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Vilela-Estrada AL, Villarreal-Zegarra D, Toyama M, Carbonel A, Fung C, Carbonetti FL, Hidalgo-Padilla L, Sureshkumar DS, Uribe-Restrepo JM, Olivar N, Gomez-Restrepo C, Brusco LI, Malagón NR, Priebe S, Diez-Canseco F. Psychometric properties of the patient health questionnaire-8 and general anxiety disorder-7 in adolescents and young adults from three Latin American cities: Internal structure, invariance, internal consistency and divergent validity. J Affect Disord 2025; 378:138-146. [PMID: 40021062 DOI: 10.1016/j.jad.2025.02.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2024] [Revised: 10/22/2024] [Accepted: 02/25/2025] [Indexed: 03/03/2025]
Abstract
BACKGROUND Depression and anxiety are the most common mental disorders in the world. Screening tools allow early diagnosis and intervention, preventing disease progression and reducing years lost to disability. Internationally, the most widely used screening instruments for depression and anxiety symptoms are the Patient Health Questionnaire (PHQ-8) and the Generalised Anxiety Disorder (GAD-7). Both have been validated in various countries; however, these studies mostly focused on the adult population and clinical settings. OBJECTIVE This study assessed the psychometric properties of the PHQ-8 and GAD-7 in adolescents and young adults in deprived urban areas of three of the largest Latin American cities. We evaluated the internal structure, measurement invariance, internal consistency, and divergent validity through correlations with the Manchester Short Assessment of Quality of Life (MANSA). METHODS The study included 1056 adolescents (ages 15-16) and 1306 young adults (ages 20-24) from Bogotá (Colombia), Buenos Aires (Argentina), and Lima (Peru). Confirmatory factor analysis was performed using the Weighted Least Squares Mean and Variance (WLSMV) adjusted estimator with polychoric matrices to assess the internal structure of the model. Measurement invariance was evaluated through multi-group factor analysis. Divergent validity was examined using Spearman's rho by correlating MANSA with the PHQ-8 and GAD-7. Finally, internal consistency was assessed with Cronbach's alpha and McDonald's omega. RESULTS Our study found that the PHQ-8 and the GAD-7 exhibited good goodness-of-fit indices for a one-dimensional model. Both scales achieved measurement invariance across different sociodemographic variables, including gender, country, education level, and age group. On the other hand, the PHQ-8 (rs = -0.52) and GAD-7 (rs = -0.46) showed a negative correlation with the MANSA, suggesting divergent validity between the higher scores on depressive and anxious symptoms are associated with lower quality of life. Finally, the PHQ-8 and GAD-7 showed adequate internal consistency in all cases evaluated (ω and α > 0.8). CONCLUSIONS Both the PHQ-8 and the GAD-7 showed good goodness-of-fit indices for a unidimensional theoretical model, adequate psychometric properties, and evidence of invariance for gender, age group, education level, and country. These findings highlight the reliability and versatility of these instruments in identifying urban young people with emotional distress in Latin America.
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Affiliation(s)
- Ana L Vilela-Estrada
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - David Villarreal-Zegarra
- Instituto Peruano de Orientación Psicológica, Lima, Peru; Department of Biomedical Informatics, School of Medicine, University of Utah, Salt Lake City, UT, United States
| | - Mauricio Toyama
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Adriana Carbonel
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Catherine Fung
- Unit for Social and Community Psychiatry, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
| | | | - Liliana Hidalgo-Padilla
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Diliniya Stanislaus Sureshkumar
- Unit for Social and Community Psychiatry, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom.
| | | | - Natividad Olivar
- Department of Psychiatry and Mental, School of Medicine, University of Buenos Aires, Argentina
| | - Carlos Gomez-Restrepo
- Department of Psychiatry and Mental Health, Pontificia Universidad Javeriana, Bogotá, Colombia; Department of Clinical Epidemiology and Biostatistics, Pontificia Universidad Javeriana, Bogotá, Colombia; Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Luis Ignacio Brusco
- Department of Psychiatry and Mental, School of Medicine, University of Buenos Aires, Argentina
| | - Nelcy Rodríguez Malagón
- Department of Clinical Epidemiology and Biostatistics, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Stefan Priebe
- Unit for Social and Community Psychiatry, East London NHS Foundation Trust, London, United Kingdom
| | - Francisco Diez-Canseco
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
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Li X, Jin W, Han L, Chen X, Li L. Comparison and application of depression screening tools for adolescents: scale selection and clinical practice. Child Adolesc Psychiatry Ment Health 2025; 19:53. [PMID: 40346636 PMCID: PMC12065149 DOI: 10.1186/s13034-025-00908-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2025] [Accepted: 04/29/2025] [Indexed: 05/11/2025] Open
Abstract
BACKGROUND Clinical assessments rely primarily on patients' emotional expressions and scale scores. However, due to cognitive differences and the complexity of emotional expression among adolescents, existing assessment tools often present challenges in their selection and application. This study reviews and analyzes the literature related to 8 commonly used adolescent depression assessment scales, including the Hamilton Depression Scale (HAMD), the Beck Depression Inventory (BDI), the Center for Epidemiologic Studies Depression Scale (CES-D), the Reynolds Adolescent Depression Scales (RADS), the Children's Depression Inventory (CDI), the Kutcher Adolescent Depression Scale (KADS), the Patient Health Questionnaire (PHQ) and the Depression Screener for Teenagers (DesTeen). Through a comprehensive analysis of each scale's strengths, limitations and practical applications, this narrative review aims to guide healthcare practitioners and researchers in selecting optimal measurement tools for different clinical and research contexts. METHODS Relevant studies on 8 frequently used or well-supported adolescent depression assessment scales (CDI, RADS, CES-D, BDI, PHQ, KADS, HAMD, DesTeen) were retrieved from PubMed, Web of Science, CNKI, and Wanfang databases. A total of 102 articles were ultimately selected for data extraction to determine the reliability and validity of these scales. Additionally, 13 original development studies of the included scales were further reviewed to extract and analyze information on their developmental background, structural dimensions, item composition, and applicability. RESULTS Recent studies on depression assessment scales have focused on the development of precise diagnosis and personalized evaluation. All 8 adolescent depression assessment scales generally exhibit good reliability and validity. Among them, the HAMD is used for detailed clinical evaluation of depressive symptoms but suffers from complexity due to its reliance on professional assessors. The BDI and the CES-D provide the most comprehensive dimensions. While the BDI is suitable for clinical assessments, it has the drawback of containing items that may be difficult to understand. The CES-D is well-suited for epidemiological research and large-scale screenings but has the limitation of unclear differentiation between emotional and somatic symptoms. The RADS is recognized for its comprehensive items and high reliability and validity, although its lengthy items may lead to respondent fatigue. The CDI allows multidimensional assessment of depressive symptoms but has been debated regarding its applicability across different age groups. The KADS, explicitly designed for adolescents, is a promising tool; however, its relatively recent development has resulted in limited validation studies. The PHQ is appropriate for rapid screening and tracking treatment effects but lacks sufficient emotional evaluation. The DesTeeen, designed for adolescents, features concise and clear item phrasing, but it's only available in the German language. CONCLUSIONS The 8 standard scales demonstrate high accuracy in screening adolescent depression, but challenges persist in selecting scales for different contexts and ensuring their cross-cultural validity.
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Affiliation(s)
- Xinyu Li
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Wei Jin
- Department of Acupuncture, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310005, China
| | - Lu Han
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Xingyu Chen
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Lihong Li
- Department of Acupuncture, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310005, China.
- Jinhua Academy of Zhejiang Chinese Medical University, Jinhua, 310053, China.
