Prevalence of and risk factors for depressive symptoms among young adolescents

OBJECTIVE: To determine the prevalence, risk factors, and risk behaviors associated with depressive symptoms in a nationally representative, cross-sectional sample of young adolescents. DESIGN: A school-based survey collected through self-administered questionnaires in grades 6, 8, and 10 in 1996. SETTING: Schools in the United States. PARTICIPANTS: 9863 students in grades 6, 8, and 10 (average ages, 11, 13, and 15). MAIN OUTCOME MEASURES: Depressive symptoms, substance use, somatic symptoms, scholastic behaviors, and involvement in bullying. RESULTS: Eighteen percent of youths reported symptoms of depression. A higher proportion of females (25%) reported depressive symptoms than males (10%). Prevalence of depressive symptoms increased by age for both males and females. Among American Indian youths, 29% reported depressive symptoms, as compared with 22% of Hispanic, 18% of white, 17% of Asian American, and 15% of African American youths. Youths who were frequently involved in bullying, either as perpetrators or as victims, were more than twice as likely to report depressive symptoms than those who were not involved in bullying. A significantly higher percentage of youths who reported using substances reported depressive symptoms as compared with other youths. Similarly, youths who reported experiencing somatic symptoms also reported significantly higher proportions of depressive symptoms than other youths. CONCLUSIONS: Depression is a substantial and largely unrecognized problem among young adolescents that warrants an increased need and opportunity for identification and intervention at the middle school level. Understanding differences in prevalence between males and females and among racial/ethnic groups may be important to the recognition and treatment of depression among youths.     

Features of sexually transmitted disease services important to African American adolescents.

OBJECTIVE: To determine the relative importance of various features of health clinics when African American adolescents consider seeking care for sexually transmitted diseases (STDs). DESIGN: Confidential interviewer-administered telephone survey. SETTING: A predominantly low-income, African American neighborhood in San Francisco, Calif. PARTICIPANTS: Random sample of African American adolescents aged 12 to 17 years; 302 (76.6%) of 394 identified eligible adolescents participated. MAIN OUTCOME MEASURES: Items and scales measuring adolescents' sense of the importance of the attributes of the provider (alpha = .58), availability of services (alpha = .61), and perceived confidentiality of health services from family (alpha = . 72) when deciding where to seek care for possible STDs. RESULTS: More than 90% (90.4%) of subjects rated items relating to provider attributes as being highly important when they consider where they would seek care for an STD; between 62.5% and 82.7% rated availability items as being highly important; and between 38.6% and 60.8% rated items pertaining to confidentiality as being highly important. Greater importance was placed on provider attributes and confidentiality by female than male adolescents. The importance placed on provider attributes and confidentiality increased as adolescents aged. CONCLUSIONS: Low-income, African American adolescents place great importance on provider attributes, less importance on availability, and even less importance on confidentiality when deciding where to seek health care for a possible STD. Health care providers and organizations need to be aware of these adolescent preferences to better promote screening and treatment of STDs in this population.     

Infrequent parental monitoring predicts sexually transmitted infections among low-income African American female adolescents

OBJECTIVE: To prospectively determine (using an 18-month follow-up period) the association between African American female adolescents' perceptions of parental monitoring and their acquisition of biologically confirmed infection with Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis. DESIGN: A prospective cohort study of 217 African American female adolescents enrolled in the control arm of a randomized trial of a human immunodeficiency virus prevention intervention program. SETTING AND PARTICIPANTS: A volunteer sample of adolescents (aged 14-18 years) recruited from low-income neighborhoods characterized by high rates of unemployment, substance abuse, violence, and sexually transmitted diseases. MAIN OUTCOME MEASURES: Adolescents provided 2 self-collected vaginal swab specimens. One was tested for C. trachomatis and N. gonorrhoeae DNA with ligase chain reaction. The other was used to inoculate culture medium for T. vaginalis. Identical assay procedures were repeated at the 6-month, 12-month, and 18-month follow-up intervals. RESULTS: Adjusted odds ratios indicated that adolescents who perceived infrequent parental monitoring at baseline were 1.8 (95% confidence interval, 1.01-3.21) and 2.4 (95% confidence interval, 1.22-4.87) times more likely to acquire chlamydia or trichomoniasis, respectively, compared with their counterparts who perceived greater levels of monitoring. Similarly, adolescents who perceived infrequent parental monitoring were 2.1 (95% confidence interval, 1.16-3.74) times more likely to test positive for a sexually transmitted infection during the course of the 18-month follow-up period. CONCLUSIONS: Adolescents' perceptions of their parental-monitoring levels predicted subsequent acquisition of biologically confirmed chlamydia and trichomoniasis infections. These findings suggest that expanded efforts leading toward effective clinic- and community-based sexually transmitted infection intervention programs involving parents may be warranted.     

