Risk factors for depression in early adolescence

The purpose of this study was to identify salient risk factors for depression in early adolescence from a group of common predictors. The following nine predictors were examined: (1) perceived quality of peer relationships, (2) perceived parental nurturance, (3) perceived parental rejection, (4) self-esteem, (5) body image, (6) pubertal status, (7) SES, (8) conduct problems, and (9) hyperactivity/inattention. The sample of 2,014 12 and 13 year olds was also divided by gender to examine potential sex differences in risk factors for depression. Finally, several mediational models were investigated. Self-esteem emerged as the strongest predictor of depression in both genders; parental behavior also emerged as an important risk factor. Therefore, these two variables are discussed as targets for those developing intervention and prevention programs.     

Bipolar depression (manic-depressive disease) in early adolescence

Bipolar Depression is rare in early adolescence. Since only rare cases were described in the literature, every case is important. In this article we described three cases of Bipolar Depression who were hospitalized in our Adolescent Unit during the past three years. All of them started at age 13--14. It is important to diagnose this illness in order to administer the required treatment in the acute phase and preventive treatment afterwards. Our experience indicates that treatment for early adolescents is identical with treatment for adults and calls for the same dosage.     

Low self-esteem prospectively predicts depression in adolescence and young adulthood

Low self-esteem and depression are strongly correlated in cross-sectional studies, yet little is known about their prospective effects on each other. The vulnerability model hypothesizes that low self-esteem serves as a risk factor for depression, whereas the scar model hypothesizes that low self-esteem is an outcome, not a cause, of depression. To test these models, the authors used 2 large longitudinal data sets, each with 4 repeated assessments between the ages of 15 and 21 years and 18 and 21 years, respectively. Cross-lagged regression analyses indicated that low self-esteem predicted subsequent levels of depression, but depression did not predict subsequent levels of self-esteem. These findings held for both men and women and after controlling for content overlap between the self-esteem and depression scales. Thus, the results supported the vulnerability model, but not the scar model, of self-esteem and depression.     

An Examination of the Association between Social relationships and depression in early adolescence

The purpose of this study was to examine the association between social relationships and depression in early adolescence. Subjects were 216 sixth and seventh graders. Depression was measured by the Children's Depression Inventory; social relationships were measured by three sociometric techniques (positive nominations, negative nominations, peer ratings) and estimates by the subject of the number of nominations and the rating (s)he received. The results indicated that depression was associated with pear and self-estimate negative nominations and ratings more than with peer and self-estimate positive nominations. A stepwise multiple regression predicting depression scores included two of the six predictors and accounted for 14% of the variance. The implications of the results for the assessment and treatment of depression are discussed.     

Gender differences in the development and adult outcome of co-occurring depression and delinquency in adolescence

Using a dual trajectory modeling approach, we examined co-occurring trajectories of depression and delinquency from age 11 to age 18 and their relation to adult outcome six years later in a community sample of 1423 (674 boys) adolescents. We also examined the effects of childhood externalizing, internalizing, and social problems on trajectory membership for depression and delinquency. The results showed that although more girls than boys were likely to follow high-level, co-occurring trajectories on depression and delinquency, the adult outcome of adolescents following high-level trajectories on both domains was poorer for boys than for girls. However, the combination of decreasing depression symptoms and increasing delinquency symptoms across adolescence was related with poorer adult outcomes for girls compared to boys. Finally, whereas boys' high-level co-occurring trajectory of depression and delinquency was predicted by childhood aggression, girls' equivalent trajectory was predicted by childhood depression and delinquency. The findings support the "gender paradox" effect (Loeber & Keenan, 1994) stating that in disorders with an unequal gender ratio, members of the gender with the lower prevalence rate tend to be more seriously affected in terms of comorbidity and poor outcome.     

Peer victimization and depression in early–mid adolescence: A longitudinal study

Background. Despite considerable evidence for psychological distress among children and young people who experience peer victimization, cross‐sectional studies cannot determine the direction of the relationship. Several recent studies have examined associations between victimization and distress. The majority find evidence for both directions but do not arbitrate between them; only one prior study has attempted to do this. Aims. To use longitudinal data to: (1) test competing hypotheses about the direction of the victimization–depression association; (2) investigate gender differences in the resulting models. Sample. Data were obtained from a Scottish school‐based cohort (N = 2,586). Methods. Self‐completion questionnaires included a depression scale and questions on victimization at each age. Results. Despite shifts in and out of victim status, there was evidence of stability in both victimization and depression. Bivariate analyses showed positive relationships between victimization and depression. Structural equation modelling (SEM) showed that at age 13, this relationship was reciprocal, with a stronger path from victimization to depression than vice versa. However, at age 15, it was almost entirely due to a path from depression to victimization among boys. Models including cross‐lagged paths fitted the data less well than those including simultaneous associations. Conclusions. Current policy focuses on victimization as a cause of distress; however, professionals should be aware that vulnerable children and young people are likely to be the targets of victimization.     

