Suicidal thoughts and attempts among adolescents: a longitudinal 8-year follow-up study

BACKGROUND: To study the prevalence of and factors associated with suicidal behaviour among 580 adolescents. METHODS: An 8-year longitudinal study included questions about suicidal attempts and thoughts at age 16. Children were evaluated with parent and teacher Rutter scales and self-reported Child Depression Inventory at age 8. At age 16, parents filled in the Child Behaviour Check List and adolescents the Youth Self Report. RESULTS: 14% of girls and 7% of boys reported suicidal thoughts or preoccupations at age 16. Emotional and behavioural problems at age 8, especially antisocial symptoms, reported by parents and teachers and depressive symptoms reported by the child were correlated with suicidal thoughts and behaviour 8 years later. At age 16, internalizing and externalizing problems and low social competence were associated with suicidal features. Only about 20% of those who reported suicidal features had been referred to child mental health services. CONCLUSIONS: Many adolescents with suicidal thoughts and behaviour had a high rate of behavioural and emotional problems already at age 8. CLINICAL IMPLICATIONS: The early school years represent an opportunity for interventions which may prevent self-destructive behaviours in adolescence.     

Bulimia and impulsive behaviour in middle adolescence

BACKGROUND: In clinical samples, bulimia seems to be associated with various dyscontrol behaviours suggesting weakness in impulse control. Population studies of adolescents, however, are needed. We evaluated the association between self-reported bulimic behaviour and a number of dyscontrol behaviours, namely bullying, truancy, excessive drinking and sexual disinhibition among adolescents aged 14-16. This is the first study on bulimia and impulsivity in a large non-selected adolescent population sample. METHODS: A self-report questionnaire was administered to a representative population sample of 14- to 16-year-old adolescents (pupils of the 8th and the 9th grades of secondary school in four different regions in Finland). 4,453 girls and 4,334 boys aged 14-16 participated. The participation rate was 85.5%. RESULTS: Bulimic behaviour was associated with bullying, truancy, excessive drinking and sexual disinhibition among both sexes. Odds ratios for bulimic-type eating pathology according to each of these behaviours varied between 1.7 and 4.1. The more dyscontrol behaviours occurred simultaneously, the more likely was bulimic-type eating pathology. CONCLUSIONS: There is an association between bulimic behaviour and dyscontrol behaviours in the general population of adolescent girls and boys.     

青少年早期的抑郁与生活事件的交叉滞后分析

目的:探讨青少年早期生活事件与抑郁的因果关系以及因果关系的动态变化。方法:连续三年对来自南京市的598名初中生进行生活事件和抑郁的测量。运用交叉滞后回归分析考察了两个变量间的因果关系。结果:①在初一到初二年级时,生活事件总分以及人际关系和学习压力因子可以预测抑郁倾向。②在初二到初三年级时,抑郁倾向可以预测生活事件总分以及人际关系和学习压力因子。③在生活事件总分、人际关系和学习压力和抑郁的因果关系上存在显著的性别差异。结论:在青少年早期,抑郁与生活事件的因果关系发生动态变化,抑郁并不总是结果变量,也可能是原因变量。     

Risk factors and life processes associated with the onset of suicidal behaviour during adolescence and early adulthood

BACKGROUND: This study examined associations between childhood circumstances, adolescent mental health and life events, and the development of suicidal behaviour in young people aged between 15 and 21 years. METHOD: Data were gathered over the course of a 21-year longitudinal study of a birth cohort of 1265 children born in New Zealand. The measures collected included: (1) patterns of suicidal behaviour (ideation, attempt) (15-21 years); (2) social background, family functioning, parental and individual adjustment during childhood (0-16 years); and (3) time dynamics of mental health and stressful life events during adolescence and early adulthood (15-21 years). RESULTS: By the age of 21 years, 28.8% of the sample reported having thought about killing themselves and 7.5% reported having made a suicide attempt. The childhood profile of those at greatest risk of suicidal behaviour was that of a young person reared in a family environment characterized by socio-economic adversity, marital disruption, poor parent-child attachment and exposure to sexual abuse, and who as a young adolescent showed high rates of neuroticism and novelty seeking. With the exception of the socio-economic and personality measures, the effects of childhood factors were largely mediated by mental health problems and exposure to stressful life events during adolescence and early adulthood. Mental health problems including depression, anxiety disorders, substance use disorder, and to some extent conduct disorder, in addition to exposure to adverse life events, were significantly associated with the onset of suicidal behaviours. CONCLUSIONS: Findings support a life course model of the aetiology of suicidal behaviour in which risk of developing suicidal behaviour depends on accumulative exposure to a series of social, family, personality and mental health factors.     

