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Social consequences of psychiatric disorders, II: Teenage parenthood
Abstract
The subject of this study was the relation between retrospectively reported early-onset psychiatric disorders and subsequent teenage parenthood in the general population.
The data were from 5,877 respondents aged 15-54 years in the National Comorbidity Survey, a nationally representative household survey. Information on respondents' DSM-III-R anxiety disorders, mood disorders, substance abuse disorders, and conduct disorder, age at the birth of the first child, and teenage sexual activity was collected in face-to-face interviews.
Early-onset psychiatric disorders were associated with subsequent teenage parenthood among both females and males, with significant odds ratios of 2.0-12.0 and population attributable risk proportions of 6.2%-33.7%. Disaggregation analyses showed that disorders were associated with increased probability of sexual activity but not with decreased probability of using contraception.
These results add to a growing body of evidence that psychiatric disorders are associated with a variety of adverse life consequences. The current policy debate concerning universal insurance coverage needs to take this into consideration. Planners of interventions aimed at preventing teenage pregnancy should consider including a mental health treatment component in their intervention packages. Mental health professionals treating adolescents need to be sensitized to their higher risk of pregnancy, while family doctors and specialists treating teenage mothers or their children need to be sensitized to the mothers' higher risk of psychiatric disorder.
... A range of study designs was used across the 18 articles (see Table 1 for details). The majority (n = 9) were cross-sectional studies (Chernick et al., 2020;Dorfman et al., 2010;Francis et al., 2015;Jiménez-Iglesias et al., 2018;Kessler et al., 1997;Kosunen et al., 2003;Moore et al., 2017;Morrison et al., 2016;Wilson et al., 2010). Four were longitudinal cohort studies (DiClemente et al., 2001;Hall et al., 2013aHall et al., , 2013bLehrer et al., 2006). ...
... Over half of the studies (n = 10) included both AYAs (DiClemente et al., 2001;Dorfman et al., 2010;Francis et al., 2015;Hall et al., 2012;Jiménez-Iglesias et al., 2018;Kessler et al., 1997;Lehrer et al., 2006;Toffol et al., 2020;Wilson et al., 2010;Zink et al., 2002). Seven studies included data for young adult participants but not adolescents (Hall et al., 2013a(Hall et al., , 2013bMoore et al., 2017;Morrison et al., 2016; Kessler 10 scale: ...
... A total of 10 studies looked at contraceptive consistency or related outcomes as its main outcome (Chernick et al., 2020;DiClemente et al., 2001;Dorfman et al., 2010;Hall et al., 2013aHall et al., , 2013bKessler et al., 1997;Kosunen et al., 2003;Lehrer et al., 2006;Morrison et al., 2016;Wilson et al., 2010). Eight of these demonstrated a significant association between depression and increased likelihood of contraceptive nonuse (Chernick et al., 2020;DiClemente et al., 2001;Dorfman et al., 2010;Kosunen et al., 2003;Lehrer et al., 2006;Wilson et al., 2010) and decreased likelihood of contraception consistency (Hall et al., 2013b;Morrison et al., 2016). ...
Introduction: Adolescents and young adults (AYAs) are at increased risk for unintended pregnancy compared to older females. Prior research suggests that mental health, particularly depression and anxiety, is associated with inconsistent use of condoms or nonbarrier contraception (i.e., contraceptive pills, injections, implants, intrauterine devices, etc.), which contributes to an increased risk for unintended pregnancy. Most research has focused on the relationship between mental health and condom use among adults. To our knowledge, the literature looking at depression or anxiety as predictors of nonbarrier contraception use has not been synthesized for AYA females, which is the aim of this study. Methods: PubMed and Cochrane databases were searched for studies that assessed depression or anxiety as predictors and outcomes related to nonbarrier contraception use of females ages 10–25 years. Of 548 articles screened, 18 studies were eligible and included in this review. Results: Four primary outcome variables were identified: contraception consistency, nonbarrier contraception use, type of nonbarrier contraception used, and use of dual contraception. Most articles (n = 16) found a significant association between depression and/or anxiety and an increased likelihood of inconsistent contraception and/or a decreased likelihood of using nonbarrier contraception. Conclusions: The presence of depression and/or anxiety in female AYAs was associated with, and in some cases predictive of, decreased nonbarrier contraception use and/or inconsistent use, which may increase the likelihood of unintended pregnancy. This study provides evidence that depression and anxiety are important considerations for medical professionals in providing holistic care to AYAs while supporting their goals around pregnancy prevention.
... Ergen babalığın öncüllerini araştıran bir sistematik derlemede ergen babalığın öncülleri ırk/etnik yapı, bireysel ve ailesel etkiler olarak bildirilmiştir (9). Yapılan birçok araştırmada siyahi ve Latin kökenli adölesanların baba olma ihtimalinin daha yüksek olduğunu vurgulanmaktadır (15,16). ...
... Adölesan babalar ebeveynlik rolüne geçiş yaparken karşılaştıkları stres ve sorunlar nedeniyle hem kendileri hem de çocukları fiziksel ve psikolojik yönden olumsuz etkilenebilir (15) Genç erkekler babalığa geçiş yaparken, bazı açılardan adölesan anneninkine benzer bir geçiş süreci yaşarlar. Kanıt temelli çalışmalarda adölesan babalık eğitimsel kazanımlardan geri kalma, düşük sosyoekonomik durum, olumsuz sağlık sonuçları, bozulmuş aile dinamikleri, yoksulluk gibi birçok olumsuz sonuç ile ilişkilendirilmiştir (7,9,10,16,20,22,23). ...
... Literatür incelendiğinde adölesan babalığın ergenin eğitimini olumsuz etkilediğini savunan araştırma sonuçları çoğunlukta olmak üzere etkisinin önemsiz olduğunu belirten çalışmalar da mevcuttur (7,16,20,21,24). Ergen ebeveynler genellikle bir bebek büyütmek için gereken zamanı oluşturmak ve iş bularak çocuklarının geçimini sağlamak için okulu bırakmayı bir çözüm olarak görürler. ...
... Studies have also investigated the impact of early onset mental health disorders on the timing and stability of partner relationships (i.e. married or cohabiting) and childbearing (Forthofer et al., 1996;Kessler et al., 1997Kessler et al., , 1998. Retrospective (cross-sectional) data from the National Comorbidity Survey in the USA has shown that anxiety, depressive, conduct and substance use disorders are associated with early first marriage (Forthofer et al., 1996), teenage parenthood (Kessler et al., 1997) and subsequent separation and divorce (Kessler et al., 1998). ...
... married or cohabiting) and childbearing (Forthofer et al., 1996;Kessler et al., 1997Kessler et al., , 1998. Retrospective (cross-sectional) data from the National Comorbidity Survey in the USA has shown that anxiety, depressive, conduct and substance use disorders are associated with early first marriage (Forthofer et al., 1996), teenage parenthood (Kessler et al., 1997) and subsequent separation and divorce (Kessler et al., 1998). However, little prospective epidemiological research has specifically assessed the impacts of early adulthood depression and anxiety on the quality of future partner relationships. ...
... These findings add to the body of research demonstrating that depression and anxiety in early adulthood have important personal and social costs, not only for the individuals experiencing poor mental health, but also their partners. Existing epidemiological research exploring early onset depression and anxiety in relation to partner relationships has focused on the consequences for early marriage and teenage parenting (Forthofer et al., 1996;Kessler et al., 1997;Gotlib et al., 1998), and also subsequent separation and divorce (Kessler et al., 1998). The current study adds new information, finding that greater levels of depression (but not anxiety) in early adulthood (aged 20-24) are associated with a lower likelihood of finding a long-term partner in the future. ...
Aims
Mental health problems in early adulthood may disrupt partner relationship formation and quality. This prospective study used four waves of Australian data to investigate the effects of depression and anxiety in early adulthood on the quality of future partner (i.e. marriage or cohabiting) relationships.
Methods
A representative community sample of Australian adults aged 20–24 years was assessed in 1999, 2003, 2007 and 2011. Analyses were restricted to those who at baseline had never entered a marriage or cohabiting relationship with no children ( n = 1592). Associations were examined between baseline depression and anxiety levels (using the Goldberg Depression and Anxiety scales) and (a) future relationship status and (b) the quality of marriage or cohabiting relationships recorded at follow-up (up to 12 years later) (partner social support and conflict scales).
Results
Depression in early adulthood was associated with never entering a partner relationship over the study period. For those who did enter a relationship, both depression and anxiety were significantly associated with subsequently lower relationship support and higher conflict. Supplementary analyses restricting the analyses to the first relationship entered at follow-up, and considering comorbid anxiety and depression, strongly supported these findings.
Conclusions
Depression and anxiety in early adulthood is associated with poorer partner relationship quality in the future. This study adds to evidence showing that mental health problems have substantial personal and inter-personal costs. The findings support the need to invest in prevention and early intervention.
... Elterliche psychische Gesundheit spielt eine wichtige Rolle für die Gesundheit der Kinder. Minderjährige Mütter sind oft durch multiple psychosoziale und biologische Faktoren belastet, die die Auftretenswahrscheinlichkeit einer psychiatrischen Erkrankung deutlich erhöhen und gleichzeitig das Risiko, minderjährig Mutter zu werden, ebenso vergrößern [22]. ...
... Eine vorbestehende kinder-und jugendpsychiatrische Erkrankung erhöht die Wahrscheinlichkeit einer Schwangerschaft in der Adoleszenz mit einer relativen Chance (Odds Ratio) von 2,0 bis 12,0 [22], meist durch Risikoverhalten einhergehend mit früherem Beginn von Sexualkontakten [6]. Insbesondere eine Aufmerksamkeitsdefizit-und Hyperaktivitätsstörung (ADHS), eine Depression, eine Störung des Sozialverhaltens, delinquentes und dissoziales Verhalten oder Substanzabusus begünstigen eine frühe Schwangerschaft [12,16,18]. ...
Background
Motherhood in adolescence is associated with risks for both the young mother and the children.
Objective
Presentation of the current state of research on the mental health of adolescent mothers and its effects on the development of their children.
Material and methods
Electronic database search in PubMed using various combined key terms such as “teenage pregnancy”, “adolescent pregnancy”, “teenage mother”, “child development”, “mother-child interaction”. Review of the literature of the sources found and discussion of current publications and databases of public institutions.
Results
In addition to psychosocial risks such as fewer education years due to family formation and lower incomes, young mothers also suffer more frequently from mental disorders, both before pregnancy and due to the additional burden of motherhood in their own developmental phase of youth. These can have unfavorable effects on the mother-child interaction and on the psychosocial and cognitive development of the children, thereby leading to the transgenerational transmission of risk factors.
Conclusion
In addition to primary prevention by avoiding teenage pregnancies, early identification of adolescent mothers and children at risk for early treatment and intervention is necessary.
... Second, relations between adolescent couples are expected to be unstable and impermanent, such that the demands of sustaining a long-term (coparenting) relationship lie outside the realm of what is developmentally normative (Collins, 2002). Finally, previous research has indicated that adolescents who become parents are at high risk for several factors associated with problematic parenting, including higher rates of psychopathology; an economically disadvantaged home environment; and deficient levels of support from parents, peers, and partner (Fagot, Pears, Capaldi, Crosby, & Leve, 1998;Flanagan et al., 1995;Kessler et al., 1997;Miller-Johnson et al., 1999;Moore & Florsheim, 2001;Stevens-Simon et al., 2001). Despite these risks associated with adolescent parenthood, it is important to note that not all adolescent parents are at equal risk for dysfunctional parenting and most do not abuse their children, which begs the question of how we can best identify, understand, and help those who are most at risk. ...
This study examined relationship factors associated with parental dysfunction among young African American and Latino couples. Parent dysfunction was defined in terms of parenting stress, child abuse potential, physically punitive behavior, and paternal disengagement. Fathers who reported positive relations with their own parents and partners before childbirth reported more positive adjustments to parenthood at follow-up. The quality of the prebirth partner relationship buffered the impact of a relationship breakup on a young father's adjustment to parenthood. The quality of a mother's relationship with her parents was the best predictor of her adjustment to parenthood. However, mothers who reported large declines in the quality of the partner relationship also reported high levels of parenting stress. Clinical and policy implications of findings are discussed.
... These results are consistent with an increasing body of work showing rather general associations between forms of psychopathology and adverse outcomes. For instance, in data from the National Comorbidity Survey, a variety of Axis I disorders, espe-cially early-onset disorders, have shown associations with early first marriage (Forthofer, Kessler, Story, & Gotlib, 1996), divorce (Kessler, Walters, & Forthofer, 1998), low educational attainment (Kessler, Foster, Saunders, & Stang, 1995), and teenage parenthood (Kessler et al., 1997). Likewise, Thompson and Bland (1995) found a general relationship between many different Axis I disorders and social problems, leading them to call for increased attention to a common underlying factor. ...
