Associations of weight-based teasing and emotional well-being among adolescents

BACKGROUND: Verbal harassment, such as bullying and hate speech, has received considerable attention recently, but less is known about weight-based teasing and its potential harmful effects on young people's psychosocial well-being. OBJECTIVE: To determine the associations of weight-based teasing and body satisfaction, self-esteem, depressive symptoms, and suicidal ideation and suicide attempts using a large sample of adolescents. DESIGN: Secondary analysis of survey and anthropometric data. SETTING: Ethnically and socioeconomically diverse communities in the urban and suburban school districts of the Minneapolis/St Paul metropolitan area. PARTICIPANTS: A school-based sample of 4746 adolescents in grades 7 to 12 at 31 public middle schools and high schools. MAIN OUTCOME MEASURES: Weight-based teasing from peers or family members, body satisfaction, self-esteem, depressive symptoms, and suicidal ideation and suicide attempts. RESULTS: Of the eligible students, 81.5% participated; 30.0% of adolescent girls and 24.7% of adolescent boys were teased by peers, and 28.7% of adolescent girls and 16.1% of adolescent boys were teased by family members. Approximately 14.6% of adolescent girls and 9.6% of adolescent boys reported teasing from both of these sources. Teasing about body weight was consistently associated with low body satisfaction, low self-esteem, high depressive symptoms, and thinking about and attempting suicide, even after controlling for actual body weight. These associations held for adolescent boys and girls, across racial, ethnic, and weight groups. Furthermore, teasing from 2 sources was associated with a higher prevalence of emotional health problems than either teasing from a single source or no teasing. CONCLUSIONS: Physicians and other health care providers should recognize the importance of weight-based teasing for young patients. Policy, programs, and education should focus on increasing awareness of what constitutes weight-based teasing, its potentially harmful effects on adolescents' emotional well-being, and reduction of this behavior.     

Socioeconomic status, depressive symptoms, and adolescent substance use

OBJECTIVE: To determine the relationships among socioeconomic status (SES), depression, and substance use among teenagers. We hypothesized that, among teenagers, substance use was associated with SES in a graded fashion and that depression is a mechanism through which SES affects substance use behaviors. DESIGN: Linear regression analyses of cross-sectional data from Wave I of the National Longitudinal Study of Adolescent Health (1995). PARTICIPANTS: Fifteen thousand one hundred twelve adolescents whose parents answered questions assessing household income and parental education. MAIN OUTCOME MEASURES: Use of cigarettes, alcohol, marijuana, and cocaine. RESULTS: For all 4 substances, frequency of use varied by SES. In the total population, inverse SES gradients were present for cigarette use (education, mean change= -0.052; 95% confidence interval [CI], -0.081 to -0.023; income, mean change= -0.038; 95% CI, -0.069 to -0.007) and alcohol use (income, mean change= 0.044; 95% CI, 0.016-0.071). The relationship between marijuana use and education was also significant but inverse-U-shaped, not linear. This relationship was only present among nonwhite teenagers. Race/ethnicity also moderated the relationships between SES and cigarette use and SES and cocaine use. For cigarette use, stratification by race/ethnicity revealed an inverse graded relationship among white non-Hispanic teenagers and a direct, graded relationship among nonwhite teenagers (ie, mean change for education among white non-Hispanic teenagers, -0.012; 95% CI, -0.016 to -0.075; mean change for education among nonwhite teenagers, 0.040; 95% CI, 0.014-0.072). For cocaine use, a weak, inverse linear relationship existed only between education and cocaine use among white non-Hispanic teenagers (mean change for education, -0.013; 95% CI, -0.026 to -0.0004). The relationship between the SES indicator and substance use weakened when depressive symptoms were entered into the model for the SES-cigarette use relationship (23% decrease in mean change associated with a 1-unit change in both education and income) and for the association between education and cocaine use among white non-Hispanic teenagers (31% decrease). CONCLUSIONS: Socioeconomic status is associated with substance use among teenagers but the nature of the relationship is not consistent across SES indicators or across race/ethnicity groups. Depressive symptoms are a mechanism through which SES affects cigarette and cocaine use behaviors among teenagers. However, these data indicate that interventions targeted toward decreasing depressive symptoms will not have a strong impact on the effects of SES on teenage substance use.     