The epidemiology of sexually transmitted infections in adolescents

This article addresses the epidemiology of several common sexually transmitted infections (STIs) in adolescents. Chlamydia is a common occurrence in adolescents, more so than is gonorrhea, but both are of particular concern because they may cause pelvic inflammatory disease. Many experts recommend screening for chlamydia in sexually active adolescents, particularly females. Trichomonas vaginalis is significant as a marker for risk of contracting other STIs and because of its association with pregnancy complications and with increased risk of transmission of HIV. Genital herpes simplex virus (HSV) infection, which usually has been caused by HSV-2, is a common finding in adolescents, and it now is caused also by HSV-1 in some populations. Human papillomavirus (HPV), though widespread in adolescents, usually is a self-limited infection, and malignancy resulting from HPV is a rare occurrence in this age group. The least common of the diseases discussed below is syphilis, but a recent sharp increase in incidence has occurred in men who have sex with men.     

Prevention and intervention of sexually transmitted diseases in adolescents.

Adolescents are the age group at greatest risk for acquiring sexually transmitted diseases. Sexually transmitted disease intervention programs based on behavioral change theories that emphasize self-efficacy and motivational enhancement may provide adolescents with skills to change risk behavior patterns. School-based sexually transmitted disease programs can reach the majority of the at-risk adolescent population. Community-based programs attempt to change community norms for a targeted high-risk population and are particularly helpful in reaching adolescents who are not in school. Finally, clinic-based interventions serve adolescents seeking health care, not only encouraging abstinence and safer sex practices for prevention of sexually transmitted disease but also providing opportunities for early detection and treatment. All three have their advantages, but each may neglect a significant portion of the population at risk. Development of structured sexually transmitted disease intervention programs utilizing school, community, and clinic settings merits further study.     

Psychosocial correlates of depressive symptoms among 12-14-year-old Norwegian adolescents

BACKGROUND: The aim of the study was to examine the relationships between various psychosocial factors and depressive symptoms in early adolescence. METHODS: A representative sample of 2,465 12-14-year-old adolescents comprising 50.8% girls and 49.2% boys, with a mean age of 13.7 years, was recruited in two counties in Norway. The participation rate was 88.3%. Depressive symptoms were measured by the Mood and Feelings Questionnaire (MFQ). RESULTS: Correlations between the total sum of stressful events/daily hassles and the total sum of MFQ were moderately high, rs = .49 and rs = .53, respectively. Depressive symptoms were more strongly correlated with school-related stress among boys than girls, whereas the correlation between daily hassles and depressive symptoms was higher for girls than boys. The results of univariate analyses showed significantly higher mean total MFQ scores among adolescents not living with both natural parents, those who had moved more than twice and those with more than 3 siblings orhaving fewer than 2 close friends. Further, adolescents from Third World societies and adopted adolescents, those from lower SES groups, having unemployed parents or living in coastal areas had higher mean depressive symptom scores. The results of multiple regression analyses yielded the following six significant predictors of total MFQ scores in order of importance: Sum of daily hassles and sum of stressful life events, gender, number of friends, ethnicity and mother's employment status. Altogether, these variables accounted for 43% of the total variance in MFQ scores. CONCLUSIONS: It is concluded that these psychosocial predictors should be addressed when assessing depressive symptoms in early adolescence. The findings of the study are discussed in view of previous research in the field and their clinical significance.     