The relationships between romantic relationship dysfunction and symptoms of borderline personality disorder (BPD), other personality disorders, and depression were examined prospectively in a community sample of 142 late adolescent women. Although BPD symptoms predicted 4-year romantic dysfunction (romantic chronic stress, conflicts, partner satisfaction, abuse, and unwanted pregnancy), the associations were not unique to BPD. Instead, relationship dysfunction was better predicted by a cumulative index of non-BPD Axis II pathology. Depression did not predict outcomes uniquely when Axis II symptoms were included, except in the case of unplanned pregnancy. The results suggest that although BPD is associated with relationship dysfunction, the effect is a more general phenomenon applying rather broadly to Axis II pathology. The results also highlight the importance of subclinical psychopathology in the construction of early intimate relationships.
... Similarly, affective states which are consistently negative have been reported to be linked to the propensity of developing depressive disorders [21]. The impacts of unmediated psychiatric health states are far-reaching, including high school drop-out [49], divorce rates [50], and early parenthood [48]. Additionally, mood significantly influences our cognition, sociability, and productivity. ...
Due to their abundance of sensors, today’s smartphones can act as a scientific tool to collect contextual information on users’ emotional, social, and physical behaviour. With the continuously growing amount of data that can be unobtrusively extracted from smartphones, mood-tracking and inference methods have become more feasible. However, this does raise critical implications for end-users, including accessibility and privacy. Following a structured selection process, we reviewed 32 papers from the ACM Digital Library on mood inference and tracking using smartphones. We conducted an in-depth analysis of used sensors, platform and accessibility, study designs, privacy, self-reporting methods, and accuracy. Based on our analysis, we provide a detailed discussion of the opportunities for research and practice that arise from our findings and outline recommendations for future research within the area of smartphone-based mood tracking and inference.
KeywordsMood trackingMood inferenceSmartphones
... Importantly, high rates of psychiatric disorders among low-income women partially reflect gender differentials. Research indicates that women-due to a variety of psychological, biological, and environmental factorsare more likely than men to experience depression, Post Traumatic Stress Disorder (PTSD), and anxiety disorders (Belle, 1990;Bassuk, Buckner & Bassuk, 1998;Kessler, Foster & Saunders, 1995). Yet the inverse relationship between SES and psychiatric disorder also helps to explain these gender-based differences, as women are over-represented among the poor. ...
... The social causation theory, in contrast, posits that social inequality, health resources gaps and context-related stress may increase the risk of mental disorders. 6, [14][15][16] The general consensus to date suggests that health selection could play a stronger role in severe mental disorders (SMD) like schizophrenia, whereas social causation would be more relevant for common mental disorders such as anxiety or depressive symptoms. 17,18 Although researchers have considered socio-economic factors mainly environmental, the two core phenotypes comprising SES, income and educational attainment (EA), are substantially heritable (40-60%). ...
Importance Despite the evidence supporting the relationship between socioeconomic status (SES) and severe mental disorders (SMD), the directionality of the associations between income or education and mental disorders is still poorly understood.
Objective To investigate the potential bidirectional causal relationships between genetic liability to the two main components of SES (i.e., income and educational attainment (EA)) on three SMD: schizophrenia (SCZ), bipolar disorder (BD) and major depressive disorder (MDD) using multivariable Mendelian randomisation.
Design, Setting, and Participants We performed a bidirectional, two-sample multivariable Mendelian randomisation (MVMR) study using summary statistics from the latest genome-wide associations studies (GWAS) of the Psychiatric Genomics Consortium (PGC), the UK biobank and the Social Science Genetic Association Consortium (SSGAC) to dissect the potential associations of income and EA with schizophrenia, BD and MDD including data for participants of European ancestry only. Data covered September 2022 to January 2023.
Main Outcomes and Measures Socioeconomic status phenotypes (household income from the UK biobank, n=397,751, and EA based on the largest meta-analysis GWAS of individuals of European ancestry, n=766,345) and SMD from the PGC (schizophrenia, n=127,906; BD, n=51,710; and MDD n=500,119). Follow-up analyses were performed using the intelligence meta-analytical phenotype, n=269,867.
Results GWAS data were derived from participants of European ancestry included in the UK Biobank, SSGAC and PGC consortiums (samples ranging from 766,345 to 51,710 individuals). Univariable MR (UVMR) showed that genetic liability to household income was associated with decreased risk of schizophrenia (IVW-ORSCZ=0.58 per-one-SD increase; P-value= 0.016) and MDD (IVW-ORMDD:0.66 P-value: 9.81e-08), with a smaller reverse effect of schizophrenia and MDD on income (IVW-βSCZ= -0.1147, P-value=7.55E-08; IVW-βDEP=-0.0356, P-value=8.70E-04). Direct effects (MVMR) after adjusting for EA were comparable. UVMR showed that genetic liability to EA was associated with lower risk of MDD and higher risk of BD, with no significant effects on schizophrenia. After accounting for income in the MMVR analyses, direct effects of genetic liability to EA was associated with increased risk of BD (MVMR-ORBIP: 2.69 per SD increase, P-value= 0.0000113) and schizophrenia (MVMR-ORSCZ: 2.09 per-SD-increase, P-value= 0.00108), but not with MDD. Effects for the association of EA with schizophrenia and BD were larger when including genetic liability to intelligence in the MVMR model, thus suggesting that they might reflect a non-cognitive component.
Conclusions and Relevance The findings of this multivariable Mendelian randomisation analysis suggest an heterogenous pattern of causal links between SES and SMD. We found evidence for a negative bidirectional association between genetic liability to household income and the risk of schizophrenia and MDD. On the contrary, we found a positive bidirectional relationship of genetic liability to EA with schizophrenia and bipolar disorder, which only becomes apparent after adjusting for income. These findings shed light on the directional mechanisms between social determinants and mental disorders and may help to guide public mental health strategies addressing inequality and economic disadvantages.
... The prevalence of mental and substance use disorders increased by 37.6% between 1990 and 2010, becoming one of the significant contributors to the burden of disease worldwide (1). Furthermore, more than 80% of the people affected reside in low-and middle-income countries (LAMICs), creating substantial social (2)(3)(4) and economic hardships (5)(6)(7)(8) for affected individuals and their families and society as a whole (9,10). For this reason, several organizations, including the World Health Organization (WHO), advocate primary prevention, control, and treatment of mental health disorders and psychosocial problems, especially those starting in the early years of life (11). ...
Background: Peru is the worst affected country by the COVID-19 pandemic showing the world highest mortality rate, thus triggering an increased mental health burden. Nevertheless, there are few population-based epidemiologic surveys of mental disorders in Peru; Therefore, nationally representative research is needed to understand the underlying population-based mental health burden and identify unmet care needs.
Objective: The present study aims to estimate the prevalence and patterns of psychiatric disorders, mental health service use, and unmet mental health care needs
Methods: This cross-sectional study will collect information from a multistage random sample of 19,500 households. A child, an adolescent, an adult, and an older adult will be interviewed in the household. Trained staff will conduct face-to-face diagnostic interviews via the Preschool Age Psychiatric Assessment, the Child and Adolescent Psychiatric Assessment, the WHO's Composite International Diagnostic Interview, and the Alzheimer Disease 8 Scale. In addition, descriptive and inferential analysis for complex sampling will be performed to estimate the prevalence and correlates.
Ethics and dissemination: IRB will approve the research protocol before the commencement of the study. Only respondents who signed their informed consents or assents will participate in the study; The parent or guardian will sign the consent for the participation of preschool children. The research findings will be disseminated in peer-reviewed publications, scientific reports, and presentations at national, and international meetings. In addition, de-identified data and study results will be posted on the Peruvian National Institute of Mental Health (PNIMH) website to be freely available to policymakers, researchers, and the general public.
... Chatbots are heavily used in consumer settings because of their ability to quickly provide tailored information and increase purchasing probability. In the health sector, chatbot use is less prevalent but has been applied to mental health intervention delivery [14,15]. ...
BACKGROUND
Behavioral health provider supply has not kept pace with demand. Simply training more professionals will not be enough to address the strain on the U.S. behavioral healthcare workforce and exacerbated behavioral health challenges among U.S. adults due to COVID-19.
OBJECTIVE
Our objective was to pilot test a mental health chatbot designed to screen users for psychological distress and refer to resources.
METHODS
Data were collected via a national, cross-sectional, internet-based survey of U.S. adults. Measures included demographics, symptoms, stigma, technology acceptance, willingness to use the chatbot, and chatbot acceptability. Relationships between these variables were explored using chi-square tests, correlations, and logistic regression.
RESULTS
Of 222 participants, 75.7% completed mental health screening within the chatbot. Participants found the chatbot to be acceptable. Demographic predictors of chatbot use included being White or Black/African American, identifying as Hispanic/Latino, having dependents, having insurance coverage, having used mental health services in the past, having a diagnosed mental health condition, and reporting current distress. Logistic regression produced a significant model with perceived usefulness and symptoms as significant positive predictors of chatbot use for the overall sample, and label avoidance as the only significant predictor of chatbot use for those currently experiencing distress.
CONCLUSIONS
Chatbot technology may be a feasible and acceptable way to screen large numbers of people for psychological distress and disseminate mental health resources. Since label avoidance was identified as the single significant predictor of chatbot use among currently distressed individuals, chatbot technology may be one way to circumnavigate stigma as a barrier to engagement in behavioral health care.
... Beyond comorbidities, gender is likely the most important to consider. While an in-depth discussion on sex differences in inflammation and depression is far beyond the scope of this review, it is worth noting that, in general, women experience higher levels of inflammation than men [167,168] while suffering disproportionately more from several psychiatric diseases [169], particularly mood disorders [170][171][172][173]. Future studies that examine sex differences in LUTS-induced mood disorders should prove to be quite revealing. ...
Anecdotal evidence has long suggested that patients with lower urinary tract symptoms (LUTS) develop mood disorders, such as depression and anxiety, at a higher rate than the general population and recent prospective studies have confirmed this link. Breakthroughs in our understanding of the diseases underlying LUTS have shown that many have a substantial inflammatory component and great strides have been made recently in our understanding of how this inflammation is triggered. Meanwhile, studies on mood disorders have found that many are associated with central neuroinflammation, most notably in the hippocampus. Excitingly, work on other diseases characterized by peripheral inflammation has shown that they can trigger central neuroinflammation and mood disorders. In this review, we discuss the current evidence tying LUTS to mood disorders, its possible bidirectionally, and inflammation as a common mechanism. We also review modern theories of inflammation and depression. Finally, we discuss exciting new animal studies that directly tie two bladder conditions characterized by extensive bladder inflammation (cyclophosphamide-induced hemorrhagic cystitis and bladder outlet obstruction) to neuroinflammation and depression. We conclude with a discussion of possible mechanisms by which peripheral inflammation is translated into central neuroinflammation with the resulting psychiatric concerns.
... Chatbots are heavily used in consumer settings because of their ability to quickly provide tailored information and increase purchasing probability. In the health sector, chatbot use is less prevalent but has been applied to mental health intervention delivery (Kessler et al., 1997;Kessler et al., 1998). ...
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Objectives
To pilot test a mental health chatbot designed to screen users for psychological distress and refer to resources, addressing the strain on the U.S. behavioral healthcare workforce and exacerbated behavioral health challenges among U.S. adults due to COVID-19.
Methods
Data were collected via a national, cross-sectional, internet-based survey of U.S. adults. Measures included demographics, symptoms, stigma, technology acceptance, willingness to use the chatbot, and chatbot acceptability. Relationships between these variables were explored using chi-square tests, correlations, and logistic regression.
Results
Of 222 participants, 75.7% completed mental health screening within the chatbot. Participants found the chatbot to be acceptable. Demographic predictors of chatbot use included being White or Black/African American, identifying as Hispanic/Latino, having dependents, having insurance coverage, having used mental health services in the past, having a diagnosed mental health condition, and reporting current distress. Logistic regression produced a significant model with perceived usefulness and symptoms as significant positive predictors of chatbot use for the overall sample, and label avoidance as the only significant predictor of chatbot use for those currently experiencing distress.
Discussion
Chatbot technology may be a feasible and acceptable way to screen large numbers of people for psychological distress and disseminate mental health resources. Since label avoidance was identified as the single significant predictor of chatbot use among currently distressed individuals, chatbot technology may be one way to circumnavigate stigma as a barrier to engagement in behavioral health care.
Limitations
Recruitment through Amazon’s mTurk limits generalizability of our findings, and chi-square test effect sizes were small.</p
... In a study in the United States (US) young maternal age was associated with greater risk of antenatal and postpartum depressive symptoms, which were attributed to financial hardship, unwanted pregnancy and lack of a partner [21]. Similar findings were reported in other studies from the United Kingdom and US [22,23]. The mean age of our women was 26.5 years, which is identical to a hospitalbased study of postnatal depression in Pakistan that showed the average age of women was 26 years. ...
... In the United States (U.S.), only 32% of students with a serious mental illness continued to postsecondary education (Government Accountability Office, 2008). Untreated, mental disorders could also negatively impact family life (Gall et al., 2000;Pearson, 2015;Pierce et al., 2020;Wagner et al., 2006) and were associated with increased risk of teenage parenthood and a substantially higher risk of divorce later in life (Corcoran, 2016;Idstad et al., 2015;Kessler et al., 1997;Paranjothy et al., 2009). More than half of young people in the juvenile justice system had a diagnosable mental disorder (Burns et al., 2004;Underwood & Washington, 2016). ...