Socio-Economic Factors Affecting Early Childhood Health: the Case of Turkey

In this study we examine the association between parents’ socioeconomic status (SES) and childhood health in Turkey, a middle income, developing country using the 2013 round of Demographic Health Survey (DHS) data set. In our investigation, we focus on 7-to-59-month-old children and as a measure of health status, we use the height-for-age z-score, which is the measure of stunting and wasting. In order to overcome the biases with respect to age and gender, we calculate the child’s standardized height measure. Using classical regression techniques, after controlling for the child’s birth order, birth weight, mother’s height, mother’s breastfeeding, nutrition status and pre-school attendance, the impact of parents’ SES on child’s health measures is assessed, and the SES indicators include region of residence, number of household members, father’s presence, parents’ education and work status, and a wealth index based on the household’s asset holdings. Our results indicate that urban residence is a dominant factor that enhances the child’s health status in Turkey: convenient access to health care services as well as better living conditions and infrastructure such as sanitation, access to clean water, availability of electricity, which are more readily available in urban areas, consistently improve the child’s health outcomes, regardless of other SES factors. Additionally, we find that mother’s education level is also crucial in determining the child’s health status: it is more likely that educated mothers have access to information for better health, and they make more efficient use of available health care services for their children.     

Self-rated health, psychosocial functioning, and health-related behavior among Thai adolescents

Background:  Despite the popularity of self-rated health (SRH) in Western countries as a useful public health tool, it has only rarely been used in Asian countries. The purpose of the current study was to determine whether measures of psychosocial functioning and health-related factors differ according to SRH in a school-based sample of Thai adolescents.
Methods:  The survey was given to 2519 adolescents attending 10 coeducational secondary high schools in Chiang Mai Province, Thailand and included measures of psychosocial functioning (loneliness, hopelessness, shyness, perceptions of social status, self-rated happiness, and perception of physical attractiveness) and certain health-related factors (height/weight, physical activity, eating breakfast, sleep).
Results:  The proportion of boys (5.1%) reporting that they were not healthy was similar to the proportion of girls (4.6%) making the same rating. These adolescents showed a pattern of overall poor health risk. Compared to adolescent peers who rated their health as healthy or very healthy, they were less physically active, got less sleep, were more likely to be overweight, and scored lower on loneliness, shyness, hopelessness, and self-rated happiness.
Conclusions:  The present pattern of poor health risk warrants attention and supports the merit of using SRH in adolescent health assessment. SRH is easy to obtain and simple to assess and single-item assessments of SRH appear to be valid measures of health status in adults and adolescent. Interventions, such as health counseling, mental health counseling, and health education, can target adolescents who rate themselves as 'not healthy' or report poor health status.     

Hopelessness and suicidal ideation among adolescents in two cultures

BACKGROUND: This study examines the cross-sectional and longitudinal associations among cognitive variables, depressive symptoms and suicidal ideation in Hong Kong Chinese and Caucasian American adolescents. METHODS: Community adolescents (n = 2,044) ages 14-18 years from Hong Kong and the United States provided information regarding their suicidal ideation, depressive symptoms, and cognitions (self-efficacy, cognitive errors and hopelessness), at two surveys, six months apart. RESULTS: Self-efficacy was a weak unique predictor of suicidal ideation in both cultures. Hopelessness was the strongest of cognitive variables in concurrent associations with suicidal ideation in bivariate and multivariate models, in both cultures, and in both boys and girls. Hopelessness continued to offer unique prediction when depressive symptoms were controlled, both concurrently and prospectively. CONCLUSIONS: Our results support hopelessness theories of suicidal ideation and behavior in Hong Kong, and extend the cognitive theory of suicidality to a modernized Asian culture.     

A multilevel analysis of the relation of socioeconomic status to adolescent depressive symptoms: does school context matter?

OBJECTIVE: To determine whether the socioeconomic context of the school environment is associated with adolescent depressive symptoms independent of individual household income.Study design Data were drawn from a 1995 nationally representative study of 7th to 12th grade students. Multivariable linear regression at the school and individual levels assessed the relation between income and depressive symptoms. Multilevel modeling techniques were then used to understand how these factors are jointly associated with adolescent depressive symptoms. PARTICIPANTS: Adolescents (n=13,235) in grades 7 through 12 from 132 schools whose parent provided income information. RESULTS: Linear regression analyses indicated that lower household income, average school income, and increasing school-level income inequality were significantly (P<.001) associated with depressive symptoms. Further examination of these relations through multilevel modeling indicated that both household income (P<.01) and average school income (P<.05) were significantly related to depressive symptoms after adjusting for covariates, with evidence for an interaction between the two. The impact of lower household income on depressive symptoms was approximately 2-fold greater for students attending a poor versus a rich school. CONCLUSIONS: School context is associated with adolescents' depressive symptoms, even after adjusting for individual-level factors. The school environment may partially buffer the adverse influence of lower household income on adolescent depressive symptoms.     

