Correlates of depression in a representative nationwide sample of adolescents (15-19 years) and young adults (20-24 years)

BACKGROUND: The authors investigated correlates of depression in a general population sample of adolescents (15-19 years) and young adults (20-24 years). METHODS: As part of the Finnish Health Care Survey a random sample of 509 adolescents (281 females, 228 males) and 433 young adults (224 females, 209 males) was interviewed in 1996. DSM-IIR major depressive episode (MDE) was assessed by the University of Michigan Composite International Diagnostic Interview Short Form (UM-CIDI SF). RESULTS: In multivariable regression analysis, current smoking (odds ratio (OR) 5.54; 95% confidence interval (CI) 1.44, 21.3) and chronic illness (OR 3.77; 95% CI: 1.04, 13.7) associated with MDE among adolescents. Among young adults, drunkenness at least twice a month (OR 4.48; 95% CI: 1.44, 14.0) or once a month (OR 2.79; 95% CI: 1.14, 6.83), not being married nor cohabiting (OR 3.50; 95% CI: 1.35, 9.08) and infrequent physical exercise (OR 4.01; 95% CI: 1.18, 14.0) were related to MDE. Female MDE associated with not being married nor cohabiting (OR 3.56; 95% CI: 1.23, 10.1) and living in southern Finland (OR 2.30; 95% CI: 1.06, 5.02). Drunkenness at least twice a month was related to MDE among males (OR 4.54; 95% CI: 1.27, 16.3). CONCLUSIONS: Attention should be paid to compromised health and health-related behaviour associating with MDE in youth. Specifically, the association between smoking and major depression in early adolescence should be borne in mind, and drinking habits or frequency of drunkenness should be carefully noted.     

Factors associated with self-rated health in Greece: a population-based postal survey

BACKGROUND: Self-rated health (SRH), as an indicator of population health, is a concept useful both for research and planning. This study reports SRH, and factors related to it, in Greece. METHODS: Population-based postal survey, using World Health Organisation (WHO) questionnaires with a sample of randomly selected geographically stratified individuals. Response rate reached 41%. RESULTS: As expected, age, income and education were related to SRH, but accounted for only 20% of the variance. CONCLUSIONS: SRH in Greece is related to sociodemographic factors, but perhaps not as strongly as in other populations. Other explanatory variables will require further research.     

Socioeconomic status, psychosocial health and health behaviours among Hungarian adolescents

BACKGROUND: While socioeconomic differences in health, morbidity, and disability are highest among middle-aged persons, there is a certain level of 'equalization' during adolescence and young adulthood. Despite this equalization, however, there still are differences in psychosocial variables or health-related behaviours, often very subtle and sometimes difficult to measure. METHODS: Using data (n = 1114) on high school students (aged between 14 and 21 years) from the Southern Plain Region, Hungary, the present study looks at the role of multiple SES indicators (objective and subjective; occupation and education; family structure) in adolescents' psychosocial health (self-perceived health, psychosomatic, and depressive symptomatology) and health behaviour (substance use and sports activity). RESULTS: Based on the results of multivariate logistic regression analyses, findings suggest the following: (i) SES self-assessment proved to be a significant predictor of adolescents' psychosocial health and health behaviours; (ii) family structure (that is, living in a non-intact family) also significantly influenced adolescents' psychosocial health and health behaviours; (iii) parents' employment status and schooling had a limited influence on their children's health outcomes; (iv) in a word, SES gradients in adolescents' psychosocial health and health behaviour were inconsistent and sometimes irregular (that is, inverse). The subjective SES measurement plays an important role (positive association), whereas certain types of parents' inactive status (in terms of labour market, that is, unemployment or retirement) seem to act in a predictable way (negative association). CONCLUSIONS: Our results indicate that despite certain level of equalization during adolescence, some important relationships between SES variables and health outcomes may occur.     

