Well-being and health behaviour by parental socioeconomic status

Background: The aim of the study was to investigate the impact of parental socioeconomic status (SES) on subjects' well-being and health behaviour in adolescence, early adulthood and adulthood, and whether these impacts remained after controlling for the person's own SES. Methods: All 16-year-old ninth-grade school pupils of one Finnish city completed questionnaires at school. Subjects were followed up using postal questionnaires when aged 22 and 32 years. Results: Females of manual class origin had lower self-esteem and more distress symptoms from adolescence to adulthood than those from a non-manual background. Lower self-esteem was found among males from manual class families in adolescence and early adulthood. In both genders, no significant class differences were found in depression, health status or prevalence of chronic illness. Unhealthier behaviours regarding smoking and physical activity were more prevalent among both genders of manual class origin, and females of this group had higher rates of overweight and higher body mass index scores. After controlling for the person's own SES, the effect of parental SES diminished but remained significant for smoking in both genders and for physical activity in males up to 22 years, and for self-esteem and BMI in females up to 32. Conclusions: This follow-up study contributes to the health inequality debate investigating parental SES differences in health behaviour and somatic health, and particularly in psychological health, which is relatively rarely investigated. The results indicate that parental SES has effects on early adult and adult well-being and health behaviour other than those mediated by current SES. Accepted: 11 November 2002 Correspondence to Taina Huurre, Lic.Ed., Ph.D.     

Socioeconomic status as a cause and consequence of psychosomatic symptoms from adolescence to adulthood

Background Few follow-up studies have investigated psychosomatic health and socioeconomic status (SES) and associations between them at different life stages. The aim of this study was to investigate differences in psychosomatic symptoms by SES in adolescence, early adulthood and adulthood and to examine whether lower SES leads to higher levels of symptoms (social causation) or higher levels of symptoms to lower SES (health selection) or both.Methods All 16-year-old ninth-grade school pupils of one Finnish city completed questionnaires at school. Subjects were followed up using postal questionnaires when aged 22 and 32 years.Results Females reported significantly higher scores of psychosomatic symptoms than males at 16, 22 and 32 years of age. Higher rates of psychosomatic symptoms were found among females of manual class origin at 16 years. In addition, at 22 years, both females and males with only comprehensive school education and, at 32 years, those who worked in manual jobs had higher scores of symptoms. When low SES both as a cause and consequence of symptoms was investigated, the findings supported both these paths among females and more the health selection among males. In both genders, especially the path from psychosomatic symptoms in adolescence to lower education in early adulthood was strong.Conclusions The results highlight the need of greater consideration of psychosomatic symptoms, particularly in adolescence, in later socioeconomic outcomes.     

An engagement and access model for healthcare delivery to adolescents with mood and anxiety concerns

Aim: Mood and anxiety disorders typically begin during adolescence or early adulthood. Yet services targeting this population are frequently lacking. This study implemented an outreach, access and assessment programme for youth with these concerns. The data reported constitute an evaluation of this mental healthcare delivery approach. Methods: This evaluation included specification of both programme and implementation theories through causal and programme logic models and formative (process) evaluation. Outreach focused on access points for youth such as schools and family physicians' offices. Concerned youth were encouraged to self‐refer. Participants completed a semi‐structured clinical interview and symptom and function questionnaire package. Results: Engagement sessions were conducted and results involved 93 youth. The majority of youth self‐referred, a process not possible in traditional physician‐referral healthcare systems. Interestingly, almost half had received prior treatment and over half had tried a psychiatric medication. Yet participants had significant symptomatology: 81% reported moderate to severe depressive symptoms; 95% reported high levels of trait‐anxiety. Functional impairment was substantial: on average, participants missed 2.6 days of school/work and functioned at reduced levels on 4.2 days in the week prior to assessment. Demographic details are presented. Conclusion: This study evaluated a mental healthcare delivery system that identified individuals with significant distress and functional impairment from mood/anxiety concerns and previous unsuccessful treatment attempts, verifying that they were in need of mental health services. This approach provides a model for outreach and assessment in this population, where earlier intervention has the potential to prevent chronic mental illness and disability.     