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Liu Y, Li S, Deng T, Li L, Wei R, Zhang Y, Ou J, Tao F, Wan Y. The association between green space around schools, screen time for entertainment, and adolescent depressive symptoms: A nationwide study from China. ENVIRONMENTAL RESEARCH 2024; 263:120100. [PMID: 39374752 DOI: 10.1016/j.envres.2024.120100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 08/10/2024] [Accepted: 10/01/2024] [Indexed: 10/09/2024]
Abstract
BACKGROUND Natural green environments are beneficial to people's mental health, while too much screen time may be harmful to adolescents' mental health. However, it is not clear how green spaces and screen time affect mental health together in adolescents. METHODS A total of 22,868 adolescents were recruited from October to December 2021 in eight cities in China, through multistage cluster sampling. The Patient Health Questionnaire (PHQ-9) was used to investigate adolescents' depressive symptoms, and the Normalised Vegetation Index for the 200m, 500m and 1000m buffer zones around the school represents the green cover around the school. We used binary logistic regression to analyse the association between green space, screen time and depressive symptoms. RESULTS In fully adjusted models, the highest quartile of NDVI in the 200m, 500m and 1000m buffer zones around the school was a protective factor for depressive symptoms. For less than 2 h of recreational screen time, the highest quartiles of the NDVI and the association with depressive symptoms were negatively correlated for the 200m, 500m and 1000m buffer zones (NDVI200: 0.904(0.848-0.964)), NDVI500: 0.863(0.808-0.921), NDVI1000: 0.862(0.808-0.920)). The highest quartiles of NDVI in all buffers were not associated with depressive symptoms when the screen time was >2 h. The association between green space and depressive symptoms at lower recreational screen time was observed to be stronger in the group of adolescents with a lower family economic status (NDVI200: 0.780(0.695-0.876), NDVI500: 0.838(0.748-0.938), NDVI1000: 0.783(0.698-0.879)). No potential gender differences were observed. CONCLUSIONS For adolescents with less than 2 h of recreational screen time per day, the greenery around the school had a protective effect on their mental health, especially for adolescents from economically disadvantaged families. Green spaces around schools are significant in improving health inequities.
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Affiliation(s)
- Yu Liu
- Department of Health Promotion and Behavioural Sciences, School of Public Health, Anhui Medical University, Anhui, China
| | - Shuqin Li
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Anhui, China; Anhui Provincial Key Laboratory of Population Health & Aristogenics, Anhui, China
| | - Tongyan Deng
- Department of Health Promotion and Behavioural Sciences, School of Public Health, Anhui Medical University, Anhui, China
| | - Lanlan Li
- Department of Health Promotion and Behavioural Sciences, School of Public Health, Anhui Medical University, Anhui, China
| | - Runyu Wei
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Anhui, China; Anhui Provincial Key Laboratory of Population Health & Aristogenics, Anhui, China
| | - Ying Zhang
- Department of Health Promotion and Behavioural Sciences, School of Public Health, Anhui Medical University, Anhui, China
| | - Jinping Ou
- Department of Health Promotion and Behavioural Sciences, School of Public Health, Anhui Medical University, Anhui, China
| | - Fangbiao Tao
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Anhui, China; Anhui Provincial Key Laboratory of Population Health & Aristogenics, Anhui, China
| | - Yuhui Wan
- Department of Health Promotion and Behavioural Sciences, School of Public Health, Anhui Medical University, Anhui, China; Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Anhui, China; Anhui Provincial Key Laboratory of Population Health & Aristogenics, Anhui, China.
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Leung CY, Kyung M, Weiss SJ. Greater perceived stress and lower cortisol concentration increase the odds of depressive symptoms among adolescents. J Affect Disord 2024; 365:41-48. [PMID: 39142582 DOI: 10.1016/j.jad.2024.08.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 07/18/2024] [Accepted: 08/11/2024] [Indexed: 08/16/2024]
Abstract
BACKGROUND Adolescent depression is a major public health concern. Although stress has been linked to more severe depression, its association with mild depression among adolescents is not understood. This study assesses the relationship between perceived stress and cortisol (a physiologic measure of stress) and examines the relationships between these stress measures and depressive symptoms among adolescents 13-19 years of age. METHODS Stress was measured with the Perceived Stress Scale-10 and through salivary sampling for cortisol four times throughout the day. The Patient Health Questionnaire-9 was used to measure depressive symptoms (range 0-27), where ≥5 indicated the threshold for experiencing at least mild depressive symptoms. Spearman coefficients and multiple logistic regression models were used to examine the relationships between our variables of interest. RESULTS The mean age of the 73 participants in our study was 15.82 years. 49 % of the participants reported depressive symptoms (PHQ-9 score ≥ 5). Both higher perceived stress (odds ratio [OR] = 1.11, p = 0.022) and lower cortisol (area-under-the curve; AUCG) (OR = 0.99, p = 0.009) were associated with increased odds of having depressive symptoms. LIMITATIONS Few participants had moderate to severe PHQ-9 depression, therefore our study reported findings on mild depression or greater. CONCLUSIONS Perceived stress and cortisol appear to reflect distinct, independent components of the stress experience. However, both greater perceived stress and less circulating cortisol may indicate difficulties in regulating stress as potential factors underlying depressive symptoms. Future research should focus on the different types of adolescent stressors and the importance of routine screening of stress and depression, including mild depression.
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Affiliation(s)
- Cherry Y Leung
- Department of Community Health Systems, School of Nursing, University of California San Francisco, San Francisco, CA, USA.
| | - Minjung Kyung
- The Catholic University of Korea, Seoul, Republic of Korea
| | - Sandra J Weiss
- Department of Community Health Systems, School of Nursing, University of California San Francisco, San Francisco, CA, USA
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Chokroverty L. Depression Part 2: Treatment. Pediatr Rev 2024; 45:494-504. [PMID: 39217118 DOI: 10.1542/pir.2024-006479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 03/21/2024] [Accepted: 03/21/2024] [Indexed: 09/04/2024]
Abstract
Depression treatment strategies are within the scope of pediatric practice and among the competencies recommended by the Academy of Pediatrics and The American Board of Pediatrics. Treatments that may be provided through collaborative care include nonpharmacologic therapies such as psychosocial treatments and evidence-based psychotherapies, and pharmacotherapy and monitoring processes for depression. Abundant support and guidance are available to pediatricians in depression care, including mental health consultation and online materials.
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Affiliation(s)
- Linda Chokroverty
- Departments of Psychiatry and Behavioral Sciences and Pediatrics, Montefiore Health Systems/Albert Einstein College of Medicine, Bronx, NY
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Tang H, Zhang Z, Chen H, Chen H, Chen X, Li S, Ye Y, Zhou J. Core items selection and psychometric properties of the adult attention-deficit hyperactivity disorder self-report scale-chinese short version (ASRS-CSV). Asian J Psychiatr 2024; 99:104136. [PMID: 38986316 DOI: 10.1016/j.ajp.2024.104136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 05/16/2024] [Accepted: 05/25/2024] [Indexed: 07/12/2024]
Abstract
OBJECTIVE This study aimed to develop and validate the Chinese Short Version of the Adult ADHD Self-Report Scale (ASRS-CSV), addressing the need for culturally appropriate diagnostic tools for Attention-Deficit Hyperactivity Disorder (ADHD) in the Chinese adult population. METHODS Utilizing a combination of intergroup difference analysis, factor analysis, and network analysis, we identified core ADHD symptoms pertinent to the Chinese cultural context. The study involved two samples: a vocational and technical school sample (N=1144) and an internet sample (N=1654), comprising adults aged 16-25 years. Reliability, validity, and diagnostic efficacy of the ASRS-CSV were assessed through psychometric testing. RESULTS The ASRS-CSV demonstrated high internal consistency (Cronbach's alpha > 0.9) and robust convergent validity (AVE > 0.7). The scale's diagnostic cutoff points were optimized, revealing high sensitivity and specificity for ADHD screening. Cross-cultural analysis highlighted differences in core ADHD symptoms between Chinese and Western populations, underscoring the scale's cultural sensitivity. CONCLUSION The ASRS-CSV is a reliable, valid, and efficient tool for screening ADHD in Chinese adults, reflecting the socio-cultural nuances of ADHD symptomatology. Its development marks a significant advancement in the field of psychiatry, offering a tailored approach for ADHD assessment in China and contributing to the global discourse on cross-cultural psychiatric diagnosis.
