Dissociation among Swedish adolescents and the connection to trauma: an evaluation of the Swedish version of Adolescent Dissociative Experience Scale

The purpose of this study was to investigate the psychometric properties of the Swedish version of Adolescent Dissociative Experience Scale (A-DES), dissociative symptoms among Swedish adolescents, and dissociative symptoms connected to trauma and sexual and physical abuse. A normative group of 400 adolescents aged 12 to 19 years and a clinical group of 20 adolescents with known experienced trauma were given A-DES. A test-retest procedure was conducted with 90 subjects from the normative group. The results showed good reliability, internal consistency and test-retest. Factor analysis in the normative sample (N = 400) resulted in a one factor solution. Correlation between A-DES and other measures of dissociation was high (r = .86). Significant differences for the total sum of A-DES were found in the normative group between adolescents with and without self-reported trauma and between the normative group and the clinical group with known experienced trauma. The Swedish version of A-DES was shown to be a screening instrument with satisfactory psychometric qualities and the capability of capturing dissociative symptoms in adolescents with self-reported trauma as well as clinical cases with identified trauma.     

Adolescent self-cutting elsewhere than on the arms reveals more serious psychiatric symptoms

Self-cutting as a form of self-harm is a common and multifaceted phenomenon among adolescents. The aim of this study was to investigate whether the location of self-cutting (arms or other areas of the body) could help to assess the severity of the underlying psychiatric problems. A sample of adolescents who reported self-cutting (n = 440) was drawn from a large sample of community adolescents (n = 4,019). The majority of self-cutting adolescents, 296 (67.2 %), reported cutting only the upper arms, while 144 (32.8 %) also cut other parts of the body. The data included a structured self-rating questionnaire, questions about self-cutting, the Youth Self-Report (YSR) for adolescents aged 11–18 years, the Beck Depression Inventory, the Toronto Alexithymia Scale and the Adolescent Dissociative Experience Scale (A-DES). The results indicate that self-cutting on other parts of body than the arms was associated with female gender, a wide range of emotional and dissociative symptoms and suicidal ideation. In logistic regression analysis, the most pronounced association between self-cutting on other places than the arms was found with YSR subscales withdrawn/depressed, social problems and thought problems, and dissociation (A-DES). We conclude that self-cutting adolescents, mostly girls, with wounds elsewhere than on the arms present with the most serious psychiatric symptoms. It is important to perform a careful physical examination when an adolescent has unexplained wounds or scars on the arms or on other parts of the body. These adolescents also need a caring and conscientious psychiatric examination and possible psychiatric treatment.     

The Korean Version of the Adolescent Dissociative Experience Scale: Psychometric Properties and the Connection to Trauma among Korean Adolescents

Objective

The Adolescent Dissociative Experience Scale (A-DES) is a screening measure for dissociative experience in adolescents. The present study aimed to investigate the reliability, validity and psychometric properties of the Korean version of the Adolescent Dissociative Experience Scale.

Methods

The Korean version of the A-DES was administered to a normative group of 371 adolescents aged 12 to 18 years and a traumatized group of 33 adolescents aged 12 to 18 years with known trauma.

Results

The internal consistency was excellent (Cronbach''s alpha=0.91) and the test-retest correlation of the A-DES was high (r=0.99). Correlation between the A-DES and other measures of dissociation was moderate (r=0.48). There were no significant age differences in mean total A-DES scores for the normative sample, or for boys or girls separately. Nor were there any significant gender differences for any age group. The mean total score of the A-DES was significantly higher in the traumatized group than in the normative group. There was a statistically significant difference between adolescents with self-reported trauma and those without a trauma history in the normative group.

Conclusion

This study demonstrated that the Korean version of the A-DES is a reliable measure with excellent internal consistency and good stability over a 4-week test-retest interval with single factor structure. It can be used to screen for dissociative symptoms in Korean adolescents between the ages 12 and 18.     

