Robert E. McKeown

Social Support Protects against the Negative Effects of Partner Violence on Mental Health

OBJECTIVES Social support for abused women may reduce the impact of abuse on mental health, yet few studies have addressed this issue. We wish to determine associations between intimate partner violence (IPV) and mental health outcomes and to assess the protective role of abuse disclosure and support on mental health among abused women. METHODS A cross-sectional survey was conducted of 1152 women, ages 18-65, recruited from family practice clinics from 1997 through 1999. They were screened for IPV during a brief in-clinic interview, and physical and mental health status was assessed in a follow-up interview. RESULTS IPV, defined as sexual, physical, or psychological abuse, was associated with poor perceived mental and physical health, substance abuse, symptoms of posttraumatic stress disorder (PTSD), current depression, anxiety, and suicide ideation/actions. Among women experiencing IPV and controlling for IPV frequency, higher social support scores were associated with a significantly reduced risk of poor perceived mental health (adjusted relative risk [aRR] 0.5, 95% confidence interval [CI] 0.3, 0.6) and physical health (aRR 0.6, 95% CI 0.5, 0.8), anxiety (aRR 0.3, 95% CI 0.2, 0.4), current depression (aRR 0.6, 95% CI 0.5, 0.8), PTSD symptoms (aRR 0.5, 95% CI 0.4, 0.8), and suicide attempts (aRR 0.6, 95% CI 0.4, 0.9). CONCLUSIONS Healthcare providers can be instrumental in identifying IPV and helping women develop skills, resources, and support networks to address IPV. Physicians, family, or friends may provide needed social support.

Frequency of obsessive-compulsive disorder in a community sample of young adolescents.

OBJECTIVE To investigate the frequency and phenomenology of obsessive-compulsive disorder (OCD) and subclinical OCD in young adolescents. METHOD A two-stage epidemiological study originally designed to investigate adolescent depression was conducted between 1986 and 1988 in the southeastern United States. In the first stage, a self-report depressive symptom questionnaire was administered to a community sample of 3,283 adolescents. In the diagnostic stage, the Schedule for Affective Disorders and Schizophrenia for School-Age Children and the Childrens Global Assessment Scale were administered to 488 mother-child pairs. RESULTS The prevalences of OCD and subclinical OCD were found to be 3% and 19%, respectively. Prevalences were similar in males and females. Females reported more symptoms of compulsions although males reported more obsessions. About 55% of adolescents with OCD reported both obsessions and compulsions. The most common compulsions were arranging (56%), counting (41%), collecting (38%), and washing (17%). Major depressive disorder (45%), separation anxiety (34%), dysthymia (29%), suicidal ideation (15%), and phobia (8%) were the diagnoses most frequently comorbid with OCD. CONCLUSIONS Findings suggest that OCD is not infrequent among adolescents and that the characteristic comorbidity and symptomatology of OCD may facilitate earlier identification and treatment by clinicians.

Aggression, Substance Use, and Suicidal Behaviors in High School Students.

OBJECTIVES We sought to analyze the frequency and correlates of suicidal behaviors in a community sample of adolescents. METHODS Information concerning suicidal thoughts and acts, aggressive behaviors, substance use and physical recklessness were collected with the 70-item self-report Youth Risk Behavior Survey from a statewide sample of 3764 South Carolina public high school students. RESULTS Seventy-five percent of students reported no suicidal behaviors, 11% reported serious suicidal thoughts, 6.4% reported specific suicidal plans, 5.9% reported attempts not requiring medical care, and 1.6% reported attempts requiring medical care. All types of suicidal behaviors occurred more frequently in females than males. Odds ratios for aggressive behaviors and cigarette use were elevated across all categories of suicide behaviors, increasing in magnitude with severity of reported suicidal behavior. Substance use was associated with some but not all categories of suicidal behaviors. The relationships were most pronounced with the use of potentially more dangerous drugs. CONCLUSIONS The results suggest that suicidal behaviors are not infrequent occurrences among adolescents and that they often coexist with other high-risk behaviors. Interventions designed to reduce suicidal behaviors should simultaneously address coexisting high-risk behaviors.