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Affiliation(s)
- Huajia Tang
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China.
| | - Zheng Zhang
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China.
| | - Honghui Chen
- Medical Psychological Center, the Second Xiangya Hospital of Central South University, Medical Psychological Institute, Central South University, National Clinical Research Center for Mental Disorders, Changsha, Hunan, China
| | - Hui Chen
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China
| | - Xianliang Chen
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China
| | - Sihong Li
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China
| | - Yanyue Ye
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China
| | - Jiansong Zhou
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China.
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Chokroverty L. Depression Part 1: Evaluation. Pediatr Rev 2024; 45:483-493. [PMID: 39217122 DOI: 10.1542/pir.2022-005688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 03/06/2024] [Accepted: 03/09/2024] [Indexed: 09/04/2024]
Abstract
By young adulthood, 1 in 5 teens will experience an episode of major depression. The second leading cause of death among youths aged 15 to 24 years is suicide, most of which will have been caused by untreated or undiagnosed depression. Depression is a highly heritable condition: depressed children often have depressed parents. Support to caregivers is important because depressed parents can have negative effects on children's development and future mental health. Groups more vulnerable to mental health disorders such as depression include Black, Indigenous, and persons of color and lesbian, gay, bisexual, transgender, or queer/questioning, who in recent years have the highest rate of suicide attempts (Black teens, sexual minority youth), the highest increases in suicide rates (Black children and youths), and the highest suicide rates (American Indian/Alaskan native). They frequently experience more adverse childhood events, which increases the risk of depression and suicide attempts. Pediatricians are most likely to care for these vulnerable youths, who often are less engaged in specialty mental health care for a variety of reasons, including stigma and barriers to access. By offering behavioral and mental health care to vulnerable populations in primary care, mental health equity may be achieved. Screening for depression and assessment for suicide are within the scope of pediatric practice and among the competencies recommended by the American Academy of Pediatrics and The American Board of Pediatrics.
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Affiliation(s)
- Linda Chokroverty
- Departments of Psychiatry and Behavioral Sciences and Pediatrics, Montefiore Health Systems/Albert Einstein College of Medicine, Bronx, NY
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Wang H, Du H, Guan Y, Zhong J, Li N, Pan J, Yu M. Association Between Frequency of Muscle-Strengthening Exercise and Depression Symptoms Among Middle and High School Students: Cross-Sectional Survey Study. JMIR Public Health Surveill 2024; 10:e50996. [PMID: 38630529 PMCID: PMC11063876 DOI: 10.2196/50996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 02/19/2024] [Accepted: 03/15/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Existing literature on the association between the frequency of muscle-strengthening exercise (MSE) and depression among adolescents is limited and contradictory. OBJECTIVE This study aimed to elucidate the association of MSE frequency with depression symptoms among middle and high school students in China. METHODS A total of 27,070 students in grades 7-12 from 376 middle and high schools were surveyed using an anonymous self-administered questionnaire between April and June 2022. Information on engaging in MSE was self-reported, and depression symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9). Poisson regression was used to examine the association between MSE frequency and depression symptoms. RESULTS Among the 27,006 eligible students, 51.6% (n=13,933) were boys, and the mean age was 15.6 (SD 1.7) years. The overall prevalence of meeting MSE recommendations (ie, engaging in MSE ≥3 days/week) was 34.6% (95% CI 32.6%-36.6%; n=9145); the prevalence was higher in boys (43.8%, 95% CI 41.8%-45.8%; 6067/13,933) than in girls (24.3%, 95% CI 22%-26.6%; 3078/13,073; P<.001). A total of 5882 (21.8%) students reported having depression symptoms. After adjustment for sociodemographic status, lifestyle factors, academic performance, and experience of physical fighting, compared to students who did not engage in MSE, the prevalence ratios (PRs) for depression symptoms were 0.98 (95% CI 0.97-0.99) for those engaging in MSE once a week, 0.95 (95% CI 0.93-0.97) for 2 days/week, 0.93 (95% CI 0.90-0.96) for 3 days/week, 0.90 (95% CI 0.87-0.94) for 4 days/week, 0.88 (95% CI 0.84-0.93) for 5 days/week, 0.86 (95% CI 0.81-0.92) for 6 days/week, and 0.84 (95% CI 0.78-0.90) for 7 days/week, respectively. CONCLUSIONS The overall prevalence of meeting MSE recommendations among Chinese adolescents is low. The frequency of MSE was inversely associated with depression symptoms.
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Affiliation(s)
- Hao Wang
- Department of Noncommunicable Disease Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Huaidong Du
- Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- Clinical Trial Service Unit & Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Yunqi Guan
- Department of Noncommunicable Disease Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Jieming Zhong
- Department of Noncommunicable Disease Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Na Li
- Department of Noncommunicable Disease Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Jin Pan
- Department of Noncommunicable Disease Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Min Yu
- Department of Noncommunicable Disease Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
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Stiles-Shields C, Reyes KM, Lennan N, Zhang J, Archer J, Julion WA, Shalowitz MU. Community Teens' COVID-19 Experience: Implications for Engagement Moving Forward. J Clin Psychol Med Settings 2024; 31:143-152. [PMID: 37803094 PMCID: PMC11174976 DOI: 10.1007/s10880-023-09975-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2023] [Indexed: 10/08/2023]
Abstract
Data collected from pediatric primary care settings during the pandemic suggest an increase in internalizing symptoms and disparities in care based upon minoritized identity status(es). To inform care moving forward, the current study characterized the pandemic and related technology usage experiences of teenaged pediatric patients from communities with high hardship indexes. As part of a larger mixed-methods study, 17 teens (Mean age = 15.99 ± .99) and 10 caregivers independently voiced experiences related to the pandemic during remote focus group and interview sessions. Thematic analyses were used to assess qualitative data; descriptive analyses were used to characterize qualitative data. Despite no direct queries about the pandemic, 41% of teens and 40% of caregivers described their lived experiences during the pandemic. Two subthemes emerged within the primary theme of COVID-19: (1) Wellness/Mental Health and (2) Smartphone Use and Utility. Although distress and negative effects were voiced, questionnaire data indicated normative psychosocial functioning for both teen self-report and caregiver proxy report. Informed by the voiced experiences of teens and their caregivers from communities with high hardship indexes, methods for better assessing and managing internalizing symptoms in teen patients are presented. A multi-modal and multi-informant approach that leverages technology to garner information about teens' experiences and deliver care may help improve the well-being of teens in communities systemically burdened with disparities.
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Affiliation(s)
- Colleen Stiles-Shields
- Institute for Juvenile Research, Department of Psychiatry, The University of Illinois at Chicago, 1747 West Roosevelt Road, Chicago, IL, 60608, USA.