Reliability and validity of the Turkish version of the adolescent dissociative experiences scale

The Adolescent Dissociative Experiences Scale (A-DES) is designed to measure dissociation in adolescents. The present study aimed to assess the reliability, validity, and psychometric characteristics of the Turkish version of the A-DES. The Turkish version of the A-DES was administered to 20 patients with a dissociative disorder, 24 patients with post-traumatic stress disorder (PTSD), 31 patients with anxiety disorder, 31 patients with mood disorder, 24 patients with attention deficit-hyperactivity disorder (ADHD), and 201 non-clinical participants. The internal consistency and the test-retest correlation of the A-DES were excellent. The mean total score of A-DES was 6.2 in dissociative disorder, 3.9 in PTSD, 2.1 in anxiety disorder, 2.4 in mood disorder, 2.5 in ADHD groups and 2.4 in non-clinical participants. There was a statistically significant difference between dissociative patients and other diagnostic groups on the A-DES total score. The good psychometric characteristics of the A-DES among Turkish participants support its cross-cultural validity.     

Family economic stress, maternal and paternal support and adolescent distress

The present study investigated the effects of family economic stress on parental support and adolescent maladjustment in 622 9th through 12th graders in a Midwestern farm community. Economic stress had a direct effect on adolescent depressive symptoms, delinquency and drug use. The findings also indicated an indirect effect: increased stress was associated with lower paternal support for female, but not male adolescents, and lower paternal support for females was associated with higher female distress.     

Childhood emotional abuse and dissociation in patients with conversion symptoms

Aim:  The aim of the present study was to evaluate the relationship between reported childhood trauma and dissociation in patients who have a conversion symptom.
Method:  Thirty-two outpatients with a conversion symptom were evaluated using Dissociative Experiences Scale, Somatoform Dissociation Questionnaire, Childhood Trauma Questionnaire, Spielberger Trait Anxiety Inventory, Clinician-Administered Dissociative State Scale, and Dissociative Disorders Interview Schedule.
Results:  A DSM-IV dissociative disorder was diagnosed in 46.9% of the patients. Conversion patients with a dissociative disorder had borderline personality disorder more frequently than those without a dissociative disorder. Among childhood trauma types, emotional abuse was the only significant predictor of dissociation in regression analysis. None of the childhood trauma types predicted borderline personality disorder criteria.
Conclusions:  Borderline personality disorder, dissociation and reports of childhood emotional abuse refer to a subgroup among patients with conversion symptom. Dissociation seems to be a mediator between childhood trauma and borderline phenomena among these patients.     

Psychotic boys performing well in school are at increased risk of suicidal ideation

Aim:  This study investigated how the level of school performance is associated with suicidal behavior and psychiatric disorders among adolescent psychiatric inpatients aged 12–17 years.
Methods:  Data were collected from 508 adolescents (300 girls, 208 boys; age 12–17 years) admitted to inpatient psychiatric hospitalization between April 2001 and March 2006. Information on the adolescents' school performance, suicidal ideation, suicide attempts and self-mutilation as well as psychiatric DSM-IV diagnoses was obtained using the Schedule for Affective Disorder and Schizophrenia for School-Age Children.
Results:  An elevated risk of suicidal ideation (OR = 3.6, 95% CI 1.3–10.2, P  = 0.017) and of psychotic disorders (OR = 3.2, 95% CI 1.0–10.0, P  = 0.048) was observed among male adolescents performing well in school. In addition, adolescents with poor school performance had an increased likelihood of substance-related disorder both in boys (OR = 2.6, 95% CI 1.1–6.1, P  = 0.027) and girls (OR = 2.5, 95% CI 1.2–5.1, P  = 0.011).
Conclusions:  Our findings indicate that psychotic inpatient male adolescents performing well in school are at an elevated risk of suicidal ideation. Although good school performance is often considered a marker of high intelligence and good general ability, symptoms of major psychiatric disorders and suicidality need to be taken very seriously among adolescents performing well in school.     

