Linda B. Nahulu

Prediction of Major Depression and Dysthymia From CES-D Scores Among Ethnic Minority Adolescents

OBJECTIVE The Native Hawaiian Mental Health Research Development Program is an epidemiological longitudinal study of adolescents residing in Hawaii. This article examines the utility of the Center for Epidemiologic Studies-Depression Scale (CES-D) for predicting DSM-III-R diagnoses of major depression (MD) and dysthymic disorder (DD) and investigates whether prediction differs by gender and ethnicity. METHOD Diagnostic Interview Schedule for Children interviews were conducted with 556 adolescents randomly selected from among more than 7,000 students who had completed the CES-D. RESULTS Six-month prevalence rates were as follows: MD = 8.5%, DD = 4.7%, either (MDDD) = 9.9%. Prevalence rates were significantly higher among females, but after CES-D scores were accounted for, gender no longer predicted depression in most analyses. When a cutoff score of 16 was used, classification accuracy was lower for Native Hawaiians than non-Hawaiians. However, after group differences in gender and grade level were accounted for, the predictive validity of the CES-D did not differ by ethnicity. CES-D factor 1 scores identified MD, DD, and MDDD about as well as the total score or all three factors together. CONCLUSIONS These results support the validity of the CES-D for screening for depression among adolescents of Native Hawaiian and other minority backgrounds.

Cultural identification and attempted suicide in Native Hawaiian adolescents.

OBJECTIVES To determine rates of lifetime suicide attempts in a community sample of Native Hawaiian adolescents and determine the contribution of Hawaiian cultural affiliation, socioeconomic status, and psychiatric symptoms as risk factors for suicide. METHOD High school students were surveyed in the state of Hawaii for lifetime suicide attempts, Hawaiian cultural affiliation, socioeconomic status, and symptoms of depression, substance abuse, aggression, and anxiety. Multiple logistic regressions were used on 3,094 subjects to develop prediction models for lifetime suicide attempts. RESULTS Native Hawaiian adolescents had significantly higher rates of suicide attempts (12.9%) than other adolescents in Hawaii (9.6%). Hawaiian cultural affiliation rather than ethnicity was uniquely predictive of suicide attempts. Logistic regression indicated that depression, substance abuse, grade level, Hawaiian cultural affiliation, and main wage earners education best predicted suicide attempts in Native Hawaiian adolescents, while depression, substance abuse, and aggression predicted suicide attempts in non-Hawaiians. CONCLUSIONS Native Hawaiian adolescents have higher rates of attempted suicide than non-Hawaiian adolescents. Strong Hawaiian cultural affiliation rather than ethnicity is a risk factor for attempted suicide.

Cumulative effect of family environment on psychiatric symptomatology among multiethnic adolescents.

PURPOSE To examine the influence of family adversity and support on levels of psychiatric symptomatology in Hawaiian and non-Hawaiian adolescents. METHOD More than 4000 students from five high schools in Hawaii completed a survey during the 1992-1993 school year about their family environment and mental health. The response rate was approximately 60%. Logistic regression analyses were performed and responses for Hawaiians and non-Hawaiians were compared. RESULTS Hawaiian adolescents experienced significantly more adversity than their non-Hawaiian counterparts. The cumulative effect of family adversity had a greater effect on psychiatric symptomatology than any single indicator. Family support reduced the risk for internalizing symptoms, particularly for Hawaiian adolescents. The influence of family support was less clear for externalizing symptoms, increasing the risk for some adolescents and decreasing the risk for others. CONCLUSION We identified strong associations between family adversity and levels of psychiatric symptomatology. We found that Hawaiian adolescents are at increased risk for psychiatric symptomatology, given the presence of family adversity and the effect of reduced family support. However, risk was also substantial for non-Hawaiians. Clinicians need to assess the family environment routinely and implement family-oriented interventions.

Suicide and suicidal-related behaviors among indigenous Pacific Islanders in the United States.