Stable prediction of mood and anxiety disorders based on behavioral and emotional problems in childhood: a 14-year follow-up during childhood, adolescence, and young adulthood

OBJECTIVE: The goal of this study was to predict the onset of mood and anxiety disorders from parent-reported emotional and behavioral problems in childhood across a 14-year period from childhood into young adulthood. METHOD: In 1983, parent reports of behavioral and emotional problems were obtained with the Child Behavior Checklist for children and adolescents 4-16 years of age from the Dutch general population. At follow-up 14 years later, lifetime mood and anxiety diagnoses were obtained by a standardized DSM-IV interview for 1,580 subjects. Cox proportional hazards models were used to predict the incidence of mood and anxiety disorders from childhood problems and demographic covariates. RESULTS: Mood disorders were significantly predicted by high scores on the anxious/depressed scale and on the internalizing composite (withdrawn, somatic complaints, and anxious/depressed). Anxiety disorders were significantly predicted by the social problems scale and the externalizing composite (delinquent behavior and aggressive behavior). Anxiety disorders predominantly started in childhood and early adolescence, whereas the incidence of mood disorders increased sharply in adolescence and young adulthood. CONCLUSIONS: These results suggest different developmental pathways for mood and anxiety disorders. The predictions based on problem behavior remained stable during the 14-year period across adolescence and young adulthood. The results therefore underline the importance of early intervention and prevention of behavioral and emotional problems in childhood.     

Cross-cultural differences in somatic presentation in patients with generalized anxiety disorder

Little is known about cultural differences in the expression of distress in anxiety disorders. Previous cross-cultural studies of depression have found a greater somatic focus in Asian populations. We examined anxiety symptoms in patients with generalized anxiety disorder (GAD) in urban mental health settings in Nepal (N = 30) and in the United States (N = 23). Participants completed the Beck Anxiety Inventory (BAI). The overall BAI score and somatic and psychological subscales were compared. While there was no difference in total BAI scores, the Nepali group scored higher on the somatic subscale (i.e. "dizziness" and "indigestion," t[df] = -2.63[50], p < 0.05), while the American group scored higher on the psychological subscale (i.e. "scared" and "nervous," t[df] = 3.27[50], p < 0.01). Nepali patients with GAD had higher levels of somatic symptoms and lower levels of psychological symptoms than American patients with GAD. Possible explanations include differences in cultural traditions of describing distress and the mind-body dichotomy.     

High somatic distress with high long-term stability in selected patients with chronic depression: A 3-year follow-up of ratings with Karolinska Scales of Personality (KSP)

The main aim of the present study was to investigate mean levels and long-term stability of three scales from the Karolinska Scales of Personality (KSP), assessing somatic components of anxiety proneness in selected patients with chronic depressive symptoms. The KSP was filled in by 84 patients (26 men and 58 women) with a history of or ongoing major depression and audiological, or other comorbid somatic, symptoms. Mean scores for the Somatic Anxiety, Muscular Tension and Psychasthenia scales were above two standard deviations compared to a normative group sampled from the population. The KSP was filled in at follow-up by 65 patients. The mean interval between the ratings was 3.5 years. Comparisons between the ratings of the three scales revealed no significant mean score differences, and quite high individual stability. The mean scores were significantly increased in comparisons with depressed patients in primary care suggesting that these patients with chronic depression may comprise a depressive sub-type characterized by high “somatic distress”. A putative origin for the high and stable scores in the presented sub-group of depressed patients, and the concept of “personality trait” in use even for pronounced symptoms, are discussed.     

High somatic distress with high long-term stability in selected patients with chronic depression: a 3-year follow-up of ratings with Karolinska Scales of Personality (KSP)

The main aim of the present study was to investigate mean levels and long-term stability of three scales from the Karolinska Scales of Personality (KSP), assessing somatic components of anxiety proneness in selected patients with chronic depressive symptoms. The KSP was filled in by 84 patients (26 men and 58 women) with a history of or ongoing major depression and audiological, or other comorbid somatic, symptoms. Mean scores for the Somatic Anxiety, Muscular Tension and Psychasthenia scales were above two standard deviations compared to a normative group sampled from the population. The KSP was filled in at follow-up by 65 patients. The mean interval between the ratings was 3.5 years. Comparisons between the ratings of the three scales revealed no significant mean score differences, and quite high individual stability. The mean scores were significantly increased in comparisons with depressed patients in primary care suggesting that these patients with chronic depression may comprise a depressive sub-type characterized by high "somatic distress". A putative origin for the high and stable scores in the presented sub-group of depressed patients, and the concept of "personality trait" in use even for pronounced symptoms, are discussed.     