Sleep paralysis in adolescents: The 'a dead body climbed on top of me' phenomenon in Mexico

Aims:  The aim of the present study was to evaluate the prevalence and characteristics of sleep paralysis in adolescents using a folk expression.
Methods:  Three hundred and twenty-two adolescents (mean age, 15.9 ± 0.88 years; 66.8% female) from three high schools in Mexico City completed both a self-reported questionnaire, including a colloquial definition of sleep paralysis and the Epworth Sleepiness Scale.
Results:  A high proportion of the adolescents (92.5%) had heard about the 'a dead body climbed on top of me' expression and 27.6% of them had experienced the phenomenon. Sleep paralysis was present in 25.5% while the prevalence rate for hypnagogic/hypnopompic hallucinations was 22%; 61% had experienced ≥2 episodes in their lifetime. The mean age of onset was 12.5 ± 3 years. Sleepiness scores for the subjects who had experienced at least one event were not significantly different from subjects who had not experienced any. In 72% of cases, the episodes were composed of both sleep paralysis and hallucinations while 20.2% consisted of only sleep paralysis and 7.8% of only hallucinations. The number and characteristics of events were not significantly different between adolescents with only one episode and those with two or more episodes.
Conclusions:  The characteristics of the 'a dead body climbed on top of me' phenomenon suggest that is identical to sleep paralysis and a frequent experience among Mexican adolescents. During adolescence, sleep paralysis seems to be a recurrent phenomenon frequently accompanied by hallucinatory experiences.     

Fatigue, depression and disability accumulation in multiple sclerosis: a cross-sectional study

Objective:  To investigate the influence of disability and the speed of disability accumulation on fatigue and depression in a large cohort of patients with multiple sclerosis (MS).
Methods:  A total of 412 patients completed the Fatigue Severity Scale (FSS) and Center for Epidemiological Studies Depression Scale (CESD). The patients were registered at our outpatient department and demographic and disease specific data were compared between patients with and without severe fatigue (FSS ≥ 5.0) and clinically significant depressive symptoms (CESD ≥ 16). We investigated the association of Expanded Disability Status Scale (EDSS) scores, multiple sclerosis severity scores (MSSS) and either CESD scores or FSS-scores with severe fatigue and clinically significant depressive symptoms in a multivariable logistic regression model, with adjustment for possible confounders.
Results:  Only CESD scores were independently associated with severe fatigue. FSS scores and female gender were independently associated with clinically significant depressive symptoms. Neither EDSS nor MSSS scores were independently associated with fatigue or depression.
Conclusion:  In patients with MS, fatigue and depression are strongly associated with each other but not with the degree of disability or the speed of disability accumulation.     

Pain in Adolescent Psychiatric Patients

Background:  Little is known about the extent of pain among adolescent psychiatric patients, and the relationships with psychosocial factors and psychiatric symptoms.
Method:  A representative sample of 129 adolescent patients were assessed with measures including the Youth Self-Report, the Mood and Feelings Questionnaire, and instruments assessing self-perceptions, coping styles, stresses, sociodemographic factors, and childhood abuse.
Results:  More than half of the adolescents (54%) reported to be bothered currently by frequent pain. Frequent pain correlated with depression, self-harm, suicide attempt, and with ruminative and emotion oriented coping. Adolescents suffering from frequent pain had more often experienced childhood abuse/neglect. A stepwise multiple regression analysis revealed that depression, alcohol intoxication and childhood neglect were the strongest concurrent predictors of frequent pain.
Conclusions:  Clinicians should ask child and adolescent psychiatric patients about pain, and be aware of possible connections with abuse/neglect, depression and suicidality.     

Risperidone in the treatment of mixed state bipolar patients: Results from a 24-week, multicenter, open-label study in Korea

Aims:  The goal of the present study was to evaluate the efficacy of risperidone combined with mood stabilizers for treating bipolar mixed state.
Methods:  The present study was a 24-week, open-label, combination, prospective investigation of the efficacy of risperidone in combination with mood stabilizers. Risperidone (1–6 mg/day) was given in combination with mood stabilizers in flexible doses according to clinical response and tolerability for 114 patients in mixed or manic episode.
Results:  Forty-four patients met our criteria for mixed state bipolar disorder and 70 met the criteria for pure mania. Mean age for the subjects was 39.0 ± 11.0 years and 55.3% were female. The combination of risperidone with mood stabilizers significantly improved the scores on the Young Mania Rating Scale (YMRS), 17-item Hamilton Rating Scale for Depression (HAMD), 18-item Brief Psychiatric Rating Scale (BPRS), Global Assessment Scale (GAS), and Clinical Global Impression Scale for use in bipolar illness Severity (CGI-BP) at 24 weeks ( P  < 0.0001). Analysis of the YMRS, BPRS, GAS, and CGI-BP scores showed significant improvement in both the manic and mixed groups. The rate of response in YMRS scores was 84.2% ( n  = 96) and the rate of YMRS remission was 77.2% ( n  = 88) at week 24 in the total population. Seventy-four patients met both YMRS ≤ 12 and HAMD ≤ 7 at week 24 (64.9%). Risperidone was well tolerated, and adverse events were mostly mild.
Conclusion:  The combination of risperidone with mood stabilizers was an effective and safe treatment for manic symptoms and coexisting depressive symptoms of bipolar disorder.     