- Section of Community Behavioral Health, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, USA.
| | - Karen M Reyes
- Section of Community Behavioral Health, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, USA
| | - Nia Lennan
- Section of Community Behavioral Health, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, USA
| | - Jim Zhang
- Rosalind Franklin University of Medicine and Science, North Chicago, USA
| | - Joseph Archer
- School of Medicine and Public Health, University of Wisconsin, Madison, USA
| | - Wrenetha A Julion
- Department of Women, Children and Family Nursing, Rush University College of Nursing, Chicago, USA
| | - Madeleine U Shalowitz
- Section of Community Behavioral Health, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, USA
- Department of Pediatrics, Rush University Medical Center, Chicago, USA
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Sidi A, Kiio M, Mwangi N, Olum M, Githinji G, Maina K, Kithinji C, Kaloki F, Temmerman M, Manguro G. Prevalence and correlates of depressive disorders in commercially sexual exploited children: A cross-sectional study in Mombasa, Kenya. CHILD ABUSE & NEGLECT 2024; 149:106690. [PMID: 38354599 DOI: 10.1016/j.chiabu.2024.106690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 02/05/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND Commercial sexual exploitation of children (CSEC) is a global concern and is among the common forms of sexual violence against children. In Kenya, about 32 % of girls and 16 % of boys experience sexual violence before the age of 18 years. While much has been written about the impact of child sexual exploitation, there's little on the prevalence of depressive disorders among CSE children. OBJECTIVES This study was conducted to assess the prevalence and correlates of depressive disorders among CSE children in Mombasa, Kenya. PARTICIPANTS AND SETTING The study was conducted among CSE children (10-17 years) in Mombasa County. METHODS A cross-sectional study conducted between May 2021 and June 2022. A total of 409 CSE children were enrolled, using a case management approach. Data was collected using the child identification tool and the Patient Health Questionnaire (PHQ-9), at the first counselling session to determine the prevalence of depression levels. RESULTS Of the 409 children, 367 (90 %) were girls while 42 (10 %) were boys. The mean age was 15 years (10-17) (SD = 1.4, t = 0.765). In 286 (70 %) 'Depression unlikely' was recorded, while 123 (30 %) 'Depression likelihood.' Prevalence of mild to severe depression was significantly higher in girls than boys (p = 0.002). Other determinants of depression were having a primary level of education (p = 0.03) and being an orphan. (p = 0.03). CONCLUSION It is important to prioritize mental health interventions such as screening and early diagnosis of mental health among CSE children in order to prevent and manage both short and long term effects.
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Affiliation(s)
- Abigael Sidi
- International Centre for Reproductive Health, Kenya.
| | - Morris Kiio
- International Centre for Reproductive Health, Kenya
| | - Norah Mwangi
- International Centre for Reproductive Health, Kenya
| | - Melanie Olum
- International Centre for Reproductive Health, Kenya
| | | | | | | | | | - Marleen Temmerman
- International Centre for Reproductive Health, Kenya; Aga Khan University, Nairobi, Kenya
| | - Griffins Manguro
- International Centre for Reproductive Health, Kenya; Ghent University, Faculty of Health Sciences, Belgium
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11
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Xu B, Chen C, Wang D. Current Psychotic-Like Experiences Among Chinese College Students: Prevalence, Correlates, and Its Relationship with Suicidal Ideation. Psychol Res Behav Manag 2024; 17:799-811. [PMID: 38434958 PMCID: PMC10908336 DOI: 10.2147/prbm.s451889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 02/19/2024] [Indexed: 03/05/2024] Open
Abstract
Background Current psychotic-like experiences (PLEs) are prevalent among adolescents. However, epidemiological data on the prevalence rate of current PLEs among college students and its clinical correlates are scarce and limited. To address this study gap, this study aimed to investigate the prevalence and correlates of current PLEs among Chinese college students. Methods A cross-sectional study was designed with a sample of 18,578 college students in China. Each participant completed a survey on social-demographic characteristics variables, PLEs, sleep disturbance, depression, anxiety, and suicidal ideation. Logistic regression analyses were conducted to explore the influential factors for PLEs among all participants and suicidal ideation among those with PLEs. Results Among Chinese college students, 40.3% of the participants reported having at least one PLE in the past month, while 7.5% had frequent PLEs. Males, age, residence location in town, left-behind experiences, poor family economic status, chronic physical illness, family history of mental disorder, BMI ≥ 28 [obesity], sleep disturbance, depression, anxiety, and suicidal ideation were independent correlates for frequent PLEs. Furthermore, the prevalence of suicidal ideation among participants with frequent PLEs was 32.1%. Lower grades, sleep disturbance, depression, and anxiety were independent predictors of suicidal ideation among college students who experience PLEs frequently. Conclusion Current PLEs are widespread among Chinese college students. Suicidal ideation is largely prevalent among individuals who suffer frequent PLEs, suggesting that special measures and attention should be provided to these students based on relevant factors to prevent their suicidal ideation and behavior.
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Affiliation(s)
- Bingna Xu
- Institute of Education, Xiamen University, Xiamen, People’s Republic of China
| | - Chunping Chen
- Institute of Education, Xiamen University, Xiamen, People’s Republic of China
| | - Dongfang Wang
- School of Psychology, South China Normal University, Guangzhou, People’s Republic of China
- Centre for Studies of Psychological Applications, Guangdong Key Laboratory of Mental Health and Cognitive Science, Ministry of Education Key Laboratory of Brain Cognition and Educational Science, South China Normal University, Guangzhou, People’s Republic of China
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12
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Cocozza V, Sickbert L, Kenny T, Espinola D, Welsh S, Turner Z, Pieroni K. Increasing Mental Health Screening in Pediatric Subspecialty Clinics: An Improvement Project at Brooke Army Medical Center. Mil Med 2024; 189:e789-e794. [PMID: 37748174 DOI: 10.1093/milmed/usad373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/31/2023] [Accepted: 09/14/2023] [Indexed: 09/27/2023] Open
Abstract
INTRODUCTION Mental health screening allows for the early identification of patients at risk of mental health disorders such as anxiety and depression. The Defense Health Administration Procedures Manual 6025.01 established that patients older than 12 years of age should receive annual mental health screening assessing suicidality risk with a standardized screening tool. MATERIALS AND METHODS To improve rates of mental health screening in this at-risk population, an A3 Lean approach to quality improvement was undertaken in the Pediatric Subspecialty Clinics at Brooke Army Medical Center. RESULTS Baseline data of Patient Health Questionnaire-9 or General Anxiety Disorder-7 screening from pediatric pulmonology and cardiology clinics were 6.3%. Plan-Do-Study-Act quality improvement methods evaluated possible interventions to improve screening. A standard operating procedure (SOP) outlining scoring and interpretation recommendations was distributed in pediatric pulmonology and cardiology clinics. Using the Armed Forces Health Longitudinal Technology Application, a post-implementation chart review was conducted for 8 weeks. With the initiation of Military Health System Genesis, the SOP was adjusted and a root cause analysis was performed. The pediatric gastroenterology clinic cares for patients presenting with functional abdominal pain; therefore, the clinic was added to the second iteration to determine if anxiety or depression may play a role. Providers were educated on documentation and coding. A second post-implementation chart review was conducted for 8 weeks. Over two iterations, mental health screening of new adolescent patients in pediatric subspecialty clinics increased by 794% from baseline. Our providers screened 50% of the adolescent patients. CONCLUSIONS With increased surveillance of an at-risk population, more adolescents will receive the standard of care. With refinement of the SOP and expansion to other subspecialties, this project has the potential to expand within Brooke Army Medical Center and other clinics in the Defense Health Administration.