Differences in biologic maturation, sexual behavior, and sexually transmitted disease between adolescents with and without cervical intraepithelial neoplasia

Because several cofactors may influence the development of cervical intraepithelial neoplasia (CIN) in young women, we compared differences in behaviors (sexual activity, contraception, and cigarette use), sexually transmitted disease (STD) infection rates (Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, and herpes simplex virus), and cervical maturation (age of menarche and percentage of cervical ectopy) in groups of sexually active female adolescents with and without CIN. Those with CIN were compared with three non-CIN groups: (1) teenagers who were referred to a teen colposcopy clinic but had no evidence of CIN (high-risk group), (2) teenagers seen at a gynecology clinic without STD symptoms (asymptomatic group), and (3) teenagers seen at the gynecology clinic with STD symptoms (symptomatic group). The percentage of cervical ectopy was measured by colpophotography. Subjects with CIN had more lifetime sexual partners than the asymptomatic group (p less than 0.001) and were more likely to smoke cigarettes than either gynecology clinic group (p less than 0.01). No differences in behaviors existed between the CIN and high-risk groups. The mean age of menarche in those with CIN was 1 year older than all three non-CIN groups (p less than 0.05), and those with CIN had a greater area of ectopy than those without CIN (p less than 0.02). Those with CIN were more likely to have a past or present history of C. trachomatis infection than the two gynecology clinic groups; no difference was found between the CIN and high-risk groups. We conclude that cofactors such as smoking, sexual promiscuity, and C. trachomatis infection may influence cervical vulnerability. However, cervical biologic immaturity is an important risk factor for development of CIN in adolescent girls.     

Subsequent sexually transmitted infection in urban adolescents and young adults

OBJECTIVE: To compare the rates of subsequent infection with Chlamydia trachomatis, Neisseria gonorrhoeae, or Trichomonas vaginalis in a group of high-risk adolescents and young adults. METHODS: At the time of treatment, 444 unmarried teenagers and young adults aged 13 to 25 years were enrolled from an urban sexually transmitted disease clinic and 3 community-based primary care clinics. Subjects were infected with C trachomatis, N gonorrhoeae, or T vaginalis, were diagnosed as having nongonococcal urethritis (in men), or were uninfected sexual contacts with one of these infections. Subjects returned at 1, 3, 5, and 7 months. RESULTS: The rate of subsequent infection was substantial. Forty percent of men and 53% of women who were uninfected contacts at enrollment were estimated to be infected within 7 months; 60% of men and 73% of women infected at enrollment were estimated to be reinfected. Among women, subjects who were infected at enrollment had a shorter time to subsequent infection (median, 140 days) compared with uninfected contacts (median, 209 days) (P =.04). Among men, findings were similar, but the difference in median time to subsequent infection was not significant (P =.08). Baseline characteristics that predicted shorter time to reinfection were female sex and infection at enrollment. When sexual behaviors in the 2 months preceding each subsequent data collection visit were included in the model, only being female and reporting at least one new interval sexual partner were significant predictors of subsequent sexually transmitted infections. CONCLUSIONS: These data support recent research that has found high rates of subsequent infection among high-risk adolescents and young adults. Contacts of a sexually transmitted infection appear to be at equally high risk for subsequent infection as those with a personal history of infection. Our data suggest that more frequent than annual screening for N gonorrhoeae, C trachomatis, and T vaginalis would be appropriate in at-risk adolescent and young adult populations, including individuals who are uninfected sexual contacts to a sexually transmitted infection.     

Psychiatric symptoms among Turkish adolescents

This research was planned to investigate psychiatric symptoms in a normal adolescent population. Four hundred and thirty-four students were selected randomly from three schools of different socioeconomic status. Symptom Check List 90-R was used to evaluate the psychiatric symptoms. The results were analyzed considering the effects of age, gender and socioeconomic status. It was concluded that being female, 15-16 years of age and having a lower socioeconomic status are risk factors for developing psychiatric symptoms.     

