Prevalence rates for depression by industry: a claims database analysis

Purpose

To estimate and interpret differences in depression prevalence rates among industries, using a large, group medical claims database.

Methods

Depression cases were identified by ICD-9 diagnosis code in a population of 214,413 individuals employed during 2002–2005 by employers based in western Pennsylvania. Data were provided by Highmark, Inc. (Pittsburgh and Camp Hill, PA). Rates were adjusted for age, gender, and employee share of health care costs. National industry measures of psychological distress, work stress, and physical activity at work were also compiled from other data sources.

Results

Rates for clinical depression in 55 industries ranged from 6.9 to 16.2 %, (population rate = 10.45 %). Industries with the highest rates tended to be those which, on the national level, require frequent or difficult interactions with the public or clients, and have high levels of stress and low levels of physical activity.

Conclusions

Additional research is needed to help identify industries with relatively high rates of depression in other regions and on the national level, and to determine whether these differences are due in part to specific work stress exposures and physical inactivity at work.

Clinical significance

Claims database analyses may provide a cost-effective way to identify priorities for depression treatment and prevention in the workplace.     

Stress and development of depression and heavy drinking in adulthood: moderating effects of childhood trauma

Purpose

Studies suggest that childhood trauma is linked to both depression and heavy drinking in adulthood, and may create a lifelong vulnerability to stress. Few studies have explored the effects of stress sensitization on the development of depression or heavy drinking among those who have experienced traumatic childhood events. This study aimed to determine the effect of childhood trauma on the odds of experiencing depression or heavy drinking in the face of an adult life stressor, using a large population-based Canadian cohort.

Methods

A total of 3,930 participants were included from the National Population Health Survey. The associations among childhood trauma, recent stress and depression/heavy drinking from 1994/1995 to 2008/2009 were explored using logistic regression, as were interactions between childhood trauma and recent stress. A generalized linear mixed model was used to determine the effects of childhood trauma and stressful events on depression/heavy drinking. Analyses were stratified by sex.

Results

Childhood trauma significantly increased the odds of becoming depressed (following 1 event: OR = 1.66; 95 %CI 1.01, 2.71; 2+ events, OR = 3.89; 95 %CI 2.44, 6.22) and drinking heavily (2+ events: OR = 1.79; 95 %CI 1.03, 3.13). Recent stressful events were associated with depression, but not heavy drinking. While most interaction terms were not significant, in 2004/2005 the association between recent stress and depression was stronger in those who reported childhood trauma compared to those with no childhood trauma.

Conclusions

Childhood trauma increases risk for both depression and heavy drinking. Trauma may moderate the effect of stress on depression; the relationship among trauma, stress and heavy drinking is less clear.     

Personality, physical activity, and symptoms of anxiety and depression: the HUNT study

Purpose

To analyze the association between physical activity (PA), symptoms of depression and anxiety, and personality traits.

Methods

Cross-sectional study from a Norwegian population-based survey conducted in the period 2006–2008. The sample consisted of a total of 38,743 subjects aged ≥19 years, 56.1 % women and 43.9 % men. Demographic variables, PA, depression and anxiety (The Hospital Anxiety and Depression Scale), and personality (Eysenck Personality Questionnaire) were assessed by self-reporting measurements.

Results

Individuals who reported moderate and high PA had significantly lower scores on depression and anxiety compared with less physically active individuals (p < 0.05). Significantly lower risk of HADS-defined depression and anxiety was associated with frequency, duration, and intensity of activity among women (p < 0.05), and significantly lower risk of HADS-defined depression was associated with frequency, duration, and intensity of activity among men (p < 0.05). There was a significant linear trend between extroversion and levels of PA (p < 0.01) and between neuroticism and PA (p < 0.01).

Conclusions

Subjects reporting regular leisure-time PA were less likely to report symptoms of HADS-defined depression and anxiety. Personality may be an underlying factor in explaining this association.     

Parents’ education and the risk of major depression in early adulthood

Background

Early-life low socioeconomic position (SEP) increases the risk of adult major depression; however, associations vary according to the measure of SEP and adults’ life stage. Although maternal education often predicts offspring health better than other SEP indicators, including paternal education, it is unclear how maternal and paternal education differentially influence early-adult depression, and how early-life and adult risk factors may mediate the association.

