Judy A. Andrews

Adolescent psychopathology: I. Prevalence and incidence of depression and other DSM-III—R disorders in high school students.

Data were collected on the point and lifetime prevalences, 1-year incidence, and comorbidity of depression with other disorders (Diagnostic and Statistical Manual of Mental Disorders [3rd ed., rev.]) in a randomly selected sample (n = 1,710) of high school students at point of entry and at 1-year follow-up (n = 1,508). The Schedule for Affective Disorders and Schizophrenia for School-Age Children was used to collect diagnostic information; 9.6% met criteria for a current disorder, more than 33% had experienced a disorder over their lifetimes, and 31.7% of the latter had experienced a second disorder. High relapse rates were found for all disorders, especially for unipolar depression (18.4%) and substance use (15.0%). Female subjects had significantly higher rates at all age levels for unipolar depression, anxiety disorders, eating disorders, and adjustment disorders; male subjects had higher rates of disruptive behavior disorders.

Cognitive-behavioral treatment for depressed adolescents

The purpose of this study was to test the efficacy of two versions of a cognitive-behavioral intervention for depressed adolescents. Fifty-nine high school students, aged 14–18, meeting DSM-III and RDC criteria for a diagnosis of depression were randomly assigned to one of three conditions: Adolescent-and-Parent, Adolescent-Only, and Wait-List. The treatments were: a) an adaptation of the Coping with Depression Course (CWD), a cognitive-behavioral group intervention teaching skills for increasing pleasant activities, relaxation, controlling depressive thoughts, improving social interaction, and communication, negotation and conflict resolution skills; and b) an intervention for the parents. The results showed that, compared to the wait-list subjects, treated subjects improved significantly on the depression measures. These gains were maintained at two years posttreatment. There was a strong trend for the results to favor the Adolescent-and-Parent condition over the Adolescent-Only condition, but only one of numerous comparisons attained statistical significance.

Assessment of Depression in Adolescents Using the Center for Epidemiologic Studies Depression Scale

Operating characteristics of the Center for Epidemiologic Studies Depression Scale (CES-D) were examined by using data from 4 samples of students in Grades 9-12. Although it appears that the CES-D scale may be appropriate for use with adolescents, the issues of stability of scores over time, appropriate cutoff scores, and usefulness in detecting cases of clinical depression remain unresolved

Suicidal Attempts among Older Adolescents: Prevalence and Co-occurrence with Psychiatric Disorders

The prevalence of suicidal attempts and ideation and the co-occurrence of attempts with psychiatric disorders were examined in a community sample of 1710 older adolescents. Structured interviews using rigorous diagnostic criteria were conducted in two annual assessments. Lifetime prevalence of attempts was 7.1% and ideation was 21.1%. Almost 90% of those who attempted also evidenced suicidal ideation. Suicide attempts occurred in conjunction with depressive, substance use, and disruptive behavior disorders but not with panic disorders. Results indicate that risk factors for an attempt are the following: being female, from a home without a father, poor education of the father, previous attempts, suicidal ideation, and mental disorders.

The influence of peers on young adult substance use.

Data collected from 294 young adults, ages 19 to 25, and both a same- and an opposite-gender best friend or mate across 3 annual assessments were analyzed to examine the similarity to and influence of the peer on the young adults substance use. The authors found similarity across time between both peers and the young adult in cigarette use, alcohol use, binge drinking, and, in most cases, marijuana use. In prospective analyses, peer use predicted young adult cigarette use, binge drinking, and problem use by the young adults. Results were generally consistent across gender and for both same- and opposite-gender peers. Findings emphasize peer influence contribution to young adult substance use and suggest the design of interventions that involve both young adults and their peers.

The Influence of Parent, Sibling, and Peer Modeling and Attitudes on Adolescent Use of Alcohol

This 1-year prospective study of 173 families with two or more children examines the influence of parent, sibling, and peer modeling (i.e., use) and attitudes on adolescent use of alcohol. Independent questionnaire data were obtained from the adolescent, father, mother, and sibling(s). Structural equation modeling methods were employed to examine these relationships. Parent attitude toward youth alcohol use and parent modeling of alcohol use were strongly related to change in adolescent alcohol use, suggesting that parents can influence the future use of alcohol by their children. Peer and sibling modeling and peer attitudes also influenced adolescent alcohol use.