Depression and anxiety in coronary artery bypass grafting patients.

PURPOSE: Heart surgery is a factor triggering off specific emotional and physiological responses of a patient. In spite of positive somatic effects of surgery, depression and anxiety can persist or appear for the first time after the operation worsening the patient's psychosocial functioning and quality of life. The aim of this study is to offer a prospective view on the incidence and course of self-reported depression and anxiety in coronary artery bypass graft (CABG) patients. SUBJECT AND METHODS: After informed consent, 53 patients who submitted to CABG were examined a few days before and after the operation and 3 months after CABG. They completed the Spielberger Anxiety Questionnaire and Beck Depression Inventory. RESULTS: Approximately 55% of the patients had high a level of anxiety preoperatively. Shortly after the surgery, 34% of patients and after 3 months 32% of them had clinically relevant level of anxiety. Thirty-two percent of patients before the surgery, 28% immediately after CABG and 26% at follow-up were depressed. CONCLUSIONS: High preoperative depression, state and trait anxiety scores appear to be predictors of postoperative psychological outcome. Preoperative assessment can identify patients at risk for clinical levels of postoperative anxiety and depression. Psychological preventive counseling and psychiatric intervention can reduce patients' emotional distress, medical and economic costs.     

Predictors of somatic symptoms in depressive disorder

We explored the relative contribution of potential psychological predictors of somatic symptoms in outpatients with major depressive disorder, including; 1) severity of depression; 2) general anxiety; 3) hypochondriacal worry; 4) somatosensory amplification; and, 5) alexithymia by sampling 100 consecutive outpatients with DSM-IV diagnoses of major depressive disorder attending the psychiatry clinics of general hospitals in Turkey. The subjects were rated by clinicians on depressive symptomatology (Hamilton Depression Rating Scale), and anxiety (Hamilton Anxiety Scale), and completed self-report measures of Hypochondriacal worry (7-item version of the Whiteley Index), the Somatosensory Amplification Scale, and the Toronto Alexithymia Scale. Multivariate models tested the independent contribution of each of the scales to the level of somatic symptoms as measured by a modified version of the SCL-90 somatization scale. At the bivariate level, somatic symptoms were associated with female gender and lower educational level, as well as the Hamilton Depression and Anxiety scales, the Whitely Index, and the Somatosensory Amplification and Alexithymia scales. In multiple regression models incorporating all variables, female gender and higher scores on the anxiety, somatosensory amplification and alexithymia scales all made independent contributions to the level of somatic symptoms and accounted for 54% of the variance. Therefore, somatic symptoms in depression are related to concomitant anxiety, tendency to amplify somatic distress, and difficulty identifying and communicating emotional distress. However, these factors do not account for the tendency for women to report more somatic symptoms.     

Burden of mental health and substance use disorders among Italian young people aged 10–24 years: results from the Global Burden of Disease 2019 Study

Purpose

The burden of mental health and substance use disorders among Italian young people have not yet been presented in detail, despite adolescents and young adults aged between 10 and 24 years constitute 14.5% of the Italian population. Therefore, the aim of this study was to provide data on the health burden of mental health and substance use disorders among young people (10–24 years) in Italy between 1990 and 2019.

Methods

Ecological study design using data from the Global Burden of Disease Study 2019. Age- and sex-specific prevalence and years lived with disability (YLDs) of mental health and substance use disorders with the uncertainty intervals were reported as well as their percentual changes between 1990 and 2019.

Results

Prevalence and YLDs rates of mental health and substance use disorders showed negative trends overall between 1990 and 2019. However, diagnoses of attention-deficit/hyperactivity, autism spectrum, conduct and eating (among males) disorders increased as well as cocaine use disorder. The highest levels of disability in terms of YLDs were due to anxiety, depressive, conduct and eating disorders and alcohol use, amphetamine use and opioid use disorders. The disease burden was higher in middle-late adolescence and young adulthood than early adolescence, among females than males for mental health disorders and among males compared to females for substance use disorders.

Conclusion

Findings of the study highlighted disorder-specific patterns of prevalence and YLDs rates and were discussed considering previous research. The public health system should continuously sustain mental health promotion and prevention efforts in young people.

