Carolyn A. McCarty

Effects of psychotherapy for depression in children and adolescents: a meta-analysis.

Serious sequelae of youth depression, plus recent concerns over medication safety, prompt growing interest in the effects of youth psychotherapy. In previous meta-analyses, effect sizes (ESs) have averaged .99, well above conventional standards for a large effect and well above mean ES for other conditions. The authors applied rigorous analytic methods to the largest study sample to date and found a mean ES of .34, not superior but significantly inferior to mean ES for other conditions. Cognitive treatments (e.g., cognitive-behavioral therapy) fared no better than noncognitive approaches. Effects showed both generality (anxiety was reduced) and specificity (externalizing problems were not), plus short- but not long-term holding power. Youth depression treatments appear to produce effects that are significant but modest in their strength, breadth, and durability.

Continuity of binge and harmful drinking from late adolescence to early adulthood.

Objective. To test the hypothesis that late adolescent drinking behavior (ages 17–20) is associated with harmful and binge drinking in early adulthood (ages 30–31). Methods. We used the National Longitudinal Survey of Youth (NLSY), a nationally representative longitudinal data set. We used harmful and binge drinking at ages 17 to 20 to predict harmful and binge drinking at ages 30 to 31, stratifying for gender and controlling for confounders. Results. Data were available on harmful drinking at both the adolescent and the early adult age period for 3790 individuals and on binge drinking for 2387 individuals. Harmful drinking during adolescence was significantly associated with harmful drinking at ages 30 to 31 for men only. Among male adolescents, 14% of harmful drinkers continued harmful drinking at ages 30 to 31, compared with 4% of nonharmful drinkers who became harmful drinkers. In Poisson regression models, binge drinking during adolescence was associated with binge drinking at ages 30 to 31 for both men and women, generating relative risks of 2.3 (95% confidence interval: 1.8–3.0) and 3.0 (95% confidence interval: 2.4–4.8), respectively. Half of binge-drinking male adolescents and one third of binge-drinking female adolescents engaged in binge drinking into early adulthood, compared with 19% for non–binge-drinking male adolescents and 8% of non–binge-drinking female adolescents. Conclusions. Problem drinking during adolescence is associated with problem drinking in early adulthood. Efforts to prevent and treat adolescent problem drinking could have an impact on the progression of alcohol-related disease.

Culture, Coping, and Context: Primary and Secondary Control among Thai and American Youth

Do cultural values and traditions influence the development of coping styles ? To address this question, we compared self-reports of coping by 6-14-year-olds in Thailand and the U.S. One hundred and forty-one children were interviewed about six common stressors: separation from a friend, injection in a doctors office, adult anger, peer animosity, school failure, and physical injury. Childrens self-reported coping methods were coded as overt or covert. Coping goals were coded as reflecting primary control (attempts to influence objective conditions), secondary control (attempts to adjust oneself to objective conditions), or relinquished control. Although findings revealed numerous cross-national similarities, there were also multiple main and interaction effects involving culture, suggesting that sociocultural context may be critical to our understanding of child coping. Consistent with literature on Thai culture, Thai children reported more than twice as much covert coping as American children for stressors involving adult authority figures (i.e. adult anger, injection in doctors office). Thai children also reported more secondary control goals than Americans when coping with separation, but American children were five times as likely as Thais to adopt secondary control goals for coping with injury. The findings support a model of coping development in which culture and stressor characteristics interact, with societal differences most likely to be found in situations where culture-specific norms become salient.

Control-Related Beliefs and Depressive Symptoms in Clinic-Referred Children and Adolescents: Developmental Differences and Model Specificity

The contingency-competence-control (CCC) model links contingency and competence beliefs to perceived control and, in turn, to depression. However, a developmental perspective suggests that noncontingency may be too abstract a concept to be directly tied to depression before adolescence. We tested the CCC model and this developmental notion, using structural equation modeling, with 360 clinic-referred 8- to 17-year-olds. The CCC model fit the data well for the full sample accounting for 46% of the variance in depression. Separate analyses by age group placed perceived contingency in the best-fit model for adolescents (ages 12-17 years) but not for children (8-11 years). This suggests that abstract cause-effect concepts may have more direct affective impact after the cognitive changes of adolescence (e.g., formal operations) than before. Finally, the CCC model accounted for much more variance in depression than conduct problems, suggesting diagnostic specificity.

Mediators of the relation between maternal depressive symptoms and child internalizing and disruptive behavior disorders

Drawing on a normative sample of 224 youth and their biological mothers, this study tested 4 family variables as potential mediators of the relationship between maternal depressive symptoms in early childhood and child psychological outcomes in preadolescence. The mediators examined included mother-child communication, the quality of the mother-child relationship, maternal social support, and stressful life events in the family. The most parsimonious structural equation model suggested that having a more problematic mother-child relationship mediated disruptive behavior-disordered outcomes for youths, whereas less maternal social support mediated the development of internalizing disorders. Gender and race were tested as moderators, but significant model differences did not emerge between boys and girls or between African American and Caucasian youths.