Methods

Longitudinal data come from the Canadian National Population Health Survey from 1994/1995 to 2006/2007, restricted to a sample (N = 1,267) that was aged 12–24 years in 1994/1995. Past-year major depressive episode (MDE) was assessed in 2004/2005 and 2006/2007 using the Composite International Diagnostic Interview Short Form for Major Depression. Logistic regression models were used to estimate odds ratios (OR) and 95 % confidence intervals (CI) for the association between both maternal and paternal education and MDE, adjusting for respondent’s demographics, early-life adversities, adult SEP, psychosocial factors, and physical health.

Results

Offsprings of mothers with less than secondary school education had higher odds of MDE (adjusted OR 2.04, 95 % CI 1.25–3.32) relative to those whose mothers had more education. Paternal education was not associated with MDE. Although adult income, student status, psychosocial stress, and several early-life adversities remained associated with MDE in the fully adjusted model, the estimate for maternal education was not reduced.

Conclusions

Maternal education was associated with MDE in early adulthood, independent of paternal education and other early-life and early-adult risk factors.     

Which Behaviour Change Techniques Are Most Effective at Increasing Older Adults’ Self-Efficacy and Physical Activity Behaviour? A Systematic Review

Background

Increasing self-efficacy is an effective mechanism for increasing physical activity, especially for older people.

Purpose

The aim of this review was to identify behaviour change techniques (BCTs) that increase self-efficacy and physical activity behaviour in non-clinical community-dwelling adults 60 years or over.

Methods

A systematic search identified 24 eligible studies reporting change in self-efficacy for physical activity following an intervention. Moderator analyses examined whether the inclusion of specific BCTs (as defined by CALO-RE taxonomy) was associated with changes in self-efficacy and physical activity behaviour.

Results

Overall, interventions increased self-efficacy (d?=?0.37) and physical activity (d?=?0.14). Self-regulatory techniques such as setting behavioural goals, prompting self-monitoring of behaviour, planning for relapses, providing normative information and providing feedback on performance were associated with lower levels of both self-efficacy and physical activity.

Conclusions

Many commonly used self-regulation intervention techniques that are effective for younger adults may not be effective for older adults.     

Early Adolescent Relationship Predictors of Emerging Adult Outcomes: Youth With and Without Type 1 Diabetes

Background

Emerging adulthood is a high-risk period for mental health problems and risk behaviors for youth generally and for physical health problems among those with type 1 diabetes.

Purpose

The purpose of this study was to examine whether adolescents’ relationships with parents and friends predict health and risk behaviors during emerging adulthood.

Method

Youth with and without diabetes were enrolled at average age 12 and followed for 7 years. Parent and friend relationship variables, measured during adolescence, were used to predict emerging adulthood outcomes: depression, risk behavior, and, for those with diabetes, diabetes outcomes.

Results

Parent relationship quality predicted decreased depressive symptoms and, for those with diabetes, decreased alcohol use. Parent control predicted increased smoking, reduced college attendance, and, for control participants, increased depressive symptoms. For those with diabetes, parent control predicted decreased depressive symptoms and better self-care. Friend relationship variables predicted few outcomes.

Conclusions

Adolescent parent relationships remain an important influence on emerging adults’ lives.     

Predictors of prescribed medication use for depression,anxiety, stress,and sleep problems in mid-aged Australian women

Objective

The study examined prevalence of self-reported use of medication recommended or prescribed by a doctor for depression, anxiety, stress, and sleep problems; and modelled baseline factors that predicted use over 3 years for each condition.

Methods

Analyses were undertaken on the 2001 and 2004 surveys of mid-aged women in the Australian Longitudinal Study on Women’s Health. Dependent variables were self-reported use in past 4 weeks of medications recommended or prescribed by a doctor for depression, anxiety, stress, or sleep problems in 2001 and 2004. Generalized Estimating Equations (GEE) were used to predict medication use for each condition over 3 years.

Results

Prevalence of prescribed medication use (2001, 2004) for each condition was depression (7.2, 8.9 %), anxiety (7.4, 9.0 %), stress (4.8, 5.7 %), and sleep problems (8.7, 9.5 %). Multivariable analyses revealed that odds of medication use across 3 years in all four conditions were higher for women with poorer mental and physical health, using hormone replacement therapy (HRT), or having seen a counsellor; and increased over time for depression, anxiety, and stress models. Medication use for depression was also higher for overweight/obese women, ex-smokers, and unmarried. Medication use for anxiety was higher for unmarried and non-working/low occupational women. Medication use for stress was higher for non-working women. Additional predictors of medication for sleep were surgical menopause, and area of residence.

