Cara C. Young

Stressful life events, worry, and rumination predict depressive and anxiety symptoms in young adolescents

PROBLEM Depression and anxiety are highly prevalent and frequently comorbid mental health disorders that often manifest during childhood and adolescence. The purpose of this study was to prospectively examine potential common underlying mechanisms predicting the development of depressive and anxiety symptoms to identify mutual underlying modifiable risk factors to target with mental health promotion and prevention interventions. METHODS A community-based sample of 11- to 15-year-old adolescents participated in a prospective, longitudinal pilot study with three waves of data collection over a 6-month period. FINDINGS At baseline, stressful life events, worry, and rumination accounted for 35% of the variance in anxiety scores (adjusted R(2) = 0.28) and 58% of the variance in depressive symptoms (adjusted R(2) = 0.53), while at Time 3 (T3; 6 months post baseline) these variables accounted for 63% of the variance in anxiety scores (adjusted R(2) = 0.59) and 45% of the variance in depressive symptoms (adjusted R(2) = 0.39). After controlling for baseline values, increases in stress, worry, and rumination were predictive of both depressive and anxiety symptoms at T3. CONCLUSIONS Study findings point to the importance of prevention and early intervention programs including content addressing stress management, rumination, and worry.

Cognitive Vulnerabilities, Negative Life Events, and Depressive Symptoms in Young Adolescents

Negative patterns of thinking, termed cognitive vulnerabilities, have been identified as risk factors for the development of depressive symptoms when adolescents experience negative life events. This study evaluated the associations among three cognitive vulnerabilities (i.e., dysfunctional attitudes, negative inferential style, and ruminative response style) and negative life events with depressive symptoms in a sample of young adolescents. All three cognitive vulnerabilities were found to be significantly associated with depressive symptoms. Furthermore, ruminative response style was found to have a significant unique contribution to the number of depressive symptoms. Findings suggest that cognitive vulnerabilities, particularly rumination, may be instrumental in explaining the development of depressive symptoms in young adolescents.

A systematic review of literature on psychosocial aspects of gynecomastia in adolescents and young men.

Gynecomastia represents a serious psychosocial challenge for many adolescent and young adult males, but short of surgery, little attention has been given to this concern. The purpose of this paper is to report findings from a systematic review of the literature about psychosocial correlates, psychosocial interventions, and quality of research evidence about young males with gynecomastia. From an initial 233 published papers, 10 studies were identified and reviewed. Five were descriptive case studies and included no statistical analyses. The other studies were all conducted with small samples. Despite the limited evidence, findings suggest that many young men suffer emotional distress concerning gynecomastia, but this distress has received few interventions beyond surgical removal of the breast tissue. Future studies are needed to address this problem more fully so that more aggressive measures such as frequent assessments of the physical and psychosocial aspects of the condition can be done by healthcare professionals.

A Systematic Review of Interventions to Reduce Stress in Adolescence

Adolescence can be a stressful developmental phase, placing youth at risk for negative health outcomes. Evidence-based interventions are crucial to helping adolescents manage stress; yet, most of the literature on adolescent stress is observational and descriptive. We systematically reviewed the literature on stress management interventions for adolescents and found there is evidence to support the effectiveness of interventions that aim to develop cognitive skills among adolescents; however, most studies had small samples and relied on different operational definitions of outcomes. Few included biological indicators of stress. Further study is needed to develop interventions to enhance adolescents’ capacity to manage stress.

Outcomes of Depression Screening Among Adolescents Accessing School-based Pediatric Primary Care Clinic Services

Purpose: Implementation of routine Patient Health Questionnaires (PHQ‐9) screening among adolescents aged 12–18 year, accessing school‐based pediatric primary care clinic services for identification of adolescents at potential risk for Major Depressive disorder (MDD). Design and Methods: Retrospective chart review (N = 256 cases) documented PHQ‐9 depression screening outcomes among adolescents accessing school‐based pediatric primary care clinic services for episodic illness and wellness visits. Data analyses included descriptive statistical methods. Results: Chart review included 137 (53.5%) females and 119 (46.5%) males. PHQ‐9 depression screening was identified for 56.3% (n = 144) of charts with scores ≥ 10 for 12.5% (n = 18) among those screened. Mental health referrals were made for 83.3% (n = 15) with PHQ‐9 scores ≥ 10. Dysthymia related concerns were reported among 20.1% (n = 29) of which 55.2% (n = 16) received mental health referrals. Female adolescents reported more sleep problems (χ2 = 9.174, p = 0.002) and tiredness (χ2 = 6.165, p = 0.013) than males. The 15–18 year age group (χ2 = 5.443, p = 0.020) was more likely to experience sleep problem and low self‐esteem than 12–14 year age group (χ2 = 5.143, p = 0.023). Conclusion: Implementation of PHQ‐9 depression screening protocol identified MDD among adolescent accessing pediatric school‐based primary care clinic services facilitating referrals to mental health providers, potentially improving morbidity and mortality among adolescents. Practice Implications: MDD is common among adolescents and associated with functional impairments and increased morbidity and mortality. Due to its high prevalence, it is imperative to improve screening and treatment access in this population via school‐based clinics. Highlights:Implementation of depression screening protocol improved screening rates in a school‐based pediatric primary care clinicDepression screening for adolescents accessing a school‐based clinic promotes early management of major depressive disorderEpisodic illness may be a confounding source of depressive symptoms identified during routine screening among adolescents

Suicide Ideation and Life Events in a Sample of Rural Adolescents.

