Prevalence and correlates of mental disorders in Israeli adolescents: results from a national mental health survey

Background: The development of epidemiological instruments has enabled the assessment of mental disorders in youth in countries that plan policy according to evidence‐based principles. The Israel Survey of Mental Health among Adolescents (ISMEHA) was conducted in 2004–2005 in a representative sample of 957 adolescents aged 14–17 and their mothers. Methods: The aims of this study were to estimate prevalence rates of internalizing and externalizing mental disorders and their socio‐demographic and health correlates. Disorders were ascertained with the Development and Well‐Being Assessment inventory and verified by child psychiatrists. Results: The prevalence rates were 11.7%, 8.1% and 4.8% for any disorder, internalizing disorders and externalizing disorders, respectively. Distinct risk factors were associated with the different types of disorders: internalizing disorders were associated with female gender, chronic medical conditions and being cared for by a welfare agency. Risk factors for externalizing disorders were male gender, having divorced or single parents, being an only child or having only one sibling. Learning disability was associated with both types of disorders. Conclusions: The risk and protective factors related to internalizing and externalizing disorders are interpreted within the framework of family composition in this multicultural society.     

Prevalence and mental health correlates of witnessed parental and community violence in a national sample of adolescents

Background:  Although research suggests that witnessed violence is linked to adverse mental health outcomes among adolescents, little is known about its prevalence or its significance in predicting psychiatric symptoms beyond the contribution of co-occurring risk factors. The purpose of this study was to identify the national prevalence of witnessed parental and community violence and to examine these life stressors as independent risk factors for posttraumatic stress disorder (PTSD) and major depressive episode (MDE) among adolescents. A secondary aim was to determine which characteristics of witnessed violence were associated with mental health outcomes.
Method:  Participants were 3,614 adolescents recruited from a 2005 US national household probability sample who completed structured telephone interviews assessing witnessed violence and Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) criteria for PTSD and MDE.
Results:  National prevalence of witnessed parental violence and witnessed community violence was estimated to be 9% and 38%, respectively. Both forms of witnessed violence predicted PTSD and MDE beyond variance accounted for by age, gender, race/ethnicity, income, and other traumatic event history. Perceptions of threat, repeated violence exposure, location of the violence, and relationship to the victim were associated with psychiatric diagnoses.
Conclusions:  Findings suggest that witnessed violence represents a significant public health burden with implications for psychological assessment and prevention efforts.     

Siesta and sleep patterns in a sample of adolescents in Greece

Background: Sleep behaviors and disturbances in adolescence are being increasingly investigated. The aim of the present study was to investigate the sleep habits of adolescents living in provincial Greece. Methods: Responses to pre‐constructed questionnaires on sleep habits and disturbances from 471 high‐school students (259 boys; 212 girls), aged 14–18 years, attending four high schools of rural and semi‐urban areas in north‐western Greece, were analyzed. Results: The median nocturnal and total sleep duration was 7.5 h (range, 2.5–11 h) and 8.5 h (range, 2.5–14 h), respectively, and the average bedtime was 23.55 hours. Male students, older adolescents and residents of towns went to bed later than female students, younger adolescents and residents of villages (P = 0.039, P = 0.0003 and P = 0.056, respectively). Siesta on a regular basis was reported by 43% and on an occasional basis by 46% of the students. Siesta median duration was 1.5 h (range 0.5–4.5 h). Daytime sleepiness, difficulties in morning awakening and in falling asleep, and night awakenings were reported by 26.3%, 17.4%, 17.2% and 11.2%, respectively. Students who had siestas reported less daytime sleepiness (P < 0.0001). Significant differences were observed between boys and girls regarding sleep disturbances. Conclusion: Adolescents in provincial Greece present with a different sleep pattern as compared to their northern European peers, characterized by late bedtime and midday siesta. Similarly to their peers in other countries, considerable rates of sleep disturbances were reported.     

Prevalence and correlates of poor sleep among adolescents

The Stanford Sleep Inventory was given to 639, 11th- and 12th-grade students to assess the prevalence and correlates of poor sleep among an adolescent population. Of the sample reported, 49.8% had no sleep problems, whereas 37.6% reported occasional sleep disturbance and 12.6% reported chronic and severe sleep disturbance. Students complaining of disturbed sleep were more likely than good sleepers to describe negatively their physical and personality characteristics. The clinical implications of these data for developing educationally-based nondrug treatment of the complaint of insomnia among adolescents are discussed.     