Socio-economic differences in use of prescribed and over-the-counter medicine for pain and psychological problems among Danish adolescents—a longitudinal study

The objective for this study was to investigate socio-economic status (SES) differentials in the use of over-the-counter and prescribed medicine for pain and psychological problems among adolescents. Data consisted of questionnaire data on medicine use and health status, collected from 17- to 18-year-old adolescents (n?=?2,400) during second round of the West Jutland cohort study 2007, and register data on prescribed medicine use, parental educational level and household income. We used multiple logistic regression analysis to calculate odd ratios for self-reported and register-based use of medicine for pain and psychological problems according to parental educational level and household income. Young girls used twice as much medicine for pain and psychological problems compared to young boys. SES differences based on parental educational level were directly associated with the use of prescribed medicine for psychological problems, and SES differences based on household income were directly associated with overall medicine use and use of over-the-counter medicine. Some of the SES differentials disappeared or decreased after adjusting for health status. There were no SES differentials in the use of prescribed medicine for pain. Conclusion: The risk of use of prescribed medicine for psychological problems increased in adolescents with decreasing parental education, while the risk of overall medicine use and use of over-the-counter medicine was increased in adolescents from low household income. Furthermore, the results indicate that some of the SES differentials in medicine use could be explained by a difference in health status across SES.     

Association between household conditions and diarrheal diseases among children in Turkey: A cohort study

BACKGROUND: This aim of the present study was to estimate the frequency of diarrheal diseases among children as well as investigating the relationship between diarrheal diseases and household conditions and other factors. METHODS: The study was performed over 12 month period in Binevler Health Center, Gaziantep, Turkey. Five health stations were selected by using a sampling technique with probability proportional to size, and all households with children under the age of 5 years were visited. A questionnaire on diarrhea, household conditions, socioeconomic status of the family and individual characteristics of the children was applied to the mothers by doctors. Three composite indices, including household conditions, socioeconomic status of the family and individual status of the children, were prepared and a classification was made as good, mild or poor in order to better evaluate the results of the study. Daily recordings of diarrheal disease symptoms were made by the parents and these records were collected every month for 1 year. RESULTS: The annual mean incidence of diarrheal diseases was found to be 1.09 per child per year (median = 1). The mean was higher in children with poor household conditions (1.48 +/- 0.12) and with poor individual status (1.48 +/- 0.14), compared with good household conditions (0.76 +/- 0.07) and good individual status (0.71 +/- 0.08). The mean was also higher in children aged between 6 and 11 months (1.51 +/- 0.18), whose father graduated from primary school or lower (1.34 +/- 0.09) and with parents having no habit of washing their hands before taking care of the child (2.00 +/- 0.33). Person-month and case-month incidence rates of diarrhea were calculated to be 8.56 and 9.12%, respectively. CONCLUSIONS: Household conditions, individual status, age, education level of fathers and parents' habit of washing hands before taking care of the child were major factors affecting the incidence of diarrhea.     

Reliability and Validity of Family Affluence Scale (FAS II) among Adolescents in Beijing, China

This study comprises two sub-studies. Study I assessed the test-retest reliability of Family Affluence Scale (FAS II) items among 95 students aged 11 and 15 years old in Beijing. Study II investigated the completion rate of traditional indicators (parents’ educational level, perceived family wealth, resident area, and school location) measuring socioeconomic status (SES) compared with FAS II, and examined the internal reliability, external and construct validity of the FAS II items in a population of 5876 schoolchildren aged 11, 13 and 15 years old in Beijing. Our study found that the FAS II items have high completion rates (> 99%) which are better than other SES indicators. Analyses of reliability showed a moderate internal reliability (Cronbach’s alpha = 0.58) and at least substantial test-retest reliability (ICC > 0.75). Moderate external validity of FAS II was found by Spearman rank correlation between FAS II and other SES indicators (parental education level and perceived family wealth) (r _s  = 0.48–0.51, p < 0.001) and ordinal regressions. Graphical log-linear Rasch model (GLLRM) showed that FAS has adequate construct validity (few LD and weak DIF). In conclusion, the FAS II is a reliable and valid SES measure for adolescents in the Beijing area.     

