Bilge Pakiz

Traumas and posttraumatic stress disorder in a community population of older adolescents

OBJECTIVE The prevalence of DSM-III-R traumas and posttraumatic stress disorder (PTSD) and their impact on psychosocial functioning were examined in a community population of older adolescents. METHODS Subjects were 384 adolescents participating in an ongoing longitudinal study. When subjects were aged 18 years, the NIMH Diagnostic Interview Schedule, Version IIIR, was used to identify lifetime traumatic events and diagnoses of PTSD, major depression, phobias, and substance dependence. Behavioral, emotional, and academic functioning in later adolescence was evaluated through self-report measures and school records. RESULTS More than two fifths of adolescents experienced at least one DSM-III-R trauma by age 18 years; PTSD developed in 14.5% of these affected youths or 6.3% of the total sample. Youths with PTSD demonstrated widespread impairment at age 18, including more overall behavioral-emotional problems, interpersonal problems, academic failure, suicidal behavior, and health problems, as well as an increased risk for additional disorders. An equally striking finding was that youths who experienced traumas but did not develop PTSD also showed deficits in many of these areas when compared with their peers who had not experienced traumas. CONCLUSIONS The substantial risk faced by youths in community settings for experiencing traumas and PTSD, along with associated impairments in later adolescence, underscores the need for programs of prompt intervention.

Prevalence of Psychiatric Disorders in a Community Population of Older Adolescents

In a community study of 386 Caucasian working-class older adolescents, a sizeable proportion met lifetime criteria for selected DSM-III-R diagnoses. Alcohol abuse/dependence had the highest lifetime prevalence rate (32.4%), followed by phobias (22.8%), drug abuse/dependence (9.8%), major depression (9.4%), and, least commonly, post-traumatic stress disorder (6.3%) and obsessive compulsive disorder (2.1%). Significant gender differences were found for major depression, post-traumatic stress disorder, and alcohol abuse/dependence, whereas socioeconomic differences occurred in major depression, phobias, and drug abuse/dependence. Adolescents with specific psychiatric disorders had significantly poorer functioning on measures of behavioral problems, interpersonal problems, self-esteem, and school performance. Results suggest the importance of identifying psychiatric disorder in adolescence, and the need for preventive strategies and prompt treatment.

Early psychosocial risks for adolescent suicidal ideation and attempts

OBJECTIVE An ongoing, 14-year, longitudinal community study examined psychosocial risks for adolescent suicidal ideation and attempts, as well as the link between earlier suicidal behavior and later functioning. METHOD Nearly 400 youths were followed between the ages of 5 and 18 years. Suicidal ideation was assessed at age 15 and lifetime suicide attempts were determined at age 18. Risk factors covered developmental periods from birth to age 15, and most were measured prospectively using multiple informants. Late-adolescent functioning (at age 18) was based on both self-reports and school records. RESULTS For both genders, the early onset (by age 14) of psychiatric disorders significantly increased the risk for suicidal ideation at age 15 and suicide attempts by age 18. Early gender-specific risks for suicidal ideation included preschool behaviors that are counter to typical gender norms, such as aggressive behavior in females and dependence in males. Suicidal ideation at age 15 and suicide attempts were both associated with deficits in later adolescence (at age 18) in behavioral and social-emotional functioning. CONCLUSIONS Suicidal ideation at age 15 was a marker of distress with long-term implications for later functioning. The early gender-specific risk factors for suicidal behavior identified in this study can aid in developing strategies for prevention and early intervention.

Psychosocial Risks for Major Depression in Late Adolescence: A Longitudinal Community Study

OBJECTIVE An ongoing 14-year longitudinal study examined psychosocial antecedents of major depression in late adolescence in a community population. METHOD Subjects were 385 adolescents followed between the ages of 5 and 18 years. Early health, familial, behavior, academic, and environmental risks for major depression were identified using data collected at ages 5, 9, 15, and 18 years. At age 18, a lifetime diagnosis of major depression was assessed using the NIMH Diagnostic Interview Schedule (DIS-III-R). RESULTS For males, neonatal health problems, dependence problems at age 5 years, perceived unpopularity and poorer perceptions of their role in the family at age 9 years, remarriage of a parent, early family discord, and anxiety at age 15 years significantly increased the risk of developing major depression. Females with major depression, compared with nondepressed females, had older parents and came from larger families, and at age 9 years had greater perceived unpopularity and anxiety, lower self-esteem, and poorer perceptions of their role in the family. Depressed females also reported more stressful life events, including death of parent and pregnancy. CONCLUSIONS Underscoring the importance of early psychosocial factors in the later development of major depression and pointing to specific risks, our findings can aid in developing strategies for prevention and early intervention.

Ages of Onset of Psychiatric Disorders in a Community Population of Older Adolescents

OBJECTIVE Ages of onset of psychiatric disorders, as well as the link between early onset and later psychosocial functioning, were examined in a community population of older adolescents. METHOD Subjects were 386 adolescents who were participants in an ongoing 14-year longitudinal study. At age 18, lifetime diagnoses and ages of onset of major depression, phobias, post-traumatic stress disorder, and substance disorders were assessed using the NIMH Diagnostic Interview Schedule, Revised Version. Behavioral, emotional, and academic functioning in later adolescence were evaluated through self-report measures and school records. RESULTS Almost one fourth of the adolescents met criteria for at least one disorder by age 14. Simple phobias emerged earliest (by early childhood), whereas for major depression and substance disorders the peak risk periods for onset were midadolescence. The early onset (by age 14) of disorders was associated with continued impairments in behavioral and emotional functioning in late adolescence (at age 18). Furthermore, the early onset of disorders, compared to later onset (ages 15 through 18), increased the risk for additional co-occurring disorders. CONCLUSIONS The striking levels of early psychopathology and associated long-term deficits in functioning found in this community population underscore the need for programs of early intervention.

Emotional and behavioral problems of Asian American adolescents: A comparative study

Social, academic, emotional functioning and social support of 99 ninth-grade Asian American students were investigated using standardized measures. When compared to 404 ninth-grade Caucasian adolescents who had attended the same school, Asian American students exhibited less delinquent behavior and performed better academically. However, they were significantly more isolated, more depressed and anxious, less apt to be involved in after school activities or seek help for their problems, and internalized their social problems. Also, they had fewer role models and less social support, underscoring the psychosocial and emotional plight of Asian American adolescents and the dire need to establish proactive outreach programs.

The Many Faces of Correlates of Depressive Symptoms in Adolescents

In a sample of White working-class adolescents, 21% scored above 12 on the Childrens Depression Inventory (CDI), with almost twice as many girls as boys in the high-CDI group. Maternal and adolescent reports indicated deficits in most areas of adolescent functioning in the high-CDI group. Within the high-CDI group, no differences in social class and family structure were found. No gender differences emerged for most correlates of depressive symptoms; both high-CDI boys and girls displayed coexisting internalizing and externalizing behaviors, including sad affect, withdrawal, antisocial behaviors, and substance abuse. Three differences appeared between high-CDI boys and girls. High-CDI boys considered themselves more unpopular, whereas high-CD! girls were seen as more externalizing by their mothers and more smoked than did high-CDI boys. Implications for interventions and research are discussed.