Les élèves de cinquième secondaire sont confrontés à de nombreuses responsabilités et à de nombreux défis lors de leur transition vers la vie postsecondaire. Cette étape de la vie coïncide avec certains des défis auxquels sont confrontés les adolescents en matière de santé mentale, car c’est à ce moment-là que la plupart des troubles mentaux se manifestent pour la première fois. Cependant, avec une bonne éducation sur ces nouveaux changements de vie, les élèves ont la possibilité de s’épanouir. La présente étude vise à comprendre si un programme mixte de connaissances en santé mentale et de compétences à la vie quotidienne vie Know Before You Go (KBYG) [traduction libre : à savoir avant de partir] améliorera les connaissances des élèves en matière de santé mentale, développera les compétences de vie nécessaires à la vie postsecondaire et réduira le stress perçu. Cent soixante-huit élèves de cinquième secondaire ont répondu à des sondages anonymes sur les connaissances en matière de santé mentale, les aptitudes à la vie quotidienne et le stress perçu avant de recevoir le programme KBYG par les enseignants à l’aide du Guide de l’enseignant, après la séance et un mois plus tard. Des tests t d’échantillons appariés et des analyses de covariance ont été effectués à l’aide du progiciel statistique pour les sciences sociales (SPSS) à un niveau de signification de α = 0,05. Les étudiants ont montré une amélioration significative de leurs connaissances et une réduction du stress entre le prétest, le post-test et le suivi (p < 0,05). Nous n’avons constaté aucune différence entre les élèves de sexe masculin et les élèves de sexe féminin en matière de connaissances, mais un stress plus élevé chez les élèves de sexe féminin lors du post-test. Lors du suivi, les élèves de sexe féminin ont démontré des connaissances plus durables et des niveaux de stress plus élevés (p < 0,05) que les élèves de sexe masculin. Le programme KBYG associé au Guide de l’enseignant peut avoir un impact positif sur la confiance perçue des élèves dans leurs capacités alors qu’ils s’engagent dans un nouveau mode de vie après l’école secondaire.
... They more frequently engage in delinquent (Tremblay et al., 2017) or violent behavior (Tremblay et al., 2017) and substance abuse (Fagot et al., 1998;Moore & Florsheim, 2001). They are more likely to experiences episodes of crisis, depression, and psychiatric illnesses (Kessler et al., 1997;Liberska et al., 2018). They have lower self-esteem (Neault et al., 2012), poorer abilities to predict the consequences of their actions, and comparatively lower self-control (Dudley & Stone, 2001). ...
Prior research on young adult fathers has included a limited number of ecological studies of this population. The purpose of the present study was to address this void in the literature by exploring the paternal commitments of adolescent and young adult fathers. We hypothesized that a qualitative study of young fathers would reveal a rich understanding of their perspectives and experiences during the prenatal period through the first year of the child’s life and the ecological issues that emerged during this period. We conducted initial interviews with 34 fathers ranging in age from 15 to 24 years old at the announcement of the pregnancy and again by the child’s first birthday. The results of a content analysis of the interviews are presented within an ecosystemic framework, which illustrates how numerous factors converge to influence a young father’s commitment to his child. Our findings indicate that, despite mixed reactions to the initial announcement of the pregnancy and numerous disadvantages in their lives, these young men generally showed a willingness to assume paternal responsibilities. The participants also revealed key issues associated with the mother of the child, living arrangements, the mother’s family, the labor market, and social and health services. Implications of these findings for effective outreach, services for young fathers, and future research are discussed.
... Depression and anxiety in young populations may have a negative impact later on in their lives. Studies have revealed associations of such psychopathology with disorders with disability (World Health Organization 2017), future mental health problems, school performance (World Health Organization, 2017;Butterworth and Leach, 2018) and employment status (Fergusson and Woodward, 2002), and interpersonal functioning i.e. partner relationship (Leach et al., 2020), childbearing (Kessler et al., 1997), marriage difficulties and divorce (Kessler et al., 1998). ...
Background
Few studies have investigated depression-anxiety in adolescents/young adults in Greece. We examined the prevalence of depression/anxiety and its correlates in a large, representative, population-based sample of young Greeks.
Methods
A structured telephone questionnaire was conducted in 2,771 adolescents/young adults aged between 15-24 years (mean age: 20.47±2.83 years). Depression/anxiety symptoms were assessed using the PHQ-9 and GAD-7 scales, respectively. Sociodemographics, mental health, and psychological parameters were also examined. Moderate to severe depression and anxiety symptoms were defined with PHQ-9≥10 and GAD-7≥10, respectively. Analysis was conducted using multivariable linear and logistic regression models.
Results
In our sample, 803 (29%) and 416 (15%) participants reported depressive and anxiety symptoms, respectively. In multivariable analysis, depression was associated with female sex, younger age, mental health history, substance use, dyslexia, lower quality of life and social seclusion (all p< 0.05). Within youth with mental health history, depression was associated with younger age, female sex, dyslexia, attention difficulties, and substance use (p<0.05). Multivariable analysis revealed similar to depression associations between anxiety and sociodemographic and clinical correlates. Mental health history plus attention/learning problems and substance use was associated with a 57% chance of being depressed. Neither depression nor anxiety was associated with unemployment/low income.
Limitations
Due to cross-sectional design, causality between correlated factors cannot be examined.
Conclusions
Depression and anxiety symptoms among youth in Greece are frequent and associated more with previous mental health history and co-existing attention/ learning difficulties, and substance use, rather than known socioeconomic factors. These results may affect preventive health strategies’ priorities.
... Especially adolescent mothers aged between 15 and 21 are considered of being at higher risk for adverse developments [1,6]. In the transition from adolescence to adulthood, giving birth increases the exposure of child maltreatment, neglect, and adverse child development as well as the risk of maternal mental health problems [7][8][9][10]. Particularly young mothers suffer from depressive mood and future anxiety which may interfere with sensitive and emotionally available parenting. ...
Background
Psychotherapy of mother-child dyads is an intervention which was developed to prevent maltreatment and negative children’s development. There is a lack of good-quality research investigating psychotherapeutic interventions and social care for mothers at high-risk living in Mother-Child Facilities in Germany. The present randomized controlled pilot trial (RCT) aimed to evaluate the need for parent-infant psychotherapy (PIP) and to explore its impact on the mother-infant relationship. Primary feasibility objectives were recruitment and attrition, with potential efficacy defined as the secondary feasibility objective.
Methods
This pilot RCT focused on (young) mothers with cumulative risk factors and their infants under 7 months of age living in Mother-Child Facilities. N =32 mother-child dyads were randomly allocated to PIP or Care as usual (CAU). Outcomes were assessed at baseline, 3 months, and 6 months of intervention. The primary potential efficacy outcome was maternal sensitivity. Secondary outcomes were maternal mental health problems, reflective functioning, parenting stress, personality organization, infant’s development, and attachment.
Results
At baseline, all mothers showed low levels of emotional availability, but results revealed improvements in sensitivity, mental health problems, stress, and depressive symptomatology favoring PIP after 6 months. Positive developments in maternal sensitivity, a healthy aspect of mother-child interaction, were only found in the PIP group. Overall attrition was high at 6 months. Some evidence of fewer depressive symptoms and lower maternal distress after 6 months of PIP-intervention exists that did not reach significance.
Conclusion
Findings revealed improvements in the mother’s well-being for both groups, but PIP had a higher impact on the mother-child dyad. In sum, there is some evidence that PIP may represent an effective intervention offer besides the social and pedagogical support in these facilities, but further research is demanded.
Trial registration
DRKS00022485 (retrospectively registered).
... Non-reduction of treatment gap has implications beyond impact on national burden of diseases (Years Lived with Disability and Disability Adjusted Life Years), such as increasing indirect economic costs (owing to absenteeism and lost productivity at work) [13], impairing family function [14], and increasing the risk of teenage childbearing [15] and domestic violence [16]. Many socio-cultural and psychosocial barriers in demand for mental health care services as well as pragmatic and health system functioning barriers along with difficulties in accessing health care has widened the treatment gap of mental illnesses at PHC facilities. ...
Aim:
To explore the factors affecting mental health service utilization from Primary Health Care facilities of Arghakhanchi district, a western hilly district of Nepal.
Background:
Mental health service utilization has many facilitating and hindering factors present at different socio-ecological levels. Stigma and lack of awareness in the community have been identified as the major barriers for mental health service demand and access worldwide.
Methods:
A cross-sectional qualitative study was conducted in Arghakhanchi district of Nepal in July-August 2019 that collected information through face-to-face In-depth and Key Informant Interviews of three categories of participants selected judgmentally. Thirty-two purposively selected participants from the three categories were interviewed using validated interview guidelines. Thematic analysis was performed using RQDA package for EZR software. Validation of translated transcripts, member checking and inter-coder percent agreement were performed to maintain rigor in the study.
Results:
Mental health stigma and inadequate awareness were identified as major factors that caused barriers for mental health service utilization at community level. They also influenced different factors at other socio-ecological levels to act as barriers. Awareness in community along with accessibility and availability of comprehensive mental health services were recommended by the participants for increasing service utilization from Primary Health Care facilities.
Conclusion:
Individual, family and community awareness could help reduce and/or eliminate mental health stigma. Accessibility of health facilities and availability of comprehensive mental health services in Primary Health Care facilities could help increase service utilization from those facilities.
... These negative health outcomes may be attributed to the fact that, during the turbulent period of adolescence, youths are not prepared for the excessive emotional, social, and financial demands of the adult and family responsibilities associated with precocious life events (Maynard, 1996;Kessler et al., 1997;Teti & Lamb, 1989). Such stressful experiences have been shown to have long-term health consequences over the life course. ...
... At an average of 17% [4], the prevalence of suicide attempts among adolescents is much higher in LMICs than those in the developed world [5][6][7][8][9]. Those stressors which contribute to suicide are also linked to other outcomes associated with low educational attainment, poor work productivity, and lower wages, resulting in lower economic growth potential for a nation [10,11]. ...
Purpose
There is economic importance to stimulating awareness about preventing adolescent suicide and other associated deleterious mental and behavioral health outcomes, especially the long-term costs from lost productivity. However, the presence of stigma and poor healthcare reporting systems which often prevent data access have frequently limited research into these topics in low-and-middle income (LMICs) countries. The majority of existing research on these topics using LMICs data primarily focuses on prevalence rates and basic correlational associations, and is often a-theoretic. Empirically rigorous work, mostly found using data from the developed world, has primarily relegated suicide into a box of utility-maximization-based decisions. Social integration theory may be a more relevant approach for researching the mitigating factors to deleterious heath behaviors among adolescents in LMICs.
Methods
Using data from the Global School-based Student Health Survey (GSHS) of six different countries, we estimate a reduced-form, simultaneous model incorporating specialized clustering to determine the influence of social integration on five different deleterious health outcomes, including three levels of suicidal behavior.
Results
Robust results indicate that positive parenting and social exclusion reduce and increase the likelihood of all outcomes, respectively, among both pooled and individual country samples.
Conclusion
Such results provide an impetus for pursuing interventions in LMICs, which focus on social-based, multi-level approaches. Such interventions could include such elements as peer-to-peer training support and awareness/promotion of mental health among parents of adolescents.
... In addition, trauma can also negatively affect academic achievement (Holt et al. 2007). The risks associated with poor mental health extend beyond childhood and predict decreased physical health, increased morbidity, and reduced educational, occupational, and financial achievement in adulthood (Härter et al. 2003;Kessler et al. 1997;Kessler et al. 1995;Lopez et al. 2006;Ormel et al. 2008). Effective mental health interventions for youth are therefore crucial for supporting resilient outcomes in children exposed to trauma. ...
Central American youth are at a high risk for experiencing trauma and related psychosocial problems. Despite this, few studies of evidence-based trauma-focused interventions with this population exist. The objective of this project was twofold: 1) to train providers in El Salvador in Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) as part of a clinical implementation project within a non-governmental organization, and 2) to conduct program evaluation to determine the feasibility of implementation and the effectiveness of the treatment. Fifteen Salvadoran psychologists were trained in TF-CBT who then provided TF-CBT to 121 children and adolescents ages 3–18 in community-based locations. The mean number of traumas reported by youth was 4.39. Results demonstrated large effect sizes for reduction in youth-reported trauma symptoms (Cohen’s d = 2.04), depressive symptoms (Cohen’s d = 1.68), and anxiety symptoms (Cohen’s d = 1.67). Our program evaluation results suggest that it was feasible to train providers in TF-CBT, that providers were in turn able to deliver TF-CBT in community-based settings, and that TF-CBT was an effective treatment option to address trauma-related concerns for youth in El Salvador. This project is an important first step in the dissemination and implementation of evidence-based trauma-focused treatment for youth in Latin American countries.
... Mental health conditions account for 16% of illnesses and injuries in 10-to 19-year-olds (World Health Organization, 2018), so adolescent psychosocial health is a growing global public health issue (Patel et al., 2007). Adolescents with poor psychosocial well-being are more likely than others to experience adverse health and developmental outcomes, such as nicotine addiction, alcohol abuse, substance abuse, school failure and dropout, delinquent behaviors, teenage pregnancy, self-harm, or suicide (Kessler et al., 1997;Dani and Harris, 2005;Ng, 2007;Lalayants and Prince, 2014;Hjorth et al., 2016;Thompson et al., 2018). ...