Household income and health status in children and adolescents in Britain

BACKGROUND: Mortality, health, and well-being across the lifespan are associated with socioeconomic position (typically operationalised as occupational status). There is some evidence that adolescence represents a period of 'relative equalisation' of health inequalities. Our aim was to examine the association between inequalities in household income and health in childhood and adolescence. METHODS: Cross-sectional survey using multistage stratified random sample of households in Britain. Information was collected on 10438 children aged 5-15 years. RESULTS: Low levels of equivalised household income was associated with poorer health for 13 out of the 22 indicators examined (odds ratio P < 0.05 for > or =1 income quintile). Multivariate analyses controlling for child characteristics, parental socioeconomic status and household composition indicated that low levels of equivalised household income increased the odds of poor health for 9 out of the 22 indicators examined. There was little evidence of any systematic differences in the extent of health inequalities across age groups (5-10 and 11-15 years). CONCLUSION: Household income is related to a range of health outcomes for children and adolescents, even when other indicators of socioeconomic status are taken into account. We found little evidence that adolescence represents a period of relative equalisation of health inequalities.     

Social reproduction of physical activity: Implications for health promotion in young people

Using a health promotion perspective, nationwide surveys onhealth behaviours and life-styles were carried out in 11 countriesin 1985–1986. The surveys were part of the study 'HealthBehaviour in School-aged Children (HBSC), a World Health Organizationcross-national survey'. The analyses of these survey data from13 and 15 year olds in Austria, Norway and Wales indicated thathigh levels of participation in physical activity by adolescentsare associated with the physical activity levels of their parentsand best friends, finding it easy to make new friends and likingschool. Intervention aimed at increasing the number of adolescentswho adopt and maintain participation in leisure-time physicalactivities is likely to be more successful if a greater numberof strategies in several different settings are applied. Thefindings are explained as being a result of the social reproductionprocess and it is suggested that awareness about how this processaffects the development of health behaviour and life-stylesis vital in establishing realistic goals when planning and evaluatingyouth health promotion efforts.     

Effects of physical exercise on depression, neuroendocrine stress hormones and physiological fitness in adolescent females with depressive symptoms

BACKGROUND: Regular physical exercise may improve a variety of physiological and psychological factors in depressive persons. However, there is little experimental evidence to support this assumption for adolescent populations. We conducted a randomized controlled trial to investigate the effect of physical exercise on depressive state, the excretions of stress hormones and physiological fitness variables in adolescent females with depressive symptoms. METHODS: Forty-nine female volunteers (aged 18-20 years; mean 18.8 +/- 0.7 years) with mild-to-moderate depressive symptoms, as measured by the Centre for Epidemiologic Studies Depression (CES-D) scale, were randomly assigned to either an exercise regimen or usual daily activities for 8 weeks. The subjects were then crossed over to the alternate regimen for an additional 8-week period. The exercise program consisted of five 50-min sessions per week of a group jogging training at a mild intensity. The variables measured were CES-D rating scale, urinary cortisol and epinephrine levels, and cardiorespiratory factors at rest and during exercise endurance test. RESULTS: After the sessions of exercise the CES-D total depressive score showed a significant decrease, whereas no effect was observed after the period of usual daily activities (ANOVA). Twenty-four hour excretions of cortisol and epinephrine in urine were reduced due to the exercise regimen. The training group had a significantly reduced resting heart rate and increased peak oxygen uptake and lung capacity. CONCLUSIONS: The findings of this study suggest that a group jogging exercise may be effective in improving depressive state, hormonal response to stress and physiological fitness of adolescent females with depressive symptoms.     