Conclusions

Self-reported use of prescribed medication for four mental health conditions is increased over time after controlling for mental and physical health and other variables. Research needs to explore decision-making processes influencing differential rates of psychoactive medication use and their relationship with health outcomes.     

The association between physical activity and depression among individuals residing in Brazil

Purpose

There is very limited literature investigating the association between physical activity (PA) and depression in South American countries such as Brazil. The purpose of the current study was to evaluate the prevalence of depression and its association with PA in a very large, representative sample of young adults (ages 18–39 years) (YA), middle-aged adults (ages 40–59 years) (MAA) and older adults (ages ≥ 60 years) (OA) residing in Brazil.

Methods

The sample for this cross-sectional study was based on the Brazilian National Health Survey conducted in 2013. The Personal Health Questionnaire depression scale (PHQ-8) was applied to measure current (past 2 weeks) depression as the outcome of interest, and the exposure was self-reported PA for leisure. Multivariable weighted logistic regression models were conducted to investigate the association between PA and depression while adjusting for socio-demographic characteristics and number of health comorbidities among YA, MAA and OA.

Results

The final study sample size was 59,399 (33,480 females; 25,919 males). After adjusting for the covariates of interest, the lack of PA for leisure was associated with a significant increase in depression only among males (YA: OR 1.45, 95% CI 1.02–2.06; MAA: OR 2.38, 95% CI 1.40–4.03; OA: OR 5.35, 95% CI 2.14–13.37). There was no significant association between PA for leisure and depression among females of all age groups.

Conclusions

Although PA for leisure is not associated with depression among Brazilian females, the obtained results suggest that this association is significant among Brazilian males, who may be able to benefit from PA for leisure to reduce their symptoms of depression.

     

The relationship between cognitive ability and depression: a longitudinal data analysis

Purpose

There is literature indicating cognitive ability and depression are related, but few studies have examined the direction of the relationship. This study examined the relationship between depression levels and cognitive abilities from adolescence to early adulthood.

Methods

Using the National Longitudinal Study of Adolescent Health (n = 14,322), this study used path modeling to investigate the relationship between depression and cognitive ability at baseline and again 8 years later.

Results

After controlling for initial levels of depression, cognitive ability, and other covariates, depressive symptoms in adolescence are related to cognitive ability in early adulthood, but adolescent cognitive ability is not related to adult depression levels. Moreover, after controlling for adolescent levels of depression and cognitive ability, the cognitive ability–depression relationship disappears in adulthood.

Conclusions

The cognitive ability–depression relationship appears early in life, and it is likely that the presence of depressive symptoms leads to lower cognitive ability. Thus, intervening at early signs of depression not only can help alleviate depression, but will likely have an effect of cognitive ability as well.     

Bouncing back: remission from depression in a 12-year panel study of a representative Canadian community sample

Purpose

This study sought to investigate time to remission from depression in a community-based sample of adults followed for 12 years.

Methods

Data were derived from the National Population Health Survey (1994/5–2006/7 and 1996/7–2008/9). Fully 1,128 adults were included who were depressed at baseline according to DSM-III/CIDI-SF criteria. Kaplan–Meier and Cox proportional hazards procedures were used to determine time to remission and the demographic (e.g., gender and marital status), psychosocial (e.g., social support and adverse childhood experience) and health-related (e.g., pain, health conditions and alcohol use) factors with which it is associated.

Results

More than three quarters of the sample (77 %) no longer screened positive for depression at 2 years, and nearly the entire sample (94 %) had remitted by 12 years. Adverse childhood experiences (i.e., childhood abuse and parental additions), lack of social support, the presence of pain and health conditions (i.e., migraines, arthritis and back pain) each predicted more time to remission. The only factor associated with time to remission in the multivariate analysis was a history of childhood physical abuse.

Conclusions

Most community members with depression get better after 2 years and nearly all will have remitted, at least once, by 12 years. The results of this study may help guide the development of interventions for chronic depression that focus on early prevention of childhood abuse.     

Personality disorders are important risk factors for disability pensioning

Purpose

To determine whether personality disorders (PDs) are associated with increased risk of disability pensioning in young adults, independent of other common mental disorders.