Prevalence and mental health outcomes of homicide survivors in a representative US sample of adolescents: data from the 2005 National Survey of Adolescents

Background: Each homicide leaves behind several friends and family members, or homicide survivors. However, limited information is available on the impact of homicide on adolescent survivors. The purpose of the current study was to identify the prevalence of homicide survivorship and to determine mental health outcomes within a sample of US adolescent survivors. Methods: A nationally representative sample of American adolescents (N = 3,614) between the ages of 12 and 17 completed structured telephone interviews assessing homicide survivorship and mental health consequences including posttraumatic stress disorder (PTSD), depression, drug use, and alcohol abuse. Results: Reported prevalence within this sample of losing a loved one to criminal homicide was 9%, losing a loved one to vehicular homicide was 7%, and losing a loved one to both types of homicide was 2%. Logistic regression analyses found that adolescents who reported being homicide survivors were significantly more likely to report depression, drug use, and alcohol abuse after controlling for demographic factors and other violence exposure. Conclusions: If the results from this study are generalizable to the US population, roughly 1 in 5 American adolescents may be impacted by homicide. Further, adolescents exposed to such a loss are at increased risk for mental health sequelae. Results suggest that greater attention needs to be paid to address the needs of these often underserved victims.     

The temporal relation between depression and comorbid psychopathology in adolescents at varied risk for depression

Background: This study examined the temporal comorbidity of depressive disorders with anxiety, externalizing, and substance use disorders in adolescents who varied in risk for depression. Methods: Participants were 240 adolescents and their mothers who had either a history of depression (high‐risk, n = 185) or were lifetime‐free of psychiatric disorders (low‐risk, n = 55). Children (54.2% females) were first evaluated in 6th grade (mean age = 11.86, SD = .57) with the K‐SADS‐PL to assess current and lifetime diagnoses, and then annually through 12th grade with the A‐LIFE to assess diagnoses since the previous evaluation. Results: For girls, the rate of depression was high regardless of prior anxiety, whereas for boys, the odds that those with prior subthreshold anxiety would have subsequent subthreshold depression were 1.5 times those of boys with no prior subthreshold anxiety, controlling for risk. In addition, the odds that girls with prior substance use disorders would have a threshold depressive disorder subsequently were three times those of girls with no prior substance use disorders, controlling for risk. Conclusions: These results highlight the importance of early detection of various forms of psychopathology in youth who then can be targeted for intervention. The prospective paths to comorbidity differed by sex, thus suggesting that interventions need to be constructed with sensitivity to these distinct diagnostic trajectories.     

Prevalence of self-perceived allergic diseases and risk factors in Italian adolescents

The aim of the study was to assess the symptoms prevalence of allergic diseases in a population of 11–15 yr old schoolchildren, to evaluate the associations between asthma and other symptoms and identify risk factors for asthma, rhinitis and eczema syndromes. A sample of 481 students was studied using an International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. Prevalence of different kind of self-reported symptoms was calculated. Using a logistic regression approach, we tried to identify risk factors for three syndromes – rhinitis, eczema and asthma. The highest and the lowest prevalence rates of self-reported symptoms were recorded for rhinitis (43.6%) and for eczema (8.1%), respectively. The prevalence of asthma was 15.7%. Univariate analysis showed a mutual association between wheeze and rhinitis symptoms. Multivariate logistic regression model for eczema syndrome revealed female gender as a significant risk factor. The polytomic logistic multivariate regression revealed female gender and family history of allergy as significant risk factors for rhinitis syndrome only, and maternal smoking and familial allergy for rhinitis and asthma together. In particular, familial allergy yields a 400% higher chance of developing asthma and rhinitis together. The synergistic effect of familial allergy on rhinitis and asthma syndromes suggests the implementation of preventive measures in children with family history of these diseases.     

超重肥胖儿童青少年代谢综合征流行现状调查

目的 了解上海市浦东新区川沙地区超重肥胖儿童青少年中代谢综合征(MS)的流行现状和临床特点.方法 对432例7～15岁超重肥胖儿童青少年进行体格测量和血液生化检测.应用Cook定义诊断MS,具有下列5项中至少3项者诊断为MS:腹型肥胖、高血压、高血糖、高甘油三脂(TG)血症和低高密度脂蛋白胆固醇(HDL-C)血症.结果 腹型肥胖、高血压、高血糖、高TG血症和低HDL-C血症的总检出率分别为85.9%、44.4%、13.4%、48.6%和9.0%.具有0、1、2和3项及3项以上MS组分者分别占4.4%、28.3%、36.3%和31.0%.约95%的个体至少有1项MS组分异常,约60%～70%的个体至少有2项异常.共检出MS134例,检出率为31.0%.结论 川沙地区超重肥胖儿童青少年多存在明显的代谢紊乱,MS的流行已相当严重,接近发达国家水平.     