Adolescents who believe that their parents treat them differently from their siblings have poorer psychosocial well-being than otherwise. This phenomenon, which is known as parental differential treatment or PDT occurs in up to 65% of families. Past studies have examined socio-demographic variables (e.g., child gender, age, and birth order) as predictors of PDT, but these immutable characteristics do little to inform interventions and help these adolescents. Hence, this study extends past research by investigating links among parent empathy, parent perception of PDT, child perception of PDT, child perception of fairness and child well-being (self-esteem, depression, anxiety, and trust in the relationship with parents). Furthermore, this study tests whether adolescent personality (openness, conscientiousness, extraversion, agreeableness, and neuroticism), child empathy, and child perception of fairness moderate these links. This study will utilize a two-wave longitudinal design with a 1-year lapse. Data will be collected from 760 Chinese adolescents studying from Secondary One to Secondary Three in 18 schools in Hong Kong and from their parents. We test our theoretical model via a multilevel structural equation model (ML-SEM). This study both addresses (a) theoretical debates about relations among empathy, PDT, fairness, and psychosocial well-being and (b) focuses on modifiable factors and behaviors, to inform future interventions, such as parent education.
... Finally, both ADHD and SUDs have been associated with poorer social functioning in affected individuals compared with unaffected individuals [20][21][22]. ADHD often begins during childhood or young adulthood, yielding impairments in academic achievement and employment attainment [23]. Substance use and SUDs often develop in the late adolescence of ADHD individuals, further worsening social outcomes [23]. ...
Introduction:
Comorbid attention deficit/hyperactivity disorder (ADHD) is present in 15-25% of all patients seeking treatment for substance use disorders (SUDs). Some studies suggest that comorbid ADHD increases clinical severity related to SUDs, other psychiatric comorbidities, and social impairment, but could not disentangle their respective influences.
Objectives:
To investigate whether comorbid adult ADHD in treatment-seeking SUD patients is associated with more severe clinical profiles in these domains assessed altogether.
Methods:
Treatment-seeking SUD patients from 8 countries (N = 1,294: 26% females, mean age 40 years [SD = 11 years]) were assessed for their history of DSM-IV ADHD, SUDs, and other psychiatric conditions and sociodemographic data. SUD patients with and without comorbid ADHD were compared on indicators of severity across 3 domains: addiction (number of SUD criteria and diagnoses), psychopathological complexity (mood disorders, borderline personality disorder, lifetime suicidal thoughts, or behavior), and social status (education level, occupational and marital status, and living arrangements). Regression models were built to account for confounders for each severity indicator.
Results:
Adult ADHD was present in 19% of the SUD patients. It was significantly associated with higher SUD severity, more frequent comorbid mood or borderline personality disorder, and less frequent "married" or "divorced" status, as compared with the absence of comorbid ADHD. ADHD comorbidity was independently associated with a higher number of dependence diagnoses (OR = 1.97) and more psychopathology (OR = 1.5), but not marital status.
Conclusions:
In treatment-seeking SUD patients, comorbid ADHD is associated with polysubstance dependence, psychopathological complexity, and social risks, which substantiates the clinical relevance of screening, diagnosing, and treating ADHD in patients with SUDs.
... Answering these questions with reference to mental health draws firstly upon the empirical claim that mental illness negatively impacts social functioning in some way. We can take this claim to be self-evident as mental disorders are, by definition, associated with some degree of impaired social functioning or with some form of impact on personal relationships (Kessler et al., 1997;Kessler, Foster, Saunders, & Stang, 1995;Kessler, Walters, & Forthofer, 1998). ...
Ethical debates concerning the biomedical enhancement of human beings have largely been conducted with reference to a Western philosophical framework and an emphasis on liberal individualist concerns. For this reason, and others that we discuss, the enhancement debate is at risk of being irrelevant to the needs and concerns of the majority of world’s population who do not subscribe to such a perspective. In this chapter we consider cosmetic psychopharmacology – referring to the use of psychotropic agents to enhance brain and mind function – in a global context. This involves not only looking at how, if at all, cosmetic psychopharmacology fits in with global mental health concerns, but also looking at its ethical status in more globally relevant terms. Given the reality of resource scarcities in mental health care, we take one of the main challenges facing the articulation of a globally relevant cosmetic psychopharmacology to be its status with regard to macro-level distributive justice concerns. We commence with an overview of both cosmetic psychopharmacology and the global mental health agenda, highlighting the significance of the distinction between a right to mental health and a right to mental health care. We then discuss certain distinctions and ethical concerns regarding cosmetic psychopharmacology, including motives for using it, the kind of value it confers, the notion of medical necessity and the overmedicalization concern. A relational account, informed by an African moral framework, is then introduced and its implications for conceptions of mental health are considered. We conclude the chapter by discussing the ethical status of cosmetic psychopharmacology in terms of the relational account, as well as how it fits in with three levels of progressively demanding claim rights to mental health and mental health care. We contend that, given the presence of more urgent needs and scarce resources, it is likely that the claim that cosmetic psychopharmacology exerts will remain at the broader and less demanding level of ensuring that societal institutions are structured in such a way that they not only refrain from impeding individuals from using it but also, where possible, actively support this option.
... perinatal SSRI exposure on anxiety-related behaviors and amygdala/hippocampus neurobiology? Given the incredible costs of anxiety-related disorders, both socially ( Kessler et al., 1997( Kessler et al., , 1995 and economically ( Greenberg et al., 1999 ), it is critical to examine these specific variables to truly understand any effects of perinatal SSRI exposure on later anxiety-related disorders and its associated neurocircuitry. ...
While the postpartum period is typically associated with increased positive affect, many women will develop a depressive- or anxiety-related disorder during this time, which can degrade the mother-infant bond and lead to detrimental consequences for the infant. Given the potential for negative consequences, effective treatments have been critical, with selective serotonin reuptake inhibitors (SSRIs) being the most commonly-prescribed pharmaceutical agents to treat postpartum depression and anxiety. However, SSRIs can readily cross the placenta and are present in breast milk, so they might, therefore, unintentionally interact with the developing fetus/infant. There is already experimental evidence that perinatal SSRI exposure has a number of long-term effects on offspring, but this review focuses on the current literature examining the timing and consequences of perinatal SSRI exposure specifically on anxiety-like behaviors in rodents and humans, with an emphasis on the anxiety-related brain regions of the amygdala and hippocampus. This review also discusses discrepancies between the rodent and human literatures and how they might inform future studies. Finally, some key factors to consider when examining the role of perinatal SSRIs on offspring anxiety will be discussed, such as the duration of SSRI exposure and the potential neuroprotective effects of SSRIs. Given the extensive prescribing of SSRIs, the potential health consequences of perinatal SSRI exposure, and the discrepancies in the literature, it will be necessary to critically examine the factors underlying offspring anxiety outcomes.
... Anxiety disorders can lead to the development of several adverse consequences including reduced educational and occupational opportunities, greater functional impairment and overall increase in morbidity and mortality rates as compared to those without an anxiety disorder [5][6][7][8]. They are associated with increased utilization of emergency medical and mental health services and have also been linked to elevated rates of teenage pregnancy and parenthood [9,10]. Additionally, anxiety disorders are also associated with several comorbid psychiatric diagnoses, especially mood disorders like Major Depressive Disorder (MDD) [6,11,12]. ...
... Konsequenzen konnte gezeigt werden, dass eine frühere depressive Störungen mit einer erhöhten Wahrscheinlichkeit für Frauen früh zu heiraten (Gotlib, Lewinsohn & Seely, 1998) und früh Mutter zu werden (Kessler et al., 1997) assoziiert ist sowie bei beiden Geschlechtern mit einer erhöhten Scheidungsrate (Kessler, Walters & Forthofer, 1998), einer geringeren Zufriedenheit mit der Qualität der Ehe (Gotlib et al., 1998), mit sexuellen Aktivitäten und mit Beziehungen zu Familie und Freunden in Zusammenhang steht (Coryell et al., 1993). ...
Depressive Störungen zählen weltweit zu den häufigsten psychischen Störungen. Sie betreffen nicht nur das erkrankte Individuum selbst, sondern sind auch von großer Relevanz für dessen soziales Umfeld und die gesamte Gesellschaft. Die klinisch-psychologische Depressionsforschung lässt sich in zwei große Forschungsbereiche unterteilen. Auf der einen Seite steht die Erforschung der Störung an sich, d.h. die Beschäftigung mit ätiologisch relevanten, auslösenden und aufrechterhaltenden Faktoren depressiver Störungen sowie ihrer Klassifikation, Diagnostik und Epidemiologie. Auf der anderen Seite beschäftigt sich die Interventionsforschung mit der wirksamen Behandlung depressiver Störungen, möglichen Unterschieden in der Wirksamkeit verschiedener Psychotherapieformen und den möglichen Wirkprozessen von Psychotherapie. In der vorliegenden Dissertation sind beide Forschungslinien durch entsprechende Fragestellungen bzw. empirische Untersuchungen vertreten. So konnte im Rahmen der ersten Studie gezeigt werden, dass depressive Personen stärker empfänglich für informationalen sozialen Einfluss sind. Im Rahmen der zweiten Studie wurde untersucht, ob sich die Wirkmechanismen einer kognitiven Intervention im Vergleich zu einer achtsamkeitsbasierte Intervention bei der Behandlung depressiver Störungen unterscheiden. Die Ergebnisse sprechen zusammengefasst eher gegen die Annahme spezifischer Mechanismen beider Therapie und sind besser mit Modellen zu generellen Wirkfaktoren vereinbar. Es wird diskutiert, inwieweit es sich bei der Veränderung von Kognitionen auch um einen solchen generellen Wirkfaktor handeln könnte.
... The consequences of depression are numerous and significant both for the afflicted individuals and for society at large (for review, see : On the individual level, the development of depression is related to role impairment/disability ( Merikangas et al., 2007) increased suicide risk by the factor 5 (Harris & Barraclough, 1997), decreased quality of life (Üstün, Ayuso-Mateos, Chatterji, Mathers, & Murray, 2004), and increased risk of somatic disease (Mathers, Fat, & Boerma, 2008). Importantly, there is abundant evidence that depression impedes role transitions in life: A history of depression predicts high school dropout, failure to enter college, college dropout (Kessler, Foster, Saunders, & Stang, 1995), teenage pregnancy ( Kessler et al., 1997), poor marital quality and divorce (Kessler, Walters, & Forthofer, 1998), and unsuccessful transition from welfare to work (Danziger, Carlson, & Henly, 2001). Adopting a more general point of view, the costs of loss of productivity in the United States due to depression are estimated at 36 billion dollars ( Kessler et al., 2006). ...