Suicidal ideation among urban nine and ten year olds

Little is known about rates and correlates of suicidal ideation among nonclinical samples of preadolescents from low-income urban backgrounds. Using the Children's Depression Inventory, we measured suicidal ideation in 131 preadolescent urban children (49% female, 90% African American/Caribbean) participating in an ongoing prospective longitudinal study of prenatal cocaine exposure and children's outcome. Suicidal ideation was reported by 14.5% of the children in this sample at 9 to 10 years of age. Children's reports of depressive symptoms, exposure to violence, and distress symptoms in response to witnessing violence were associated with suicidal ideation, but prenatal cocaine exposure, parent-rated child behavior, and caregivers' psychological distress symptoms were not. Suicidal ideation may be more prevalent among preadolescents from urban, low-income backgrounds than clinicians suspect, particularly among children exposed to violence.     

Acne, anxiety, depression and suicide in teenagers: a cross-sectional survey of New Zealand secondary school students

AIM: To examine the associations between acne and depressive symptoms, anxiety and suicidal behaviours. METHODS: This was a secondary analysis of a cross-sectional survey -'Youth2000' (New Zealand national survey of youth health). A total of 9567 secondary school students aged 12-18 years participated in the survey. The main outcome measures were self-reported acne, depressive symptoms (Reynolds Adolescent Depression Scale > 77), anxiety (Anxiety Disorder Index from Multidimensional Anxiety Scale for Children) and self-reported suicide attempts. RESULTS: 'Problem acne' was associated with an increased probability of depressive symptoms, odds ratio 2.04 (95% confidence interval 1.70-2.45); anxiety, odds ratio 2.3 (1.74-3.00); and suicide attempts, odds ratio 1.83 (1.51-2.22) in a logistic model that included age, gender, ethnicity, school decile and socio-economic status. The association of acne with suicide attempts remained after controlling for depressive symptoms and anxiety, odds ratio 1.50 (1.21-1.86). CONCLUSION: Young people presenting with acne are at increased risk of depression, anxiety and suicide attempts. Attention should be paid to their mental health, and the importance of asking directly regarding suicide is emphasised.     

Suicidal behaviors in adolescents

Objective. Suicidal ideation and suicide attempt are generally considered as non-fatal suicidal behaviors (NFSB) by most researchers. Across different cultures, the prevalence of NFSB has been found to be alarmingly high among adolescents. As there is no published study estimating prevalence rates in India, we conducted a study on adolescents in Delhi to find prevalence of NFSB and other related behaviors and to identify risk factors for NFSB.Methods: We collected data from 1205 adolescents in the age group from 12 to 19 years from 2 schools through semi-structured questionnaire on demographic variables, NFSB, death wish, deliberate self harm (DSH), Adjustment Inventory for School Students (AISS) by Sinha et al. & BDI.Results: Prevalence of suicidal ideation (lifetime), suicidal ideation (last year), suicide attempt (lifetime), suicide attempt (last year) were 21.7%, 11.7%, 8% and 3.5%, respectively. All the significant variables were entered into a logistic regression analysis model, and the adjusted odds ratios, with 95% confidence intervals, were obtained for them. Hindu religion, female sex, older adolescent, physical abuse by parents, feeling neglected by parents, history of running away from school, history of suicide by a friend, death wish and DSH were found to be significant risk factors for NFSB.Conclusions: There is high prevalence of suicidal ideation, suicide attempt, death wish and deliberate self-harm in adolescent population of two schools in Delhi. Clinical implications of these findings are discussed.     

Identifying Suicide Risk in Adolescents With Firearm Access: Screening in the Emergency Department

ObjectiveThis study compares current suicidal ideation, prior suicide attempt and associated self-reported risk factors in adolescents with and without access to firearms.MethodsUsing data from a clinically applied behavioral health assessment completed by adolescents presenting to a tertiary children's hospital emergency department (ED; N = 15,806), we evaluated the association between firearm access (ie, firearm in the home or ability to obtain one within 24 hours), each of the included suicide risk factors (ie, depressive symptoms, trauma victimization, bullying victimization), and our primary outcomes (ie, current suicidal ideation and prior suicide attempt). We performed regression analyses on 3 groups: 1) The overall population; 2) Only the participants with firearm access; and 3) Only the participants without firearm access.ResultsFourteen percent (2179/15,806) of the sample reported a firearm in the home or ability to access one within 24 hours. Overall, 6.8% of participants reported current suicidal ideation and 9.1% reported prior suicide attempt. Youth with firearm access had 1.52 times higher odds of current suicidal ideation and 1.61 times higher odds of prior suicide attempt compared to youth without firearm access. All included suicide risk factors were found to significantly increase the odds of current suicidal ideation and prior suicide attempt in the overall sample; this increase was similar in the groups with and without firearm access.ConclusionsAdolescents with firearm access have higher odds of suicidal ideation and prior attempt compared to those without firearm access, highlighting the need for universal ED-based screening for suicidality and lethal means.     