Prevalence and correlates of partner violence among South African adolescents

BACKGROUND: Little is known about the prevalence of partner violence among adolescents, nor of the factors with which it is associated. The objectives of this study were to document prevalence rates for partner violence among high school students in Cape Town, and to explore factors that are associated with such violence. METHOD: The sample consisted of 596 Grade 8 and 11 students attending public high schools in Cape Town, who were selected using a multistage cluster design. They completed an anonymous and confidential questionnaire. The dependent variable was whether they had ever perpetrated partner violence, or intended to do so. The independent variables, which were derived from a modified version of the Theory of Planned Behaviour (TPB), included attitudes, subjective norms (general and peer social influence and outcome expectancy) and self-efficacy. Separate multiple logistic regression models were developed of partner violence intentions or behaviours on the scales derived from the TPB and demographic variables. Regression coefficients from adjusted models were used to examine the potential mediating role of partner violence intentions in the association between each scale and partner violence behaviours using the Sobel test. RESULTS: Among participants who reported being in a relationship, 20.7% reported perpetrating partner violence, and 16.4% reported intending to do so. After adjusting for demographic characteristics and other predictor scales, perpetration of partner violence was significantly associated with attitudes and outcome expectancy, while intention to perpetrate partner violence was significantly associated with attitudes and general social influence. The influence of attitude and general social influence on violent behaviours were each partially mediated by partner violence intentions. CONCLUSIONS: There are high levels of partner violence among high school students in Cape Town. Interventions to address this problem should focus on violence-related attitudes and outcome expectancy.     

Self-concept and psychopathology in deaf adolescents: preliminary support for moderating effects of deafness-related characteristics and peer problems

Background: High rates of psychopathology were found amongst deaf adolescents, but little is known about the psychosocial risk factors. This study investigated whether (1) less severe deafness and/or acquired or otherwise complicated deafness, and (2) having mainly contacts with hearing people, each represent chronic stressful conditions that moderate the associations between self‐esteem and emotional problems. In addition, the moderating effect of observed peer rejection on the association between social acceptance and behavioural problems was explored. Method: Deaf adolescents of normal intelligence (N = 68) completed the Self Perception Profile for Adolescents. Psychopathology was assessed using a semi‐structured interview with adolescents and reports by parents, teachers and expert ratings. Data on moderator variables were collected from school records, parental and teachers’ reports. Results: Emotional mental health problems were negatively associated with self‐esteem and positively with peer rejection. The association between self‐esteem and emotional problems was moderated by the deafness variable less severe deafness or acquired or otherwise complicated deafness. Behavioural mental health problems were positively associated with social acceptance and peer rejection but negatively with the amount of involvement with hearing people. Peer rejection moderated the association between social acceptance and behavioural problems. Conclusions: The findings emphasise the importance of considering self‐concept dimensions, peer problems and deafness‐ and context‐related characteristics when assessing and treating deaf adolescents.     

Prevalence and psychological correlates of occasional and repetitive deliberate self-harm in adolescents

OBJECTIVE: To determine the prevalence and the associated psychological and social factors of occasional and repetitive deliberate self-harming behavior in adolescents. DESIGN: Cross-sectional self-report survey. SETTING: One hundred twenty-one schools in Germany. PARTICIPANTS: A representative sample of 5759 ninth-grade students was studied between 2004 and 2005. OUTCOME MEASURES: Deliberate self-harm (DSH) and suicidal behaviors, emotional and behavioral problems (Youth Self-Report), living standard, family composition, parental conflict and illness, school type and performance, relationship to peers, bullying, body satisfaction and dieting, media consumption, smoking, and alcohol and drug use. RESULTS: Occasional forms of DSH within the previous year were reported by 10.9% of the ninth-grade students. Four percent of the students reported repetitive forms of DSH. Suicidal behavior was strongly associated with repetitive DSH, an association that held for both subtypes of DSH. The findings also indicated that social background factors were important concomitants of occasional DSH but were not related to an increased likelihood of repetitive DSH. Symptoms of depression/anxiety and delinquent/aggressive behavior were associated with self-harming behavior in both adolescent girls and boys. CONCLUSIONS: The data suggest that there is a link between social factors and occasional DSH and, especially in repetitive DSH, that there is a strong association between DSH and suicidal behavior as well as DSH and emotional and behavioral problems. These findings indicate a different pathway in the development of DSH in adolescents. The results support a need to investigate the possible neurobiological underpinnings of DSH within a longitudinal model to enhance the knowledge of this poorly understood behavior.     

