were examined by means of frequency and percentage distributions. Connections were examined using Spearman correlation coefficient and analysis of variance. In all, 373 mothers and 314 fathers took part in the study. Fifty-five (13%) mothers had depressive symptoms. Results show that the number of pregnancies, deliveries or children, the mode of delivery or the mother's age were not associated with depressive symptoms. However, mothers who had depressive symptoms had fewer years of education, shorter duration of breast-feeding and were more dissatisfied with family life compared with mothers who exhibited no depressive symptomatology. The families of mothers with depressive symptoms had also experienced more problems and changes having a profound impact on the family compared with other mothers.     

Rates and predictors of depression in adoptive mothers: moving toward theory

There are approximately 1.8 million adopted children living in the United States. Adoptive parents may experience depressive symptoms and put their children at risk for negative outcomes. The results of this study describe the rates of depression in 300 adoptive mothers and associations with hypothesized explanatory variables, which predict approximately half of the variance in maternal depressive symptoms: expectations of themselves as mothers, the child, and family and friends; feeling of rest; past and present psychiatric difficulties (self-esteem, history of depression); and interpersonal variables (bonding, marital satisfaction, perceived support). These findings are useful in planning effective interventions to mitigate depressive symptoms.     

伴品行障碍多动症的相关危险因素研究

目的：探讨伴品行障碍的注意缺陷多动障碍(简称ADHD CD)的相关危险因素，为ADHD CD的预防、干预提供理论依据。方法：采用自制问卷和家庭环境量表对50例ADHD CD患者和50例正常儿童进行测验，将结果进行x^2检验和Logistic回归分析。结果：1．与对照组相比，ADHD CD组的阳性家族史、母孕期患病及服药、异常分娩、出生体重偏低、早期发育延迟、软体征和既往病史的发生率高；父母关系不良、管教方法粗暴、父母及老人管教态度不一致的发生率高。2．ADHD CD患者家庭的亲密度、情感表达、知识性、娱乐性、组织性和道德宗教观得分低于对照组家庭；而矛盾性则高于正常对照家庭。3．管教方法粗暴或放纵、低情感表达和家庭矛盾性高是ADHD CD的相关危险因素。结论：管教方法粗暴、低情感表达和家庭矛盾性高是ADHD CD的相关危险因素。     

Prevalence and correlates of depressive symptoms in the elderly of rural communities in southern Taiwan

The purpose of this study was to determine the prevalence and level of depressive symptoms and the influence of demographic characteristics on depressive symptoms in elders residing in rural Taiwan. Also, the association was explored between depressive symptoms and life stressors in the Taiwanese Elderly Stress Inventory (TESI). A cross-sectional design utilizing face-to-face administered instruments was used. A total of 195 older community residents participated in the study. Levels of depressive symptoms wese measured by the Geriatric Depression Scale - Short Form (GDS-SF) while life stressors were assessed with the Taiwanese Elderly Stress Inventory (TESI). Overall, 57% of the subjects had a GDS-SF score of 7 or above (M = 7.58, SD = 3.89), indicating that the majority were depressed. Additionally, gender, educational level, marital status, living arrangements, and socioeconomic status (SES) were significant factors to depressive symptoms. Women were more likely to experience depression than men. Elders who had received no formal education, were separated from their spouse due to death or divorce, lived alone, or had lower SES were at higher risk of more severe depression. Also, significant correlations were found between depressive symptoms and 19 stressors identified in the TESI. These stressors mostly include events related to physical functioning and family issues. The findings of this study will provide community health professionals in Taiwan with a better recognition of depressive symptoms in rural elders and stressors that are associated with depressive symptoms. This information can be used to plan health-related services and interventions for rural elders.     

Prevalence of Depressive Symptoms and Associated Factors Among Radiographers in the West Bank Hospitals of Palestine: A Cross-Sectional Study

The radiographer is one of the most important and needful components of the workforce in the health care system. This study aimed to investigate the prevalence of depressive symptoms and explore its associated risk factors among radiographers working in the West Bank hospitals. A cross-sectional design was used for the study. Beck's depression inventory-II Arabic version was administered to respondents and Statistical Package of the Social Sciences (SPSS v 21) was used for the data analysis.The prevalence of depressive symptoms among radiographers was (66.9%). The results showed a significant association between gender and depression; men were at higher odds of having higher depression categories as than women by 9.6 times (95% CI 3.65-22.4). In addition, radiographers who had no children were at higher odds to report higher depression categories than radiographers who had from one to more than five children by 8.9 times (95% CI 1.55- 52.02). In addition, the results showed that the radiographers who had bachelor degree were at higher odds of having higher depression categories than diploma and master or more radiographers by 2.4 times (95% CI 1.04-5.78). To work in private hospitals had lower odds of having higher depression categories than radiographers who work in government hospitals by 0.24 times (95% CI 0.17-0.51). The results showed a significant association between monthly salary and depression categories; radiographers who took monthly salary 1000-1199$ were at higher odds of having higher depression categories than radiographers who took more than 2000US $ by 2.5 times (95% CI 1.24-5.33). The radiographers who smoke were at higher odds of having higher depression categories than radiographers who did not smoke by 2 times (95% CI 1.08-4.18). Other variables showed no significant association with depression categories among radiographers.Depressive symptoms among radiographers were found to be prevalent. Gender, number of children, education level, monthly salary, smoking cigarettes, work experience, and working sector were associated with the generation of depressive symptoms.