Methods

2,770 young adults from the general population were assessed for PDs by the Structured Interview for DSM-IV Personality, and for common mental disorders by the Composite of International Diagnostic Interview. These data were linked to the Norwegian National Insurance Administration’s recordings of disability benefits for a 10-year period. Logistic regression analyses were applied to investigate the association between PDs and disability pensioning. The analyses were conducted for three types of PD measures: categorical diagnoses (any PD), dimensional scores of individual PDs and higher order components retrieved by principal component analyses.

Results

Having any PD was strongly associated with disability pensioning, regardless of disability diagnosis. The estimated odds ratio (OR) was substantially higher for PDs [OR 4.69 (95 % confidence interval (CI) 2.6–8.5)] than for mood disorders [OR 1.3 (CI 0.7–2.3)] and anxiety disorders [OR 2.3 (CI 1.3–4.3)]. Measured dimensionally, all PD traits except antisocial traits were significantly associated with disability pensioning. After adjusting for co-occurring traits of other PDs, only schizoid, dependent and borderline PD traits showed a significant positive association with disability pension, while antisocial traits showed a significant negative association. The principal component analyses showed that negative affectivity, psychoticism, and detachment was associated with an increased risk of disability pensioning, while antagonism/disinhibition and obsessivity were not.

Conclusions

PDs are strongly associated with disability pensioning in young adults, and might be more important predictors of work disability than anxiety and depressive disorders. Certain aspects of pathologic personalities are particularly important predictors of disability.     

Traumatic event exposure and depression severity over time: results from a prospective cohort study in an urban area

Purpose

A substantial proportion of adults experience traumatic events each year, yet little is known about the effects of different types of traumatic events on depression severity over time. We prospectively assessed the effects of traumatic event exposure during a 1-year period on changes in depression severity during that period among a representative sample of adults living in Detroit, Michigan in the United States.

Methods

We used data from 1,054 participants in the first two waves of the Detroit Neighborhood Health Study (2008–2010). Depression severity was measured with the Patient Health Questionnaire-9 (PHQ-9). Negative binomial regression was used to estimate the effect of traumatic event exposure on depression severity at Wave 2, adjusting for Wave 1 PHQ-9 score and potential confounders.

Results

The mean depression severity score at Wave 2 among those exposed to at least one traumatic event during follow-up was 1.71 times higher than among those with no traumatic event exposure [95 % confidence interval (CI) 1.27–2.29]. Also positively associated with depression severity at Wave 2 (vs. no traumatic events) were assaultive violence (mean ratio 2.49, 95 % CI 1.41–4.38), injuries and other directly experienced shocking events (mean ratio 2.59, 95 % CI 1.62–3.82), and three or more traumatic events (mean ratio 2.58, 95 % CI 1.62–4.09).

Conclusions

Violence, injuries, and other directly experienced traumatic events increase depression severity and may be useful targets for interventions to alleviate the burden of depression in urban areas.     

Who Benefits from Diabetes Self-Management Interventions? The Influence of Depression in the Latinos en Control Trial

Background

Depressive symptoms are common among adults with diabetes. Depression and social support may influence diabetes self-management.

Purpose

This study aimed to examine change in depressive symptoms and the role of depression and support on clinical and dietary outcomes among Latinos with type 2 diabetes participating in a diabetes self-management intervention.

Methods

Participants (N?=?252) were randomized to the intervention or usual care. Mixed effects models were used to examine interaction effects between intervention status and depressive symptoms (Centers for Epidemiologic Studies Depression (CES-D) score) and support for diabetes self-management behaviors at baseline. Outcomes were measured at baseline and 4 and 12 months and included dietary quality, physical activity, depressive symptoms, and hemoglobin A1c levels.

Results

Intervention participants had lower CES-D scores at follow-up than control participants. An interaction effect between intervention status and CES-D scores predicted diet quality.

Conclusion

Latinos with depressive symptoms may derive the greatest benefits from diabetes self-management interventions. Additional research on support during diabetes self-management interventions is warranted.     

Social support and physical activity as moderators of life stress in predicting baseline depression and change in depression over time in the Women’s Health Initiative

Purpose

To determine whether social support and/or physical activity buffer the association between stressors and increasing risk of depression symptoms at baseline and at 3-year follow-up.

Methods

This is a secondary analysis of data from the Women’s Health Initiative Observational Study. 91,912 community-dwelling post-menopausal women participated in this prospective cohort study. Depression symptoms were measured at baseline and 3 years later; social support, physical activity, and stressors were measured at baseline.