6～11岁肥胖儿童行为问题调查

目的：调查6～11岁肥胖儿章行为问题。方法：采用Achenbach’s儿童行为量表（CBCL），对安徽省安庆市与铜陵市111名调查对象进行问卷调查。结果：肥胖儿童行为问题发生率为36．94％，男、女分别为40．38％和33．90％，性别间差异无统计学意义（P〉0．05）。4～16岁正常儿童青少年行为问题总发生率为12．97％（男童13．44％、女童12．52％），肥胖儿童整体及按性别比较，行为问题发生率均较高（u分别为7．52、5．70和4．96，P均〈0．01）。男童行为问题各因子发生率由高到低依次为：强迫行为34．62％、分裂焦虑23．08％、抑郁19．23％、体诉15．39％、交往不良13．46％、社交退缩9．62％、多动9．62％、攻击性9．62％和违纪表现5．77％，各因子发生率差异有统计学意义（X^2=25．25，P〈0．05）；女童行为问题各因子发生率依次为：分裂强迫23．73％、抑郁11．86％、多动10．17％、性问题10．17％、体诉848％、攻击性8．48％、社交退缩6．78％、残忍表现6．78％和违纪表现5．09％，差别有统计学意义（X^2=15．59，P〈0．05）。男、女童共有的6个行为问题因子：社交退缩、多动、体诉、违纪表现、攻击性、抑郁，无性别差异（P均〉0．05）。结论：肥胖儿童行为问题发生率远远高于全国4～16岁儿童青少年，肥胖男童主要表现在强迫行为、分裂焦虑、抑郁、体诉、交件不良，女童主要表现在分裂强迫、抑郁、多动、性问题。     

Peer victimization and depression among Hong Kong adolescents

The present study examined the gender differences in the relationship between victimization and depression, as well as in the buffering effect of social support, in Hong Kong adolescents. Based on social role theory, we predicted (a) that victimization would be associated with higher depression in boys than in girls, and (b) that social support would have a stronger buffering effect in boys than in girls. Results showed that boys reported more victimizations than girls, and victimization was slightly more strongly associated with depressive symptoms in boys than in girls. Parental support had a direct effect on depression, but no buffering effect. A buffering effect was found for friend support, but only in boys; high support from friends was associated with fewer depressive symptoms at high levels of victimization.     

领悟社会支持与青少年内化问题的关系:自尊的调节作用

目的:探讨自尊在领悟社会支持与青少年内化问题之间的调节作用。方法:采用领悟社会支持量表、自尊量表和焦虑抑郁量表对455名初中生进行调查。结果:领悟社会支持与青少年内化问题显著负相关(r=-0.33,P0.001);自尊能够增强领悟社会支持对青少年内化问题的保护效应(b=0.15,P0.001)。结论:自尊对领悟社会支持与青少年内化问题的关系具有调节作用。     

Prevalence and social correlates of postnatal depression in a low income country

Summary Background: Postnatal depression is an important public health problem worldwide. Recent evidence suggests that rates may be relatively higher in developing countries. We aimed to explore the prevalence of postnatal depression and its association with social support and other risk factors in a sample of Pakistani women. Methods: Population-based survey of 149 women at 12 weeks postnatal using the Edinburgh Postnatal Depression Scale (EPDS), Multidimensional Scale of Perceived Social Support (MSPSS) and Personal Information Questionnaire (PIQ). Results: Thirty six percent women scored ≥12 on EPDS. High depression score was associated with lower social support, increased stressful life events in the preceding year and higher levels of psychological distress in the antenatal period. Conclusions: There is a high prevalence of postnatal depression in Pakistani women. Early interventions should be developed that target the antenatal period and strengthen social support networks in women at risk.     