Frequency of common psychosomatic symptoms and its influence on self-perceived health in a Hungarian student population

The objectives of this investigation were to describe the frequencyof some common psychosomatic symptoms and variations in self-assessedhealth status and to determine whether there are gender differencesin these symptoms and the perception of one's own health ina student population. Finally, we examined the relationshipbetween the frequency of symptoms and self-perceived health.The design is a cross-sectional survey, as the first phase ofa longitudinal cohort study. The participants in the study (n=691)were students of the medical faculty of Albert Szent-GyörgyiMedical University, Szeged, Hungary, aged 18–31 yearsconsisting of 39.4% men and 60.6% women. The response rate was70.5%. Data were collected by using a self-administered questionnairecontaining various items designed to measure self-perceivedhealth and health-related variables including some common psychosomaticsymptoms. The following symptoms appeared the most frequentamong students in both sexes: sleeping problems, chronic fatigueand backache. Using the appropriate t-test, mean scores of thesymptom indices by sex showed an excess of occurrence amongfemale students in particular of 2 symptoms: tension headacheand chronic fatigue. Most students evaluated their own healthas good. Students who scored lower on self-perceived healthhad experienced more symptoms. Based on these results we canconclude that the frequency of the symptoms under study hasan influence on self-perceived health. A follow-up of the surveypopulation seems to be necessary.     

Adolescents' physical activity habits – results from a national health survey

Background The MABAT Youth National Health and Nutrition Survey was conducted in Israel by the Ministry of Health and the Center for Disease Control. This article presents results of physical activity (PA) habits in Israel, in relation to recommendations by world health organizations. Methods Participants were 6274 adolescents, grades 7–12, enrolled in a cross‐sectional, representative, school‐based survey. Sufficient level of PA was defined as any moderate and vigorous level of PA that adds up daily to 60 min/day. Light PA was considered to be an insufficient level of PA. Results Only 10.5% of the participants reported performing sufficient PA. Large gender differences were found, with 17.7% of boys versus only 4.6% of girls meeting the guidelines. Conclusions Results highlight the need to develop programmes for school children in Israel to promote PA. Such programmes have been initiated in many countries that have a large percentage of adolescents with a sedentary lifestyle.     

Influence of social support on health among gender and socio-economic groups of adolescents

BACKGROUND: The influence of social support on health was explored among gender and socio-economic groups with the aim of contributing to the explanation of socio-economic health differences among Slovak adolescents. METHODS: The sample consisted of 2616 Slovak adolescents (52.4% male, 47.6% female, mean age 15 years). The data were assessed by a self-reported questionnaire including measures of social support, socio-economic status and health. RESULTS: There are significant gender differences in social support, which are unfavourable for males. On the other hand, there are significant gender differences in health, unfavourable for females. Low social support is significantly related to worse health. There are significant socio-economic differences in both health and social support, which are unfavourable for lower socio-economic groups. Three groups, females, adolescents from lower socio-economic groups, and also adolescents reporting low social support, less frequently consider their health as excellent or very good. Females suffer from more health complaints, report worse psychological health, vitality and mental health in comparison to males, to adolescents from higher socio-economic groups, and to adolescents reporting high social support. Males and adolescents from lower socio-economic groups more frequently reported low social support in comparison to females and adolescents from higher socio-economic groups. No significant differences in the influence of social support on health among gender and socio-economic groups of adolescents were confirmed. CONCLUSION: Social support is related to health and it is unequally distributed among gender and socio-economic groups. Social support had a positive impact on health, but this effect was independent of gender and socio-economic groups.     

Child public health: A new basis for child health workers

To treat and alleviate diseases in children is an importanttask that demands extensive knowledge, skills and training.It forms the basis of our understanding of sick children andtheir needs, and its quality is a measure of the efforts ofsociety to care for its citizens. With the health of children,however, a much broader view must be taken, including otheraspects of children's well-being than their diseases and theirmedical care. To reach the goals set by international organizationsand national governments for the populations' health, policiesbased on public health ideas and functions must be vigorouslypursued. Although these actions are valid for the whole population,there are major reasons why children should be seen as particularlyimportant. Merging the broad aspects of health and public healthfunctions with children's special needs creates child publichealth, which aims to place the health of children and adolescentsin its full social, economic and political context. It is nota new speciality; rather it is a counterbalance towards thefullness of health. Its activities - in teaching, research andservice - should be practical and relevant and include knowledgeand experience from many professions and sciences. With sucha broad competence, child public health is fit to take on awide range of child health issues, be it healthy public policyfor children and adolescents, support for vulnerable groups,education and training or creating centres of relevance forresearch and surveillance of children's and adolescents' health.     