Depression is a widespread and burdensome psychological disorder. Although a variety of equally effective psychotherapeutic treatments for depression exist, their success rates are insufficient, and relapse after treatment is common. Thus, there is a strong need to improve the scientific understanding of depression and its treatment. An aspect that is not yet fully understood is the interpersonal perspective on the disorder. Building on previous findings, the current dissertation project uses the Interpersonal Circumplex model as a framework to clarify (1) the interpersonal characterization of patients with depression, (2) how interpersonal changes during psychotherapy are associated with treatment success, and (3) what interpersonal characteristics and in-session micro-processes contribute to a productive psychotherapy process. To these ends, three empirical studies were conducted: Study 1 was conducted in a naturalistic treatment setting and pursued the following goals: to refine the interpersonal characterization of outpatients with depression by using the Impact Message Inventory (IMI) to assess covert reactions (thoughts, feelings, and action tendencies referring to the patient) as perceived by the patients’ significant others, and to investigate the change in impact messages during psychotherapy and its association with treatment outcome. The data demonstrated that, on average, patients with depression are best characterized by their submissiveness, but cluster analysis revealed a differentiation into four distinct sub- groups. Over therapy, patients decreased in their friendly-submissive, submissive, hostile submissive, and hostile impact messages and became more dominant and friendly-dominant. The reduction of submissive and hostile-submissive impact messages was related to positive outcome, whereas the change in friendly- submissiveness was not. Study 2 was carried out in the context of a randomized controlled trial of two forms of Cognitive-Behavioural Therapy for depression and expanded the first study’s view by relating the patients’ own perception of their interpersonal problems using the Inventory of Interpersonal Problems (IIP) to impact messages, and by concurrently testing the predictive power of these perspectives in relation to therapy process and outcome. The results revealed that IIP affiliation was the best predictor of the therapeutic alliance and of cognitive-emotional processing. While a pre-post decrease in IIP distress was related to simultaneous outcome, the best predictor of symptomatic change subsequent to therapy was an increase in IMI dominance. Study 3 sought to investigate how interpersonal in-session micro-processes that unfold between patient and therapist predict post-session evaluations of the therapeutic process, and how complementarity, an indicator of interpersonal harmony, develops over the course of a session. As predicted, more emotional arousal was associated with deviations from complementarity, whereas a positive alliance was related to friendly patient behavior. Multilevel growth modeling revealed a significant cubic trend of complementarity over the course of a session. The closing section of the dissertation integrates the results theoretically and discusses them with regard to their clinical implications and their contribution to the field of psychotherapy research. Based on a recapitulation of the project’s limitations, suggestions for future research are made. In sum, the three studies provide evidence that integrating distinct perspectives on patient interpersonal style and adhering to particular interpersonal therapeutic strategies may help improve the process and outcome of psychotherapy for depression. Zusammenfassung Depression ist eine weit verbreitete und belastende psychische Störung. Obwohl eine Vielzahl gleichermaßen wirksamer Psychotherapien zur Behandlung von Depression existieren, sind die Erfolgsraten unzureichend und Rückfälle nach der Behandlung häufig. Somit besteht die Notwendigkeit, das wissenschaftliche Verständnis der Depression und ihrer Behandlung zu maximieren. Besonders vielversprechend erscheint diesbezüglich die Erforschung der zwischenmenschlichen Facetten der Erkrankung. Das vorliegende Dissertationsprojekt stützt sich auf das Interpersonale Zirkumplex-Modell und verfolgt die Ziele, (1) die zwischenmenschliche Charakterisierung von Patienten mit Depression zu differenzieren, (2) zu analysieren wie interpersonale Veränderungen während der Psychotherapie mit Behandlungserfolg zusammenhängen, und (3) zu untersuchen welche zwischenmenschlichen Eigenschaften und Mikroprozesse in Therapiesitzungen zu einem produktiven Therapieprozess beitragen. Zu diesen Zwecken wurden drei empirische Studien durchgeführt: Studie 1 verfolgte einerseits das Ziel, die zwischenmenschliche Charakterisierung von depressiven Patienten anhand der verdeckten Reaktionen (Gedanken, Gefühlen und Handlungstendenzen) ihrer Bezugspersonen mit Hilfe des Impact Message Inventory (IMI) zu verfeinern, andererseits wurde untersucht wie die Veränderung des interpersonalen Stils während der Therapie mit dem Therapieerfolg zusammenhängt. Die Daten bestätigten, dass depressive Patienten durchschnittlich als unterwürfig beschrieben werden können, jedoch ergab eine Cluster-Analyse eine Differenzierung in vier verschiedene Untergruppen. Während der Therapie wurden die Patienten dominanter und freundlicher. Die Reduktion der Unterwürfigkeit hing mit dem Behandlungserfolg zusammen. Studie 2 wurde im Rahmen einer randomisierten, kontrollierten Studie zur Beforschung zweier Formen Kognitiver Verhaltenstherapie bei Depression durchgeführt und ging über die erste Studie hinaus, indem sie die durch das Inventar Interpersonaler Probleme (IIP) erhobenen und von Patienten selbst berichteten zwischenmenschlichen Probleme mit Impact Messages in Zusammenhang setzte und die differenzielle Vorhersagekraft dieser Perspektiven hinsichtlich des Therapieprozesses und -ergebnisses testete. Die Ergebnisse zeigten, dass IIP Affiliation der beste Prädiktor für die therapeutische Beziehung und der kognitiv- emotionalen Verarbeitung war. Während die Prä-Post-Abnahme des generellen Belastungsfaktors des IIP in engem Zusammenhang mit gleichzeitiger Symptomreduktion stand, war der beste Prädiktor für Symptomreduktion nach der Therapie ein Anstieg der fremdberichteten Dominanz im IMI. Studie 3 verfolge das Ziel, zu erforschen wie die Patient-Therapeut-Interaktion während therapeutischer Sitzungen mit der Prozessevaluation nach denselben Sitzungen zusammenhängt. Zudem wurde untersucht, wie sich interpersonale Komplementarität, ein Indikator für Interaktionsharmonie, während einer Therapiesitzung entwickelt. Eine Abweichung von Komplementarität war ein Prädiktor für emotionale Aktivierung, während freundliches Patientenverhalten eine gute Therapiebeziehung vorhersagte. Der Verlauf der Komplementarität während einer Sitzung erwies sich als kubisch. In ihrer Gesamtheit legen die drei Studien nahe, dass die Integration unterschiedlicher Perspektiven bezüglich des zwischenmenschlichen Stils depressiver Patienten sowie das Verfolgen bestimmter interpersonaler therapeutischer Strategien dazu beitragen kann, den Prozess und das Ergebnis von Depressionstherapien zu verbessern.
... Just as males and females differ in the clinical manifestation of depression, they also experience unique, sex-based consequences of depressive illness. Depression in adolescent females is associated with high-risk sexual behavior and unplanned pregnancy, 15 and low academic performance. 16 The mean length of depressive episodes in girls has been reported to be approximately 5 months, equivalent to two-thirds of a school year. ...
Purpose:
Depression is a debilitating illness with frequent onset during adolescence. Depression affects women more often than men; men are more likely to complete suicide and less likely to seek treatment. The Adolescent Depression Awareness Program (ADAP) is a school-based depression intervention that educates adolescents about depression symptoms and addresses accompanying stigma. The study aims examined gender differences in the ADAP's impact on depression literacy and stigma.
Methods:
Data came from a randomized trial (2012-2015). Six thousand six hundred seventy-nine students from 54 schools in several states were matched into pairs and randomized to the intervention or wait-list control. Teachers delivered the ADAP as part of the health curriculum. Depression literacy and stigma outcomes were measured before intervention, 6 weeks later, and at 4 months. Multilevel models evaluated whether gender moderated the effect of ADAP on depression literacy and stigma.
Results:
At 4 months, there was a main effect of the ADAP on depression literacy (odds ratio [OR] = 3.3, p = .001) with intervention students achieving depression literacy at higher rates than controls. Gender exhibited a main effect, with women showing greater rates of depression literacy than men (OR = 1.51, p = .001). There was no significant intervention × gender interaction. The ADAP did not exhibit a significant main effect on stigma. There was a main effect for gender, with women demonstrating less stigma than men (OR = .65, p = .001). There was no significant interaction between the intervention and gender on stigma.
Conclusions:
The ADAP demonstrates effectiveness for increasing rates of depression literacy among high school students. In this study, gender was not associated with ADAP's effectiveness.
Background
For almost two decades, researchers and clinicians have argued that certain aspects of mental health treatment can be removed from clinicians’ responsibilities and allocated to technology, preserving valuable clinician time and alleviating the burden on the behavioral health care system. The service delivery tasks that could arguably be allocated to technology without negatively impacting patient outcomes include screening, triage, and referral.
Objective
We pilot-tested a chatbot for mental health screening and referral to understand the relationship between potential users’ demographics and chatbot use; the completion rate of mental health screening when delivered by a chatbot; and the acceptability of a prototype chatbot designed for mental health screening and referral. This chatbot not only screened participants for psychological distress but also referred them to appropriate resources that matched their level of distress and preferences. The goal of this study was to determine whether a mental health screening and referral chatbot would be feasible and acceptable to users.
Methods
We conducted an internet-based survey among a sample of US-based adults. Our survey collected demographic data along with a battery of measures assessing behavioral health and symptoms, stigma (label avoidance and perceived stigma), attitudes toward treatment-seeking, readiness for change, and technology readiness and acceptance. Participants were then offered to engage with our chatbot. Those who engaged with the chatbot completed a mental health screening, received a distress score based on this screening, were referred to resources appropriate for their current level of distress, and were asked to rate the acceptability of the chatbot.
Results
We found that mental health screening using a chatbot was feasible, with 168 (75.7%) of our 222 participants completing mental health screening within the chatbot sessions. Various demographic characteristics were associated with a willingness to use the chatbot. The participants who used the chatbot found it to be acceptable. Logistic regression produced a significant model with perceived usefulness and symptoms as significant positive predictors of chatbot use for the overall sample, and label avoidance as the only significant predictor of chatbot use for those currently experiencing distress.
Conclusions
Label avoidance, the desire to avoid mental health services to avoid the stigmatized label of mental illness, is a significant negative predictor of care seeking. Therefore, our finding regarding label avoidance and chatbot use has significant public health implications in terms of facilitating access to mental health resources. Those who are high on label avoidance are not likely to seek care in a community mental health clinic, yet they are likely willing to engage with a mental health chatbot, participate in mental health screening, and receive mental health resources within the chatbot session. Chatbot technology may prove to be a way to engage those in care who have previously avoided treatment due to stigma.
Background
Despite the evidence supporting the relationship between socioeconomic status (SES) and severe mental disorders (SMD), the directionality of the associations between income or education and mental disorders is still poorly understood.
Objective
To investigate the potential bidirectional causal relationships between genetic liability to the two main components of SES (income and educational attainment (EA)) on three SMD: schizophrenia, bipolar disorder (BD) and depression.
Methods
We performed a bidirectional, two-sample univariable Mendelian randomisation (UVMR) and multivariable Mendelian randomisation (MVMR) study using SES phenotypes (income, n=397 751 and EA, n=766 345) and SMD (schizophrenia, n=127 906; BD, n=51 710 and depression, n=500 119) genome-wide association studies summary—statistics to dissect the potential direct associations of income and EA with SMD.
Findings
UVMR showed that genetic liability to higher income was associated with decreased risk of schizophrenia and depression, with a smaller reverse effect of schizophrenia and depression on income. Effects were comparable after adjusting for EA in the MVMR. UMVR showed bidirectional negative associations between genetic liability to EA and depression and positive associations between genetic liability to EA and BD, with no significant effects on schizophrenia. After accounting for income, MVMR showed a bidirectional positive direction between genetic liability to EA and BD and schizophrenia but not with depression.
Conclusions
Our results suggest a heterogeneous link pattern between SES and SMD. We found a negative bidirectional association between genetic liability to income and the risk of schizophrenia and depression. On the contrary, we found a positive bidirectional relationship of genetic liability to EA with schizophrenia and BD, which only becomes apparent after adjusting for income in the case of schizophrenia.
Clinical implications
These findings shed light on the directional mechanisms between social determinants and mental disorders and suggest that income and EA should be studied separately in relation to mental illness.
Although the literature on psychiatric disorders during pregnancy and the postpartum period in adolescents is generally sparse, it is growing. Researchers have primarily studied perinatal depression, with much more limited research on anxiety, bipolar, psychosis, and sleep disorders. Overall, the existing research suggests the prevalence of psychiatric disorders in pregnant teens is higher than the prevalence in older women. Psychiatric illness is a risk factor for teen pregnancy and pregnancy increases the risk of psychiatric disorders in teens. Maternal psychiatric illness can have adverse effects both prenatally and postnatally. This chapter will summarize what we know about psychiatric disorders in pregnant and parenting teens and will draw on the much larger body of knowledge on pregnant and parenting adult women to enlarge our understanding of this topic.
This article makes observations about policy implications and offers a combination of commentary and recommendation regarding the special issue on the impact of childhood psychopathology interventions on subsequent substance abuse. The authors mention forward-looking directives to expand the mandate for early intervention, to expand the research agenda for randomized clinical trials, and to develop a policy-oriented evidence base. They also note topics that require consideration and offer recommendations with regard to how to proceed. The special issue, as well as this discussion, will spark thought and action directed toward the evaluation of interventions for youths to assess the degree to which treating mental disorders has beneficial effects on the sequelae of the initial intervention target.
This study examined the interpersonal and psychological functioning of expectant and nonexpectant adolescent couples. Interpersonal processes were assessed using the Structural Analysis of Social Behavior (L. S. Benjamin, 1974) and psychological functioning was assessed using the Diagnostic Interview for Children and Adolescents—Revised (W. Reich, 1991). Compared with their nonexpectant peers, expectant couples exhibited higher rates of negative interpersonal processes, including demand–withdraw behaviors and lower rates of positive interpersonal processes. Expectant males reported higher rates of behavior disorders, substance use disorders, and internalizing disorders than nonexpectant males. Higher rates of substance-use disorders mediated the effect of expectancy status on demand–withdraw behavior. Results help clarify the links between the psychological risks associated with adolescent pregnancy and the interpersonal functioning of young expectant couples.
Parenting and child impulsivity are consistent predictors of children's externalizing symptoms; however, the role of the range of parenting (i.e., variation in parenting across contexts), and its interactions with child impulsivity, are poorly understood. We examined whether characteristic parenting practices and parenting range predicted the course of externalizing symptoms in 409 children (Mage = 3.43 years at baseline, 208 girls) across ages 3, 5, 8, and 11. We assessed parent positive affectivity (PPA), hostility, and parenting structure at child age 3 using three behavioral tasks that varied in context, examining range by modeling a latent difference score for each parenting dimension. Greater PPA range, mean structure, and parenting structure range all predicted fewer symptoms at age 3 for children with higher impulsivity. Lower mean hostility predicted fewer symptoms at age 3 for children with lower impulsivity. Greater PPA, and smaller PPA range, predicted a decrease in symptoms for children higher in impulsivity. Lower hostility range predicted a decrease in symptoms for children with lower impulsivity but predicted maintaining symptoms for children with higher impulsivity. Results demonstrate the differential roles average parenting practices and parenting range play in the development of child externalizing psychopathology, especially in the context of child impulsivity.