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Affiliation(s)
- Victoria Cocozza
- Pediatric Residency Program, Brooke Army Medical Center, Fort Sam Houston, TX 78234, USA
| | - Lydia Sickbert
- Pediatric Residency Program, Brooke Army Medical Center, Fort Sam Houston, TX 78234, USA
| | - Timothy Kenny
- Pediatric Residency Program, Brooke Army Medical Center, Fort Sam Houston, TX 78234, USA
| | - Dimas Espinola
- Pediatric Subspecialty Clinic, Brooke Army Medical Center, Fort Sam Houston, TX 78234, USA
| | - Sebastian Welsh
- Department of Pediatric Pulmonology, Tripler Army Medical Center, Honolulu, HI 96859, USA
| | - Zachary Turner
- Department of Pediatric Cardiology, Brooke Army Medical Center, Fort Sam Houston, TX 78234, USA
| | - Kevin Pieroni
- Department of Pediatric Gastroenterology, Brooke Army Medical Center, Fort Sam Houston, TX 78234, USA
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13
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Wellen BCM, Wright NM, Bickford MA, Bakken EH, Riley AR. Integrated behavioral health services in pediatric primary care and emergency department utilization for suicide risk. Front Psychiatry 2023; 14:1241642. [PMID: 38025456 PMCID: PMC10666189 DOI: 10.3389/fpsyt.2023.1241642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 10/30/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Universal screening for suicide risk in primary care settings is a promising avenue for preventing self-harm and improving health outcomes. Triaging youth to an appropriate level of care, including diverting lower-risk patients from the emergency department (ED) is a meaningful goal. Previous research indicates integrated behavioral health (IBH) may prevent unnecessary admission to the ED on the day of suicide risk screening. We hypothesized that youth who received an IBH consultation the same day as suicide risk screening would be less likely to be admitted to the ED, but more likely to contact IBH services and utilize primary care in the following month. Methods We conducted a retrospective chart review of 3,649 youth aged 10-18 years who were screened with the Ask Suicide-Screening Questions (ASQ) in two pediatric primary care practices. We collected demographic data, ASQ and Patient Health Questionnaire-9 (PHQ-9) scores, as well as patient contacts with IBH, the ED, and medical primary care the day of screening and the following 31 days. We conducted a series of logistic regressions and chi-square analyses to determine whether contact with IBH on the same day as positive suicide risk screenings predicted same-day admission to the ED, IBH contact, and medical primary care utilization. Results Among the 7,982 ASQ scores, 1,380 (18%) were non-acute and 87 ASQs (1%) screened acutely positive. Over 90% of positive screens were diverted from the ED regardless of IBH contact. None of the patients died from suicide. Same-day IBH was associated with higher likelihood of general ED visits for all positive screens (acute and non-acute together). None of the positive screens that received an IBH consultation on the same day as screening were admitted to the ED in the subsequent month. Contact with IBH the same day as screening positively predicted utilization of IBH and medical primary care services in the subsequent month, especially for youth with minority race and ethnicity identities. Discussion In the context of clinics with IBH and systematic risk assessment processes, most youth who screen positive for suicide risk are diverted from the ED. However, contrary to our hypothesis, our study showed that youth who received same-day IBH consultations were more likely to be admitted to the ED compared to peers who did not receive IBH consultations. These findings suggest that systematic suicide screening combined with IBH consultations in pediatric primary care can effectively identify risk levels and triage patients to appropriate care.
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Affiliation(s)
- Brianna C. M. Wellen
- Department of Pediatrics, Oregon Health & Science University, Portland, OR, United States
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, United States
| | - Naomi M. Wright
- Department of Pediatrics, Oregon Health & Science University, Portland, OR, United States
| | - Mira A. Bickford
- Build EXITO Scholars Program, Portland State University, Portland, OR, United States
| | - Eliza Hayes Bakken
- Department of Pediatrics, Oregon Health & Science University, Portland, OR, United States
| | - Andrew R. Riley
- Department of Pediatrics, Oregon Health & Science University, Portland, OR, United States
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14
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Zachariades F, Maras D, Mervitz D, Martelli B, Prayal-Brown A, Hayawi L, Barrowman N, Lamontagne C. Virtual psychoeducation for improvement of pain catastrophizing in pediatric presurgical patients and caregivers: a proof-of-concept study. Can J Anaesth 2023; 70:1753-1764. [PMID: 37789219 DOI: 10.1007/s12630-023-02583-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 04/19/2023] [Accepted: 04/20/2023] [Indexed: 10/05/2023] Open
Abstract
PURPOSE Pain catastrophizing (PC) is the tendency to magnify the threat value of pain sensations and is associated with greater postsurgical pain intensity, functional disability, and pain chronicity. Higher parental PC predicts higher chronic postsurgical pain in youth. Treating PC in caregivers and youth prior to surgery may improve recovery and surgical outcomes. We developed and evaluated a psychoeducational workshop addressing PC for presurgical youth and their parents/caregivers. We hypothesized that parent/caregiver and youth PC scores would decrease over time. We also explored preintervention levels of youth anxiety and depression as moderators of outcome. METHODS Youth (n = 43) and caregivers (n = 41) attended a virtual, group-based single-session intervention (SSI). Single-session intervention content addressed pain neuroscience, PC, and adaptive coping strategies for managing pain and PC drawn from cognitive-behavioural, acceptance and commitment, and dialectical behaviour therapy approaches. Participants completed questionnaires assessing PC at preintervention, postintervention, and two weeks postsurgery. Youth mood and anxiety were assessed at preintervention. RESULTS Caregiver PC scores decreased from pre- to postintervention (P = 0.006), and this was maintained at postsurgery (P = 0.002). Youth PC scores decreased from preintervention to postsurgery, but only for those with higher preintervention anxiety (P = 0.01). CONCLUSION Our results provide proof-of-concept support for a virtual SSI targeting caregivers and youth PC during the perioperative period. The present findings highlight the possible need to screen presurgical candidates for symptoms of anxiety. Replication with larger and more diverse samples, and a more robust design are warranted.
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Affiliation(s)
| | - Danijela Maras
- Mental Health Service, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Deborah Mervitz
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada
- Acute Pain Service, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Brenda Martelli
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada
- Acute Pain Service, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Audrey Prayal-Brown
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Lamia Hayawi
- Clinical Research Unit, Research Institute, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Nick Barrowman
- Clinical Research Unit, Research Institute, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
| | - Christine Lamontagne
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada.
- Chronic Pain Services at the Children's Hospital of Eastern Ottawa, Ottawa, ON, Canada.
- Children's Hospital of Eastern Ontario, 401 Symth Rd., Ottawa, ON, K1H 8L1, Canada.
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15
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Joseph VA, Kreski NT, Keyes KM. Sleep deprivation and suicide risk among minoritized US adolescents. BMC Psychiatry 2023; 23:638. [PMID: 37653474 PMCID: PMC10472686 DOI: 10.1186/s12888-023-05074-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 08/02/2023] [Indexed: 09/02/2023] Open
Abstract
OBJECTIVES To assess (1) the prevalence of suicide ideation/behavior among adolescents with short sleep by race/ethnicity and (2) the association between sleep duration and suicidal ideation and behavior among American youth by race/ethnicity from 2007 to 2019. METHODS Data were drawn from the Youth Risk Behavior Surveillance System (YRBSS). Logistic regression analyses were used to assess the relationship between sleep duration and suicidal ideation/behavior. RESULTS Overall, suicide ideation/behavior increased among U.S. adolescents of all racial groups from 2007 to 2019. Adjusting for race/ethnicity, sexual identity, age, sex, substance use, trauma, and bullying, those with short sleep had approximately twice the odds [OR: 1.92 (95% CI: 1.65, 2.23)] of suicide ideation/consideration compared to those with long sleep. Stratified analyses indicated that Black students with short sleep had higher odds of making a suicide plan (OR = 1.51, 95% C.I.: 1.27, 1.79) compared with Black students with long sleep. A similar pattern was observed across other racial/ethnic groups (e.g., Hispanic: (OR = 1.74, 95% C.I.: 1.53, 1.97). CONCLUSION Emphasis on suicide interventions is of the essence, especially with increasing rates. Sleep duration significantly predicts suicide risk among all adolescents. Additional research is needed to assess factors that predict suicide among minoritized adolescents, specifically Black and Hispanic adolescents.