Snoring in preschoolers: associations with sleepiness, ethnicity, and learning

Sleep-disordered breathing (SDB) in children is associated with poor school performance, with minority children being at increased risk for both conditions. The latter have been attributable to low socio-economic status (SES). To further study these relationships, the contribution of SES to SDB and learning was examined in 1,010 validated questionnaires collected from parents of both white and African-American low-SES preschoolers. Twenty-two percent of disadvantaged preschoolers were reported to be at risk for SDB. These children were more likely to be African American, and had a higher incidence of daytime sleepiness, lower academic performance, and hyperactivity. Maternal education level did not account for these differences.     

Adolescent Suicide Triggered by Problems at School in Korea: Analyses Focusing on Depression,Suicidal Ideation,Plan, and Attempts as Four Dimensions of Suicide

This study aims to investigate adolescent suicide triggered by problems in Korean schools, by focusing on four dimensions of suicide: depression, suicidal ideation, plan, and attempts. Data were collected from 664 middle- and high-school students in Korea, and structural equation modeling analyses were utilized. The results reveal that academic stress and school violence, as risk factors, are related to adolescent suicide. Academic stress increases depression, suicidal ideation, plan, and attempt, but decreases family and academic resilience. School violence also increases depression, suicidal ideation, plan, and attempt, but decreases only family resilience. As protective factors, family and ego resilience influence the four dimensions of suicide. While family resilience decreases all of the four dimensions in suicide significantly, ego resilience decreases depression and suicidal ideation, but has no effect on suicidal plan and attempts. This implies that the function of ego resilience as a protective factor becomes relatively weaker for the more acute dimensions, such as suicidal plan and attempts. In addition, family resilience can be a key protective factor for all of the four dimensions of suicide.     

Maternal depressive symptoms are adversely associated with prevention practices and parenting behaviors for preschool children.

OBJECTIVE: To determine the relationship between maternal depressive symptoms and select prevention practices and parenting behaviors for older preschool children. METHODS: A telephone survey of mothers and female guardians of children entering kindergarten in Monroe County, New York, was administered to 400 eligible parents in 2001. The Mental Health Inventory-5 was used to determine maternal depressive symptoms. We examined the impact of maternal depression on well-child care, immunizations, routine dental care, tooth brushing, frequent reading, safe motor vehicle seating location, car seat or booster seat use, discipline consistency, and parenting confidence. RESULTS: A total of 17.7% of mothers had depressive symptoms, with increased rates among women who were poor, less educated, and single parents. Children of mothers with depressive symptoms were more likely to have not received routine dental care in the past year (21.1% vs 8.2%, P = .001), brush their teeth less than twice a day (37.1% vs 25.2%, P = .041), or be read to less than 3 times per week (31.0% vs 13.7%, P < .001) compared with children of mothers without depressive symptoms. In addition, mothers with depressive symptoms were more likely to describe inconsistent discipline practices (36.6% vs 20.1%, P = .005) and less confidence in their parenting (39.4% vs 18.5%, P < .001). All associations remained significant in multivariate analyses controlling for maternal race, ethnicity, education, income, age, and household structure. CONCLUSIONS: Maternal depressive symptoms are associated with diminished positive parenting behaviors including dental care, reading, and discipline consistency for older preschoolers. These findings have implications for clinical pediatrics as well as preventive public health efforts.     