     

Age-related change in personality disorder trait levels between early adolescence and adulthood: a community-based longitudinal investigation

OBJECTIVE: To investigate change in personality disorder (PD) traits between early adolescence and early adulthood among individuals in the community. METHOD: PD traits were assessed in 1983 (mean age = 14), 1985-86 (mean age = 16) and 1992 (mean age = 22) in a representative community sample of 816 youths. RESULTS: Overall, PD traits declined 28% during both adolescence and early adulthood. PD traits were moderately stable during the first 2-year interval, and were as stable as they have been reported to be among adults over similar intervals. PD trait stability declined slightly as the inter-assessment interval increased. Adolescents with PDs tended to have elevated PD traits during early adulthood. CONCLUSION: PD traits tend to decline steadily in prevalence during adolescence and early adulthood. However, adolescents with PDs often have elevated PD traits as young adults, and the stability of PD traits appears to be similar during adolescence and early adulthood.     

Detecting psychological distress among patients attending secondary health care clinics : Self-report and physician rating

A study was conducted to determine the prevalence of psychological distress, as reported by patients and their physicians, in orthopedic, neurology, dermatology, and ophthalmology clinics; to study their accuracy in detecting psychological distress; and to determine if there is any connection among psychological distress, accuracy of detecting distress, and use of mental health and primary health care physicians' prognosis for the somatic complaints. Five hundred and fifty-six patients, ages 18–21, responded to the Psychiatric Epidemiology Research Interview Demoralization Scale (PERI-D), a measure of psychological distress, and to questions about their mental health and use of mental health and primary health services. Physicians, who were blind to patients' responses, were asked to what extent they thought the cause of patients' complaints was physical and to what extent they thought it was psychological in nature, and to prognosticate. Based on the PERI-D, about 25% of patients were distressed, this was less for females than males and varied between clinics. Based on self-reporting, about 14% of patients (males and females) were distressed. Based on physician reporting, about 17% (males less) were distressed. Physicians identified 35% of the PERI-D-distressed cases and 79% of nondistressed cases. About 66% of patients identified their distress and 83% their lack of distress. Increased use of primary health care and mental health care was related to distress. The prognosis was negatively related to distress. Based on this study, there is a need for more attention to psychological distress among secondary health care patients. Patients' ability to identify their distress suggests the importance of involving the patient in the diagnostic process. Correct detection of distress alone does not appear to decrease the use of primary medical and mental health services.     

Patterns of Health Care Service Utilization by Individuals with Mental Health Problems: a Predictive Cluster Analysis

This study aimed at identifying and characterizing clusters of mental health service users based on various characteristics in a sample of individuals with mental health problems. Data were collected in the epidemiological catchment area of South-West Montreal, Quebec in 2011 and 2014. Among the 746 participants who reported experiencing a mental health problem (high psychological distress and/or a mental disorder), 29% had used mental health services. A Two-Step cluster analysis was carried out to generate participant profiles based on their visit to mental health professional. Four clusters were identified: 1) young males with high quality of life and social support and who were less likely to have mental health problems and to utilize mental health services; 2) older females living with a partner and having a family doctor who were less likely to have mental health problems and to utilize mental health services; 3) single females with generalized anxiety disorder and somatic illness who were more likely to utilize mental health services, and 4) depressed females with high psychological distress, low quality of life and social support who were likely to utilize mental health services. The results reinforce the importance to develop programs that target the specific needs of subgroups of people experiencing mental health problems, given their considerable heterogeneity.     

Interactions between anxiety subtypes,personality characteristics,and emotional regulation skills as predictors of future work outcomes

IntroductionThis study examined long-term predictive links between different types of anxiety in late adolescence and work-related outcomes in young adulthood. The presence of adaptive personality traits and positive emotion regulation and coping skills were hypothesized to buffer these associations, reducing the negative effects of anxiety on future work outcomes.MethodsHypotheses were tested using multi-reporter data from a community sample of 184 youth in the United States followed from ages 17–30. Trait anxiety, anxious arousal, rejection sensitivity, and implicit rejection were each examined in late adolescence as predictors of work-related ambition, work performance, job satisfaction, and career satisfaction in young adulthood. Conscientiousness, grit, emotion regulation (ER) and coping skills were examined as potential moderators.ResultsAlthough trait anxiety was the only anxiety variable directly predictive of work outcomes in regression analyses, personality variables and ER skills interacted with multiple types of anxiety to predict work outcomes. Interestingly, findings reflected a pattern in which a combination of greater conscientiousness and greater anxiety, and greater ER skills and greater anxiety, predicted more positive work outcomes.ConclusionsThese findings not only suggest that the development of traits such as conscientiousness and ER skills may be helpful for youth with higher levels of anxiety, but also that higher levels of anxiety, when appropriately balanced by other qualities, may be adaptive for promoting positive career development for some youth.     

