A sample validation of the Adolescent Stress Questionnaire (ASQ) in New Zealand

The Adolescent Stress Questionnaire (ASQ) is a 56‐item scale measuring stress in 10 domains. The scale has been tested in a number of countries worldwide with mixed support. The current study tested the factor structure, construct validity, and reliability in a sample (n = 1,601) comprising a general population of adolescents in New Zealand. Support was found for the 10‐factor structure with adequate internal consistency as well as strong factorial invariance between male and female participants. Significant inverse correlations were found between all ASQ domains and both life satisfaction and perceived academic achievement. Most ASQ domains revealed gender differences, with female participants reporting greater stress than males. Toward a nonbinary perspective of gender, gender‐neutral participants reported greater stress than males and females in certain stress domains. Results based on regression analyses indicate that nonacademic ASQ domains were generally related to life satisfaction whereas academic ASQ domains were related to perceived academic achievement. Positive and negative interaction effects were observed between gender and ASQ domains on life satisfaction and academic achievement. Overall, the current results indicate that the ASQ appears to be a reliable, valid instrument for adolescent stress in New Zealand with relevance to perceived life satisfaction and achievement.     

Support for the Multidimensional Adolescent Stress Questionnaire in a Sample of Adolescents in the United Kingdom

Adolescence is a time of physical, social and emotional development, and this development can be accompanied by feelings of stress. The Adolescent Stress Questionnaire is a 56‐item scale measuring stress in 10 domains. Developed in Australia, the scale has been translated, and its reliability and validity have been tested in a number of countries across Europe, where the 10‐factor, 56‐item version of the scale has received little support. The present study tested the factor structure, construct validity and reliability in a sample (n = 610) of adolescents in the United Kingdom. Support was found for the 10‐factor, 56‐item version of the scale, and correlations with self‐concept measures, sex scores on stress factors and Cronbach's α‐values, suggesting that the scale may be a viable assessment tool for adolescent stress. Results for alcohol‐specific analyses support the domain‐specific nature of the scale. Future work may seek to investigate the stability of age‐specific stress domains (e.g. the stress of Emerging Adult Responsibility) in samples that include younger adolescents. Copyright © 2014 John Wiley & Sons, Ltd.     

A holistic understanding of the effect of stress on adolescent well‐being: A conditional process analysis

Although traditional assumptions tend to conceptualize stress as inherently dysfunctional, psychological theory suggests that it is not intrinsically maladaptive. Contemporary models emphasize that the stress response can be differentiated into both negative and positive aspects, known as distress and eustress. Research examining the differential effect of positive and negative stress on adolescent well‐being is limited and has been hindered by a lack of appropriate measurement tools. The aim of the present study was to utilize the recently developed Adolescent Distress‐Eustress Scale to provide a balanced understanding of the impact of stress on positive mental health, holistically considering the effect of both distress and eustress on adolescent well‐being. One thousand eighty‐one Australian adolescents (M_age = 15.14, 54.03% female) completed an online survey composed of the Adolescent Distress‐Eustress Scale alongside measures of well‐being, self‐efficacy, psychological ill‐being, physical activity, and daytime sleepiness. Conditional process analysis suggested that distress exerted no direct influence on well‐being, with the observed negative relationship fully mediated by psychological and behavioural variables. Contrastingly, eustress was both directly related to increased well‐being and exerted an indirect effect through relationships with mediating variables. These results demonstrate that stress can have profoundly positive consequences. Theoretical contributions, implications for practice, and perspectives for future research are discussed.     

Adolescents' and parents' agreement on posttraumatic stress disorder symptoms and functioning after adolescent injury

Few investigations have simultaneously assessed concordance between youth and parent ratings of posttraumatic stress disorder (PTSD) symptoms and functioning. Randomly sampled adolescent injury survivors ages 12-18 and their parents were assessed on the inpatient ward and again at 2, 5, and 12-months postinjury (N = 99). Adolescent PTSD symptoms and functioning were rated by both adolescents and parents. Parent PTSD was also assessed; 27% of parents endorsed symptoms consistent with a diagnosis of PTSD over the course of the year after adolescent injury. The PTSD positive parents demonstrated significantly greater discordance in ratings of adolescent PTSD symptoms, family cohesion, and mental health functioning. These findings suggest caution in clinical and policy applications of parental ratings of adolescent symptomatic and functional outcomes after injury.     