Trends in vigorous physical activity and TV watching of adolescents from 1986 to 2002 in seven European Countries

BACKGROUND: The aim is to study trends in physical activity and TV viewing in seven European countries in the period 1985-2002. METHODS: The data are collected through questionnaires in the survey 'Health Behaviour in School-aged Children. A WHO Cross-national study', using nationally representative samples of 11-, 13-, and 15-year-olds. Between 1985/86 and 2001/02, a standard set of items was used to measure vigorous physical activity and TV watching in the study. Austria, Finland, Hungary, Norway, Scotland, Sweden, and Wales used these measures in all surveys. RESULTS: Between 1985/86 and 2001/02, there was a slight increase in Finland in the proportions reporting vigorous physical activity 4 or more times a week, whereas as pattern of stability was observed for the other countries. Across all surveys and countries boys were more likely to report regular vigorous physical activity than girls. No clear pattern emerges when examining trends over time in TV watching. Boys reported spending more time watching TV than girls in all countries. The correlation between the two behaviours at the 1986 and 1998 measurement points was non-significant. CONCLUSION: The finding that boys were more likely to report regular vigorous physical activity and TV watching confirms results of previous studies. The present study of seven European countries generally indicates stability or a small increase in physical activity of boys and girls aged 11-15 from the mid-1980s to the early 2000s.     

Aspects of alienation and symptom load among adolescents

Background: The purpose was to examine the association betweenaspects of alienation and symptom load among adolescents. Furthermorean integrated purpose was to construct and validate an indexof alienation. Methods: Cross-sectional data from 5205 schoolchildren aged 11–15 years from a random sample of schoolsin Denmark were used. Data stems from the Danish contributionto the cross-national study Health and Behaviour in School-agedChildren (HBSC). Alienation was measured with a new index fulfillingfour criteria: (i) theoretical foundation, (ii) inter-correlationbetween items, (iii) correlation between each of the index'sitems and the outcomes and (iv) no differential item functioning.The final index included three indicators of alienation: helplessness,feeling left out of things and lack of confidentiality withparents. Symptom load was measured by HBSC Symptom Checklistand divided into physical and psychological symptoms respectively.High symptom load was defined as experiencing at least one symptomon a daily basis. Results: The odds-ratio (OR) for high symptomload increased with the degree of alienation. For students withall three indicators of alienation, the OR for high physicalsymptom load was 2.49 (1.05–5.87). The OR for high psychologicalsymptom load for the corresponding degree of alienation was6.50 (3.11–13.56). Conclusion: The index of alienationfulfilled psychometric criteria for scalability. Furthermorethe analyses showed a graded and significant association betweenalienation and high symptom load. This suggests alienation tobe taken into account in future health interventions among adolescents.In school settings this may be done using principles of empowerment.     

Fertility in Norwegian women: results from a population-based health survey

AIMS: Reproductive behaviour has changed during the most recent decades, with increased infertility and subfertility. This study evaluated fertility, estimated the prevalence of fertility problems, and assessed possible predictors for impaired fertility. METHODS: Eligible subjects were 9,983 menopausal women participating in two health surveys. Data were collected by comprehensive questionnaires. RESULTS: Of all women 89.3% were fertile, 4.8% were subfertile, 4.1% were voluntarily childless, and 1.8% were involuntaruly childless. Impaired fertility was associated with a higher level of education and excessive alcohol intake. There were significant differences in subfertility among the parous women, with increased subfertility with decreasing age. Among the nullipara, involuntary childlessness was more prevalent in the youngest age group, while voluntary childlessness increased with advancing age. CONCLUSIONS: Fertility problems were quite common, and have increased in younger age groups, though seemingly fewer women remained childless past their reproductive age in the youngest age group.     