Gender differences in adolescent depression: do symptoms differ for boys and girls?

BACKGROUND: Limited prior research suggests that depressed women are more likely to experience certain symptoms of depression than are depressed men. The purpose of this study was to examine whether such gender differences in depressive symptoms are present during adolescence. METHODS: The Childhood Version of the Schedule for Affective Disorders and Schizophrenia and the Beck Depression Inventory were administered to adolescents presenting for evaluation at an outpatient clinic (n=383; ages 11.9 to 20.0). RESULTS: Depressed girls and boys had similar symptom prevalence and severity ratings for most depressive symptoms. However, depressed girls had more guilt, body image dissatisfaction, self-blame, self-disappointment, feelings of failure, concentration problems, difficulty working, sadness/depressed mood, sleep problems, fatigue, and health worries than depressed boys on some comparisons. In contrast, depressed boys had higher clinician ratings of anhedonia, depressed morning mood, and morning fatigue. LIMITATIONS: Longitudinal research is needed to test whether such relatively gender-specific symptoms play different roles in the onset, maintenance, or remittance of depression for boys and girls. CONCLUSIONS: These findings indicate that, in general, the experience of depression is highly similar for adolescent girls and boys. However, some gender differences previously found among depressed adults appear to be present by adolescence, possibly suggesting somewhat distinct etiologies for depression among males and females.     

Perceived tiredness among adolescents and its association with sleep habits and use of psychoactive substances

This study investigated the variation in perceived tiredness among 11, 13 and 15-year-old Finnish adolescents (n=4187). Additionally interrelationships between sleep habits, use of psychoactive substances (alcohol, tobacco and coffee) and perceived tiredness among 15-year-olds were examined. This study is part of an international, WHO-coordinated survey of school children's health and lifestyle (the HBSC Study). In Finland, research data represented the whole country. The data were collected in March–May 1994. Pupils responded anonymously to a standardized questionnaire during a class period. Subjective tiredness was very common and increased with age among adolescents. Perceived tiredness on at least four school mornings a week increased from 24 to 35% among boys and from 16 to 34% among girls. Feeling tired more often than once a week increased from 20 to 37% in girls and from 24 to 50% in boys. Structural equation models showed that interrelationships between three factors – sleep habits, use of psychoactive substances and perceived tiredness – were statistically significant. For these three factors the two remaining factors explained 24% of the variance of perceived tiredness among boys and 20% among girls, and the two remaining factors explained 42% (16%) of the variation in sleep habits. For the variance of the use of psychoactive substances sleep habits and perceived tiredness explained 26% (12%). Subjective tiredness is strongly age related; this together with the use of psychoactive substances and sleep habits regulate adolescents’ daily life and well-being.     

流动儿童歧视知觉与抑郁:应对方式与社会支持的调节

目的:考察应对方式与社会支持对歧视知觉与抑郁关系的调节作用。方法:采用个体歧视知觉问卷、流调中心抑郁量表(CES-D)、简易应对方式问卷、社会支持问卷对长沙市558名流动儿童进行调查。结果:歧视知觉对抑郁有显著正向预测(β=0.446,P<0.001);积极应对对歧视知觉与抑郁关系有增强作用;社会支持对积极应对的增强作用有缓冲效应。结论:积极应对、社会支持对流动儿童歧视知觉与抑郁关系有共同调节作用。     

Sex differences in patterns of relations between family interactions and depressive symptoms in adolescents

Aim

To gain insight into the relations between protective/risk family interactions and depressive symptoms in adolescent boys and girls.