Results

Stressors at baseline, including verbal abuse, physical abuse, caregiving, social strain, negative life events, financial stress, low income, acute pain, and a greater number of chronic medical conditions, were all associated with higher levels of depression symptoms at baseline and new onset elevated symptoms at 3-year follow-up. Social support and physical activity were associated with lower levels of depressive symptoms. Contrary to expectation, more social support at baseline strengthened the association between concurrent depression and physical abuse, social strain, caregiving, and low income. Similarly, more social support at baseline increased the association between financial stress, income, and pain on new onset depression 3 years later. Physical activity similarly moderated the effect of caregiving, income, and pain on depression symptoms at baseline.

Conclusion

Stressors, social support, and physical activity showed predicted main effect associations with depression. Multiplicative interactions were small in magnitude and in the opposite direction of what was expected.     

Parental socio-economic position during childhood as a determinant of self-harm in adolescence

Purpose

Socio-economic position (SEP) during childhood and parental social mobility have been associated with subsequent health outcomes in adolescence and adulthood. This study investigates whether parental SEP during childhood is associated with subsequent self-harm in adolescence.

Methods

This study uses data from a prospective birth-cohort study (the Avon Longitudinal Study of Parents and Children) which followed 14,610 births in 1991–1992 to age 16–18 years (n = 4,810). The association of parental SEP recorded pre-birth and throughout childhood with self-harm was investigated using logistic regression models, with analyses conducted separately for those reporting self-harm (a) with and (b) without suicidal intent. The impact of missing data was investigated using multiple imputation methods.

Results

Lower parental SEP was associated with increased risk of offspring self-harm with suicidal intent, with less consistent associations evident for self-harm without suicidal intent. Associations were somewhat stronger in relation to measures of SEP in later childhood. Depressive symptoms appeared to partially mediate the associations. Adolescents of parents reporting consistently low income levels during childhood were approximately 1.5 times more likely to engage in SH than those never to report low income.

Conclusions

Lower SEP during childhood is associated with the subsequent risk of self-harm with suicidal intent in adolescence. This association is stronger in those experiencing consistently lower SEP.     

Childhood Socioeconomic Position and Blood Pressure Dipping in Early Adulthood: a Longitudinal Study

Background

The experience of low socioeconomic position in childhood may increase risk for adult cardiovascular disease above and beyond the effects of current socioeconomic position. One limitation of most previous research is that childhood socioeconomic position was assessed retrospectively.

Methods

Measures of ambulatory blood pressure, heart rate, and heart rate variability were obtained from 110 young men (22 years) who were enrolled in a long-term study of child development at age 6.

Results

Men who had lower childhood socioeconomic position had smaller decreases in systolic blood pressure (SBP) during sleep independent of current education, daytime SBP, and body mass index (BMI). They also displayed smaller decreases in low-frequency heart rate variability during sleep. Twenty-four-hour SBP was negatively associated with childhood socioeconomic position independent of current education and BMI.

Conclusions

While the mechanisms are unclear, childhood socioeconomic position may influence blood pressure in early adulthood independent of current life circumstances.     

Levetiracetam Versus Phenytoin: A Comparison of Efficacy of Seizure Prophylaxis and Adverse Event Risk Following Acute or Subacute Subdural Hematoma Diagnosis

Background

Although both levetiracetam and phenytoin are used for seizure prophylaxis in subdural hematomas (SDHs), there is little data on their comparative efficacies. We compared the efficacy and risk of using levetiracetam versus phenytoin for seizure prophylaxis following acute or subacute SDH diagnosis.

Methods

In this retrospective cohort study, the clinical data registry at a tertiary care hospital was searched for all cases of acute or subacute SDHs that were admitted to hospital in 2002, 2003, or 2011. Risk of clinical and/or electrographic seizures, and risk of adverse drug events were compared between the two exposure arms.

Results

124 subjects in the phenytoin arm and 164 subjects in the levetiracetam arm were included. There was no significant difference in clinical and/or electrographic seizure risk, though there was a decreased risk of adverse events in the levetiracetam arm (p < 0.001). In subjects with midline shift >0 mm, levetiracetam was associated with an increased risk of electrographic seizures during hospitalization (p = 0.028) and a decreased risk of adverse drug effects (p = 0.001), compared with phenytoin use.