Anxiety Symptomatology in Mexican-American Adolescents

Mexican-American adults and adolescents in general have been reported to have high levels of anxiety symptomatology. In our study of a tri-ethnic sample of 2528 junior and senior high school students, the Youth Self Report (YSR) version of the Child Behavior Checklist (CBCL) and a sociodemographic questionnaire was used to assess the anxiety symptoms of Hispanic youth. We compared the ratings on anxiety symptoms, using Achenbach's anxiety subscale on the YSR, between two populations. The anxiety levels of youth in coastal southeast Texas (Galveston County) were compared to the anxiety levels of youth in the lower Rio Grande Valley. We found that Mexican-Americans of the Lower Rio Grande Valley scored higher on anxiety symptoms than the tri-ethnic population of Galveston County. Other factors associated with higher anxiety scores for Mexican-American youths included being born outside the US, linguistic fluency, father absent from the home, mother's education, and household size. Multiple regression analyses showed that socio-economic status (SES), family composition, and linguistic fluency had a greater relative impact on anxiety symptomatology than all other factors, both for the total sample as well as for the Mexican-American sample. These results parallel previous findings, with Mexican-American adults, which suggest either higher risk for anxiety symptomatology or a culturally related bias in the reporting of such symptoms.     

Cluster A Personality Symptomatology in Youth

There is an increasing recognition of the importance of studying the childhood antecedents of adult personality disorders as well as personality disorders themselves within childhood and adolescence. This has been a long neglected area of research. The two papers within this special issue of Journal of Psychopathology and Behavioral Assessment by Esterberg et al. (2010) and De Clercq et al. (2010) make significant strides toward addressing this delinquent focus of investigation. This commentary addresses three issues stimulated by these two particular studies: the distinction between personality and other mental disorders, dimensional models of classification, and openness to experience.     

Symptomatology of intracranial vascular ectasias

The ectasia of intracranial arteries shows a versatile neurological picture containing all symptoms from paraphrased deficiency of brain nerves and vegetative imbalances until the suspicion of a tumor cerebri. Two cases of our own are represented and compared with data in literature also referring on their etiology.     

Temperament and self-esteem in late adolescence.

The purpose of this study was to investigate the relationship between temperament and self-esteem (or social competence) among late adolescents. The Dimensions of Temperament Scale and the Short Form of the Texas Social Behavior Inventory were administered to 186 students. It was found that Adaptability, Attention/Distractibility, and Reactivity all showed significant correlations with self-esteem. An interactive framework suggested that temperament may mediate how each individual perceives and experiences social demands and constraints, thereby influencing the level of positive regard and success during development.     

Denial in adolescence. Some contradictory aspects

Adolescents are simultaneously subject to extremely divergent feelings of strength and of weakness and dependency, aggravated by intense regressive longings. In order to tolerate and master these feelings, adolescents commonly employ the defense of denial. This may result in splitting. A case except shows how such a defensive strategy may hinder or further psychic development.     

Psychosocial aspects of truancy in early adolescence.

The authors studied truancy in junior high school students, largely by structured interviews of 33 truants. Truancy at this age was commonly associated with significant difficulties at home, at school and with peers. Two modal types of truants were delineated: "authority defying" and "peer phobic." The school environment, including the response to truancy and the transition to the junior high, was found to play a critical role in creating and aggravating truancy. The authors discuss the findings with respect to strategies for prevention and remediation.     

Ecology of depression in late childhood and early adolescence: a profile of daily states and activities

This study investigated daily states and time use patterns associated with depression. Four hundred eighty-three 5th to 9th graders reported on their experience when signalled by pagers at random times. Depressed youth reported more negative affect and social emotions, lower psychological investment, lower energy, and greater variability in affect. These differences were weaker for 5th and 6th graders, suggesting that self-reported feeling states are a poor indicator of depression prior to adolescence. No differences were found in the daily activities of depressed youths nor in the amount of time spent alone, but depressed youths experienced other people as less friendly and more often reported wanting to be alone, especially when with their families. They also spent less time in public places and more time in their bedrooms. Finally, depressed boys, but not girls, spent much less time with friends, particularly of the same sex, suggesting that social isolation is more strongly associated with depression for boys.     

Encopresis in adolescence: two case studies.