Prevalence and correlates of environmental tobacco smoke exposure among adolescents in Mangolia

Objective To estimate the prevalence and identify correlates of environmental tobacco exposure (ETS) among adolescents in Mongolia. Methods A cross-sectional study was carried out in 2003 in Mongolia within the framework of the Global Youth Tobacco Survey. Information was obtained on exposure to Environmental tobacco smoke (ETS) in the home and outside home, parental and peer smoking. Demographic characteristics such as age and sex were also obtained. Data were analyzed to obtain frequencies of characteristics. Logistic regression analysis was conducted to assess the association between ETS and relevant predictor variables. Results 73.9% (71.6%–76.1%) males and 71.7% (69.7%–73.7%) females reported being exposed to ETS either in the home or elsewhere. The odds of exposure were 5.85 (3.83–8.92) if both parents were smokers, 3.65(3.10–4.30) if only father smoked and 6.54 (3.48–12.32) if only mother smoked. Older adolescents were more likely to be exposed to ETS than younger adolescents. Prevalence of exposure to ETS within the home was similar between males and females but males had a higher prevalence of exposure outside of the home than females (50.7% and 42.4% respectively (p <0.001). Overall proportion of adolescents exposed to ETS in the home was higher than those exposed outside suggesting that domestic exposure was the main form of ETS among adolescents in Mongolia. Conclusion Exposure to environmental tobacco smoke is high among school going adolescents in Mongolia. Public health interventions aimed to reduce morbidity from tobacco among adolescents should also accord particular attention toward environmental tobacco smoke.     

Prevalence and correlates of pelvic examinations in sexually active female adolescents.

OBJECTIVES: The pelvic examination is an important component of reproductive health services for adolescent girls and is recommended for those who become sexually active. The aims of this study were to describe self-reported rates of pelvic examinations in sexually active adolescent girls and to determine factors associated with having obtained an examination. METHODS: Cross-sectional data from a national self-administered survey of nurses' adolescent daughters were used. Subjects were those girls (N = 635) who reported ever having had sexual intercourse. Bivariate and multivariate analyses were used to identify demographic and psychological variables, preventive health behaviors, and risk behaviors associated with having ever obtained a pelvic examination. RESULTS: Median subject age was 16.0 years (range 12-19 years), and 46% of subjects reported having had a pelvic examination. Variables associated with having obtained an examination were older age (odds ratio [OR] 1.29, 95% confidence interval [CI] 1.09-1.53), cigarette smoking (OR 1.51, 95% CI 1.02-2.24), higher number of sexual partners (OR 1.29, 95% CI 1.14-1.47), and no condom use during last sexual intercourse (OR 1.80, 95% CI 1.19-2.70). CONCLUSIONS: Fewer than half of these sexually active adolescents had ever obtained a pelvic examination. Younger subjects who did not smoke regularly, had fewer partners, and used condoms were less likely to have obtained an examination; these adolescents may not be seeking reproductive health care services or be recognized by parents or providers as being in need of services.     

Prevalence of intentional under- and overdosing of insulin in children and adolescents with type 1 diabetes

Schober E, Wagner G, Berger G, Gerber D, Mengl M, Sonnenstatter S, Barrientos I, Rami B, Karwautz A, Fritsch M, on behalf of the Austrian Diabetic Incidence Study Group. Prevalence of intentional under‐ and overdosing of insulin in children and adolescents with type 1 diabetes. Objective: The aim of this study was to evaluate the prevalence of insulin under‐ and overdosing in paediatric patients. Research design and methods: Cross‐sectional study including 241 patients (age 14.0 + 2.7 yr, 42.5% males) with type 1 diabetes from 21 diabetic outpatient clinics. Haemoglobin A1c (HbA1c), height, and weight were available from clinical records. Patients were interviewed with the Diabetes Self‐Management Profile (DSMP) interview. T test, U test, and chi‐squared test were used for comparison. Results: On the basis of the DSMP, 103 (42.7%) patients (group A) showed adherence to the therapeutic insulin regimen, while 71 (29.5%) patients (group B) confessed intentional over and/or under‐dosing of insulin. Sixty‐seven (27.8%) adolescents (group C) reported management problems leading to unintended inappropriate insulin dosages. In group B, 55 (22.8%) injected higher insulin doses and 58 (24.1%) omitted insulin. Patients of group B compared to group A were older 15.0 (±2.5) vs. 14.0 (±2.5) yr (p < 0.01), older at onset 9.5 (±3.6) vs. 8.3 (±3.8) yr (p = 0.05), were more often girls (69 vs. 45.6%), had a higher actual HbA1c (8.7 ± 1.7 vs. 7.8 ± 1.2%), and a higher average HbA1c in the previous year (8.3 ± 1.6 vs. 7.9 ± 1.2%) (p < 0.01). No significant differences could be found between group A and group C. Conclusion: Intentional overdosing of insulin is almost as prevalent in children and adolescents as insulin omission. Females are more at risk.     