The relationship between selected socioeconomic factors and basic anthropometric parameters of school-aged children and adolescents in Poland

The aim of the present paper was to examine the associations between anthropometric parameters, overweight, obesity, and socioeconomic status (SES) of children and adolescents in Poland. Data were collected in the “Elaboration of reference blood pressure ranges for children and adolescents in Poland” OLAF-PL0080 (OLAF) study, a nationally representative survey on growth and blood pressure references for children and adolescents aged 7–18 years. Body height, weight, and waist circumference (WC) were measured, and body mass index (BMI) was calculated. Anthropometric parameters were standardized for age and gender and expressed as z-scores. Statistical analyses were conducted on 10,950 children and adolescents whose parents provided socioeconomic questionnaires. The associations between anthropometric parameters, overweight (including obesity), and SES were analyzed using multiple regression and multiple logistic regression. The height was positively associated with higher levels of maternal education and, in the case of girls, also with paternal education. Higher level of income per capita, but not the highest, was associated with higher weight, BMI, and WC and, in the case of boys, also tall stature. The height, weight, BMI, and waist were significantly inversely associated with number of children in the family. Lower number of children in the family and higher level of income, but not the highest, increased odds of overweight and obesity. In the case of girls, the odds of obesity decreased with paternal higher level of education. Conclusion: The social position associated with parents’ education, better environment, and SES correlate with body height and weight of a child. However, it is associated with higher risk of overweight and abdominal obesity.     

An Investigation of Adolescents' Substance Use Behaviors, Depressed Affect, and Suicidal Behaviors

Data from a four-wave panel design of 975 adolescents were used to study inter-relationships among suicidal behaviors, depressive symptoms, and substance use behaviors. Persistently high levels of problem drinking and depressive symptoms were associated with higher levels of suicidal thoughts and attempts. Higher levels of depressive symptoms and greater cigarette and illicit drug use distinguished suicidal ideators from attempters. Adolescents attempting suicide reported lower levels of family social support, a greater use of substances to cope with stressors, and a higher density of substance-using peers. Implications of the findings for preventive interventions with high-risk teens are discussed.     

Consequences and correlates of adolescent depression

OBJECTIVE: To examine the correlates and consequences of high levels of depressive symptoms among adolescents. DESIGN: Secondary analysis of the 1997 Commonwealth Fund Survey of the Health of Adolescent Girls, a survey of a nationally representative sample of 4648 adolescent boys and girls between the ages of 10 and 18 years, inclusive, conducted in school settings. The self-administered questionnaire contains a screening instrument for depression based on the Children's Depression Inventory. OUTCOME: Days of school missed, performance at grade level, alcohol use, drug use, smoking, and bingeing. RESULTS: After controlling for sociodemographics, life events, sexual abuse, physical abuse, and exposure to violence, relative to other children, children and adolescents with high degrees of depressive symptoms missed about 1 day more of school in the month preceding the survey (P<.05) and had higher odds of smoking (odds ratio, 1.84; P<.001), bingeing (odds ratio, 2.02; P<.001), and suicidal ideation (odds ratio, 16.59; P<.001). CONCLUSION: High levels of depressive symptoms are correlated with serious and significant consequences, even after controlling for life circumstances.     

Depression in mothers of children presenting for emergency and primary care: impact on mothers' perceptions of caring for their children.

CONTEXT: Maternal mental health conditions may influence how mothers utilize emergency health care for their children. However, little is known about the prevalence of depression among mothers of children presenting for emergency health care and how maternal depression affects a mother's perception of how difficult it is to care for her children. OBJECTIVES: To screen for maternal depression and to examine whether mothers with depressive symptoms perceive that these symptoms interfere with their roles in caring for their children. DESIGN: Cross-sectional survey. SETTING: An urban, tertiary-care, children's hospital. PARTICIPANTS: Mothers bringing their children, aged 6 months to 18 years, to an emergency department for low-acuity illness (n = 243) or to a pediatric primary care clinic (n = 249) for well-child care. MAIN OUTCOME MEASURE: Positive screening tests for depression using the Prime MD Patient Health Questionnaire. RESULTS: The prevalence of positive screening tests for depression was similar in both emergency and primary care settings, with 18% of mothers having either major (9%) or subthreshold (9%) depression and 5% percent having suicidal ideation. Seventy-six percent of mothers with a positive screen for major depression and 17% of those with a negative screen for depression reported that their mental health symptoms made it difficult to care for their children. Mothers with a positive screen for depression reported poorer health status for themselves (P =.014) but not for their children (P =.37). CONCLUSIONS: Screening questionnaires in both primary care and emergency care settings with sociodemographically similar groups of mothers produced similar rates of depression. The high rates of depressive symptoms and of mothers' reports that these symptoms cause them difficulty in caring for their children indicate that resources to screen for and address depressive symptoms in mothers should receive higher priority in pediatric health care settings.