Aim
The aim of the current study was to investigate, in line with the ‘Social Cure’ tradition, whether identification with various groups (including the family, school and friends) predicted better psychological wellbeing amongst high school students. While previous research had shown there was a relationship between identification with these groups and mental health in adolescents, this work was cross-sectional, meaning that the direction of the relationship could not be established. The further aim of the current study was therefore to investigate these relationships over time.
Method
Data were collected via self-report questionnaires from 409 pupils in several Scottish high schools. We measured students’ mental wellbeing via the GHQ-12 questionnaire, as well as identification with their family, school and friend groups.
Findings
Of the three groups investigated, only school identification predicted psychological wellbeing over time, indicating that educational practitioners are in a unique position to influence young people’s mental health. Furthermore, the finding that school identification predicts mental health over time supports the theory presented in the social cure literature: that group identification predicts mental wellbeing.
Limitations
A potential limitation was the use of self-report questionnaires. However, we feel that the strict policy of anonymity will have reduced socially desirable responses.
Conclusion
The findings highlight the importance of the school for young people’s mental health. Future research and interventions should consider the importance of identification with the school when attempting to enhance young people’s mental wellbeing.
Context
With over one-third of detained girls experiencing teenage pregnancy, it is critical that the juvenile justice system better addresses the sexual and reproductive health (SRH) needs of youth. Although pregnancy attitudes and intentions (PAI) are associated with pregnancy outcomes among the general adolescent population, this relationship has not been examined among justice-involved youth.
Methods
Participants were drawn from a longitudinal study characterizing trajectories of behavioral and reproductive health and recidivism among newly justice-involved youth in a Northeast family court. Baseline and four-month follow-up data from 288 justice-involved youth (JIY) were analyzed to characterize PAI; examine associations between pregnancy intentions and unprotected sexual activity (i.e., no hormonal, intrauterine, or barrier protection against pregnancy); and explore the relationship between pregnancy intentions and psychiatric symptoms.
Results
At baseline, 39% of JIY youth were sexually active, 44% of these youth reported inconsistent condom use and 14% had not used birth control at last sexual intercourse. Nearly half of sexually active youth reported some intent around pregnancy and those with any pregnancy intentions were more likely to report depression, low self-esteem, substance use, and trauma history. Pregnancy intentions at baseline predicted higher rates of unprotected sexual activity at four months (OR: 16.9, CI = 2.48–115.7).
Conclusions
This study highlights the importance of developing and implementing more comprehensive SRH assessments and brief interventions for youth entering the justice system.
Objective
To explore the mental health needs of students, and the professional development and support needs of teachers and school health professionals, as a way to foster community engagement and help set priorities for a comprehensive school mental health system in the Detroit Public Schools Community District (DPSCD).
Setting
The study team surveyed all DPSCD staff in June 2019 and all students in grades 8–12 between October and December 2019.
Study Design
A descriptive study based on anonymous, web‐based surveys focused on student trauma exposure and mental health symptoms, student mental health resource utilization, staff burnout, and professional development needs.
Data Collection
All students (grades 8–12) and district staff were eligible to participate; the student survey was made available in six languages. Parents/guardians could opt children out; schools could exclude children unable to complete the survey independently. Student surveys were administered in school; staff surveys were sent via email.
Principal Findings
Thirty‐four percent of DPSCD students reported moderate/severe depression symptoms; 22% had seriously considered suicide in the past year. Rates exceed national averages; 37% of students with severe depression and 34% of those with suicidal ideation had not accessed mental health supports. Staff indicated high levels of burnout and substantial interest in learning about self‐care strategies or coping with vicarious trauma. Over 75% of teachers and school mental health professionals expressed interest in learning about best practices for supporting students impacted by trauma or mental illness.
Conclusions
A large number of DPSCD students are experiencing symptoms of depression and anxiety, and many students who need care are not accessing it. Addressing the mental health needs of students is a high priority for staff, but they need more training and support, as well as support for their own vicarious trauma and high levels of burnout.
Mental health problems in childhood and adolescence may have effects into adulthood. With the KiGGS cohort, data are available for the first time that can be used to track the effects of internalising and externalising problems in childhood or adolescence into young adulthood on a national database. From the KiGGS baseline survey (2003–2006) to KiGGS Wave 2 (2014–2017), a total of 3,546 children and adolescents aged 11 to 17 years were tracked over a period of eleven years into young adulthood. Mental health problems in childhood or adolescence were variously associated with impaired mental health, lower life satisfaction and poorer quality of life and indicators of sexual and reproductive health in young adulthood.
When psychosocial protective factors at the time of the KiGGS baseline survey were considered, the longitudinal correlations of internalising and externalising problems with indicators of mental health, life satisfaction and physical and psychological quality of life decreased, as did, to a lesser extent, the correlations with indicators of sexual and reproductive health and, for externalising disorders, also with low educational status (reference: medium). Implications for prevention and intervention are discussed.
Psychische Auffälligkeiten in Kindheit und Jugend können Auswirkungen bis in das Erwachsenenalter haben. Mit der KiGGS-Kohorte stehen erstmals bundesweite Daten zur Verfügung, mit denen sich die Effekte von internalisierenden und externalisierenden Auffälligkeiten in Kindheit oder Jugend im jungen Erwachsenenalter untersuchen lassen. Von der KiGGS-Basiserhebung (2003-2006) bis zu KiGGS Welle 2 (2014-2017) konnten insgesamt 3.546 Kinder und Jugendliche im Alter von 11 bis 17 Jahren über einen Zeitraum von elf Jahren bis in das junge Erwachsenenalter nachverfolgt werden. Psychische Auffälligkeiten in Kindheit oder Jugend waren in unterschiedlicher Weise mit einer eingeschränkten psychischen Gesundheit, geringerer Lebenszufriedenheit und Lebensqualität sowie mit Indikatoren der sexuellen und reproduktiven Gesundheit im jungen Erwachsenenalter verbunden. Bei Berücksichtigung psychosozialer Schutzfaktoren zum Zeitpunkt der KiGGS-Basiserhebung verringerten sich vor allem die längsschnittlichen Zusammenhänge von internalisierenden und externalisierenden Auffälligkeiten mit Indikatoren der psychischen Gesundheit, der Lebenszufriedenheit und der körperlichen und psychischen Lebensqualität sowie in geringerem Ausmaß auch mit Indikatoren der sexuellen und reproduktiven Gesundheit und für externalisierende Auffälligkeiten auch mit einem niedrigen Bildungsstatus (Referenz: mittel).
Psihološko blagostanje sastavni je dio ljudske sposobnosti za vođenje ispunjenog života, koji podrazumijeva sposobnosti formiranja i održavanja međuljudskih odnosa, učenja, rada ili bavljenja različitim aktivnostima i hobijima, te mogućnost svakodnevnog donošenja odluka ili pravljenja različitih životnih izbora. Svjetska zdravstvena organizacija prepoznala je važnost psihološkog blagostanja definirajući zdravlje kao stanje potpunog fizičkog, mentalnog i socijalnog blagostanja, a ne samo kao odsustvo bolesti ili nemoći. Nasuprot blagostanju je psihološka abnormalnost koja se može svakome dogoditi te uveliko narušiti svakodnevno funkcioniranje. Prevalencija psiholoških poremećaja u BiH slična je prevalenciji na svjetskom nivou: najviše su prisutni anksiozni i somatski poremećaji, nakon kojih slijede poremećaji raspoloženja, te shizofrenija i poremećaji ličnosti. Razvoju psiholoških poremećaja doprinosi prisustvo mnogih rizičnih i zaštitnih faktora. Jedan od mogućih načina gledanja na rizične i zaštitne faktore je pogled kroz razvojnu perspektivu, koji je predstavljen u ovom radu. Prema navedenim podacima, teško je postaviti granicu između dječije i adolescentne te odrasle psihopatologije; zapravo bi bilo korisnije kada ona u konceptualnom smislu ne bi ni postojala. Da bi se istinski razumjeli rizici za razvoj psihopatologije, neophodno je da teoretičari i istraživači usvoje pogled na psihološke poremećaje kroz cjeloživotnu perspektivu. Ključne riječi: psihološki poremećaj, prevalencija, rizični i zaštitni faktori, cjeloživotni razvoj
In many systems of mental health service provision, the identity of the patient as a parent does not receive sufficient recognition. This is true irrespective of the patient’s diagnosis or type of service provided and, therefore, clearly reflects deficiencies of service design, training and professional role identity. As one family put it succinctly in one of our research projects: “Psychiatric services are excellent when it is a question of treatment of symptoms but absolutely useless when it comes to family issues or anything beyond the symptoms of mental illness.” It is with this consideration in mind that we outline the role of the psychiatrist and highlight pertinent issues that arise when a patient is a parent.
Background:
Given gaps in the treatment of mental health, brief adaptive interventions have become a public health imperative. Transdiagnostic interventions may be particularly appropriate given high rates of medical comorbidity and the broader reach of transdiagnostic therapies. One such approach utilized herein is acceptance and commitment therapy (ACT), which is focused on increasing engagement with values, awareness, and openness to internal experiences. ACT theory posits that experiential avoidance is at the center of human suffering, regardless of diagnosis, and, as such, seeks to reduce unworkable experiential avoidance.
Objective:
Our objective is to provide the rationale and protocol for examining the safety, feasibility, and effectiveness of optimizing an ACT-based intervention via a mobile app among two disparate samples, which differ in sociodemographic characteristics and symptom profiles.
Methods:
Twice each day, participants are prompted via a mobile app to complete assessments of mood and activity and are then randomly assigned to an ACT-based intervention or not. These interventions are questions regarding engagement with values, awareness, and openness to internal experiences. Participant responses are recorded. Analyses will examine completion of assessments, change in symptoms from baseline assessment, and proximal change in mood and activity. A primary outcome of interest is proximal change in activity (eg, form and function of behavior and energy consumed by avoidance and values-based behavior) following interventions as a function of time, symptoms, and behavior, where we hypothesize that participants will focus more energy on values-based behaviors. Analyses will be conducted using a weighted and centered least squares approach. Two samples will run concurrently to assess the capacity of optimizing mobile ACT in populations that differ widely in their clinical presentation and sociodemographic characteristics: individuals with bipolar disorder (n=30) and distressed first-generation college students (n=50).
Results:
Recruitment began on September 10, 2019, for the bipolar sample and on October 5, 2019, for the college sample. Participation in the study began on October 18, 2019.
Conclusions:
This study examines an ACT-based intervention among two disparate samples. Should ACT demonstrate feasibility and preliminary effectiveness in each sample, a large randomized controlled trial applying ACT across diagnoses and demographics would be indicated. The public health implications of such an approach may be far-reaching.
Trial registration:
ClinicalTrials.gov NCT04098497; https://clinicaltrials.gov/ct2/show/NCT04098497; ClinicalTrials.gov NCT04081662; https://clinicaltrials.gov/ct2/show/NCT04081662.
International registered report identifier (irrid):
DERR1-10.2196/17086.
Zusammenfassung. Fragestellung: Ziel der Längsschnittstudie ist es, herauszufinden, welche mütterlichen Faktoren die Auswirkungen adoleszenter Mutterschaft auf die kognitive und sprachliche Entwicklung sowie Verhaltensprobleme bei Kindern im Vorschulalter beeinflussen. Basierend auf dem aktuellen Stand der Literatur wurden mütterliche Feinfühligkeit (EA), Sozioökonomischer Status (SES) und psychische Belastung als mögliche Einflussfaktoren identifiziert. Methodik: N = 31 adoleszente und N = 47 adulte Mütter mit ihren Kindern im Alter von 3.0 bis 5.9 Jahren (M = 3.55) nahmen an der Studie teil. Kindliche Variablen beinhalteten die kognitive Entwicklung (WPPSI-III), Sprachentwicklung (SSV) und Verhaltensprobleme (SDQ). Mütterliche Faktoren umfassen mütterliche Feinfühligkeit in der Mutter-Kind Interaktion (EA), sozioökonomischen Status (SES) sowie psychische Belastung (BSI-18). Ergebnisse: Kinder adoleszenter Mütter erzielten schlechtere Leistungen in ihrer kognitiven und sprachlichen Entwicklung und wurden von ihren Müttern als verhaltensauffälliger beschrieben als Kinder adulter Mütter. Mediationsanalysen zeigten, dass der Effekt des Alters der Mütter auf die kognitive Entwicklung der Kinder über eine geringere Feinfühligkeit mediiert wurde. Ferner wurde der Zusammenhang zwischen mütterlichem Alter und kindlichen Verhaltensauffälligkeiten über eine höhere psychische Belastung der Mütter mediiert. Schlussfolgerung: Kinder adoleszenter Mütter weisen, verglichen mit gleichaltrigen Kindern adulter Mütter, im Vorschulalter Entwicklungsdefizite auf. Diese können teilweise durch eine geringere Feinfühligkeit und eine höhere psychische Belastung adoleszenter Mütter erklärt werden.
Purpose
This study aimed to examine whether the timing of depression onset relative to age at sexual debut is associated with teenage pregnancy.