Disordered eating and body dissatisfaction in adolescents with type 1 diabetes and a population-based comparison sample: comparative prevalence and clinical implications

Objective:  To compare the prevalence of disordered eating and body dissatisfaction between adolescents with type 1 diabetes and a population-based sample of youth.
Subjects:  A clinic-based sample of 143 adolescents (73 male and 70 female) with type 1 diabetes who participated in the Assessing Health and Eating among Adolescents with Diabetes (AHEAD) study was compared with a population-based sample of 4746 youths (2377 male, 2357 female, and 12 missing) who participated in Project Eating Among Teens (Project EAT).
Method:  Participants completed surveys and anthropometric measurements of height and weight.
Results:  Although some adolescents with type 1 diabetes endorsed unhealthy weight control practices, overall, they reported less weight dissatisfaction and were less likely to use any unhealthy weight control behaviors and more likely to report regular meal consumption than the population-based sample. Females with type 1 diabetes were less likely to report dieting, fasting, or eating very little food to control weight during the past year than their population-based peers. However, males with type 1 diabetes were less likely than their peers to exercise and to consume more fruits and vegetables for healthy weight control. Of medical concern were insulin omission (1.4% males and 10.3% females) and dosage reduction (1.4% males and 7.4% females) as means of weight control among youth with type 1 diabetes.
Conclusions:  Despite medical supervision, some adolescents with type 1 diabetes reported unhealthy weight control behaviors and weight concerns, including insulin manipulation. Altering the insulin regimen may cause complications. All adolescents warrant attention for unhealthy behaviors and weight concerns.     

Prevalence of selective immunoglobulin A deficiency in Greek children and adolescents with type 1 diabetes

Background

The association of selective immunoglobulin A (IgA) deficiency with type 1 diabetes (T1D) remains unclear. This study was to evaluate serum IgA concentrations in Greek children and adolescents with T1D.

Methods

In two hundred individuals with T1D, serum IgA concentrations were quantitatively determined using nephelometry.

Results

Immunoglobulin A deficiency was detected in 6 (3.0%) of 200 patients who were subjected to immunological evaluation. Recurrent infections were not recorded, but human papilloma virus infection was clinically suspected and confirmed by laboratory examination in a 5-year-old girl. In regard to coincidence of selective IgA deficiency with autoimmune diseases, celiac disease was detected in a girl and juvenile idiopathic arthritis in a boy. Serum IgA concentrations differed significantly when patients were grouped according to age at the beginning of the study (P<0.001), age at diagnosis of T1D (P=0.015) and coincidence of celiac disease (CD) (P=0.038). However, when the age of the patients was adjusted, difference in serum IgA concentrations was not statistically significant despite CD was present or not. Moreover, serum IgA concentrations were positively correlated with serum IgG (P<0.001) and IgE (P=0.001) concentrations and negatively correlated with serum antigliadin antibody IgG (P=0.035) concentrations. There was no association or correlation of serum IgA concentrations with glycemic control.

Conclusion

The prevalence of selective IgA deficiency in Greek children and adolescents with T1D is high (3.0%). The correlation of serum IgA concentrations with serum IgG, IgE and anti-gliadin antibody IgG concentrations needs further investigation.

     

Socio-demographic and psychopathologic correlates of enuresis in urban Ethiopian children

AIM: To examine the association between enuresis and psychopathology in urban Ethiopian children. METHODS: A two-stage mental health survey of 5000 urban children found enuresis to be by far the most common disorder. Logistic regression modelling was carried out to determine the independent associations of a number of socio-demographic and psychopathological characteristics with enuresis. RESULTS: Male sex, younger age and lower achieved educational grade of the child were all independently associated with childhood enuresis. The odds of having enuresis were significantly higher for children in families with significant financial worries and in children from homes where parents were separated. Children with DSMIII-R anxiety disorders, especially simple phobia, or disruptive behaviour disorders were found to have significantly higher odds of having enuresis. CONCLUSION: Psychopathology, both anxiety and behavioural disorders, as well as family stressors in urban Ethiopian children were found to be risk factors for enuresis. Although a cause-effect relationship could not be ascertained, the findings of higher association of psychopathology with enuresis in this and other studies indicate that there is a need for evaluating children with enuresis for the presence of concurrent psychopathology, especially in traditional societies where undetected psychopathology may be more common.