Mark Stemmler

Depression in adolescence.

Adolescence is an important developmental period for understanding the nature, course, and treatment of depression. Recent research concerned with depressive mood, syndromes, and disorders during adolescence is reviewed, including investigations of the prevalence, course, risk factors, and prevention and treatment programs for each of these three levels of depressive phenomena in adolescence. A broad biopsychosocial perspective on adolescent depression is recommended, and possible directions for future integrative research are proposed. Based on current research and knowledge, implications for research, program, and national policy are considered.

Approach and Avoidant Coping: Implications for Adolescent Mental Health.

We conducted a short-term longitudinal study examining the structure of coping behavior and the relationship between coping style and depression during adolescence. The sample consisted of 603 adolescents in Grades 6–11 who were surveyed in the fall of 1989 and again in the fall of 1990. A two-dimensional model of coping was found using confirmatory factor analysis with the factors being approach and avoidant coping. Four cross-sectional and seven longitudinal coping groups were formed to explore group differences in depression. Approach copers reported the fewest symptoms of depression, while avoidant copers reported the most. Subjects who changed over time from approach to avoidant coping evidenced a significant increase in depressive symptoms, whereas subjects who switched from avoidant to approach coping displayed a significant decrease in depression over a one-year period. These findings imply that adolescents who are able to elicit social support, engage in problem solving, and cognitively restructure events within a positive light are more likely to successfully negotiate the challenges of adolescence.

The Alzheimer's Disease Activities of Daily Living International Scale (ADL-IS)

BACKGROUND Activities of daily living (ADL) deficits are integral components of dementia disorders, and ADL measures are among the most robust markers of the course of Alzheimers disease (AD). Despite this acknowledged importance, no clearly useful ADL instrument for cross-cultural application in pharmacologic trials in the early stages of AD had been available. METHOD An international effort was launched to develop an ADL scale for pharmacologic trials in early AD. Steps taken from 1990 to the present included: (1) international scientific working group meetings and reviews, (2) reviews of existing measures, (3) collating of existent, nonredundant items, (4) querying experts for new items, (5) interviews with informants and subjects in the USA, France, and Germany, toward the identification of potential new items, (6) identification of an item pool based upon these procedures, (7) creation of a trial instrument, (8) piloting of this instrument, and (9) refinement of the scale based upon statistical analysis of the pilot data. Final item selection was based upon: (1) relevance for > or = 80% of subjects in severity-stratified USA and German samples; (2) absence of gender and national biases; (3) significant (p <.05) discrimination between (a) normal versus mildly impaired and (b) mildly impaired versus moderately to moderately severely impaired subjects; and (4) Global Deterioration Scale (GDS) scores accounting for > or = 12% of variance in the item after controlling for age and gender. RESULTS An ADL scale consisting of 40 items that correlate with the global and cognitive progress of AD is developed for international usage in pharmacologic trials in incipient, mild, moderate, and moderately severe AD. The scale contains 40 items falling within 13 ADL categories. The 40-item scale is shown to have .81 correlation with GDS staging, .81 with mental status assessment (Mini-Mental State Examination), and .81 with a psychometric test (the SKT) (p values < .001). CONCLUSION This scale can be used to measure therapeutic response in AD.

Factors Contributing to Gender Differences in Depressive Symptoms: A Test of Three Developmental Models

In a longitudinal study on 115 early adolescents, the impact of major events, relationship stressors, and coping style in interaction with biological changes on depressive outcome in late adolescence were explored. Three developmental models proposed by Nolen-Hoeksema and Girgus (1994, Psychol. Bull. 115: 424–433), which attempt to explain the emergence of gender differences in adolescent depressive symptoms, were tested. Multiple regression analyses conducted to test Model 1 identified two etiological factors associated with gender differences of depression, namely, stress in the adolescent–mother relationship and a more negative body image. Tests of Model 2 revealed etiological factors which correlated with depression in adolescent girls but not adolescent boys. The correlational patterns of avoidant coping and body image emerged as relevant factors for Model 2. Finally, tests of Model 3 searched for factors which were more likely to be observed in adolescent girls than boys and which would put girls at risk should they interact with a third etiological factor. Early maturational timing emerged as a factor for Model 3.

Coping with everyday stress and links to medical and psychosocial adaptation in diabetic adolescents

PURPOSE To study coping with everyday stressors in a longitudinal sample of 98 adolescents with insulin-dependent mellitus (type 1) diabetes. METHODS The adolescents with type 1 diabetes were classified into three homogeneous groups of metabolic control by latent class analysis, based on annual tests of hemoglobin A1 values. Questionnaires assessing frequent minor stressors as well as ways of coping with these stressors were given annually over the course of 4 years. Latent class analysis revealed three distinctive groups of metabolic control over time. Adolescents who exhibited continuously poor, satisfactory, and good metabolic control. Eighty percent of the adolescents stayed in the group assigned to them over the 4-year period. RESULTS Adolescents with stable good metabolic control were characterized by lower levels of minor stressors that decreased over time, but those with stable satisfactory and poor metabolic control experienced continuously higher stress levels. Adolescents with stably good metabolic control also employed less avoidant coping in dealing with minor stressors, compared with the two other groups. CONCLUSIONS Because of the danger of long-term complications, it is important to discriminate among different groups of metabolic control over time. Further, the impact of non-illness-related minor stressors on metabolic control should be considered for prevention purposes.