Methods
Using data from 1,025 adolescent girls who reported having had sex in the National Comorbidity Survey—Adolescent Supplement, we applied cox proportional hazards models to test whether depression onset before first sex, at the same age as first sex, or after first sex compared with no depression onset was associated with experiencing a first teenage pregnancy. We examined the unadjusted risk by depression status as well as risk adjusted for adolescents' race/ethnicity, marital status, poverty level, whether the adolescent lived in a metropolitan area, living status, age at first sex, parental education, and age of mother when the adolescent was born.
Results
In both unadjusted and adjusted models, we found that adolescents with depression onset at the same age as having initiated sex were at an increased risk of experiencing a teenage pregnancy (unadjusted hazard ratio [HR] = 2.5, 95% confidence interval [CI]: 1.08–5.96; adjusted HR = 2.7, 95% CI: 1.15–6.34) compared with those with no depression onset. Moreover, compared with those with no depression onset, the risk of pregnancy for girls experiencing depression onset before first sex also increased but was not significant (adjusted HR = 1.5, 95% CI: .82–2.76).
Conclusions
Timing of first depressive episode relative to age at first sexual intercourse plays a critical role in determining the risk of teenage pregnancy. Timely diagnosis and treatment of depression may not only help adolescents' mental well-being but may also help them prevent teenage pregnancy.
Background: Evidence supports the contribution of various stigma-related constructs to help-seeking. These constructs have yet to be tested in a single model among college students, a group highly affected by mental illness.
Aims: Using data from 153 college students, this study examines factors contributing to help seeking for mental illness.
Method: Using path analysis, the current study evaluated a model of the relationship between level of familiarity, personal stigma, desired social distance, label avoidance, attitudes towards treatment seeking and intentions to seek treatment.
Results: Findings support a model of help-seeking describing the relationship between familiarity with mental illness, personal stigma, social distance, label avoidance, attitudes and intentions to seek treatment.
Conclusions: Findings suggest label avoidance, attitudes towards treatment seeking and intentions to seek treatment might be augmented through interventions aimed at increasing college students’ levels of familiarity, or intimate contact, with individuals with mental illness. Additional implications for practice and further research are addressed.
Background:
Those studying nursing are at greater risk for developing mental health problems than other tertiary students. Mental Health First Aid (MHFA) training may assist students to support peers and build mental health literacy. Understanding motivation to participate in training can identify factors influencing uptake and completion. This paper explores motivators for university nursing students to participate in MHFA training and uses previous experience and confidence in assisting someone with a mental health problem to triangulate data.
Method:
A randomised controlled trial was employed to measure the impact of the course for nursing students at a large Western Australian university. An online survey was administered prior to MHFA training with undergraduate nursing students (n = 140). Thematic analysis of open-ended questions explores motivators to participate and help provided to an individual. Baseline frequencies describe demographics, confidence in helping and exposure to someone with a mental health problem. A Chi Square test compared confidence in helping and exposure to someone with a mental health problem.
Results:
More than half of participants reported contact with individuals experiencing mental health problems (55%; n = 77); approximately a third (35.8%) reported limited confidence to assist. Those in previous contact with someone with a mental health problem (71.5%; n = 55) were significantly more likely to feel confident in helping (p = 0.044). Mental health literacy, helping others, career and experiences were described as training motivators.
Conclusion:
Exploiting motivators, both intrinsic and extrinsic may increase MHFA training uptake and completion. Tertiary institutions would benefit from policy to embed MHFA training into nursing degrees. The training may have utility for university degrees more broadly.
Trial registration:
Australian New Zealand Clinical Trials Registry; ACTRN12614000861651. Registered 11 August 2014 (retrospectively registered).
Rationale:
Although several systematic reviews have addressed the antecedents and consequences of adolescent motherhood, none have examined adolescent fatherhood.
Objectives:
The aims of this systematic review were to identify evidence-based factors that increase the probability of adolescent fatherhood and to identify outcomes that differ between adolescent fathers compared to two other groups, namely adult fathers and non-father age peers. The current study used a theoretical framework, Parke's systems view, to guide the review.
Method:
The search strategy included a bibliographic search of PubMed and PsycINFO. To be included, publications had to be (a) peer-reviewed, (b) quantitative studies, (c) published in English, and (d) compare adolescent fathers (<20 years) to adult fathers (>19 years) or to non-father peers (13- to 19-years old).
Results:
A total of 2869 unique published sources were screened and 39 met these inclusion criteria. More than half of the articles focused on antecedents (k = 24), with the most consistent evidence showing that adolescent fathers come from disadvantaged backgrounds characterized by single-parent households and low parental socioeconomic status. There is also evidence that adolescent fathers were disproportionately Black or Latino (vs. White), had lower academic competence, engaged in more delinquent behavior (e.g., vandalism), and had peers who engaged in more anti-social behaviors. Articles on the outcomes of adolescent fatherhood (k = 23) yielded consistent evidence that their offspring are at greater risk of being preterm or low birthweight and psychological disorders as compared to the offspring of adult fathers.
Conclusions:
Much of the literature was published prior to the year 2000, and methodological weaknesses are noted. Nonetheless, this review has implications for beginning to establish an evidence-based understanding of adolescent fathers. Future rigorous and theory-driven research can provide an even clearer picture and a basis for intervention.
The relation between fatherhood and behavioral and school problems was studied in a nationally representative sample of adolescent youths. Data were obtained from the National Longitudinal Survey of Work Experience of Youth (NLSY). Of the 6400 youths interviewed in 1980, 367 (5.7%) reported that they had fathered a child before the age of 19 years. This group was compared with 1000 non-fathers selected at random from the same data set. The groups differed by race and family socioeconomic characteristics. Academic, drug, and conduct problems were significantly more common among adolescent fathers than among non-fathers. Race and family income, and fatherhood status were independently related to various problem behaviors. These results confirm previous findings demonstrating a relation between delinquency and adolescent fatherhood.
The high prevalence of alcohol and drug abuse and mental illness imposes a substantial financial burden on those affected and on society. The authors present estimates of the economic costs from these causes for 1985 and 1988, based on current and reliable data available from national surveys and the use of new costing methodology. The total losses to the economy related to alcohol and drug abuse and mental illness for 1988 are estimated at $273.3 billion. The estimate includes $85.8 billion for alcohol abuse, $58.3 billion for drug abuse, and $129.3 billion for mental illness. The total estimated costs for 1985, $218.1 billion, include $51.4 billion for direct treatment and support costs; $80.8 billion for morbidity costs, the value of reduced or lost productivity; $35.8 billion for mortality costs, the value of foregone future productivity for the 140,593 premature deaths associated with these disorders, based on a 6 percent discount rate and including an imputed value for housekeeping services; and $47.5 billion in other related costs, including the costs of crime, motor vehicle crashes, fire destruction, and the value of productivity losses for victims of crime, incarceration, crime careers, and caregiver services. The cost of acquired immunodeficiency syndrome associated with drug abuse is estimated at $1 billion, and the cost of fetal alcohol syndrome is estimated at $1.6 billion. The estimates may be considered lower limits of the true costs to society of alcohol and drug abuse and mental illness in the United States.
The association between problem behaviors and parental status was studied in a national sample of urban (n = 1263) and rural (n = 388) young women 15 to 17 years of age. When assessed according to age at childbearing, there was a clear association between problem behavior and the birth of a first child prior to age 19 years. The three parental status groups studied appeared ordered in risk, with school-aged mothers having engaged in the most problem behaviors, and followed, in turn, by young adult mothers (ie, those who had a child between 19 and 21 years of age), and then by women who had not had a child by age 21 years. Young urban women who engaged in three or more problem behaviors were more likely than women who claimed no involvement in problem behaviors to subsequently have a child prior to age 19 years. In addition, black adolescents reported fewer problem behaviors than did white adolescents. When individual behaviors were analyzed, school-aged mothers were more likely than either young adult mothers or nonmothers to have reported school suspension, truancy, runaway, smoking marijuana, and fighting. Although similar results were found in both samples, the effects appeared more consistent for young urban women. In future studies, researchers must determine whether adolescent mothers are at risk for parenting difficulties because of their previous involvement in problem behaviors.
We describe the functioning and well-being of patients with depression, relative to patients with chronic medical conditions or no chronic conditions. Data are from 11,242 outpatients in three health care provision systems in three US sites. Patients with either current depressive disorder or depressive symptoms in the absence of disorder tended to have worse physical, social, and role functioning, worse perceived current health, and greater bodily pain than did patients with no chronic conditions. The poor functioning uniquely associated with depressive symptoms, with or without depressive disorder, was comparable with or worse than that uniquely associated with eight major chronic medical conditions. For example, the unique association of days in bed with depressive symptoms was significantly greater than the comparable association with hypertension, diabetes, and arthritis. Depression and chronic medical conditions had unique and additive effects on patient functioning.
The U.S. has one of the highest rates of adolescent pregnancy and childbearing in the industrialized world--and the highest rates in the U.S. are found among low-income black adolescents. This paper addresses the problem via a four-part theoretical framework based on an ecological developmental model. Variables that contribute to adolescent pregnancy in the black community are examined at the individual, family, sociocultural, and social structural levels. The potential utility of this framework is discussed, and suggestions are offered for research and programmatic intervention.
PIP
The US has 1 of the highest rates of adolescent pregnancy and childbearing in the industrialized world--and the highest rates in the US are found among low-income black adolescents. This paper addresses the problem via a 4-part theoretical framework based on an ecological developmental model. Variables that contribute to adolescent pregnancy in the black community are examined at the individual, family, sociocultural, and social structural levels. In terms of social policy considerations, this ecological framework provides a conceptual basis for the claim that the problem of joblessness among both males and females should be a salient issue on any agenda that focuses on reducing black adolescent pregnancy. The potential utility of this framework is discussed, and suggestions are offered for research and programmatic intervention.
Data were obtained from low-income, single-parent mothers for a test of the "life course" hypothesis that chronic stress mediates the relationship between teenage motherhood and both physical abuse and neglect of children. Large numbers of live births, a life history of unemployment, and low educational achievement were the measured stressors. Findings support the hypothesis, showing the number of live births as the most important mediator for both types of maltreatment.
This study presents estimates of lifetime and 12-month prevalence of 14 DSM-III-R psychiatric disorders from the National Comorbidity Survey, the first survey to administer a structured psychiatric interview to a national probability sample in the United States.
The DSM-III-R psychiatric disorders among persons aged 15 to 54 years in the noninstitutionalized civilian population of the United States were assessed with data collected by lay interviewers using a revised version of the Composite International Diagnostic Interview.
Nearly 50% of respondents reported at least one lifetime disorder, and close to 30% reported at least one 12-month disorder. The most common disorders were major depressive episode, alcohol dependence, social phobia, and simple phobia. More than half of all lifetime disorders occurred in the 14% of the population who had a history of three or more comorbid disorders. These highly comorbid people also included the vast majority of people with severe disorders. Less than 40% of those with a lifetime disorder had ever received professional treatment, and less than 20% of those with a recent disorder had been in treatment during the past 12 months. Consistent with previous risk factor research, it was found that women had elevated rates of affective disorders and anxiety disorders, that men had elevated rates of substance use disorders and antisocial personality disorder, and that most disorders declined with age and with higher socioeconomic status.
The prevalence of psychiatric disorders is greater than previously thought to be the case. Furthermore, this morbidity is more highly concentrated than previously recognized in roughly one sixth of the population who have a history of three or more comorbid disorders. This suggests that the causes and consequences of high comorbidity should be the focus of research attention. The majority of people with psychiatric disorders fail to obtain professional treatment. Even among people with a lifetime history of three or more comorbid disorders, the proportion who ever obtain specialty sector mental health treatment is less than 50%. These results argue for the importance of more outreach and more research on barriers to professional help-seeking.
The extent of social dysfunctioning and its relationship to psychological disorders among Dutch primary care patients was examined. Social dysfunctioning in these patients was rather limited, but was more pronounced in patients with a psychological disorder than in those without. Disabilities were largely restricted to the occupational and social roles, with family role functioning and self-care relatively intact. Social dysfunctioning was moderately related to psychopathology, with higher levels of dysfunctioning in more severe and depressed cases. The extent of social dysfunctioning among patients with both anxiety and depression was similar to that of patients with a single diagnosis of depression. Depressed patients had a similar level of dysfunctioning to non-psychotic psychiatric out-patients. Analyses regarding the effects of diagnosis and severity on social dysfunctioning revealed considerable overlap between these two aspects of psychopathology. This study supports the need for a simultaneous but separate assessment of psychopathology and social dysfunctioning. However, future research should incorporate additional predictors of social dysfunctioning (e.g. personality, life events, long-term difficulties, physical disorders), and prospective studies should be conducted to clarify the temporal sequences of symptom severity, diagnosis, and comorbidity on the one hand, and social dysfunctioning on the other.
• Most cases in epidemiologic surveys of community populations have never been treated by mental health professionals. We studied how community cases and patients may be similar or different with respect to their social functioning in such areas as work, marriage, and parenting. There are grounds for two contrasting hypotheses: the universal hypothesis (disorder is accompanied by disability independently of treatment status) and the patient-specific hypothesis (disorder is accompanied by disability only for cases who become patients). We investigated these hypotheses using data from symptom scales and social functioning scales that are part of the Psychiatric Epidemiology Research Interview. The sample consisted of 205 adults from the general population and 204 psychiatric patients from Jerusalem. The results provided some support for each hypothesis depending on the types of symptoms and functioning and disorder involved; however, the relationship between symptoms and social functioning in patients as well as cases from the community was weaker than had been supposed.