Dissociation and alexithymia among men with alcoholism

Aim:  The aim of the present study was to evaluate the relationship between alexithymia and dissociation among men with alcoholism.
Methods:  Participants were 176 patients consecutively admitted to the inpatient unit of a addiction treatment center. The Toronto Alexithymia Scale, the Symptom Checklist-Revised, the Dissociative Experiences Scale, the Beck Depression Inventory, the Spielberger State–Trait Anxiety Inventory, and the Michigan Alcoholism Screening Test were administered to all participants.
Results:  Fifty-three patients were considered as having alexithymia. The alexithymic group had a significantly higher rate of dissociative taxon members (patients with pathological dissociation; 62.3%) according to Bayesian probability. Trait anxiety, overall psychiatric symptom severity, and pathological dissociation predicted alexithymia on covariance analysis. A multivariate analysis of covariance demonstrated that these predictors were related only to difficulty of identifying feelings, whereas trait anxiety was a significant covariant for difficulty of expressing feelings as well.
Conclusion:  Alexithymic phenomena are interrelated with dissociation and chronic anxiety among men with alcoholism. The relevance of this triad for prevention and treatment of alcoholism deserves interest in further research.     

Correlation between addictive behaviors and mental health in university students

Aims:  The present study aims to clarify the relationships of addictive behaviors and addiction overlap to stress, acceptance from others and purpose in life.
Methods:  A survey was conducted on 691 students at eight universities. The Eating Attitude Test-20 was used to identify students with food addiction or food addictive tendencies. The Kurihama Alcoholism Screening Test was used to identify students with alcohol addiction or alcohol addictive tendencies. The Fagerström Test for Nicotine Dependence was used to identify students with nicotine addictive tendencies or nicotine addiction. The Visual Analog Scale was used to assess stress and acceptance from others. The Purpose in Life Test was used to measure meaning and purpose in life. Results were compared between students with addictive behaviors, with addictive tendencies and without addictive behaviors.
Results:  Significant differences among the three groups were observed for stress, acceptance from others, and Purpose in Life scores for students with food and nicotine addiction, but no significant differences existed in relation to alcohol addiction. In addition, 28.8% of students displayed addictive behaviors in one of the three areas (food, alcohol or nicotine), 8.5% displayed addictive behaviors in two of the three areas, and 0.4% had addictive behaviors in all three areas. Significant differences existed in stress and acceptance from others among students with one addictive behavior, ≥two addictive behaviors and no addictive behaviors. However, no significant differences existed in Purpose in Life scores with respect to overlapping addictions.
Conclusion:  The results suggest a relationship between mental health, addictive behaviors and overlapping addiction among university students.     

Traumatic experiences and dissociation in a non-clinical group of university students in Ecuador: a cross-sectional study

Background: In Ecuador, as in most Latin American countries, scientific research on trauma and dissociation is scarce. The aim of this study was to examine the prevalence of potentially traumatic experiences and dissociative symptoms in adolescents and young adults who were students at the Central University in Quito, Ecuador.

Methods: A cross-sectional study in which 144 students completed a self-administrated questionnaire consisting of Linköping Youth Life Experience Scale (LYLES), Adolescent-Dissociation Experience Scale (A-DES ) and background variables. Data collection was conducted in autumn 2012. Standard multiple regression analysis was used to analyse the data.

Results: All students reported a history of a minimum of five potentially traumatic experiences with a mean of 14.8. Eight participants (5.6%) scored above 3.7 on the Adolescent-Dissociation Experience Scale, which is considered clinically significant dissociation. No correlation was found between high scores on LYLES and A-DES.