Adolescent health, stress and life satisfaction: the paradox of indulgent parenting

A survey of adolescents aged 15 to 16 years was used to examine the relationship between their perceptions of indulgent parenting and adolescent weight status to overall satisfaction with life, as associated with adolescent perceptions of body image, health and stress. In addition, perceptions of parental indulgence were examined in terms of their association with adolescent eating behaviours and health. The results revealed a paradox related to indulgent parenting, with both positive and negative outcomes for adolescents. Structural equation analyses showed that parental indulgence was not only related to lower stress and higher life satisfaction, but also to unhealthy eating behaviours. Path analysis indicated that both positive and negative eating outcomes for adolescents were related to parental indulgence. This research has many implications for both parent and adolescent health education, focusing on parenting styles, stress and healthy lifestyles.     

Adolescent Bariatric Surgery: Treatment Delayed, Treatment Denied, a Crisis Invited

Adolescent obesity has serious immediate and long-term health consequences. There are no effective behavioral or pharmacologic treatments of extreme obesity among adolescents. Bariatric surgery is the most effective means to achieve durable weight loss, with amelioration or resolution of most obesity-related co-morbidities. Surgery should be performed when: 1) the risk of operative complications and of recidivism is lowest; 2) the outcomes of the operation are likely to be the best possible; and 3) there is little need to consider subsequent bariatric surgery for weight regain and reappearance of co-morbidities. A higher BMI is an independent risk factor for operative morbidity and mortality, and is associated with less weight loss and greater likelihood of weight regain. The higher BMI criterion for adolescent bariatric surgery exposes the adolescent to a higher risk for operative death and complications, and suboptimal outcomes following bariatric surgery.     

儿童至成人过渡期癫痫青少年参与健康照护意向及影响因素研究

目的调查儿童至成人过渡期的癫痫患者参与健康照护意向并分析其影响因素。方法采用便利抽样法,选取428例儿童至成人过渡期的癫痫青少年为研究对象,采用患者参与健康照护意向量表、社会支持量表和青少年健康相关行为自我效能量表,调查其参与健康照护意向并分析其影响因素。结果癫痫青少年参与健康照护意向总分(124.39±16.82)分,6个参与维度得分由高到低依次为:参与就医决策、参与诉求、参与质询监督、参与信息互动、参与治疗照护和参与诊疗决策。多元线性回归分析结果显示,年龄、病程、发作类型、共患疾病种类、家庭结构类型、社会支持、自我效能水平为青少年参与健康照护意向的主要影响因素(P<0.05,P<0.01)。结论癫痫青少年参与健康照护意向处于中等水平;年龄越大、病程越长和混合性发作疾病类型、流动家庭结构的青少年参与健康照护意向水平较高;提供多角度社会支持、提高自我效能,能增加癫痫青少年参与健康照的意愿,有利于该群体由儿童至成人医疗的顺利过渡。     

Sources of adolescent stress,smoking and the use of other drugs

Stress is an established correlate of smoking behaviour in regular adult smokers and has been related to the use of alcohol and other drugs as well. Empirical data supporting these assertions are entirely consistent with theoretical conceptions of both smoking and other substance use behaviours. Despite both supportive theory and empirical evidence with adults, however, little work has been done to extend such views to adolescent smoking and the use of other substances, where the evolution of these health risk behaviours is still plastic and potentially amenable to intervention. The present study reports associations between sources of adolescent stress assessed by an instrument purposely constructed for that exercise and both smoking behaviour and the use of alcohol and other substances. Some sources of stress in the self‐reported experience of adolescents statistically related both to current smoking and to the use of alcohol and other drugs. Associations were generally stronger for smoking than for other substances and both stronger and broader for girls than for boys. Stress arising from compulsory school attendance was broadly associated with substance use for both boys and girls and this was in line with past evidence; for girls, however, associations extended to stressors arising from other sources and particularly those to do with the family. The theoretical bases for these findings are discussed in the context of the stress reduction properties of smoking and other substance use, and the implications for intervention through targeted stress management are raised. Copyright © 1999 John Wiley & Sons, Ltd.     