Family Support and Conflict: Prospective Relations to Adolescent Depression

The relations between family support, family conflict, and adolescent depressive symptomatology were examined longitudinally in a sample of 231 female and 189 male adolescents and their mothers. Structural equation models revealed that less supportive and more con-flictual family environments were associated with greater depressive symptomatology both concurrently and prospectively over a 1-year period. Conversely, adolescent depressive symptomatology did not predict deterioration in family relationships. Depressive symptomatology and, to a greater extent, family characteristics showed high levels of stability over the 1-year period. Counter to our expectations, the relations between family variables and depressive symptomatology were similar for boys and girls. The results suggest that the quality of family interactions is relevant for understanding the development of depressive symptoms in adolescents.

Adolescent modeling of parent substance use: The moderating effect of the relationship with the parent.

This study examined a hypothesis derived from social learning theory, that adolescents would be more likely to model the substance use of each parent if they had a relatively good relationship with the parent than if their relationship with that parent was relatively poor. Data from 657 adolescents (51% female; 11 to 15 years of age at the 1st assessment), 357 fathers, and 633 mothers across a 6-year assessment period were used for these analyses. As hypothesized, all adolescents modeled mothers cigarette use and fathers marijuana use, older adolescents modeled mothers marijuana use and younger girls and older boys modeled fathers alcohol use if they had a relatively good or moderate relationship with that parent but did not model their parents use if the relationship with that parent was relatively poor. Caution is noted in assuming that relatively good relationships with a parent are always protective.

Cognitive-behavioral group treatment of adolescent depression: Prediction of outcome †

This paper attempts to identify variables which distinguish depressed adolescents who were recovered versus not recovered at post treatment in a controlled outcome study. Fifty-nine adolescents meeting Research Diagnostic Criteria for major and/or intermittent depression were randomly assigned to one of three conditions: (a) a cognitive-behavioral, psycho-educational treatment group for adolescents (n=21); (b) an identical protocol for adolescents, but with their parents enrolled in a separate parent group (n=19); and (c) a waitlist control condition (n=19). Thirty-seven of the 40 actively treated subjects were retained for prediction analyses examining treatment recovery via two assessment methods: (a) a discriminant function analysis predicting membership in KSADS/RDC diagnosis-based Recovered (n=16) and Not Recovered (n=21) groups; and (b) a hierarchical block regression analysis predicting residual pre-to-post change on the Beck Depression Inventory. Because of the small sample, potential predictor variables were limited to those which demonstrated significant univariate correlations with the respective outcome variables. Recovery in the discriminant function analysis was associated with lower intake levels on the BDI, lower intake state anxiety, higher enjoyment and frequency of pleasant activities, and more rational thoughts on the Subjective Probability Questionnaire. The overall canonical correlation was .6277. In the hierarchical block regression analysis predicting residual BDI scores, better outcome was associated with a greater number of past psychiatric diagnoses, parent involvement in treatment, and younger age at onset of first depressive episode. The overall regression solution yielded a multiple R=.842. The discussion focuses on the continuity between the current findings and results obtained from similar studies conducted with depressed adults, as well as the degree to which the observed results are consistent with the “capitalization” model of depression therapy outcome.

Elementary School Age Children's Future Intentions and Use of Substances

This study describes the lifetime prevalence and future intentions related to trying cigarettes, chewing tobacco, alcohol, marijuana, and inhalants of students in the 1st through 7th grade. This article also describes the identification of these substances by children in the 1st through 3rd grade. Participants were 1,075 1st through 5th graders within a school district in western Oregon who were followed for 3 years. Across most substances, prevalence and intentions increased with grade, with a moderate increase between 3rd and 4th grade and a larger increase between 5th and 6th grade. Boys were more likely than girls to identify alcohol and cigarettes and were more likely than girls to report trying chewing tobacco. In addition, 3rd-grade boys were more likely to identify marijuana and, in the early grades, alcohol. Boys were also more likely than girls to intend to use tobacco and drink alcohol when older. For alcohol and cigarettes, intention was related to subsequent trying of the substance, suggesting that intention may be an early warning sign of subsequent substance use.