Conclusions: The prevalence of potentially traumatic experiences in the study population is very high compared to studies conducted in high-income settings. The low prevalence of dissociation suggests high resilience in the study population but more research on morbidity is needed to draw conclusions about mental health outcomes. Further research should include study populations in less advantageous contexts.     

Relationship between depressive mood and chronotype in healthy subjects

Aim:  The endogenous circadian clock generates daily variations of physiological and behavior functions such as the endogenous interindividual component (morningness/eveningness preferences). Also, mood disorders are associated with a breakdown in the organization of ultradian rhythm. Therefore, the purpose of the present study was to assessed the association between chronotype and the level of depressive symptoms in a healthy sample population. Furthermore, the components of the depression scale that best discriminate the chronotypes were determined.
Methods:  This cross-sectional study involved 200 volunteers, aged 18–99 years, 118 women and 82 men. The instruments were the Montgomery–Äsberg Depression Rating Scale (MADRS), the Morningness/Eveningness Questionnaire, the Self-Reporting Questionnaire-20, and the future self-perception questionnaire.
Results:  Logistic regression showed that subjects with the eveningness chronotype had a higher chance of reporting more severe depressive symptoms compared to morning- and intermediate-chronotypes, with an odds ratio (OR) of 2.83 and 5.01, respectively. Other independent cofactors associated with a higher level of depressive symptoms were female gender (OR, 3.36), minor psychiatric disorders (OR, 3.70) and low future self-perception (OR, 3.11). Younger age, however, was associated with a lower level of depressive symptoms (OR, 0.97). The questions in the MADRS that presented higher discriminate coefficients among chronotypes were those related to sadness, inner tension, sleep reduction and pessimism.
Conclusion:  Identification of an association between evening typology and depressive symptoms in healthy samples may be useful in further investigation of circadian typology and the course of depressive disease.     

Factors associated with ideation and acts of deliberate self-harm among 18-year-old boys

BACKGROUND: The aims of the study were: (1) to identify the prevalence of ideation and acts of deliberate self-harm in 18-year-old boys; (2) to report the use of mental health services among these boys; (3) to identify risk factors assessed at age 8 and (4) to identify associated cross-sectional factors at age 18 of self-reported ideation and acts of deliberate self-harm. METHODS: The participants in this community-based 10-year follow-up study consisted of 2,348 boys born during 1981. At baseline, three informant sources were used: parents, teachers and the children themselves. The questionnaires used were the Rutter Parents Scale, the Rutter Teacher Scale and the Children's Depressive Inventory. At follow-up, boys' psychopathology, adaptive functioning and substance use were studied using the Young Adult Self-Report questionnaire. Further questions about demographic factors and life events were added at both stages. RESULTS: The prevalence of ideation of deliberate self-harm was 4.0%, and of acts 2.2%, during the preceding 6 months. Of the subjects who reported ideation, 9.7%, and of those who reported acts, 16.0%, had used mental health services during the previous year. Self-reported depressive symptoms at age 8 predicted ideation and acts of deliberate self-harm 10 years later. Suicidal boys' problems in many life areas were linked with suicidal tendency through psychiatric symptoms, especially anxious/depressed symptoms and aggressive behaviour. CONCLUSIONS: The connection between self-reported depressive symptoms at age 8 and ideation and acts of deliberate self-harm at age 18 is a good reason to already pay special attention to children's own intimations of distress in elementary school. It is likely that an effective way to prevent suicidality among adolescents is to search for and treat psychiatric problems among young people. Self-reported screening questionnaires used, e.g. in school healthcare, may provide an opportunity to recognize these problems.     

Assessment of depressive symptoms in Japanese school children and adolescents using the Birleson Depression Self-Rating Scale

OBJECTIVE: The aim of this study was to investigate the prevalence of depressive symptoms in children and adolescents in the general Japanese population using a depression self-rating scale and determine whether this prevalence varies according to age, gender, or region. METHOD: The Birleson Depression Self-Rating Scale for children (DSRS) was used to examine the extent to which depressive tendencies were present among 2,453 elementary and middle-school children (6 to 15 years old) in two cities in Japan. RESULTS: The mean DSRS score was high at 8.75 +/- 5.66. A significant increase in score was observed with increasing age. There were no significant differences between regions. Using a DSRS cutoff score of 15 points as a risk of depression, the scores of 14.9% of the subjects exceeded the cutoff. CONCLUSIONS: As determined using the DSRS, a high proportion of Japanese children and adolescents have depressive tendencies.     