Biopsychosocial Outcomes of Laparoscopic Adjustable Gastric Banding in Adolescents: a Systematic Review of the Literature

Adolescent obesity is a significant global health challenge. Severely obese adolescents commonly experience one or more serious medical comorbidities, such as type 2 diabetes mellitus and hypertension as well as psychosocial comorbidities such as depression, disordered eating behaviour, anxiety and low self-esteem. The aims of this review are to examine the literature on biopsychosocial (e.g. weight loss, medical comorbidities, mental health, and complications) outcomes of adolescent bariatric surgery and to identify areas where current data are deficient and a need for further research is indicated. A systematic review was conducted to examine the biopsychosocial outcomes of adolescent gastric banding. Eleven studies published before May 2013 examining outcomes of adolescent laparoscopic adjustable gastric banding (LAGB) surgery were identified. Available reported data indicate that LAGB surgery was effective in achieving significant weight loss. There is also evidence of the resolution of medical comorbidities; however, reporting of medical comorbidities assessment criteria is limited. Limited consideration was given to the psychosocial outcomes of LAGB surgery. The psychosocial outcomes of adolescent LAGB are not well researched. The current literature on adolescent LAGB is limited by a focus on weight loss and biomedical outcomes. There is currently little understanding of the behavioural, emotional or social factors that influence adolescents’ experience of LAGB surgery. Further research is required to examine the specific psychosocial needs and experiences of adolescent LAGB patients, so appropriate treatment approaches may be developed to ensure optimal outcomes for adolescents from LAGB surgery.     

The Influence of Premigration Trauma Exposure and Early Postmigration Stressors on Changes in Mental Health Over Time Among Refugees in Australia

As a result of the precarious conditions in which they migrate, refugees are likely to have experiences that increase their risk of mental health problems. Refugees tend to be predisposed to relatively high levels of distress upon resettlement, and a key predictor of these issues is traumatic experiences that occur before their arrival. Despite high initial levels of ill-health, on average, refugees tend to experience mental health recovery over time. However, both levels of mental health upon settlement and recovery over time may be negatively influenced by stressors in the postsettlement period. The present study examined changes in psychological distress and posttraumatic stress symptoms over 5 years among 2,169 refugees from various backgrounds, predominately from Iraq and Afghanistan, who participated in the Building a New Life in Australia (BNLA) study. A multivariate latent growth curve model found mental ill-health decreased on average, β = −.21 for distress and β ₌ −.31 for PTSD, ps < .001, and premigration trauma exposure predicted more initial PTSD symptoms and reduced recovery over time, β_Intercept = .21, β_Slope = −.54, p < .001. Postmigration stressors, such as loneliness, financial concerns, and cultural integration, predicted higher levels of mental health problems as well as reduced recovery over time. These findings suggest that beyond trauma exposure, the mental health of refugees upon resettlement and their recovery over time is impacted by stressors in the early resettlement period, which has important implications for interventions and services to support and encourage well-being in refugee populations.     

Measurement Invariance of the Perceived Stress Scale and Latent Mean Differences across Gender and Time

Measurement invariance of the 2‐factor model of the Perceived Stress Scale—10‐item version (Cohen & Williamson, 1988) was tested across men and women at two time points and in the combined total sample over a 2‐year time frame (n = 871). Measurement invariance results indicated that the scale measured the latent factors, stress and counter‐stress, equivalently in men and women and over time. With measurement invariance demonstrated, differences in latent means were tested. Results indicated that men had lower levels of frequencies of stressors, and at one time point, higher levels of counter‐stress, when compared with women. When examining change in frequencies of stressors and counter‐stress over 2 years with the combined male and female sample, stressors remained stable, yet counter‐stress increased over time. These findings may aid in the interpretation of results when examining stressors and counter‐stress in clinical samples where one would expect stress to increase, whereas positive psychological states decrease. Copyright © 2012 John Wiley & Sons, Ltd.     