Physical and mental health shortly after a disaster: first results from the Enschede firework disaster study

OBJECTIVES: Two to three weeks after the explosion of a fireworks storage facility in a residential area (May 2000, Enschede, The Netherlands) we assessed the self-reported physical and mental health among those affected by the disaster. METHODS: A questionnaire survey was conducted among 3792 residents, passers-by, and rescue workers, who were involved in and/or affected by the disaster and were > or =18 years of age. RESULTS: At least 30% of those affected by the disaster reported serious physical and mental health problems 2-3 weeks after the explosion. Compared with reference values in the general Dutch population, high scores were found for somatic symptoms, sleeping problems, and restrictions in daily functioning due to physical and mental problems, such as anxiety, depression, and feelings of insufficiency. The strength of these differences varied between groups, based on the level of involvement and the level of being affected. CONCLUSIONS: Results indicate that the fireworks disaster had a substantial impact on the health of those affected by the disaster. The health impact was most pronounced for residents and passers-by and also for rescue workers living in the affected area, but to a lesser degree. Physical and mental health problems were strongly associated with the shocking experiences during and shortly after the disaster.     

Medical consumption of respondents and non-respondents to a mailed health survey

Non-response bias can distort the results of health surveys.The occurrence of selective non-response can be assessed whendata are available for both respondents and non-respondents.The objective of this study was to compare the medical consumptionof respondents and non-respondents to a mailed health survey.A mailed health survey was conducted among approximately 13,500adults and among parents of approximately 1,500 children aged5–15 years. The net response rate was 70.4%. A panel dataset that could be matched with the health survey data was availablefor all eligible persons. This data set comprises administrativeinformation on hospitalizations, annual health care expendituresand demographic variables. The results of this study show thatresponse was associated with age, sex, degree of urbanizationand type of insurance. After correcting for differences in demographicvariables, respondents and non-respondents differ in the utilizationof several types of care. Relatively more users than non-usersresponded. Response was not associated with the utilizationof care related to severe conditions such as in-patient hospitalcare. The conclusion from this study is that when a mailed healthsurvey is used to measure medical consumption, the non-responsebias will result in a small overestimation of utilization.     

Views of treatment decision making from adolescents with chronic illnesses and their parents: a pilot study

Objective Shared decision making may increase satisfaction with health care and improve outcomes, but little is known about adolescents’ decision‐making preferences. The primary purpose of this study is to describe the decision‐making preferences of adolescents with chronic illnesses and their parents, and the extent to which they agree. Design Survey. Setting and participants Participants were 82 adolescents seen at one of four paediatric chronic illness subspecialty clinics and 62 of their parents. Main variables Predictor variables include sociodemographics, health parameters, risk behaviour, and physical and cognitive development. The main outcome variable is preferences for decision‐making style. Results and conclusions When collapsed into three response categories, nearly equal percentages of adolescents (37%) and parents (36%) preferred shared decision making. Overall, the largest proportion of adolescents (46%) and parents (53%) preferred passive decision making compared to active or shared decision making. Across five response choices, 33% of pairs agreed. Agreement was slight and not significant. Improved general health perceptions (OR = 0.76, 95% CI = 0.59–0.99) and improved behaviour (OR = 0.75, 95% CI = 0.56–0.99) were significantly associated with parents’ preferences for less active decision making. Older age was significantly associated with agreement (OR 1.58, 95% CI = 1.09–2.30) between parents and adolescents. The paucity of significant predictor variables may indicate physicians need to inquire directly about patient and parent preferences.     

Major depressive episodes and work stress: results from a national population survey

