Anne Mari Sund

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

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

Insecure Attachment as a Risk Factor for Future Depressive Symptoms in Early Adolescence

OBJECTIVE To investigate whether insecure attachment is a predictor of subsequent depressive symptoms among adolescents 12-14 years of age, when controlled for depressive levels the preceding year, various demographic and psychosocial factors, and stressful life events. METHOD A representative sample of 2,360 young adolescents was assessed at two time points 1 year apart. Measures included were depressive symptoms measured by the Mood and Feelings Questionnaire (MFQ), attachment to parents and friends measured by the Inventory of Parent and Peer Attachment, stressful events, and various sociodemographic factors. The initial response rate was 88.3% and the attrition rate was 4.3%. RESULTS The proportions of high scorers (MFQ > 33) increased threefold from T1 to T2 (3.4% to 10.9%). Results of multivariate logistic regression analyses showed that the following variables at T1 were predictive of depressive symptoms at T2 : severe depressive symptoms (odds ratio [OR] = 5.30), gender (OR = 4.08), attachment to parents (OR = 1.36), and stressful life events (OR = 1.12). No interactions between attachment and severe depressive symptoms and gender and stressful life events, respectively, were found. CONCLUSIONS Insecure attachment to parents may contribute to the development of severe depressive symptoms among young adolescents. Improving the adolescent-parent relationship could be a focus for interventions both in community services and in clinical work.

Emotional/behavioural, social correlates and one-year predictors of frequent pains among early adolescents: Influences of pain characteristics

In a one‐year longitudinal study, emotional/behavioural correlates and predictors of four common pain complaints (headaches, stomach, back and limb pain), were examined in a representative school sample of 2360 adolescents aged 12‐ to 15‐years.

School factors and the emergence of depressive symptoms among young Norwegian adolescents

The aims of this study were to examine correlates of self-reported depressive symptoms within the school area, and possible predictors of change in depressive symptom levels over a 1-year period in a large representative sample of 12 to 15-year-old adolescents in central Norway. The school variables were: school stress, class wellbeing, teacher support, and grades. Possible confounding factors were age, SES, ethnicity, and parental divorce. We also examined the strengths of these relationships. In the cross-sectional multivariate analyses of the whole sample, at time-point one (T1), all four school factors were independently associated with depressive symptom levels at small to moderate levels. In the longitudinal multivariate analyses of the whole sample, self-reported depressive symptom levels at time-point two (T2) were predicted by depressive symptom levels at T1, gender and teacher support. For girls, three of the school variables significantly predicted depressive symptom levels at T2, while this was not the case for boys. Prevention in schools might be of importance.

Specific depressive symptoms and disorders as associates and predictors of suicidal acts across adolescence.

OBJECTIVE To examine the role of depressive symptoms and disorders as associates and predictors of suicidal acts across adolescence. METHOD A representative sample of Norwegian school students (N = 2464, mean age 13.7 years) in grades 8 and 9 was reassessed after one year (T2) with the same questionnaire. All high scorers of depressive symptoms on the Mood and Feelings Questionnaire (MFQ) at T2 were defined as cases. One control from low or middle scorers, matched for age and gender, was randomly assigned to every two cases. This subset (n = 345) was diagnostically assessed by face-to-face K-SADS-PL interviews (mean age = 14.9 years). The same subset was reassessed after 5 years (T3) by using the same questionnaire (n = 252, mean age = 20.0 years) and telephone K-SADS-PL interviews (n = 242). The participation rate was 76.9% (n = 265). RESULTS Cognitive symptoms dominated the depressive symptom profile among suicide attempters, irrespective of age and time. Among younger adolescents, suicidal thoughts and acts of self-harm without suicidal intent were associated with suicidal acts. Recurrent thoughts about death, hopelessness, disturbed concentration and middle insomnia were associates of suicidal acts among older adolescents. Worthlessness by 15 years was a significant predictor of suicidal acts between 15 to 20 years. MDD and a depressive episode, not otherwise specified, continued to be significant associates among younger adolescents, while dysthymia by 15 years remained a predictor of suicidal acts between 15 to 20 years, even when controlled for depressive symptoms. CONCLUSIONS Self-harm without suicidal intent, middle insomnia, cognitive depressive symptoms and a formal psychiatric diagnosis of any depressive disorder should alert professionals in the risk assessment of suicidal adolescents.