Coping Behaviours and Post‐traumatic Stress in War‐affected Eastern Congolese Adolescents

This study explores coping strategies used by war‐affected eastern Congolese adolescents across age and sex, and the association between post‐traumatic stress symptoms and engagement and disengagement coping. Cross‐sectional data were collected in 11 secondary schools across four areas in the Ituri province, Democratic Republic of Congo. A total of 952 pupils (45.3% girls, 54.7% boys) aged 13–21 years (M = 15.83, standard deviation = 1.81) participated in self‐report assessment, using instruments that were either specifically developed (Adolescent Complex Emergency Exposure Scale, assessing traumatic exposure), validated (Impact of Event Scale Revised, assessing post‐traumatic stress symptoms) or reviewed (Kidcope, assessing coping strategies) for the study population. Reported coping strategies varied with age, and boys more frequently reported problem solving and resignation as compared with girls. Disengagement coping was associated with lower symptom scores in younger adolescent girls, as was the interaction effect between engagement and disengagement coping. We conclude that disengagement coping is not necessarily a maladaptive reaction to stressful events in war‐affected situations and that future research should aim to better understand the heterogeneous patterns of stress and coping responses, including the role of factors such as the nature and appraisal of stressors, available resources for coping and cultural preferences. Copyright © 2013 John Wiley & Sons, Ltd.     

Adolescent bariatric surgery

Obesity has become an increasingly serious problem in pediatric and adolescent populations in the United States. Although bariatric surgery has been offered to morbidly obese adolescents for the past several decades, it remains controversial. However, the benefits of weight loss surgery in this population have been realized, particularly its long-term physical and emotional effects on adolescents. This article reviews the demographics and health implications of adolescent obesity, describes the most common adolescent bariatric surgical procedures and their outcomes, discusses the ethical issues involved in elective surgery in this population, and outlines the key components of an adolescent bariatric surgical program.     

Laparoscopic Gastric Banding in Adolescents

Background: Adolescent obesity has undesirable short- and long-term effects. Laparoscopic adjustable gastric banding has been considered a procedure of choice for adolescent morbid obesity. We retrospectively evaluated our single-team banding experience in the adolescent population. Methods: We reviewed the medical and clinic records and conducted telephone questionnaire interviews, to evaluate the results of banding using the Swedish adjustable gastric band (SAGB^?) in the 60 adolescents at our institution who had been followed ≥3 years. Results: An average of 39.5 months of follow-up has been conducted in the patients who have been followed ≥3 years. Mean age at the time of the operation was 16 years (9 to 18). 60% reported a family history of obesity. Associated co-morbidities included hypertension, diabetes, sleep apnea and asthma. Mean preoperative BMI was 43 (35-61) kg/m². Mean postoperative BMI after 39.5 months follow-up was 30 (20-39) kg/m². No co-morbidities have existed after the operation. 6 patients (10%) underwent band repositioning and 2 patients underwent band removal, due to slippage; 7 of the 8 slippages occurred with an earlier perigastric technique which transgressed lesser sac. There was no mortality. Average postoperative hospital stay was 24 hours. Conclusions: Gastric banding in adolescents is a safe, satisfactory and reversible weight reduction procedure.     

Does dispositional mindfulness buffer the links of stressful life experiences with adolescent adjustment and sleep?

According to the mindfulness stress buffering hypothesis, mindfulness protects individuals from negative effects of stress. Prior investigations focused on the potential of mindfulness for reducing internalizing symptoms for adults in the context of general stress. We provided the first test of the mindfulness stress buffering hypothesis in the context of both adolescent general stress and interparental conflict (IPC) in relation to internalizing and externalizing, as well as sleep. Participants were 150 adolescents who reported dispositional mindfulness, perceived stress, IPC, internalizing, and externalizing. Participants wore an actigraph which objectively measured sleep for a week. Results suggested a stress buffering effect of mindfulness for the effects of general stress on internalizing symptoms at trend levels. Mindfulness stress buffering was not evident in relation to externalizing or sleep, or for the effect of IPC appraisals on adjustment or sleep. Greater IPC appraisals were associated with greater sleep onset latency, but mindfulness was not associated with objective measures of sleep quality or quantity. This study indicates that mindfulness may protect adolescents from the internalizing problems that often result from general stress, but that these stress buffering effects of mindfulness may not generalize to all types of stressors or adjustment/health outcomes.     

Patient and Parent Perspectives of Adolescent Laparoscopic Adjustable Gastric Banding (LAGB)

Background

Adolescent obesity is a significant global health challenge and severely obese adolescents commonly experience serious medical and psychosocial challenges. Consequently, severe adolescent obesity is increasingly being treated surgically. The limited available research examining the effectiveness of adolescent bariatric surgery focuses primarily on bio-medical outcomes. There is a need for a more comprehensive understanding of the behavioural, emotional and social factors which affect adolescents’ and parents’ experience of weight loss surgery.