Objectives. We determined the proportion of workers meeting criteria for major depressive episodes in the past year and examined the association between psychosocial work-stress variables and these episodes.Methods. Data were derived from the Canadian Community Health Survey 1.2, a population-based survey of 24324 employed, community-dwelling individuals conducted in 2002. We assessed depressive episodes using the Composite International Diagnostic Interview.Results. Of the original sample, 4.6% (weighted n=745948) met criteria for major depressive episodes. High job strain was significantly associated with depression among men (odds ratio [OR]=2.38; 95% confidence interval [CI]=1.29, 4.37), and lack of social support at work was significantly associated with depression in both genders (men, OR=2.70; 95% CI=1.55, 4.71; women, OR=2.37; 95% CI=1.71, 3.29). Women with low levels of decision authority were more likely to have depression (OR=1.59; 95% CI=1.06, 2.39) than were women with high levels of authority.Conclusions. A significant proportion of the workforce experienced major depressive episodes in the year preceding our study. Gender differences appear to affect work-stress factors that increase risk for depression. Prevention strategies need to be developed with employers and employee organizations to address work organization and to increase social support.Depression is the leading cause of disability and is projected to become the second leading cause of the global burden of disease by 2020.1 Lifetime and 12-month (having had an episode in the past year) prevalence rates of major depressive disorder are estimated at 12.8%2 to 16.6%3 (16.5% of women, 8.9% of men2) and 3.9%2 to 6.7%4 (5.0% of women, 2.6% of men2), respectively. A substantial proportion of those affected by this disorder are of working age, but little is known about its prevalence or risk factors within the general working population. One of the few epidemiological studies conducted on the subject reported that 15.7% of employed individuals (19.5% of women, 11.4% of men) met lifetime criteria for major depressive disorder and that 8.6% (10.2% of women, 5.9% of men) met 12-month criteria.5Changes in workplace structure over the past 30 years may have contributed to increased stress and psychiatric morbidity.6 Aging of the population, coupled with a shortage of younger workers in some sectors, has also resulted in many people remaining in the workforce beyond usual retirement age. Depression at work reduces employees’ productivity,7 increases disability and depression-related absence, and may lead to premature early retirement.8 The prevalence and associated costs of depression necessitate an increased understanding of work-related factors that may contribute to this condition.Previous studies had 2 common methodological limitations that our study addressed. First, most studies have focused on distinct occupational groups9^,10 rather than on the general population.5^,11 Second, most studies have relied on self-report questionnaires to measure depressive symptoms rather than on standardized diagnostic interviews. We determined the proportion of employed individuals who met the 12-month criteria for a major depressive episode as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV )12 and examined the relationship between psychosocial work characteristics and 12-month major depressive episodes. We hypothesized that individuals experiencing increased job strain (higher job demands and lower decision latitude) would be at higher risk for 12-month major depressive episodes.     

Determinants of levels and changes of physical functioning in chronically ill persons: results from the GLOBE Study

STUDY OBJECTIVE: Declines in physical functioning are a common result of chronic illness, but relatively little is known about factors not directly related to severity of disease that influence the occurrence of disability among chronically ill persons. The aim of this study was to assess the effect of a large number of potential determinants (sociodemographic factors, health related behaviour, structural living conditions, and psychosocial factors). DESIGN: Longitudinal study of levels and changes of physical functioning among persons suffering from four chronic diseases (asthma/chronic obstructive pulmonary disease (COPD), heart disease, diabetes, chronic low back pain). In 1991, persons suffering from one or more of these diseases were identified in a general population survey. Self reported disabilities, using a subset of the OECD disability indicator, were measured six times between 1991 and 1997. These data were analysed using generalised estimating equations, relating determinants measured in 1991 to disability between 1991 and 1997, and controlling for a number of potential confounders (age, gender, year of measurement, and type and severity of chronic disease). SETTING: Region of Eindhoven (south eastern Netherlands). PARTICIPANTS: 1784 persons with asthma/COPD, heart disease, diabetes mellitus and/or low back pain. MAIN RESULTS: In a "repeated prevalence" model, statistically significant (p<0.05) and strong associations were found between most of the determinants and the prevalence of disabilities. In a "longitudinal change" model, statistically significant (p<0.05) predictors of unfavourable changes in physical functioning were low income and excessive alcohol consumption, while we also found indications for effects of marital status, degree of urbanisation, smoking, and external locus of control. CONCLUSIONS: Other factors than characteristics of the underlying disease have an important influence on levels and changes of physical functioning among chronically ill persons. Reduction of the prevalence of disabilities in the population not only depends on medical interventions, but may also require social interventions, health education, and psychological interventions among chronically ill persons.