Associations between attempted suicide, violent life events, depressive symptoms, and resilience in adolescents and young adults

Were violent/nonviolent traumatic life events and victimization by/witnessing violence associates of attempted suicide among depressed adolescents who were also less resilient at early adulthood? The present study examined a subset of mainly depressed, age- and gender-matched, adolescents derived from a representative sample of 2464 students (T1, mean age = 13.7 years) followed up after 1 year (T2Q) and reassessed 5 years later (T3, n = 252, mean age = 20.0 years, 73% participation), with a questionnaire, including the Connor-Davidson Resilience Scale and The Kiddie—Schedule for Affective Disorders and Schizophrenia—Present and Lifetime version psychiatric interviews, which also tapped traumatic life events. Logistic regression analyses revealed that attempters were victims, not witnesses of violence, more depressed, and less resilient than nonattempters, and that resilience was a moderator of lifetime violent events and attempted suicide, even in the presence of antecedent depression.

Prevalence, Course, Incidence, and 1-Year Prediction of Deliberate Self-Harm and Suicide Attempts in Early Norwegian School Adolescents

In this survey of early Norwegian school adolescents, the prevalence, course, and incidence of self-harm behavior with or without suicide intent were examined, in addition to predictors of self-harm for a 1-year follow-up period. Lifetime prevalence rates of self-harm without suicide intent and suicide attempts were 2.9% and 3.0%, respectively, while 1-year incidence rates were 3.6% and 1.7%, respectively. In multivariate analysis, five predictors significantly differentiated self-harmers from non-self-harming adolescents. Early school adolescents having frequent or intense suicidal ideation over an extended time period and attempting self-harm repeatedly with or without suicide intent should be identified and offered treatment.

One-Year Incidence, Course, and Outcome Predictors of Frequent Headaches Among Early Adolescents

Objective.—To examine the prevalence rate, course, annual incidence, and predictors of frequent headaches (at least once a week) in a 1‐year longitudinal study of a representative school sample of 2355 adolescents aged 12 to 14 years.

Does extended medication with amphetamine or methylphenidate reduce growth in hyperactive children

The purpose of the present study was to examine growth in children on extended stimulant treatment. Ninety-one hyperactive boys were studied, of whom 68 were treated with amphetamine and 23 with methylphenidate. The age range was 3-10 years. All children were treated with one of these stimulants for a minimum of 1 year. The yearly mean values for height and weight were all between the 25th and 90th percentile of the population norms. During the 1st year of treatment children who used amphetamine showed significantly smaller weight gains than those who used methylphenidate ( F = 6.9, df = 64, P < 0.05). Four patients (17%) in the methylphenidate group and 21 (31%) in the amphetamine group had a weight loss during the 1st year, ranging from 0 to 9.5 kg. Within this group of 25 patients there was a significantly higher number of children with a pretreatment weight greater than that of the 50th percentile group (chi-square = 5.59, P < 0.05). All 25 patients showed sufficient weight gain at later examinations. Multiple regression analyses showed that neither cumulative doses nor age had a significant effect on growth when initial weight and height were controlled for. These findings indicate that, for most children, extended treatments with amphetamine or methylphenidate do not have negative effects on growth. However, some children show weight loss during the 1st year of treatment, more often when amphetamine is used. Among those children who may show reduced weight gain, most are above mean weight before treatment begins.

Dialectical Behavior Therapy Compared With Enhanced Usual Care for Adolescents With Repeated Suicidal and Self-Harming Behavior: Outcomes Over a One-Year Follow-Up.

OBJECTIVE We conducted a 1-year prospective follow-up study of posttreatment clinical outcomes in adolescents with recent and repetitive self-harm who had been randomly allocated to receive 19 weeks of either dialectical behavior therapy adapted for adolescents (DBT-A) or enhanced usual care (EUC) at community child and adolescent psychiatric outpatient clinics. METHOD Assessments of self-harm, suicidal ideation, depression, hopelessness, borderline symptoms, and global level of functioning were made at the end of the 19-week treatment period and at follow-up 1 year later. Altogether 75 of the 77 (97%) adolescents participated at both time points. Frequencies of hospitalizations, emergency department visits and other use of mental health care during the 1-year follow-up period were recorded. Change analyses were performed using mixed effects linear spline regression and mixed effect Poisson regression with robust variance. RESULTS Over the 52-week follow-up period, DBT-A remained superior to EUC in reducing the frequency of self-harm. For other outcomes such as suicidal ideation, hopelessness, and depressive or borderline symptoms and for the global level of functioning, inter-group differences apparent at the 19-week assessment were no longer observed, mainly due to participants in the EUC group having significantly improved on these dimensions over the follow-up year, whereas DBT-A participants remained unchanged. CONCLUSION A stronger long-term reduction in self-harm and a more rapid recovery in suicidal ideation, depression, and borderline symptoms suggest that DBT-A may be a favorable treatment alternative for adolescents with repetitive self-harming behavior. CLINICAL TRIAL REGISTRATION INFORMATION Treatment for Adolescents With Deliberate Self Harm; http://clinicaltrials.gov/; NCT00675129.