Correlates of depressive symptoms in adolescents with type 1 diabetes

Abstract: Purpose:  To determine correlates of depression in adolescents with type 1 diabetes.
Methods:  Data on 117 adolescents participating in a longitudinal study (72 F, 45 M; 95 W; age = 14.3 ± 2.0 yr; duration = 6.3 ± 3.7) were collected with the Children's Depression Inventory (CDI), Diabetes Family Behavior Scale (DFBS), Family Adaptability and Cohesion Scale (FACES), and chart review at study entry and 2-year follow-up.
Results:  Fifteen per cent of adolescents in this sample demonstrated depressive symptoms (CDI > 13) at study entry and 10% at 2 yr follow-up. Adolescents aged 14.1–16 yr and those with diabetes > 10 yr demonstrated the highest rates. When demographic/clinical variables were controlled, the DFBS warmth-caring subscale (p = 0.001) and the FACES adaptability subscale (p = 0.005), but not DFBS guidance-control (p = 0.635), contributed significantly to the explained variance in depressive symptoms ( R ² = 0.27) at study entry. At 2 yr follow-up, study entry CDI scores were the only significant predictor of depressive symptoms ( R ² = 0.40). By 2 yr, adolescents with depressive symptoms had significantly higher HbA1c than those without (p = 0.03).
Conclusion:  The prevalence of depressive symptoms in adolescents with type 1 diabetes coupled with the potential impact of depressive symptoms on metabolic control suggest the need for early diagnosis and treatment. Greater attention to psychosocial outcomes of youth, family functioning, and the potential burden of diabetes over time to youth/families is indicated.     

Parent-adolescent agreement on psychosocial symptoms and somatic complaints among adolescents with inflammatory bowel disease

Aim: To investigate parent–adolescent agreement on psychosocial and somatic symptoms in adolescents with inflammatory bowel disease (IBD). Methods: A questionnaire‐based postal survey comprising Finnish adolescents aged 10–18 years with IBD (n = 156) and their parents. Emotional, behavioural and somatic symptoms were measured using the Child Behaviour Checklist (parent report) and the Youth Self‐Report. Results: In paediatric IBD, adolescents and parents agreed on the presence of a psychosocial problem (in subclinical/clinical range) in 5% of the cases but disagreed in 21%. In 74% of the dyads, respondents agreed that no problems existed. Agreement in reporting psychosocial or somatic symptoms was poor to low (κ = 0.00–0.38). The lowest agreement was on anxious/depressed mood (κ = 0.02) and thought problems (κ = 0.00) and the highest on social problems. The parents reported more somatic symptoms in their adolescents than the adolescents themselves (p < 0.001). Conclusion: Young IBD patients and their parents disagree in reporting psychosocial and somatic symptoms of the patients. The adolescents as well as their parents need to be involved; otherwise, many symptoms of clinical significance would go unnoticed.     

Adolescents and sexually transmitted diseases.

Pediatricians with busy practices have limited time to spend with each patient. But because much of adolescent morbidity and mortality is related to behavioral issues, time and energy are crucial to providing effective counseling and care to adolescents. Many barriers to provision of services to adolescents exist, including time, space, décor, office hours, office fees, and support personnel. Despite these barriers to care of adolescents and, in particular, sexually active adolescents, the need for pediatricians to provide these services is clear. Services include anticipatory guidance and counseling about developing sexuality and sexual behaviors, as well as management of health consequences of sexual behavior. Primary care providers have an opportunity to assist adolescents to develop mature and healthy sexual relationships. This necessitates a full understanding of each patient's unique situation, listening to adolescents' concerns, and honest and straightforward discussion of sensitive information. Beginning the process of discussion of sexuality and relationships early in the pediatric years may help adolescents and their parents to develop healthy sexual attitudes and behaviors.