Adolescents experience both developmental and situational periods of transition along with myriad stressful life events when they enter and exit high school. These life events may be associated with thinking of, planning, and attempting suicide. Yet despite the development of prevention programs to treat at-risk individuals, suicide rates among adolescents have remained relatively high. Recent research suggests that suicidal ideation is associated with stressful life events and the use of maladaptive coping mechanisms, but studies have been limited to cross-sectional designs and clinical samples. We conducted a longitudinal study of 1345 rural adolescents (50.7% Hispanic) attending public schools in central Texas. The purpose of this analysis was to determine changes in suicide ideation rates over time and to test hypotheses about the life events and coping mechanisms associated with suicide ideation. Gender and race/ethnic differences in suicide were also explored. Rates of reported suicide ideation declined significantly from the first to the last year of high school (p=.015). Statistically significant relationships were found between suicide ideation, several types of life events, and maladaptive coping strategies. Gender and racial/ethnic differences were also found. Taken together, these findings suggest new approaches to developing and testing interventions that can assist specific populations of adolescents to learn how to cope with their life events in productive and health-promoting ways.

Transition Planning for the College Bound Adolescent with a Mental Health Disorder

Health promotion, disease prevention and anticipatory guidance are the hallmarks of nursing practice, particularly in pediatrics. While there is a wealth of information on anticipatory guidance for the pediatric patient at different ages and developmental stages, there is a paucity of information on anticipatory guidance for the adolescent and emerging adult in transitioning to manage their own health care. While an established need for anticipatory guidance and a transition plan from pediatric to adult health care is apparent for youth routinely followed for significant medical, intellectual, or developmental conditions, a group particularly vulnerable to destabilization of their health as they transition to self-directed adult health care management is composed of youth with mental health disorders. The risk for destabilization increases as they move away from social supports to the university setting. This article reviews available literature on anticipatory guidance for the college bound adolescent with a mental health disorder and makes recommendations for transition planning including examining the college and community services that would support mental health as well as personal choices regarding lifestyle habits while attending the university. Recommendations are made for nurses to be the leaders in filling this anticipatory guidance gap in preparing youth with mental health disorders for a successful transition to and through college life.

Familial Factors, Cognitive Vulnerabilities, and Stressful Events Related to Depressive Symptoms in Latino Adolescents

This study examined familial factors unique to Latino adolescents within a cognitive vulnerability stress framework, in which negative patterns of thinking contribute to the development of depressive symptoms following stressful life events. Participants were Latino adolescents (N = 90), 12 to 18 years old. Almost half (~48%) reported elevated depressive symptoms. The final regression model explained 67% of the prevalence of depressive symptoms; stressful life events (including family conflict) and a ruminative response style emerged as unique predictors. Additional sociocultural factors contributing to the model’s explanatory power were familism, family cohesion, and perceived discrimination. Rumination and stressful life events should be considered targets for depression prevention and early intervention programs with Latino youth. Such programs would benefit from cultural modifications that encourage family cohesion and a sense of familism.

Screening for rumination and brooding may be a feasible method of identifying adolescents at high risk for depression.

The purpose of this study was to explore the usefulness of a standardized measure of rumination and brooding (Ruminative Response Scale [RRS]), to accurately identify adolescents at risk for depression. Participants (N=111; mean age=13.06 years) completed standardized measures in a cross-sectional study. ROC analyses yielded high area under the curve estimates for the RRS (.94, p<.001) and the brooding subscale (.91, p<.001), indicating both are excellent at discriminating between adolescents at high and low risk for depressive symptoms. Findings suggest depression prevention may benefit from screening for and targeting rumination or brooding with adolescence.

Physical Activity Interventions to Decrease Substance Use in Youth: A Review of the Literature

ABSTRACT Background: Adolescent substance use, a major problem in the United States, has a significant negative effect on both short- and long-term mental and physical health. Physical activity (PA) may offer potentially effective strategies to combat substance use in youth. Like substance use, PA behaviors developed during adolescence persist into adulthood, so adolescence may be an ideal period in which to implement PA interventions to prevent substance abuse. However, there are no known systematic literature reviews of PA-based interventions that target substance use in adolescence. Objectives: To review PA interventions for adolescents, including research designs, intervention characteristics, and measures of substance use. Methods: Five databases were searched for articles published in English peer-reviewed journals. Search terms were related to the adolescent population, substance use, and PA interventions. Results: 17 articles fit inclusion criteria. The results suggest that PA interventions may decrease substance use in teens. A majority of the interventions were delivered in high schools. Substance use measures/outcomes included intention or willingness to use, cessation, and actual use. Alcohol use was measured most, followed by marijuana and tobacco use. Although most of the studies utilized group sessions to deliver interventions, decreased substance use was also associated with one-time, multi-health consultations. Conclusions/Importance: School-based interventions targeting multiple health behaviors may offer a particularly effective and efficient way to decrease substance use in adolescents.