Conclusions

Levetiracetam generally appears to have a similar efficacy to phenytoin in preventing clinical and/or electrographic seizures following acute/subacute SDH diagnosis, though patients with midline shift >0 mm may have associated with a higher risk of electrographic seizures on levetiracetam compared with patients on phenytoin. Levetiracetam is associated with a lower risk of adverse drug effects. A prospective, randomized study would more definitively determine any difference in efficacy and risk between phenytoin and levetiracetam.     

Stressful childhood experiences and health outcomes in sexual minority populations: a systematic review

Purpose

Stressful childhood experiences (SCE) are associated with many different health outcomes, such as psychiatric symptoms, physical illnesses, alcohol and drug abuse, and victimization experiences. Lesbian, gay, bisexual, and transgender (LGBT) people are at risk to be victims of SCE and show higher prevalence of SCE when compared with heterosexual controls.

Methods

This review analyzed systematically 73 articles that addressed different types of SCE in sexual minority populations and included items of household dysfunction. The samples included adults who identified either their sexual orientation as non-heterosexual or their gender identity as transgender.

Results

The studies reported childhood sexual abuse (CSA), childhood physical abuse (CPA), childhood emotional abuse (CEA), childhood physical neglect, and childhood emotional neglect. Items of household dysfunction were substance abuse of caregiver, parental separation, family history of mental illness, incarceration of caregiver, and witnessing violence. Prevalence of CSA showed a median of 33.5 % for studies using non-probability sampling and 20.7 % for those with probability sampling, the rates for CPA were 23.5 % (non-probability sampling) and 28.7 % (probability sampling). For CEA, the rates were 48.5 %, non-probability sampling, and 47.5 %, probability sampling. Outcomes related to SCE in LGBT populations included psychiatric symptoms, substance abuse, revictimization, dysfunctional behavioral adjustments, and others.

Conclusions

LGBT populations showed high prevalence of SCE. Outcomes related to SCE ranged from psychiatric symptoms and disorders to physical ailments. Most studies were based in the USA. Future research should aim to target culturally different LGBT population in the rest of the world.     

Configurations of early risk and their association with academic,cognitive, emotional and behavioural outcomes in middle childhood

Purpose

Risk factors for children’s development are multifarious and co-occur, having cumulative as well as individual impacts. Yet common configurations of early childhood risks remain little understood. The current study aimed to identify patterns of early risk exposure and to examine their relationship with diverse outcomes in middle childhood.

Methods

Using latent class analysis in a large, community-based, UK sample (N = 13,699), we examined 13 putative risk factors to identify patterns of exposure.

Results

Four risk configurations were identified: low (65 %), socio-demographic (14 %), family dysfunction (12 %), and multiple (9 %) risk classes. As expected, children in the low risk group fared best on all outcome measures, and those with multiple risk, worst. Importantly, specificity in associations with outcomes emerged, such that cognitive outcomes were predominantly linked with socio-demographic adversities, emotional difficulties with family dysfunction, and conduct problems increased across risk classes.

Conclusions

Better understanding of configurations of childhood risk exposures may help to target resources for children in need.     

Resilience, lifestyle and symptoms of anxiety and depression in adolescence: the Young-HUNT study

Purpose

This study investigated the symptoms of anxiety and depression in adolescence, their associations with lifestyle and resilience and the possibility that resilience factors can attenuate the associations between unhealthy lifestyle and symptoms of anxiety and depression.

Methods

Adolescents (n = 7,639) aged 13–18 years completed a questionnaire regarding lifestyle and health. Symptoms of anxiety and depression were measured by the SCL-5, a five-item shortened version of the Hopkins Symptom Checklist. Resilience factors included questions on friends and family relations and two sub-scales of the Resilience Scale for Adolescents; Family cohesion and Social competence.

Results

Of the total population, 13 % reported symptoms of anxiety and depression. Resilience characteristics were associated with lower symptom levels (ORs ranging from 0.2 to 0.6), and substance use and infrequent physical activity with higher symptom levels (ORs ranging from 2.1 to 4.0). The associations with substance use were strengthened by social competence, but attenuated by family cohesion. The association with physical activity was attenuated by both social competence and family cohesion.

Conclusion

Symptoms of anxiety and depression were frequent in adolescents and were associated with unhealthy lifestyle factors as substance use and low physical activity. Resilience characteristics seemed to protect against symptoms and markedly influenced the associations between lifestyle factors and symptoms of anxiety and depression. The importance of family and other supportive relationships should be emphasized in treatment and prevention of anxiety and depression in adolescence.