The authors present a comprehensive review on U.S. Pacific Islander suicide and suicide-related behaviors to extend the knowledge and understanding of suicide and suicide-related behaviors among the indigenous peoples of the state of Hawai‘i, the territories of American Samoa, Guam, Commonwealth of the Northern Mariana Islands, and the Pacific Island Nations of Micronesia (Federated States of Micronesia, the Republic of Belau [Palau], and the Republic of the Marshall Islands). Historical, geographic, epidemiological, social, and cultural information is presented on these Pacific Island populations. Suicide behavioral data are presented for Pacific Islanders living within the U.S. and affiliated Pacific territories and nations from the existing scientific literature along with archival data and 2 epidemiological studies that assess suicidal behaviors and related psychosocial factors and measures of psychopathology among large community samples of youth in Hawai‘i. The authors describe common patterns and differences among these populations, along with social-cultural practices that may explain suicide phenomenology among these U.S. indigenous peoples who—while small in numbers when compared with the total U.S. population—possess striking health disparities when compared to other populations within the U.S. and in their island homelands.

Psychosocial risk and protective influences in Hawaiian adolescent psychopathology.

A large community sample of adolescents of a Native Hawaiian (Asian/ Pacific Islander) minority group was studied along with a small comparison group of non-Hawaiians, for the relationship between psychopathology (as measured by standard symptom scales) and (a) perceived support from family and friends, and (b) discussing problems with others. Expected gender patterns for friend support but not for family support were found. The Hawaiian boys appeared atypical, reporting nearly equal family support as Hawaiian girls. Discussing problems with another person was correlated with lower anxiety and depression scores but not aggression and substance abuse scores. It is concluded that gender and cultural factors influence symptom prevalence and severity as well as the impact of psychosocial risk factors.

Psychiatric symptoms of Hawaiian adolescents

The purpose of this study was to examine the interrelationship of depressive symptoms with symptoms of anxiety, aggression, and substance abuse in Native Hawaiian adolescents. A total of 1,819 Native Hawaiian students were recruited from three high schools as part of the initial phase of an ongoing, 4-year, longitudinal, cross-sequential study. Psychiatric symptoms were measured with the Center for Epidemiological Studies-Depression Scale (CES-D), Spielbergers State Anxiety Inventory (SAI), Braver Aggression Dimension Scale (BADS), and Substance Abuse Subtle Screening Inventory-Abbreviated (SASSI-A). Scales were standardized for this minority population. Depressive symptoms were strongly associated with symptoms of anxiety and aggression but only weakly associated with self-reported substance abuse. Girls had substantially higher scores than boys on all scales. Ninth graders reported more aggressive symptoms than did 12th graders. The educational level of the adolescents main caregiver was not associated with symptoms reported in any of the scales. Native Hawaiian adolescents report similar symptoms and symptom clusters as do adolescents on the mainland U.S. However, Native Hawaiian adolescent girls report a greater number of symptoms in all categories when compared to boys. This distinguishes them from most mainland adolescent populations.

Variation in self-esteem among adolescents in an Asian/Pacific-Islander sample

Abstract Variation in global self-esteem among adolescents differentiated in terms of age, gender, Hawaiian/part-Hawaiian and non-Hawaiian ethnicity, self-reported grades (SRGs) and socioeconomic status (SES) was examined in the present study. Being older, male or non-Hawaiian and higher SRGs or SES were hypothesized to be associated with higher global self-esteem. Six hundred and ninety-six Hawaiian/part-Hawaiian and non-Hawaiian high school students provided responses to demographic items, the 10-item Rosenberg Self-Esteem Scale [RSES; Rosenberg, M. (1965). Society and the adolescent self-image . Princeton, NJ: Princeton University Press], and items assessing SRGs and SES. Adolescent males reported significantly higher self-esteem than adolescent females. Adolescents differing in SRGs and SES also varied significantly from one another in self-esteem, with the general pattern indicating higher SRGs and SES to be associated with higher self-esteem. The significant age-by-SRGs interaction effect suggested the consequence of academic success throughout the high school years. Findings regarding the present Asian/Pacific-Islander adolescent sample corresponded with that found for other adolescent samples of different ethnic compositions, which provided support for the generalizability of variation in global self-esteem and its noted correlates across various socio-cultural contexts.