Prävention von Problemen des Sozialverhaltens im Vorschulalter

Zusammenfassung. Theoretischer Hintergrund: In Deutschland herrscht ein Mangel an methodisch kontrollierten Evaluationen von Programmen zur Pravention von Verhaltensproblemen bei Kindern und Jugendlichen. Fragestellung: Die vorliegende Studie evaluiert die Wirksamkeit eines Kindertrainings, eines Elterntrainings sowie einer Kombination aus beiden Programmen. Methode: Aus einer Stichprobe von 675 Kindergartenkindern und ihren Familien nahmen 227 an einer der drei Trainingsbedingungen teil, 227 Kinder dienten als aquivalente Kontrollgruppe. Erfolgsmase wurden 2-3 Monate sowie bis zu 24 Monate nach Abschluss der Trainings erhoben. Sie bestanden aus den Angaben von Erzieherinnen im Preschool Social Behavior Questionnaire sowie aus Inhaltsanalysen von Schulzeugnissen der 1. Klasse. Ergebnisse: Die Trainings fuhrten zu kurzzeitigen positiven Effekten bei Problemen des Sozialverhaltens, der Hyperaktivitat/Unaufmerksamkeit und emotionalen Storungen. Die deutlichsten Effekte zeigten sich bei den kombinierten Progr...

Zur Entwicklung externalisierender Verhaltensprobleme im Übergang vom Vor- zum Grundschulalter

Zusammenfassung. Im Beitrag werden quer- und langsschnittliche Daten aus der Erlangen-Nurnberger Praventions- und Entwicklungsstudie vorgestellt. Diese Daten beruhen auf elterlichen Befragungen zu Erziehungsmerkmalen und Verhaltensproblemen bei 448 Kindern im Alter von drei bis sechs Jahren. Die Ergebnisse zeigen, dass Einzelmerkmale der Erziehung mit der Entwicklung problematischen Verhaltens hochstens moderat korrelieren. Eine Faktorenanalyse uber die verschiedenen Erziehungsmerkmale erbrachte zwei inhaltlich gut zu interpretierenden Faktoren (engagierte/selbstbewusste Elternschaft und problematisches Diziplinierungsverhalten), die jeweils deutliche Korrelationen mit dem Problemverhaltens aufwiesen. Diese Effekte waren insbesondere beim problematischen Disziplinierungsverhalten ausgepragt und bestatigten sich sowohl fur die Mutter als fur die Vater. Fur diesen Faktor ergaben sich auch geschlechtsspezifische und nichtlineare Effekte im Entwicklungsverlauf. Diese Ergebnisse werden vor dem Hintergrund der ...

Duration of lithium treatment and brain lithium concentration in patients with unipolar and schizoaffective disorder : A study with magnetic resonance spectroscopy

Twenty psychiatric patients on lithium medication were examined with 7-Li-magnetic resonance spectroscopy of the brain. Patients on long-term lithium treatment (> 6 months) were compared with a short-term group who had been taking lithium for between 4 and 8 weeks. Patients met DSM-III-R criteria for either recurrent unipolar depressive disorder (DSM-III-R 296.3x) or schizoaffective disorder, depressive type (DSM-III-R 295.70). The brain:serum lithium ratio was 0.76 +/- 0.26; there was no significant difference between short-term and long-term treatment. In the group of long-term treatment patients there was a positive correlation between lithium dose per day and brain lithium concentration (R = .72, p < .01), and between lithium plasma concentration and brain lithium concentration (R = .65, p < .05). In the short-term group, however, there was no significant correlation for these parameters. No differences between unipolar and schizoaffective disorder were found.

Beurteilung von sozialen Verhaltensproblemen und Erziehungsschwierigkeiten im Vorschulalter

Zusammenfassung. Der Artikel beschreibt die psychometrische Uberprufung der deutschen Version des Eyberg Child Behavior Inventory (ECBI) an einer Stichprobe von 718 Vorschulkindern mit Angaben von 715 Muttern und 566 Vatern. Die Itemanalyse ergab eine grose Bandbreite von mittleren Intensitats- und Problemratings sowie uberwiegend zufriedenstellende Trennscharfen und Interkorrelationen der 36 ECBI-Items. Die Uberprufung der ECBI-Skalen erbrachte gute und mit der US-amerikanischen Standardisierung vergleichbare Reliabilitaten (z.B. Cronbachs α .90). Dagegen zeigten sich zum Teil deutlich hohere Intensitats- und Problemwerte in unserer deutschen Stichprobe, was auf kulturspezifische Antwortmuster hindeutet. Es bestatigte sich jedoch das Ergebnis, dass Mutter im Vergleich zu Vatern von hoheren Problemraten berichteten und Jungen im Vergleich zu Madchen fast durchgangig hohere Belastungswerte aufwiesen. Die Daten zur Validierung des Verfahren anhand des Social Behavior Questionnaire (SBQ) erbrachten innerhalb...

Prevention of familial transmission of depression through a family‐oriented programme targeting parenting as well as the child's social competence

Purpose – The purpose of this article is to evaluate the prevention programme EFFEKT‐E that was designed for preschool children of depressive mothers and contains an intervention for children and for mothers.Design/methodology/approach – Research was carried out in mother‐child clinics in Germany. In total, 220 strained mothers, who were screened for elevated levels of depressive symptoms, were enrolled in the control and 186 in the training group. For evaluation, mothers rated emotional disturbance and social competence of the child as outcome measures before and after the training. Changes in parenting behaviour, perceived parental competence and parenting stress were also assessed.Findings – An effect on emotional disturbance of the child emerged (d=0.52) in the training group. Perceived parental competence increased (d=0.72) and parental stress decreased (d=0.23) significantly under training. EFFEKT‐E has proven to be a valuable programme for preventing depression in offspring of mothers who feel depr...