Understanding animal fears: a comparison of the cognitive vulnerability and harm-looming models

Background

A high prevalence of lifetime psychiatric disorders among help-seeking substance abusers has been clearly established. However, the long-term course of psychiatric disorders and mental distress among help-seeking substance abusers is still unclear. The aim of this research was to examine the course of mental distress using a six-year follow-up study of treatment-seeking substance-dependent patients, and to explore whether lifetime Axis I and II disorders measured at admission predict the level of mental distress at follow-up, when age, sex, and substance-use variables measured both at baseline and at follow-up are controlled for.

Methods

A consecutive sample of substance dependent in- and outpatients (n = 287) from two counties of Norway were assessed at baseline (T1) with the Composite International Diagnostic Interview (Axis I), Millon's Clinical Multiaxial Inventory (Axis II), and the Hopkins Symptom Checklist (HSCL-25 (mental distress)). At follow-up (T2), 48% (137/287 subjects, 29% women) were assessed with the HSCL-25, the Alcohol Use Disorders Identification Test, and the Drug Use Disorders Identification Test.

Results

The stability of mental distress is a main finding and the level of mental distress remained high after six years, but was significantly lower among abstainers at T2, especially among female abstainers. Both the number of and specific lifetime Axis I disorders (social anxiety disorder, generalized anxiety disorder, and somatization disorder), the number of and specific Axis II disorders (anxious and impulsive personality disorders), and the severity of substance-use disorder at the index admission were all independent predictors of a high level of mental distress at follow-up, even when we controlled for age, sex, and substance use at follow-up.

Conclusion

These results underscore the importance of diagnosing and treating both substance-use disorder and non-substance-use disorder Axis I and Axis II disorders in the same programme.     

Childhood parental bonding affects adulthood trait anxiety through self-esteem

IntroductionThe association between trait anxiety and parental bonding has been suggested. However, the mechanism remains uncertain and there is no study focused on general adult population. We investigated the association and the mechanism between childhood parental bonding and adulthood trait anxiety in the general adult population.Material and methodsA cross-sectional retrospective survey was conducted in 2014 with 853 adult volunteers from the general population. The Parental Bonding Instrument, Rosenberg Self-Esteem Scale, and State-Trait Anxiety Inventory Form Y (STAI-Y) were self-administered. Structural equation modelling was used for the analysis.ResultsChildhood parental bonding affected adulthood trait anxiety indirectly mediated by self-esteem. Trait anxiety was decreased by parental care and increased by parental overprotection through self-esteem. This model explained 51.1% of the variability in STAI-Y trait anxiety scores.ConclusionsThis study suggests an important role of self-esteem as a mediator between childhood parental bonding and adulthood trait anxiety.     

Panic disorder, trait anxiety, and alcohol use in pregnant and nonpregnant women

OBJECTIVE: The present study examined differences in rates of panic disorder and trait anxiety in pregnant and nonpregnant women receiving care at an urban obstetrics and gynecology clinic. The study further examined correlates and differences in alcohol use among these women. In addition, the study assessed whether panic disorder and trait anxiety influence alcohol use and whether pregnancy status moderates these associations. METHODS: The sample consisted of 412 pregnant and 139 nonpregnant women receiving care at Virginia Commonwealth University (VCU) Health Systems' obstetrics and gynecology clinics for the first time. Participants completed a questionnaire packet, including instruments about emotional and psychologic functioning (eg, panic disorder, anxiety), health-related behaviors (eg, alcohol use), and demographic information. RESULTS: Pregnant women were less likely than nonpregnant women to have panic disorder. There were no differences in trait anxiety levels between pregnant and nonpregnant women. After controlling for demographics, panic disorder and trait anxiety were significant predictors of greater alcohol use in pregnant and nonpregnant women. An interaction revealed that pregnant and nonpregnant women with low trait anxiety had similar levels of alcohol use; however, nonpregnant women with high trait anxiety consumed significantly more alcohol than pregnant women with high trait anxiety. CONCLUSIONS: Current study findings support the need to examine panic disorder and trait anxiety as potential risk factors for alcohol use among pregnant and nonpregnant women in the community. Findings have important implications for assessment and treatment of panic, anxiety, and alcohol use.     