A method often used for computing the variance of a complicated sample estimate is to first apply the Taylor approximation to reduce non-linear forms of the variables to linear form. This article shows the useful results which can be obtained by merely reversing the order between selection units and component variables in this linear expression. The method is completely general (assuming that the samples are large enough to justify using the Taylor approximation) involving no restrictions on (a) the form of the estimate, (b) the number of random variables involved in the estimate, (c) the type, complexity or number of the sample designs involved in the estimate.
We discuss the use of standard logistic regression techniques to estimate hazard rates and survival curves from censored data. These techniques allow the statistician to use parametric regression modeling on censored data in a flexible way that provides both estimates and standard errors. An example is given that demonstrates the increased structure that can be seen in a parametric analysis, as compared with the nonparametric Kaplan-Meier survival curves. In fact, the logistic regression estimates are closely related to Kaplan-Meier curves, and approach the Kaplan-Meier estimate as the number of parameters grows large.
This article describes a generalized program for the computation of sampling errors. It employs computerized linearization of nonlinear estimates by the use of the first-order Taylor approximation. It can be used for any estimate derived from any “large” probability sample. In most instances the only inputs required are the weighted sample data and the form of the estimate whose precision is to be measured. In these cases, both the estimate and its sampling error can be produced with the same amount of data preparation and programming effort as is required to produce the estimate only.
Balanced repeated replications (BRR) is a general method for computing standard errors. It is useful when mathematical distribution theory is impractical or lacking, and especially for analytical statistics based on complex samples where clustering destroys the independence of observations. Presented are results of methods used to measure standard errors of regression coefficients for several multivariate techniques. The basic designs of the several samples comprised two primary selections (PS) per stratum.Each replication was a half-sample, created by selecting one PS from each stratum. The variance of the coefficient , estimated from the entire sample, is measured by , where bj is the same estimator based on a half-sample. To increase the precision of the variance estimate, select k repeated replications and obtain the mean of the k computed variances, . Balanced repeated replications reduce the number of repetitions needed; e.g., 48 balanced replications sufficed for 47 strata in our samples. Though proofs are complete only for linear statistics, rationale and results are offered to indicate that BRR provides needed estimates of errors for nonlinear statistics.The ratios, , of actual standard errors to those of simple random sampling, (srs), are investigated for several statistics in five empirical studies. In each study the average values of exceed 1.00 and range from 1.05 for less clustered to 1.46 for more clustered samples.
This article provides estimates of direct treatment costs and indirect costs from lost productivity associated with the morbidity and mortality of depression. Data are based on epidemiologic estimates of the prevalence of major depressive illness and on the number of suicides assumed to be secondary to depression. The number of hospitalizations, hospital days, physician and mental health provider visits, home/nursing home costs, and pharmaceutical costs are estimated. The direct and indirect costs are estimated to be approximately $16.3 billion per year. These economic figures provide a lower-bound estimate of the full economic burden of major depression and further emphasize the need for timely recognition and treatment to potentially minimize the negative impact of the illness on society.
To the Editor— Although we welcome discussion of the relative merits of different research criteria for Psy chiatric diagnosis, the article by Drs Overall and Hollister in theArchives(36:1198-1205, 1979) "Comparative Evaluation of Research Diagnostic Criteria for Schizophrenia" troubles us for several reasons. First of all, the authors do not address the issue of the different purposes of various sets of research diagnostic criteria. Whereas the purpose of the actuarial approach taken by Drs Overall and Hollister is to simulate competent or expert clinical practice, the purpose of the Washington University criteria, research diagnostic criteria (RDC), and DSMIII criteria is to improve usual clinical practice by incorporating into the criteria distinctions that have been shown by research study to have some validity in terms of such variables as course, response to specific therapy, familial pattern, etc. Given this difference in purpose, it is hardly adequate to approach the evaluation
The advent of more explicit diagnostic criteria and the growing interest in "lifetime" rates of mental disorders has made imperative an accurate determination of time-related diagnostic criteria. We used data from two independent test-retest studies of the Diagnostic Interview Schedule (DIS) and the Composite International Diagnostic Interview (CIDI) to study the reliability of different time-related questions in these fully standardized diagnostic interviews. With two exceptions (anxiety disorders and alcohol-related questions), the test-retest reliability of most time-related questions in both interviews was judged to be satisfactorily high. Furthermore, the validity of time-related questions in the DIS (age at symptom onset, duration and frequency of illness episodes) was examined by comparing them with detailed "consensus" ratings done independently by different clinicians for 207 former psychiatric inpatients. A surprisingly high concordance was found for former psychotic patients except for those still severely disturbed at the follow-up investigation. Some severe restrictions were also found for nonpsychotic disorders with regard to judgment of the age at onset of phobias, panic attacks, and depression. For a more valid assessment of time-related symptom information, the use of specific memory aids is suggested.
The National Survey of Family Growth (1982) is used to examine the extent to which racial differences in premarital birth rates can be explained by differences in parents' socioeconomic status, family structure, and residential characteristics. The findings document a large diversity in premarital births within both populations. Black women from high-risk backgrounds are three times more likely to have a premarital birth than black women from low-risk backgrounds. Racial differences in premarital births arise because (1) black women are more likely to come from high-risk backgrounds and (2) black women from low-risk backgrounds are more likely to have a premarital birth than white women with similar characteristics. There are similar rates of premarital births by race among persons from high-risk backgrounds.
What has been the recent trend in illegitimacy in the United States? The answer depends on what is being measured. If the focus is on illegitimacy rates, then the trend is mixed. Illegitimacy ratios, however, have been skyrocketing. We show that this is primarily the result of declining nuptiality (and rising marital dissolution) and secondarily the result of decreases in marital fertility. We argue that the illegitimacy ratio is the better index of the social consequences of out-of-wedlock childbearing and that the high ratios of recent decades are unlikely to abate in the foreseeable future.
A study of inner-city Black and Caucasian males and females in two junior and two senior high schools provided data on sexual knowledge, attitudes and behaviors, and substance use based on over 2500 anonymous, voluntary self-administered questionnaires. Substance use was high among Caucasians, particularly females. Females smoked more cigarettes than males and men drank more alcohol. Marijuana smoking showed only small racial, age, and gender differences. Compared to Blacks, Caucasians used more hard drugs. Using an index scoring types of substances and frequencies of use, sexually active students were higher than virgins in all subgroups, with those who initiated intercourse early appearing highest on the index. A regression model explaining 21% of the variance in substance use showed independent effects of age, race, gender, and sexual activity. The importance of an index for screening early use is discussed, and research on the relationship of low-level youthful experimentation with future dysfunctional use is proposed.
Most cases in epidemiologic surveys of community populations have never been treated by mental health professionals. We studied how community cases and patients may be similar or different with respect to their social functioning in such areas as work, marriage, and parenting. There are grounds for two contrasting hypotheses: the universal hypothesis (disorder is accompanied by disability independently of treatment status) and the patient-specific hypothesis (disorder is accompanied by disability only for cases who become patients). We investigated these hypotheses using data from symptom scales and social functioning scales that are part of the Psychiatric Epidemiology Research interview. The sample consisted of 205 adults from the general population and 204 psychiatric patients from Jerusalem. The results provided some support for each hypothesis depending on the types of symptoms and functioning and disorder involved; however, the relationship between symptoms and social functioning in patients as well as cases from the community was weaker than had been supposed.
Historically, researchers have focused on identifying risk factors for teen motherhood, largely ignoring teen fathers. This study uses the 1958 National Child Development Study of Great Britain to examine antecedents of teen fatherhood. Teen fathers were compared with later fathers and nonfathers by using epidemiological methods. Results indicate that boys who became fathers while in their teens were at increased risk for experiencing problems at home and at school and were more likely to demonstrate aggressive, truant, and law-breaking behaviors. Many of these risk factors were also evident among those who became fathers while in their early 20s.
This is the first in a series of investigations of the social consequences of psychiatric disorders based on the National Comorbidity Survey. Data on the relationship between preexisting psychiatric disorders and subsequent educational attainment are presented.
The National Comorbidity Survey is a nationally representative survey of 8,098 respondents in the age range 15-54 years. A subsample of 5,877 respondents completed a structured psychiatric interview and a detailed risk factor battery. Diagnoses of DSM-III-R anxiety disorders, mood disorders, substance use disorders, and conduct disorder were generated, and survival analyses were used to project data on school terminations to the total U.S. population.
Early-onset psychiatric disorders are present in more than 3.5 million people in the age range of the National Comorbidity Survey who did not complete high school and close to 4.3 million who did not complete college. The most important disorders are conduct disorder among men and anxiety disorders among women. The proportion of school dropouts with psychiatric disorders has increased dramatically in recent cohorts, and persons with psychiatric disorders currently account for 14.2% of high school dropouts and 4.7% of college dropouts.
Early-onset psychiatric disorders probably have a variety of adverse consequences. The results presented here show that truncated educational attainment is one of them. Debate concerning whether society can afford universal insurance coverage for the treatment of mental disorders needs to take these consequences into consideration.
This paper reviews reliability and validity studies of the WHO - Composite International Diagnostic Interview (CIDI). The CIDI is a comprehensive and fully standardized diagnostic interview designed for assessing mental disorders according to the definitions of the Diagnostic Criteria for Research of ICD-10 and DSM-III-R. The instrument contains 276 symptom questions many of which are coupled with probe questions to evaluate symptom severity, as well as questions for assessing help-seeking behavior, psychosocial impairments, and other episode-related questions. Although primarily intended for use in epidemiological studies of mental disorders, it is also being used extensively for clinical and other research purposes. The review documents the wide spread use of the instrument and discusses several test-retest and interrater reliability studies of the CIDI. Both types of studies have confirmed good to excellent Kappa coefficients for most diagnostic sections. In international multicenter studies as well as several smaller center studies the CIDI was judged to be acceptable for most subjects and was found to be appropriate for use in different kinds of settings and countries. There is however still a need for reliability studies in general population samples, the area the CIDI was primary intended for. Only a few selected aspects of validity have been examined so far, mostly in smaller selected clinical samples. The need for further procedural validity studies of the CIDI with clinical instruments such as the SCAN as well as cognitive validation studies is emphasized. The latter should focus on specific aspects, such as the use of standardized questions in the elderly, cognitive probes to improve recall of episodes and their timing, as well as the role of order effects in the presentation of diagnostic sections.
Child maltreatment and teenage firstbirths: a rela-tionship mediated by chronic sociodemographic stress?
- Zuravian
Zuravian SJ: Child maltreatment and teenage firstbirths: a rela-tionship mediated by chronic sociodemographic stress? Am J Or-thopsychiatry 1988; 58:91–10
Family History Research Diagnostic Criteria
- J Endicott
- Andreasen
- Spitzer
Endicott J, Andreasen N, Spitzer RL: Family History Research Diagnostic Criteria, 3rd ed. New York, New York State Psychi-atric Institute, Biometrics Research, 197
The consequences of single motherhood. Ameri-can
- Mclanahan
McLanahan SS: The consequences of single motherhood. Ameri-can Prospect 1994; 18:48–5
The Pregnant Adolescent: Problems of Premature Parenthood
- F G Bolton
Bolton FG: The Pregnant Adolescent: Problems of Premature
Parenthood. Beverly Hills, Calif, Sage Publications, 1980
- Osiris Ann Vii
- Arbor
OSIRIS VII. Ann Arbor, University of Michigan, Institute for Social Research, 1981
Economic Costs to Society of Alcohol and Drug Abuse and Mental Illness: 1980
- H J Harwood
- D M Napolitano
- P Kristiansen
- J J Collins
Harwood HJ, Napolitano DM,
Kristiansen P, Collins JJ: Economic Costs to Society of Alcohol and Drug Abuse and Mental Illness: 1980. Research
Triangle Park, NC, Research
Triangle Institute, 1984
Kids Having Kids: Economic Costs and Social Consequences of Teen Pregnancy
- R A Maynard
Maynard RA (ed): Kids Having Kids: Economic Costs and Social
Consequences of Teen Pregnancy. Washington, DC, Urban Institute Press, 1996
Single motherhood in the United States: growth, problems and politics, in Single Parent Families
- S S Mclanahan
- I Garfinkel
McLanahan SS, Garfinkel I: Single motherhood in the United
States: growth, problems and politics, in Single Parent Families;
The consequences of single motherhood
- S S Mclanahan
McLanahan SS: The consequences of single motherhood. American Prospect 1994; 18:48-58
- J Endicott
- N Andreasen
- R L Spitzer
Endicott J, Andreasen N, Spitzer RL: Family History Research
Diagnostic Criteria, 3rd ed. New York, New York State Psychiatric Institute, Biometrics Research, 1978
- H L Smith
- P L Cutright
Smith HL, Cutright PL: Thinking about change in illegitimacy
ratios: United States, 1963-1983. Demography 1988; 25:235-247