The CES-D as a Screen for Depression and Other Psychiatric Disorders in Adolescents

The performance of the Center for Epidemiologic Studies Depression Scale (CES-D) as a screen for depression was explored in a two-stage epidemiological study of adolescents. The study consisted of a CES-D screening stage completed by a school sample of 2,465 young adolescents and a structured psychiatric interview stage completed by 332 mother-adolescent pairs. Adolescents with interview validated depression had elevated screening scores (mean = 31.10, SD = 11.30) compared with individuals with no disorder (mean = 21.01, SD = 11.77). Using receiver operating characteristic curves, a cut point of 12 for males produced the best overall screening characteristics (sensitivity = 0.85, specificity = 0.49), while for females, a cut point of 22 was optimal (sensitivity = 0.83, specificity = 0.77).

Severe Dating Violence and Quality of Life Among South Carolina High School Students

BACKGROUND Little research has addressed the impact of dating violence and forced-sex victimization and perpetration on adolescent well-being. In this cross-sectional study, we provide (1) estimates of severe dating violence (SDV) by victimization and perpetration status, (2) estimates of lifetime forced-sex victimization and perpetration, (3) demographic and health behaviors correlated with SDV, and (4) associations between SDV and forced sex and well-being as assessed by (1) health-related quality of life (H-R QOL) and (2) life satisfaction measures. METHODS We used a stratified cluster sample of 5414 public high school students, grades 9 through 12, who responded to the 1997 self-administered South Carolina Youth Risk Behavior Survey. RESULTS Nearly 12% of adolescents self-reported SDV as a victim (7.6%) or a perpetrator (7.7%), and SDV rates (victimization/perpetration combined) are higher in girls (14.4%) than boys (9.1%). Race, aggressive behaviors, substance use, and sexual risk-taking are correlates of SDV. Among young women, SDV victimization, not perpetration, was associated with recent poor H-R QOL and suicide ideation or attempts, but not lower life-satisfaction scores. Among young men, SDV perpetration, not victimization, was strongly associated with poor H-R QOL and suicide attempts, and lower scores for all domains of life satisfaction. CONCLUSIONS This research provides evidence that SDV and forced sex are associated with poor H-R QOL, low life-satisfaction scores, and adverse health behaviors in adolescent female victims and male perpetrators. Screening for dating violence is needed to identify and intervene early to reduce the impact of dating violence.

Prevalence of PTSD in a community sample of older adolescents

OBJECTIVE To examine prevalence and correlates of trauma and posttraumatic stress disorder (PTSD) symptoms and diagnosis in older adolescents aged 16 through 22 years. METHOD The second cycle of a longitudinal epidemiological study in the Southeast included a semistructured interview assessing PTSD symptomatology administered to 490 adolescents. RESULTS Approximately 3% of female subjects and 1% of male subjects satisfied the DSM-IV criteria for PTSD. Females reported more traumatic events than males, and black subjects reported more events than white subjects. Being female (odds ratio = 12.32), experiencing rape or child sexual abuse (odds ratio = 49.37), and witnessing an accident or medical emergency (odds ratio = 85.02) were associated with increased risk of PTSD. CONCLUSIONS While relatively few adolescents satisfy the criteria for PTSD, most subjects who experienced a traumatic event reported some PTSD symptoms. Specific types of traumatic events were associated with occurrence of PTSD.

Prevalence and Correlates of ADHD Symptoms in the National Health Interview Survey.