Encopresis is an underreported psychopathological symptom of adolescence, not necessarily defining a specific diagnostic entity. The two cases presented offer an opportunity to evaluate encopresis occurring in markedly different adolescent pathological entities and developmental backgrounds. The first patient presented a longitudinal life course wherein toilet training and fecal considerations were prominent throughout his development. Indeed, this young man had such areas of cohesive functioning, as to be appropriately considered within the range of characterological pathology, severe, though it may be. In marked contrast, the second patient's encopresis represented but a small part of a totally encompassing psychotic disintegration.     

Developmental status and AIDS attitudes in adolescence.

We postulated that among adolescents and young adults, the development of consistent and responsible attitudes with respect to acquired immunodeficiency syndrome (AIDS) precautions would follow a pattern similar to that of the development of a sense of identity. Late-adolescent trainee teachers and nurses (N = 262) were administered identity and intimacy measures and a questionnaire measuring attitudes toward and knowledge of AIDS prevention. Attitudes were shown to be conceptually complex, with dimensions expressing the identity statuses of diffusion, foreclosure, moratorium, and achievement. Few relationships were found between AIDS attitudes and sex, course, measures of identity, or intimacy. However, attitudes toward AIDS precautions and identity status were predictive of future intention to use a condom. Intimacy level was negatively related to such an intention, suggesting that those in steady relationships may not recognize the need for AIDS protection.     

Risk for suicidal ideation and suicide attempts associated with co-occurring depression and conduct problems in early adolescence

This study investigates the early manifestation of co-occurring depression and conduct problems as a predictor of heightened risk for later suicidal ideation and behavior in a community sample of 521 adolescents. Self-reported symptoms of depression and conduct problems were evaluated in early 6th grade. Suicidal thoughts and behaviors were tracked through multiple assessments carried out over the middle school years. Compared to adolescents with depression symptoms only, conduct problem symptoms only, or low psychopathology, those with co-occurring depression and conduct problem symptoms had the highest risk for subsequent suicidal ideation, recurrent suicidal behaviors, and suicide attempts.     

Association of parental depression with psychiatric course from adolescence to young adulthood among formerly depressed individuals

The authors examined whether parental major depressive disorder (MDD) is associated with course of depression and other psychopathology among formerly depressed adolescents as they enter adulthood. The sample consisted of 244 individuals (age 24) in a longitudinal study who had experienced MDD by 19. Maternal MDD was associated with MDD recurrence, chronicity and severity, anxiety disorders, and (among sons only) lower psychosocial functioning in offspring between the ages of 19 and 24. Paternal MDD was associated with lower functioning. Sons of depressed fathers had elevated suicidal ideation and attempt rates in young adulthood. Recurrent paternal MDD was associated with depression recurrence in daughters but not sons. The impact of parental MDD on offspring could not be attributed to characteristics of the offspring's depression prior to age 19.     

The longitudinal relation between personality disorder symptoms and depression in adolescence: the mediating role of interpersonal stress

The relation between personality disorder (PD) symptoms, depression, and interpersonal stress were examined over 6 months in a sample of 143 adolescents from a low-income urban high school. Both self report questionnaires in the full sample and structured interviews in a subset of 54 girls indicated the following: PD symptoms predicted greater depressive symptoms and interpersonal stress over time; PD symptoms were highly stable; depressive symptoms did not predict change in PD symptoms over time. Moreover, an integrative model was supported, wherein the route by which PD symptoms led to greater depression was via the generation of interpersonal stress. These results suggest that adolescents' PD symptoms play a destructive role in the construction of interpersonal circumstances during a key period for depression onset.     

Abortion in adolescence

Sexual attitudes and behavior of adolescent females have been the topic of much interest over the past decade. Feelings about contraception, conception, and abortion have been described in relation to the adolescents' beliefs about the possibility of becoming pregnant, who will or will not "protect" them, and the influence of significant others on their decision making. This study explores differences in 35 women who had abortions during their teenage years with 36 women whose abortions occurred after the age of twenty. A demographic questionnaire, the Millon Clinical Multiaxial Inventory, and the Beck Depression Inventory were completed by women who were members of a patient-led support group. Premorbid psychiatric histories, the decision-making process itself, and distressing symptoms postabortion are reported. Specific differences in perceptions of coercion, preabortion suicidal ideation, and nightmares post-abortion were found in the adolescent group. Antisocial and paranoid personality disorders as well as drug abuse and psychotic delusions were found to be significantly higher in the group who aborted as teenagers. Hypotheses regarding the influences of adolescent development on mother/child relationships, power struggles, and the use of fantasy as a coping device are explored.