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Affiliation(s)
- Victoria A Joseph
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 W 168th St, New York, NY, 10032, USA.
| | - Noah T Kreski
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 W 168th St, New York, NY, 10032, USA
| | - Katherine M Keyes
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 W 168th St, New York, NY, 10032, USA
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Wang H, Bragg F, Guan Y, Zhong J, Li N, Pan J, Yu M. Association between duration of electronic screen use for non-educational purposes and depression symptoms among middle and high school students: a cross-sectional study in Zhejiang Province, China. Front Public Health 2023; 11:1138152. [PMID: 37261230 PMCID: PMC10229063 DOI: 10.3389/fpubh.2023.1138152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 04/10/2023] [Indexed: 06/02/2023] Open
Abstract
Background Existing literature on the association of electronic screen use duration with depression among adolescents is contradictory. The current study aimed to elucidate the association between duration of electronic screen use for non-educational purposes and depression symptoms among middle and high school students in Zhejiang Province, China. Methods A cross-sectional study of 27,070 students in grades 7-12 from 376 middle and high schools was conducted through an anonymous self-administered questionnaire between April and June 2022. Poisson regression was utilized to examine the association between electronic screen use duration for non-educational purposes and depression symptoms. Results Of the 27,006 eligible students, 51.6% (13932) were boys and the mean (SD) age was 15.6(1.7) years. The overall prevalence of symptoms of depression was 22.4% (95%CI 21.4-23.4); girls (27.6%, 26.2-29.0) had a higher prevalence than boys (17.7%, 16.7-18.8). After adjustment for socio-demographic status, lifestyle factors, self-perceived health, academic performance, loneliness and sadness, compared to those who did not use electronic screens for non-educational purposes, the prevalence ratios (PRs) for depression symptoms were 1.03 (95% CI 1.02-1.04) for those exposed to electronic screens for <1 h/day, 1.07 (1.05-1.09) for 1.0-1.9 h/day, 1.10 (1.07-1.13) for 2.0-2.9 h/day, 1.14 (1.10-1.18) for 3.0-3.9 h/day, 1.18 (1.12-1.23) for 4.0-4.9 h/day, and 1.21 (1.15-1.29) for ≥5 h/day. Conclusion Duration of electronic screen use for non-educational purposes was positively associated with symptoms of depression among middle and high school students, even with a relatively short daily duration of use.
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Affiliation(s)
- Hao Wang
- Department of NCDs Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Fiona Bragg
- Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Yunqi Guan
- Department of NCDs Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Jieming Zhong
- Department of NCDs Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Na Li
- Department of NCDs Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Jin Pan
- Department of NCDs Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Min Yu
- Department of NCDs Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
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Jenkins JH, Sanchez G, Miller EA, Santillanes Allande NI, Urano G, Pryor AJ. Depression and anxiety among multiethnic middle school students: Age, gender, and sociocultural environment. Int J Soc Psychiatry 2023; 69:784-794. [PMID: 36529994 PMCID: PMC10152214 DOI: 10.1177/00207640221140282] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Depression and anxiety-related disorders are common among adolescents. Research attention to early adolescence and low-income ethnically diverse populations is limited. AIM To conduct screening for depression and anxiety at an early age with attention to gender and socioenvironmental context within a low-income setting. METHOD Mixed methods included the PHQ-9A and GAD-10 screening instruments and ethnographic interviews. RESULTS 75 ethnically diverse middle school students were included. Mean years age was 11.2 (0.74). Females had higher PHQ-9A sum scores than males (p = .002, Mann-Whitney test) and higher GAD-10 sum scores than males (p = .016, Mann-Whitney test). After controlling for multiple comparisons, girls had higher mean responses on three PHQ-9A items (p < .006, two-sided t-test) and only one GAD-10 item (p < .005, two-sided t-test). Ethnographic interviews revealed contexts associated with girls' experiences of depression and anxiety, including gender-based violence in both school and home environments. Salient for girls and boys alike were worries about consequences of COVID-19 for family with respect to illness, death, job loss, economic hardship. Fears over student perceptions of intensified discrimination and racism in school and community were prominent. These problems were experienced by students as barriers to educational engagement. CONCLUSION Specific attention to early adolescence is needed to identify emergence of subsyndromal conditions which may benefit from therapeutic attention to reduce symptom severity, identify sociocultural, structural, and gender-specific stressors, and to enhance educational engagement.
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Affiliation(s)
- Janis H Jenkins
- Department of Anthropology, University
of California San Diego, La Jolla, CA, USA
| | - Giselle Sanchez
- Department of Anthropology, University
of California San Diego, La Jolla, CA, USA
| | - Eric A Miller
- School of Medicine, University of
California San Diego, La Jolla, CA, USA
| | | | - Grace Urano
- Department of Anthropology, University
of California San Diego, La Jolla, CA, USA
| | - Alexandra J Pryor
- School of Medicine, University of
California San Diego, La Jolla, CA, USA
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Ajayi AI, Chamdimba E, Sawadogo N, Gitahi N, Tarnagda AM, Ilboudo AK, Munthali A, Thakwalakwa C, Otukpa EO, Ushie BA, Kabiru CW. Socio-ecological factors associated with probable depression among pregnant and parenting adolescent girls: findings from a cross-sectional study in Burkina Faso and Malawi. Reprod Health 2023; 20:38. [PMID: 36882850 PMCID: PMC9990966 DOI: 10.1186/s12978-023-01588-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 02/23/2023] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND Pregnant and parenting adolescent girls are at risk of poor mental health because of stigma and social exclusion. Despite one in four girls starting childbearing by the age of 19 in Africa, no study, to the best of our knowledge, has examined the multi-layered factors (individual, family, friends, and neighborhood-related factors) associated with depressive symptoms among pregnant and parenting girls in Africa. Our study contributes to addressing this gap by examining the socio-ecological factors associated with depression symptoms among pregnant and parenting adolescent girls. METHODS Our study adopted a cross-sectional design. Between March and September 2021, we interviewed 980 pregnant and parenting adolescent girls in Ouagadougou, Burkina Faso, and 669 in Blantyre, Malawi. We recruited pregnant and parenting adolescent girls in randomly selected urban and rural enumeration areas in Burkina Faso (n = 71) and Malawi (n = 66). We assessed depressive symptoms using the Patient Health Questionnaire (PHQ-9), which generated an overall score of 27. We considered a score of 10 or more as probable depression. We also obtained information on individual, family, friends, and neighborhood characteristics. We employed logistic regression models to examine the significant factors associated with probable depression among pregnant and parenting adolescent girls. RESULTS The prevalence of probable depression was 18.8% and 14.5% in Burkina Faso and Malawi, respectively. At the individual level, having secondary education was significantly associated with a lower likelihood of probable depression in Malawi (AOR: 0.47; 95% CI 0.27-0.82) but not in Burkina Faso. At the family level, denying paternity (AOR: 3.14; 95% CI 1.34-7.11 in Malawi) and no parental support (AOR: 2.08; 95% CI 1.22-3.55 in Burkina Faso) were associated with higher odds of probable depression. At the community level, perceived neighborhood safety was associated with a lower likelihood of probable depression in Malawi (AOR: 0.74; 95% CI 0.61-0.89) and Burkina Faso (AOR: 0.81; 95% CI 0.73-0.90). Having a safety net within the community was associated with lower odds of probable depression in Burkina Faso (AOR: 0.87; 95% CI 0.78-0.96) but not in Malawi. CONCLUSION Depressive symptoms are common among pregnant and parenting adolescents, suggesting the need to screen them regularly for depression during antenatal and postnatal visits. Factors associated with depression among pregnant and parenting girls operate at multiple levels suggesting a need for multilevel interventions that address all areas of vulnerabilities.