Demographic and Social Variables Associated with Psychiatric and School-Related Indicators for Asian/Pacific-Islander Adolescents

Background: Factors associated with Asian/Pacific-Islander adolescent adjustment is a greatly neglected research area. Aims: The purpose of the present study was to investigate the relation between demographic, social and adjustment measures based on a large-scale investigation of Asian/Pacific-Islander youths. Method: A total of 2577 adolescents were surveyed across 4 public schools in Hawai‘i during the 1992-1993 school year. Results: Three social variables (number of relatives frequently seen, family support and friends’ support) exhibited statistically significant but low correlations. Family support had the highest negative association with the four psychiatric symptoms (depression, anxiety, aggression, substance use). Friends’ support was inconsistently associated with the adjustment measures, and the number of relatives frequently seen resulted in negligible effects. In contrast, demographic variables, especially ethnicity, played a much greater role in the association with the four school-related measures (grade-point average, absences, suspensions, conduct infractions). Discussion: For Asian/Pacific-Islander youths, the quality of the social supports, including family relations, may be particularly important in the adolescents’ adjustment. When examining school-related outcomes, demographic variables, with particular emphases on ethnicity and culture, must be considered. When developing and implementing prevention and intervention services and programs, consideration of family and ethnic-cultural influences should be taken into account, with further research needed in several related domains: other SES influences, life stressors, migration-generational effects, ethnic identity, self-concept indicators and socio-political aspects.

Path models linking correlates of self-esteem in a multi-ethnic adolescent sample

Abstract Path analysis was performed to delineate the interrelations between state anxiety, aggression, substance abuse, depression, gender, ethnicity, family support, and self-esteem in a sample of 684 Hawaiian/part-Hawaiian and non-Hawaiian (e.g. Caucasian, Filipino, Hispanic, Japanese, or Mixed/two or more ethnicities) adolescents. The theorized model proposed that self-esteem was determined by family support and gender, and that family support, in turn, was predicted by state anxiety, aggression, substance abuse, depression, and ethnicity. The derivation of this model was based on previously documented findings of the associations between self-esteem and indices of adolescent adjustment, theorized multi-directionality of these interrelations, non-existence of an exhaustive theory accounting for the predictive links between these variables, and centrality of the ohana or family system and its integral network of support within the Native-Hawaiian culture. Goodness-of-fit indices indicated a poor fit between the theorized model and data. Subsequent model modifications were based on succeeding path analytical results, and conjointly encompassed an effort to find a model that fit the data well. Changes to the theorized model included eliminating three paths (i.e. from aggression and ethnicity to family support and from gender to self-esteem), and adding three paths (i.e. from depression, state anxiety, and aggression to self-esteem). The retained “final” Model 6 fit the data very well, and delineated the prediction of self-esteem by depression, state anxiety, aggression, and family support, which was, in turn, determined by depression, state anxiety, and substance use.

Influence of Family Adversity on School-Related Behavioural Problems among Multi-Ethnic High School Students

This study examines the influence of family adversity indicators on school-related behavioural problems among Hawaiian and non-Hawaiian adolescents. Questionnaire data from 2787 students were linked to school information, including grade point average (GPA), absences, suspensions and conduct infractions. Logistic regression analyses were performed. The cumulative effect revealed higher increases in the odds ratios for school-related behavioural problems among non-Hawaiians. Surprisingly, there was no cumulative effect of family adversity among Hawaiian adolescents. Given their high rates of adversity and behavioural problems, any family adversity may significantly impact this group. The family environment must be considered in the prevention and intervention of school-related behavioural problems.