Growth in adolescent delinquency and alcohol use in relation to young adult crime, alcohol use disorders, and risky sex: a comparison of youth from low- versus middle-income backgrounds

BACKGROUND This study examined adolescent delinquency and alcohol use in relation to young adult crime, alcohol use disorders (AUDs), and risky sex. Analyses further examined the influences of late childhood involvement in these problem behavior outcomes, with mediation through teen delinquency and alcohol use, and examined differences in the pathways for youth from low- compared to middle-income backgrounds. METHOD Multiple-group latent growth curve modeling was conducted using data collected from a sample of 808 youth followed from age 10 to age 24. Self-report assessments included delinquent involvement, alcohol use, and sexual activity in late childhood; delinquency and alcohol use in adolescence; and crime, AUDs, and risky sex in early adulthood. RESULTS Late childhood delinquent involvement was associated with young adult crime, AUDs, and risky sex indirectly through adolescent delinquency, and had a persistent direct effect on crime. Adolescent delinquency also mediated the relation between early sex onset and crime. Early alcohol use predicted a higher level of, and a faster rate of increase in, adolescent drinking, which predicted, in turn, young adult AUDs and risky sex. Significant group differences indicated stronger associations between adolescent delinquency and each young adult outcome for youth from low- compared to those from middle-income backgrounds. CONCLUSIONS Early intervention may help prevent the development of crime, AUDs, and risky sex behaviors, especially among disadvantaged youth.

Parental Emotional Support and Subsequent Internalizing and Externalizing Problems Among Children

ABSTRACT. This study examined the association between early emotional support provided by parents and child internalizing and externalizing problems, using a nationally representative, longitudinal sample of 1361 children. Parental emotional support was assessed using the Home Observation for the Measurement of the Environment, incorporating both parent report and interviewer observation. We found that, controlling for child externalizing problems at age 6 years, parental emotional support at age 6 years was negatively related to child externalizing problems at age 8 years. A developmental model that assessed the timing of the emergence of this relationship was then analyzed by including parental emotional support at ages 2, 4, and 6 years as predictors of child externalizing problems at age 8 years. The developmental model suggested that less parental emotional support as early as age 2 years is associated with later externalizing problems in children. This study discusses the importance of very early parental emotional support in promoting positive child development.

Adolescent School Failure Predicts Later Depression Among Girls

PURPOSE Past research has found that social, academic, and behavioral problems are linked with depression during childhood and adolescence. The present study tests a longitudinal cascade model of adolescent problems predicting depression into adulthood, while additionally testing for gender differences. METHODS Using prospective longitudinal analysis with a sample of 808 youth followed from age 10 to 21, we tested whether social problems, school failure, and delinquency in adolescence increased risk for a major depressive episode in emerging adulthood. Structural equation modeling was used to test for gender differences. RESULTS Both early conduct problems and adolescent school failures predisposed girls to depression in young adulthood. Among the boys, none of the problems conferred risk for depression. CONCLUSIONS This study highlights the mutual interplay between school failure and psychological functioning. It is suggested that school adaptation in adolescence be considered a mental health issue.

Depressive symptoms in adolescence: the association with multiple health risk behaviors

OBJECTIVE Although multiple studies of adolescents have examined the association of depression with individual health risk behaviors such as obesity or smoking, this is one of the few studies that examined the association between depression and multiple risk behaviors. METHODS A brief mail questionnaire, which screened for age, gender, weight, height, sedentary behaviors, physical activity, perception of general health, functional impairment and depressive symptoms, was completed by a sample of 2291 youth (60.7% response rate) aged 13-17 enrolled in a health care plan. A subset of youth who screened positive on the two-item depression screen and a random sample of those screening negative were approached to participate in a telephone interview with more in-depth information obtained on smoking and at-risk behaviors associated with drug and alcohol use. RESULTS Youth screening positive for high levels of depressive symptoms compared to those with few or no depressive symptoms were significantly more likely to meet criteria for obesity, had a poorer perception of health, spent more time on the computer, got along less well with parents and friends, had more problems completing school work and were more likely to have experimented with smoking and a wide array of behaviors associated with drug and alcohol use. CONCLUSIONS Because many adverse health behaviors that develop in adolescence continue into adulthood, the association of depressive symptoms with multiple risk behaviors and poor functioning suggest that early interventions are needed at an individual, school, community and primary care level.

Child and adolescent telepsychiatry: variations in utilization, referral patterns and practice trends

Seattle Childrens Hospital is a tertiary referral hospital that has provided telepsychiatry to seven partner sites in the north-west since 2001. Service utilization data, patient demographics and diagnoses were collected for the period from the service inception in October 2001 until November 2007. During the study period, 701 patients were treated with a mean of 2.8 appointments per patient (SD 1.9). Five psychiatrists and four psychologists provided care. Utilization varied across referring sites and was largely dependent upon the availability of telepsychiatrists, although the degree of support from administration and stakeholders also contributed to the success of the service. A total of 190 primary care practitioners referred patients to telepsychiatry, including 106 family physicians and 71 paediatricians. Paediatricians referred to the service more frequently than family physicians (t = 2.8, P < 0.05). Overall, telepsychiatry with young people is feasible, acceptable and increases access to mental health care. There appear to be four core components necessary to a successful telepsychiatry programme: psychiatrists who are interested in exploring new ways to reach underserved young people; clearly identified stakeholders who can collaborate with one another to make good use of the telepsychiatry service; a childrens mental health ‘champion’ who represents these stakeholders and wants services for their community; and a stable administration that perceives telepsychiatry as valuable for their patients and their doctors.