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Affiliation(s)
- Anthony Idowu Ajayi
- Sexual, Reproductive, Maternal, New-born, Child and Adolescent Health (SRMNCAH) Unit, African Population and Health Research Center, Manga Close, Nairobi, Kenya.
| | - Elita Chamdimba
- Centre for Social Research, University of Malawi, P. O. Box 280, Zomba, Malawi
| | - Nathalie Sawadogo
- Institut Supérieur des Sciences de La Population, Université Joseph Ki-Zerbo, B.P. 7118, Ouagadougou 03, Burkina Faso
| | - Nyawira Gitahi
- Dalla Lana School of Public Health, University of Toronto, 155 College St Room 500, Toronto, ON, M5T 3M7, Canada
| | - Abdoul Moumini Tarnagda
- Institut Supérieur des Sciences de La Population, Université Joseph Ki-Zerbo, B.P. 7118, Ouagadougou 03, Burkina Faso
| | - Abdoul Kader Ilboudo
- Institut Supérieur des Sciences de La Population, Université Joseph Ki-Zerbo, B.P. 7118, Ouagadougou 03, Burkina Faso
| | - Alister Munthali
- Centre for Social Research, University of Malawi, P. O. Box 280, Zomba, Malawi
| | | | - Emmanuel Oloche Otukpa
- Sexual, Reproductive, Maternal, New-born, Child and Adolescent Health (SRMNCAH) Unit, African Population and Health Research Center, Manga Close, Nairobi, Kenya
| | - Boniface Ayanbekongshie Ushie
- Sexual, Reproductive, Maternal, New-born, Child and Adolescent Health (SRMNCAH) Unit, African Population and Health Research Center, Manga Close, Nairobi, Kenya
| | - Caroline W Kabiru
- Sexual, Reproductive, Maternal, New-born, Child and Adolescent Health (SRMNCAH) Unit, African Population and Health Research Center, Manga Close, Nairobi, Kenya
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Picardi A, Fagnani C, Gigantesco A, Toccaceli V, Stazi MA, Medda E. Stability and change in genetic and environmental influences on depressive symptoms in response to COVID-19 pandemic. Front Psychiatry 2023; 14:954737. [PMID: 36860500 PMCID: PMC9968727 DOI: 10.3389/fpsyt.2023.954737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 01/23/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND The rapid spread of the new Coronavirus and the consequent restrictions to contain transmission generated an unprecedented psychological impact on the general population. The Italian Twin Registry performed a longitudinal study to investigate to what extent genetic and environmental influences contributed to changes in depressive symptoms. METHODS Data from adult twins were collected. All participants completed an online questionnaire including the 2-item Patient Health Questionnaire (PHQ-2) just before (February 2020) and immediately after the Italian lockdown (June 2020). Genetic modeling based on Cholesky decomposition was used to estimate the role of genetic (A) and both shared (C) and unshared (E) environmental factors in the observed longitudinal course of depressive symptoms. RESULTS Longitudinal genetic analysis was based on 348 twin pairs (215 monozygotic and 133 dizygotic pairs) with a mean age of 42.6 years (range 18-93 years). An AE Cholesky model provided heritability estimates for depressive symptoms of 0.24 and 0.35 before and after the lockdown period, respectively. Under the same model, the observed longitudinal trait correlation (0.44) was approximately equally contributed by genetic (46%) and unshared environmental (54%) influences, while longitudinal environmental correlation was lower than genetic correlation (0.34 and 0.71, respectively). CONCLUSIONS Although the heritability of depressive symptoms was rather stable across the targeted time window, different environmental as well as genetic factors seemed to act before and after the lockdown, which suggests possible gene-environment interaction.
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Affiliation(s)
- Angelo Picardi
- Centre for Behavioural Sciences and Mental Health, Italian National Institute of Health, Rome, Italy
| | - Corrado Fagnani
- Centre for Behavioural Sciences and Mental Health, Italian National Institute of Health, Rome, Italy
| | - Antonella Gigantesco
- Centre for Behavioural Sciences and Mental Health, Italian National Institute of Health, Rome, Italy
| | - Virgilia Toccaceli
- Centre for Behavioural Sciences and Mental Health, Italian National Institute of Health, Rome, Italy
| | - Maria Antonietta Stazi
- Centre for Behavioural Sciences and Mental Health, Italian National Institute of Health, Rome, Italy
| | - Emanuela Medda
- Centre for Behavioural Sciences and Mental Health, Italian National Institute of Health, Rome, Italy
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20
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Mental disorders at the beginning of adolescence: Prevalence estimates in a sample aged 11-14 years. PUBLIC HEALTH IN PRACTICE 2022; 4:100348. [PMID: 36545674 PMCID: PMC9761382 DOI: 10.1016/j.puhip.2022.100348] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 11/15/2022] [Accepted: 11/30/2022] [Indexed: 12/05/2022] Open
Abstract
Objectives This study aims to provide a deeper insight into mental disorders in early adolescence. We report prevalence rates (mental health problems, depressive symptoms, eating disorders, NSSI, STBs) to be used in future studies and clinical ventures. We also expected to find gender differences, with girls being be more affected than boys are. Study design 877 adolescents (M = 12.43, SD = 0.65) from seven German high schools completed a series of questionnaires assessing their mental health (SDQ, PHQ-9, SEED, DSHI-9, Paykel Suicide Scale, FAS III). Methods We calculated cut-off-based prevalence estimates for mental health issues for the whole sample and compared estimates between genders. Results 12.5% of the sample reported general mental health problems. The estimated prevalence of depressive symptoms lay at of 11.5%. Additionally, 12.1% and 1.3% of the participants displayed relevant symptoms of anorexia or bulimia nervosa, respectively. A total of 10.8% reported engaging in non-suicidal self-injury (NSSI) at least once in their lifetime, of whom 5.6% reported repetitive NSSI. 30.1% of the participants described suicidal thoughts, 9.9% suicide plans, and 3.5% at least one suicide attempt. Girls were generally more affected than boys, except for bulimia nervosa, suicidal behavior, and partly NSSI. Conclusion Our findings corroborate the established relevance of early adolescence for the development of mental health problems and suggest that a substantial proportion of young adolescents suffer from such problems early on. Considering the ongoing COVID-19 pandemic and reported negative mental health consequences, the current findings underline the importance of preventive interventions to avoid the manifestation of mental disorders during adolescence.