Method

A self-reported cross-sectional survey was conducted on a representative sample of 1191 secondary school students (617 girls and 574 boys) aged from 14 to 19 years, with a median of 16, from all secondary schools in the Primorsko-goranska County, Croatia in January and February 2010. Students reported their depressive symptoms, perceptions about the relationship with their mother and father, family activities, and parents’ conflict resolution strategies. Data were analyzed by hierarchical multiple regression to calculate the effects of family supportive and harmful interactions on depressive symptoms in girls and boys.

Results

Depressive symptoms were reported often and very often by 19.1% of girls and 15.8% of boys. Girls’ assessment of the family relations was significantly more positive than boys’, including the assessment of family activities, constructive family conflict resolution, or father’s and mother’s warmth and affection. Multiple correlation analysis revealed that the examined family variables accounted for 16.3% of the variance of depressive symptoms in boys and for 17.2% in girls. Hierarchical multiple regression analysis showed a difference in the relation of family variables and depressive symptoms between boys and girls. Depressive symptoms in girls were more linked to the lack of protective family factors (9.9% of the explained variance in girls vs 5.5% in boys), while depressive symptoms in boys were more linked to the existence of harmful family factors (10.8% of the explained variance in boys vs 7.3% in girls).

Conclusion

Family activities and the father''s warmth and affection have a higher significance for girls than for boys, while destructive parental conflict and the mother''s aggression and hostility are equally significant for both girls and boys. These results indicate the targets for family-based preventive and intervention programs for depression in adolescents.Depression has been described as one of the most frequent internalized mental health problems experienced by the youth (1) and is associated with a great deal of personal distress and disruption (2). The incidence of depression significantly increases from childhood to adolescence from approximately 5% to 10%-20% (3). This rise may be attributed to the developmental process related to hormonal changes in puberty (4), a greater capacity for abstract thinking and rumination (5), increased psychological stress in developmental transition, or changing relations with parents and peers (6). Depressive symptoms may interfere with adolescents’ abilities to engage effectively in developmental tasks that may have an impact on their psychological health and well-being. In addition, depressed adolescents are at an increased risk of developing depressive disorders in adulthood (7).The multiple pathways to depression are caused by the complex interplay among genetic, biological, cognitive, interpersonal, family, and environmental factors (2,8). Researchers have identified a large number of risk factors and, to a lesser degree, protective factors related to the manifestation of depression, with parental and family factors playing a big role in the former (8,9). The most often identified and analyzed family-related risk factors for child depression include parental rejection, harsh parental discipline, and lack of parental warmth and availability (10,11), as well as marital/family conflict, and parents’ stress and depression (12). The protective factors most often analyzed are supportive parental interaction, fostered through parental warmth, family cohesion, and common family activities (13,14).The relationship between risk factors and the subsequent depression in adolescence varies by sex (15,16). While during preadolescence depression rates for boys and girls are approximately the same, during adolescence girls are more likely to develop more frequent and more severe depressive symptoms than their male counterparts (5). Sex may also moderate the relation with parents and marital conflicts as predictors of depression (5,16,17).Although several studies suggest that family interactions play an important role in the development of depression (8), their results regarding the relevant parental or family factors contributing to it and the mechanisms through which they operate are inconsistent. Moreover, the respective influence of each parent on an adolescent’s social functioning and psychosocial adjustment is rarely specified, even more so when it comes to the role of the fathers. The multidimensional nature of protective and risk factors for depression and the possible differential contribution of relations with mother and father separately for men and women is stressed in recent research (17,18).The aim of our study was to gain an insight into the relationship between protective and harmful family interactions and depressive symptoms among adolescent boys and girls through analysis of their perception of their mother’s and father’s relation toward them, family activities, and modalities of parental conflict resolution. We hypothesized that the specific family relations and each parent’s interaction were significantly correlated with depressive symptoms in adolescents, and that the positive family relations (closeness, warmth. and affection) had a more protective role for girls than for boys.     