Insulin-treated diabetes patients with fear of self-injecting or fear of self-testing: psychological comorbidity and general well-being.

OBJECTIVE: To examine psychological functioning and self-management behaviours of Dutch adult patients with insulin-requiring diabetes mellitus suffering from extreme fear of self-injecting (FSI) and/or fear of self-testing (FST). METHODS: A cross-sectional survey was performed in a sample of insulin-treated diabetes patients (n=1275; 51.1% male; age 49.7+/-15.8 years; 58.0% Type 1 diabetes), assessing FSI and FST. Patients completed the questionnaires concerning trait/state anxiety, depression, fear of hypoglycemia, diabetes-related distress, diabetes self-care activities, and general well-being. Comparisons were made on these measures between patients with extremely high scores on FSI and/or FST (> or = 95th percentile) and the other patients. Patients with extreme scores on FSI and/or FST were invited to take part in a second survey to assess the prevalence of major depression, common fears/phobias, and psychoneuroticism. RESULTS: People with extreme FSI/ FST scores, as compared to the other patients, reported higher levels of trait/state anxiety and depression. This group also reported more fear of hypoglycaemia and diabetes-related distress, had lower levels of general well-being, and reported less frequent self-monitoring of blood glucose. The second survey showed 11.1% of patients with extreme FSI/FST reporting scores indicating major depression. Prevalence of scores greater than or equal to the high scores on phobias (38.0-63.3%) and psychoneuroticism (27.8%) were consistently higher than norm group prevalences. DISCUSSION: Extreme levels of FSI and/or FST are associated with high diabetes-related distress, poor general well-being, and psychological comorbidity, as well as poorer adherence to the diabetes treatment regimen. It is concluded that patients with extreme FSI/FST are often burdened with more than this specific phobia.     

抑郁症患者焦虑/躯体化症状早期的变化与氟西汀疗效的相关性研究

目的探讨抑郁症患者焦虑／躯体化症状的早期变化对氟西汀抗抑郁治疗达症状缓解的预测作用。方法对103例重症抑郁患者给予氟西汀治疗6w,剂量固定于20 mg／d,于治疗前及治疗后的第1、2、4、6w末用汉密顿抑郁量表17项(HAMD-17)评定临床症状,其中焦虑／躯体化因子分用来评定焦虑／躯体化症状。结果治疗6w末103例患者中32例(31．1％)达到症状缓解标准,71例(68．9 ％)未达到症状缓解标准。早期HAMD-17中焦虑／躯体化因子分及胃肠道症状条目分的变化与症状缓解存在正相关,而该因子中其余条目的变化与症状缓解不相关。结论HAMD-17中焦虑／躯体化因子分及胃肠道症状有关的条目分早期改善可能是氟西汀治疗后症状能基本缓解的预测因子。     

Longitudinal trajectories and predictors of anxiety symptoms among adolescent survivors exposed to Wenchuan earthquake

This study aimed to investigate the developmental trajectories and associated predictors of anxiety symptoms among Chinese adolescents exposed to Wenchuan earthquake. 1573 adolescent survivors were followed up at 6, 12, 18, and 24 months post-earthquake. Self-report measures were used to evaluate earthquake exposure, anxiety symptoms, negative life events, social support, and trait resilience. Growth mixture modeling (GMM) and multi-nominal logistic regression were used to analyze data. The results showed that 45.6%, 50.9%, 39.2%, and 39.9% of participants showed clinical levels of anxiety symptoms at 6, 12, 18, and 24 months post-earthquake, respectively. Four developmental trajectories were identified: resistance, recovery, delayed-onset anxiety, and chronic anxiety. Gender, injury of family members, negative life events, social support, and trait resilience were significant predictors for distinct anxiety trajectories. Individualized and appropriate psychosocial interventions should be provided for adolescents affected by natural disasters, especially those at higher risk for chronic or delayed mental problem symptoms.