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21
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Clark KA, Harvey TD, Hughto JM, Meyer IH. Mental Health Among Sexual and Gender Minority Youth Incarcerated in Juvenile Corrections. Pediatrics 2022; 150:e2022058158. [PMID: 36385576 PMCID: PMC9724172 DOI: 10.1542/peds.2022-058158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/19/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES This study examined differences by sexual and gender minority (SGM) and incarceration statuses in mental health indicators among youth. METHODS Population-based, cross-sectional data are from the 2019 Minnesota Student Survey (N = 72 324) and includes public school students (Mage = 15.49) and youth incarcerated in juvenile correctional facilities (Mage = 15.48). We categorized youth into 4 groups: (1) non-SGM youth in public schools, (2) non-SGM youth in correctional facilities, (3) SGM youth in public schools, and (4) SGM youth in correctional facilities. Multivariable regression models assessed associations among SGM and incarceration statuses and mental health indicators after controlling for sociodemographic characteristics and exposure to adverse childhood experiences. RESULTS More youth in juvenile correctional facilities identified as SGM (28.8%) compared with youth in public schools (20.4%, P = .002). SGM youth in correctional facilities reported a higher prevalence of suicidal ideation (42.2%), suicide attempt (37.5%), and self-harm (57.8%) compared with all other groups. Depressive symptom severity was similarly elevated among SGM youth in correctional facilities and SGM youth in public schools. SGM youth in correctional facilities, compared with non-SGM youth in public schools, demonstrated elevated odds of suicide ideation (adjusted odds ratio [aOR] = 2.2, 95% confidence interval [95% CI] = 1.3-3.9), suicide attempt (aOR = 6.3, 95% CI = 3.6-10.9), and self-harm (aOR = 3.6, 95% CI = 2.1-6.3). CONCLUSIONS Incarcerated SGM youth disproportionately experience negative mental health indicators. Findings suggest that tailored, intersectional, and responsive mental health interventions are needed to support incarcerated SGM youth.
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Affiliation(s)
- Kirsty A. Clark
- Department of Medicine, Health, and Society, Program in Public Policy Studies
- LGBTQ+ Policy Lab, Vanderbilt University, Nashville, Tennessee
| | - Tyler D. Harvey
- SEICHE Center for Health and Justice, Yale School of Medicine, New Haven, Connecticut
| | - Jaclyn M.W. Hughto
- Departments of Behavioral and Social Sciences, and Epidemiology, School of Public Health
- Center for Health Promotion and Health Equity, Brown University, Providence, Rhode Island
| | - Ilan H. Meyer
- Williams Institute, UCLA School of Law, Los Angeles, California
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22
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Huang BW, Guo PH, Liu JZ, Leng SX, Wang L. Investigating adolescent mental health of Chinese students during the COVID-19 pandemic: Multicenter cross-sectional comparative investigation. World J Psychiatry 2022; 12:1323-1334. [PMID: 36438680 PMCID: PMC9693833 DOI: 10.5498/wjp.v12.i11.1323] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/16/2022] [Accepted: 10/14/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has caused significant challenges for adolescent mental health.
AIM To survey adolescent students in China to determine the effects of the COVID-19 pandemic on their mental health.
METHODS A multicenter cross-sectional comparative investigation was conducted in March 2022. We collected demographic information and survey data related to the COVID-19 pandemic. The Patient Health Questionnaire-9 and Generalized Anxiety Disorder Screener scales were used for objective assessment of depression and anxiety.
RESULTS We collected mental health questionnaires from 3184 students. The investigation demonstrated that adolescents most strongly agreed with the following items: Increased time spent with parents, interference with academic performance, and less travel. Conversely, adolescents most strongly disagreed with the following items: Not having to go to school, feeling an increase in homework, and not socializing with people; 34.6% of adolescents were depressed before COVID-19, of which 1.9% were severely depressed. After COVID-19, 26.3% of adolescents were prone to depression, of which 1.4% were severely depressed. 24.4% of adolescents had anxiety before COVID-19, with severe anxiety accounting for 1.6%. After COVID-19, 23.5% of adolescents were prone to anxiety, of which 1.7% had severe anxiety.
CONCLUSION Chinese adolescents in different grades exhibited different psychological characteristics, and their levels of anxiety and depression were improved after the COVID-19 pandemic. Changes in educational management practices since the COVID-19 pandemic may be worth learning from and optimizing in long-term educational planning.
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Affiliation(s)
- Bo-Wen Huang
- Department of General Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Pei-Han Guo
- Senior High School, The Experimental High School Attached to Beijing Normal University, Beijing 100032, China
| | - Jian-Zhou Liu
- Department of General Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Sean X Leng
- Department of Medicine, Johns Hopkins University School, Baltimore, MD 21205, United States
| | - Li Wang
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences/School of Basic Medicine Peking Union Medical College, Beijing 100730, China
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23
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Oyenubi A, Kim AW, Kollamparambil U. COVID-19 risk perceptions and depressive symptoms in South Africa: Causal evidence in a longitudinal and nationally representative sample. J Affect Disord 2022; 308:616-622. [PMID: 35429537 PMCID: PMC9007986 DOI: 10.1016/j.jad.2022.04.072] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 02/15/2022] [Accepted: 04/10/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Studies worldwide have highlighted the acute and long-term depressive impacts of psychosocial stressors due to the 2019 coronavirus disease (COVID-19) pandemic, particularly in low- and middle-income countries. Among the wide range of risk factors for depression that transpired during pandemic, greater perceptions of individual vulnerability to the COVID-19 have emerged as a major predictor of increased depressive risk and severity in adults. METHODS We estimated the extent to which COVID-19 risk perceptions affected adult depressive symptoms in a longitudinal, nationally representative sample in South Africa. We used covariate balanced propensity scores to minimize the bias from treatment assignment to estimate average causal effects of COVID-19 risk perceptions. RESULTS The point prevalence of perceived COVID-19 infection risk increased between the third and fifth months of the pandemic, which corresponded with elevations in national COVID-19 infection rates. Approximately 33% of adults met or surpassed the PHQ-2 cut-off score of 2. An increase in perceived risk of COVID-19 infection predicted worse depressive symptoms in adults four months later. CONCLUSIONS Our findings highlight the widespread mental health burdens of the COVID-19 pandemic and emphasize the importance of greater psychological resources and structural changes to promote equitable access to COVID-19 risk mitigation policies.
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Affiliation(s)
- Adeola Oyenubi
- School of Economics and Finance, University of the Witwatersrand, Johannesburg, South Africa
| | - Andrew Wooyoung Kim
- SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Anthropology, University of California, Berkeley, Berkeley, CA, United States.
| | - Uma Kollamparambil
- School of Economics and Finance, University of the Witwatersrand, Johannesburg, South Africa
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24
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Ramos-Vera C, Serpa Barrientos A, Vallejos-Saldarriaga J, Saintila J. Network Analysis of Depressive Symptomatology in Underweight and Obese Adults. J Prim Care Community Health 2022; 13:21501319221096917. [PMID: 35514113 PMCID: PMC9083035 DOI: 10.1177/21501319221096917] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 03/21/2022] [Accepted: 04/07/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Depressive symptoms can affect people's quality of life and social environment. In addition, in severe situations, they can lead to suicidal behaviors. OBJECTIVE This study aimed to analyze the differences in depressive symptoms in underweight and obese Peruvian adults. METHODS A cross-sectional study was carried out based on secondary data obtained from the Instituto Nacional de Estadística e Informática (INEI), Lima, Peru. A sample of 10 053 participants was considered, of which 55.96% were women. Two Gaussian plot models were estimated and the levels of depressive symptomatology were compared between the 2 groups (adults with underweight and obese). RESULTS A total of 1510 (15.02%) were underweight adults and 8543 (84.98%) were obese adults. There were differences in the reporting of depressive symptoms in the underweight group; the most central items were "Depressed mood" (PH2), "Tiredness/low energy" (PH4), and "Psychomotor difficulties" (PH8). CONCLUSION This study provides new evidence on the dynamic relationship between depressive symptoms according to the body mass index categories (underweight and obese) assessed.
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