Unsuspected depressive mania in pre-pubertal Hispanic children referred for the treatment of 'depression' with history of social 'deviance'

BACKGROUND: Despite an emerging Literature on the mixed nature of pediatric mania, initial presentation with conduct problems continues to mislead mental health clinicians. The present report focuses on Hispanic pre-pubertal children referred for the treatment of depression in the context of conduct problems. METHODS: Eleven boys and two girls received a structured psychiatric assessment in a practice setting to make sense of the presenting clinical complexity. Diagnoses were assigned using the DSM-IV criteria. RESULTS: Ten of the boys and both girls met criteria for depressive mania. Their family histories were replete with affective disorder. Five (50%) of the boys and both of the girls (100%) with depressive mania had family histories of bipolar disorder. Six (60%) of the boys and neither of the girls with depressive mania had psychotic features. Those with depressive mania exhibited clear-cut circadian changes in symptomatology. Euphoria, oscillating with affective states indicative of psychic pain, was characteristically restricted to the evenings or nighttime. However, the drive to seek treatment had stemmed from social 'deviance'. CONCLUSION: Children with depressive mania are often unrecognized in clinical settings. Boys with conduct problems may be disproportionately represented among such children. These data support Akiskal's hypothesis that externalizing (conduct) problems in clinically referred children with depression are indicative of bipolar disorder.     

Early Risk Factors for Depressive Symptoms among Korean Adolescents: A 6-to-8 Year Follow-up Study

Depression during adolescence is critical to the individual''s own development. Hence, identifying individuals with high-risk depression at an early stage is necessary. This study aimed to identify childhood emotional and behavioral risk factors related to depressive symptoms in Korean adolescents through a longitudinal study. The first survey took place from 1998 to 2000, and a follow-up assessment conducted in 2006, as the original participants reached 13-15 yr of age. The first assessment used the Korean version of Child Behavior Checklist and a general questionnaire on family structure, parental education, and economic status to evaluate the participants. The follow-up assessment administered the Korean Children''s Depression Inventory. Multiple regression analysis revealed that childhood attention problems predicted depressive symptoms during adolescence for both boys and girls. For boys, family structure also predicted adolescent depressive symptoms. This study suggests that adolescents with attention problems during childhood are more likely to experience depressive symptoms.     

Suicidal ideation in high school students: Depression and other correlates

English-Canadian high school students (129 boys, 117 girls) participated in a study of the relationship between suicidal ideation and selected personal variables, stress, and social support. Associations were found between suicidal ideation and the variables of gender, self-esteem, locus of control, depression, drug use, stress, perception of health, family status, academic performance, social support, and anomie. Multiple regression analysis identified depression and alcohol use as best individual predictors among these variables. Semi-partial correlation analyses showed that removal of the effect of depression resulted in a loss of initially significant relationships between suicidal ideation and the other variables except for alcohol use, drug use, and health satisfaction.     

Examination of a sociocultural model of disordered eating among male and female adolescents

Objectives. The study tests a version of Stice's (1994) sociocultural model of disordered eating that was modified to incorporate social comparisons. Additionally, it examines how self‐reported body‐mass index and perceived weight status influence associations within the model. Method. Questionnaires were administered in a state secondary school; the sample consisted of 250 female and 257 male adolescents aged 11–16 years. Results. The results supported the sociocultural model among both male and female adolescents. Perceived pressure to lose weight was directly associated with eating behaviour, as well as indirectly associated through social comparisons, internalization and body dissatisfaction. However, social comparisons were most strongly related to body dissatisfaction among adolescents who perceived themselves as overweight. Conclusions. The findings indicate that models of eating disordered behaviour, developed for adolescent girls, are also appropriate for understanding this behaviour among male adolescents. The results suggest that social comparisons represent a useful addition to Stice's (1994) original model and a potentially fruitful target for interventions.     