Methods

Patient and parents’ perspectives of adolescent LAGB were examined using a qualitative research methodology. Individual, semi-structured interviews were conducted with eight adolescent patients and five parents. Thematic analysis was used to identify key themes in the qualitative data.

Results

Patients and parents generally considered adolescent laparoscopic adjustable gastric banding (LAGB) to be a life-changing experience, resulting in physical and mental health benefits. Factors considered to facilitate weight loss following surgery included parental support and adherence to treatment guidelines. Many adolescents reported experiencing surgical weight loss stigma and challenging interpersonal outcomes after weight loss for which they felt unprepared.

Conclusions

Patients and parents perceived LAGB positively. There are opportunities to improve both the experience and outcomes of adolescent LAGB through parental education and enhancements to surgical aftercare programmes.

     

Editorial Commentary: Adolescent Patients Undergoing Hip Arthroscopy Require a Considerable Improvement in Postoperative Outcomes Scores to Achieve Substantial Clinical Benefit: The International Hip Outcome Tool-33 Seems Optimal for Measuring Substantial Clinical Benefit In Young,Active Patients

Arthroscopic treatment of femoroacetabular impingement syndrome in adolescents is increasing, with evidence supporting similarly improved outcomes as in adult populations. Adolescent patients present unique challenges compared with adult counterparts, often with greater demands on their hips and greater baseline functional statuses. Further, elective surgery in adolescents demands long-lasting outcomes for treatment success. There is increased effort in the orthopaedic literature to define improvements in outcomes that are significant to the patient, including minimal clinically important difference, substantial clinical benefit, and patient acceptable symptomatic state. Delineation of these benchmarks in the adolescent population is important for measuring the success of arthroscopic hip surgery as indications are refined. The international Hip Outcome Tool (iHOT)-33 seems optimal for measuring substantial clinical benefit in young, active patients. Finally, the iHOT-12 has been shown to lose little information compared with the iHOT-33 and it is less burdensome for patients.     

Stress from a psychiatric epidemiological perspective

From voodoo deaths to life events, stress produces many psychophysiological responses. Social changes constitute an important stress factor and there is a correlation between stress scores and mental health risk. In personal studies, a three-way relationship among life events, socioeconomic status and health impairment scores has been demonstrated. Furthermore, there was a reciprocal influence between life events and impairment scores that has previously been somewhat overlooked. Recently, an emphasis has developed on current stressors rather than on previous life events, such stressors being tied to social role. There are powerful associations between social stressors and psychiatric symptomatology. especially symptoms of anxiety and/or depression. The individual's responses to stress depend little on attitudes and values but almost entirely upon the individual's ‘definition of the situation’. Whether or not the character of life in western society is more stressful than in the past is debatable, and even the most fortunate of persons may live lives that have their full share of difficulty and private despair.     

The Relative Impact of Traumatic Experiences and Daily Stressors on Mental Health Outcomes in Sri Lankan Adolescents

Prior trauma, current stress, and poor social support contribute to youth mental health problems. As daily stressors often increase in the aftermath of traumatic events, trauma could plausibly impact psychopathology not only directly but also indirectly via ongoing stress. In this study, we examined the relative roles of trauma and daily stressors in mental health outcomes in 753 Sri Lankan adolescents residing in areas impacted by the 2004 tsunami. In 2008, participants completed measures of trauma exposure, daily stressors, social support, posttraumatic stress symptoms (PTSS), emotional and behavioral problems (EBP), and functional impairment; a subsample (n = 89) repeated these assessments 16 months later. Regression models revealed positive associations between cumulative trauma and all three mental health measures. Significant variance in these associations could be explained indirectly, via daily stressors. For PTSS, the indirect effect accounted for 26.1% of the total effect of trauma, unstandardized coefficient ab = 0. 739, 95% CI [0.459, 1.122]. For EBP this percentage was 42.4%, ab = 0.287, 95% CI [0.189, 0. 404], and for functional impairment 70.0%, ab = 0.072, 95% CI [0.049, 0.121]. Indirect effects on impairment were strongest when perceived social support was low. Although we also present evidence that pathways between stressors and psychopathology may have been bidirectional, findings support the notion that adolescents' daily stressors are important transmitters of the impact of traumatic events and highlight the need for interventions focused not only on trauma processing but also on reducing current stress and improving social support.