Relationship of attention-deficit-hyperactivity disorder symptoms, depressive/anxiety symptoms, and life quality in young men

Aim:  Attention-deficit–hyperactivity disorder (ADHD) continues to be among the most frequently missed of psychiatric diagnoses in adults because its presentation in adulthood so often mimics those of better-known disorders. The aim of the present study was to examine the relationship between ADHD symptoms, depression/anxiety symptoms, and life quality in young men.
Methods:  Nine hundred and twenty-nine draftees into the Taiwanese army completed the Adult ADHD Self-Report Scale (ASRS), the World Health Organization (WHO) Quality of Life–Brief Version, the Epworth Sleepiness Scale, the second edition of the Beck Depression Inventory, and the Beck Anxiety Scale. Based on high ASRS scores, a total of 328 adults (35.3%) were identified as having ADHD: 65 (7.0%) with definite ADHD and 263 (28.3%) with probable ADHD.
Results:  The 328 subjects in the ADHD group had more severe depressive, anxiety symptoms and daytime sleepiness, and had poorer quality of life than the 601 controls (all P  < 0.05).
Conclusions:  ADHD should be included in the differential diagnosis for young men presenting with anxiety, depression, daytime sleepiness, and poor quality of life.     

A preliminary functional magnetic resonance imaging study of prefrontal-amygdalar activation changes in adolescents with bipolar depression treated with lamotrigine

Objectives:  Hypotheses regarding mood dysregulation in bipolar disorder (BD) have centered on limbic overactivity with relative prefrontal underactivity during mood episodes. Therefore, we hypothesized that adolescents with bipolar depression successfully treated with lamotrigine would show decreases in amygdalar activation, and increases in prefrontal activation.
Methods:  Eight adolescents with BD underwent functional magnetic resonance imaging (fMRI) at baseline and after eight weeks of lamotrigine treatment. Blocks of negatively and neutrally valenced emotional pictures were presented during scanning, and subjects were asked to rate how each picture made them feel. Activation in bilateral amygdalae and dorsolateral prefrontal cortices (DLPFC) for negative minus neutral pictures was correlated with Children's Depression Rating Scale (CDRS) scores.
Results:  Mean (SD) CDRS scores decreased significantly, from 53.0 (10.6) at baseline to 26.3 (5.3) at Week 8. This clinical improvement was correlated with decreased right amygdalar activation ( r  = 0.91, p = 0.002). At Week 8, but not baseline, CDRS score was positively correlated with bilateral amygdalar activation ( r  = 0.85, p = 0.007). DLPFC activation was not correlated with change in CDRS score.
Conclusions:  These preliminary results indicate that adolescents with BD treated with lamotrigine demonstrated less amygdalar activation when viewing negative stimuli as depressive symptoms improved. Larger controlled studies are needed to confirm these findings.     

Traumatic experiences and dissociative symptoms among Swedish adolescents. A pilot study using Dis-Q-Sweden

The aim of this study was to explore the occurrence of dissociative symptoms in relation to reported traumatic experiences among adolescents. A normative sample of 216 adolescents and a clinical sample of 30 cases with a history of traumatization were given the Swedish translation of Dissociation Questionnaire, DIS-Q. The results showed that 8.8% of the adolescents reported scores above the cut-off score of 2.5 on the Dis-Q-Sweden, with a female–male ratio of 2.6:1. In the normative sample, 53 (24.5%) of the adolescents reported one or more trauma experiences. The adolescents who self-reported trauma experiences in the normative sample scored higher on the total Dis-Q-Sweden scores and on three of the four subscales compared to the adolescents with no such experiences. The clinical group exhibited significantly higher Dis-Q-Sweden scores than the normative sample on every scale, with 60% above the cut-off score. The study confirms the results from earlier studies that adolescents with a history of trauma exhibit more dissociative symptoms in this study according to Dis-Q-Sweden. The impact of trauma qualities and background factors on the development of dissociative symptoms need to be studied further.