亲子沟通对青少年社会适应的影响:社会支持的中介作用

目的:探讨社会支持在青少年亲子沟通对抑郁和社交回避的中介作用。方法:以浙江省两所中学269名青少年为研究对象,通过青少年亲子沟通问卷、社会支持评定量表、自评抑郁量表和社交回避与苦恼量表考察青少年亲子沟通、社会支持与抑郁程度、社交回避的关系。结果:1女生的亲子沟通显著好于男生(t=3.141,P0.01),母子沟通好于父子沟通,初一、初二的亲子沟通好于初三和高二(F=5.933,P0.001);2亲子沟通、社会支持、抑郁和社交回避的相关均达到显著水平;3社会支持在亲子沟通对抑郁中有部分中介效应,社会支持在亲子沟通对社交回避中有完全中介作用。结论:改善青少年亲子沟通,可以增强其社会支持,从而提高其社会适应水平。     

The relationship between social support, depression and treatment for depression in people with multiple sclerosis

BACKGROUND: Studies have been fairly consistent in finding a relationship between social support and depression. However, little is known about the relationship between depression and social support in the context of treatment for depression. This study examined the effects of treatment for depression on social support among patients with multiple sclerosis (MS). METHOD: Sixty-three moderately depressed MS patients received 16 weeks of cognitive behaviour therapy (CBT), supportive expressive group psychotherapy (SEGP) or sertraline. Depression was measured using the Beck Depression Inventory and social support was measured using Arizona Social Support Interview Schedule. RESULTS: Treatment for depression was associated with significant increases in perceived social support, utilized social support and satisfaction with support, as well as reduction in need for emotional support. There were no significant changes in structural support or need for physical support. There were also no differences in change in social support across treatments. All changes in social support were fully explained by depression. Improvements in utilized social support and satisfaction with social support were fully mediated by improvements in depression. Baseline depression predicted improvements in perceived support and need for emotional support. CONCLUSIONS: These findings suggest that improvements in social support among MS patients during treatment for depression can be explained by depression. However, different domains of social support may be differentially sensitive to changes in depression.     

School connectedness is an underemphasized parameter in adolescent mental health: results of a community prediction study.

There is limited prospective research on the relation between school connectedness (i.e., the extent to which students feel accepted, valued, respected, and included in the school) and mental health symptoms in adolescents. A sample of 2,022 students (999 boys and 1,023 girls) ages 12 to 14 years were measured at 2 time points (12 months apart) on school connectedness and mental health symptoms (general functioning, depression, and anxiety symptoms). School connectedness correlated extensively with concurrent mental health symptoms at both time points (between 38% and 55% covariation with depression, 26% to 46% with general functioning, and 9% and 16% for anxiety symptoms). Using hierarchical linear modeling, school connectedness also predicted depressive symptoms 1 year later for both boys and girls, anxiety symptoms for girls, and general functioning for boys, even after controlling for prior symptoms. The reverse, however, was not true: Prior mental health symptoms did not predict school connectedness 1 year later when controlling for prior school connectedness. Results suggest a stronger than previously reported association with school connectedness and adolescent depressive symptoms in particular and a predictive link from school connectedness to future mental health problems.     

The role of depression in the quality of life among patients undergoing renal substitutive therapy

BACKGROUND: Depression is highly prevalent among patients with end-stage renal disease, nevertheless few patients are assessed or offered medical treatment to minimize its effects. This study assessed quality of life among these patients and studied the association between end-stage renal disease and depression. MATERIAL AND METHODS: We carried out a cross-sectional study with 123 patients over 19 who were undergoing renal substitutive therapy. Quality of life and depression were assessed using the Kidney Disease Quality of Life Short Form-36 and the Beck Depression Inventor. In order to measure the patients' metabolic state, we carried out medical and laboratory tests. Quality of life predictors were analyzed with multiple ordinal logistic regression models. RESULTS: The highest scores from the generic core belonged to social functioning dimensions (62.7) and mental health (65.9). For the specific core, the highest scores were in dimensions associated with support offered by the dialysis team (78.2) and from social support networks (75.3). Depression was the most consistent predictor of quality of life. CONCLUSION: The use of programs and measuring tools to measure quality of life prior to and during renal dialysis or hemodialysis, as well as a timely psychiatric evaluation, can be very useful in monitoring improvement, decline and response to anti-depressant treatment throughout the course of end-stage renal disease.