Objective: Study the prevalence and correlates of ADHD symptoms in the National Health Interview Survey (NHIS). Methods: NHIS includes 10,367 children ages 4 to 17. Parents report lifetime diagnosis of ADHD and complete the Strengths and Difficulties Questionnaire (SDQ). Prevalences of clinically significant ADHD and comorbid symptoms by race and ethnicity, gender, and age are presented. Results: Prevalence of clinically significant SDQ ADHD symptoms is 4.19% (males) and 1.77% (females). Male prevalence by race is 3.06% for Hispanics, 4.33% for Whites, and 5.65% for Blacks. Significant differences in prevalence occur across gender (p < .01) and among males across race (p < .01), age (p < .01), and income (p < .02). In the full sample, 6.80% of males and 2.50% of females have a parent-reported lifetime ADHD diagnosis but are negative for SDQ ADHD. Likewise, 1.59% of males and 0.81% of females are positive for SDQ ADHD but negative for parent report of ADHD diagnosis. SDQ ADHD positive children have substantially higher proportions of elevated scores on other SDQ subscales. Conclusion: ADHD symptoms vary by race and ethnicity, gender, and age and are associated with other emotional and behavioral difficulties. Both overdiagnosis and underdiagnosis of ADHD may be issues in the U.S. population of 4- to 17-year-olds.

Prevalence and Correlates of Depressed Mood Among Youth With Diabetes: The SEARCH for Diabetes in Youth Study

OBJECTIVE.The objective of this study was to determine if depressed mood among youth with diabetes was associated with type and duration of diabetes, mean glycosylated hemoglobin (HbA1c) level, and the frequency of diabetic ketoacidosis (DKA) and hypoglycemic episodes, hospitalizations, and emergency department (ED) visits. METHODS.A total of 2672 youth (aged 10–21 years) who had diabetes for a mean duration of 5 years completed a SEARCH study visit, in which their HbA1c was measured and information about their demographic characteristics, diabetes type and duration, and episodes of DKA, hypoglycemia, hospitalizations, and ED visits over the previous 6 months was collected. Their level of depressed mood was measured using the Center for Epidemiologic Studies Depression Scale (CES-D). RESULTS.Among these youth, 14% had mildly (CES-D 16–23) and 8.6% had moderately or severely (CES-D ≥24) depressed mood. Females had a higher mean CES-D score than males. After adjusting for demographic factors, and duration of diabetes, we found the prevalence of depressed mood to be higher among males with type 2 diabetes than those with type 1 diabetes and to be higher among females with comorbidities than those without comorbidities. Higher mean HbA1c and frequency of ED visits were associated with depressed mood. The prevalence of depressed mood among youth with diabetes was similar to that of published estimates of depressed mood among youth without diabetes. CONCLUSIONS.Physicians and other health care professionals should consider screening youth with diabetes for depressed mood in clinical settings, particularly youth with poor glycemic control, those with a history of frequent ED visits, males with type 2 diabetes, and females with comorbidities.

Correlates of aggressive and violent behaviors among public high school adolescents

PURPOSE This study analyzed the types and predictors of violent behaviors reported by 4,137 South Carolina adolescents, grades nine through twelve. METHODS The 70 item self-report Youth Risk Behavior Survey developed and piloted by the Centers for Disease Control and Prevention was utilized in 57 of the states public high schools. A series of logistic regression analyses were performed for each race/gender group to explore the relation of the demographic and potential risk variables to fighting and carrying weapons. RESULTS Results indicate that 38 percent of males and 11 percent of females reported carrying a weapon. Eleven percent of males and five percent of females reported fights resulting in an injury. The strongest predictors of fighting were binge drinking and sexual activity for males, any alcohol use and illegal drug use for white females, and sexual activity for black females. For carrying a weapon, the strongest predictors included alcohol use and sexual activity in all but white females, and illegal drug use among whites, but not blacks. CONCLUSION Prevention of adolescent violence calls for creative approaches in school and community settings and will require long-term intervention strategies, focused on adolescent behavior change and environmental modifications.

Incidence and Predictors of Suicidal Behaviors in a Longitudinal Sample of Young Adolescents

OBJECTIVE This analysis examines 1-year transition probabilities and baseline predictors for suicidal behaviors in young adolescents. METHOD Adolescents from a two-stage, community-based longitudinal study were classified into suicidal behavior categories (attempt, plan, ideation, and none) for baseline and follow-up years. Transition probabilities for movement among categories were calculated, and polytomous logistic regression analysis was used to examine predictors of suicidal behaviors. RESULTS Among those with no suicidal behaviors at baseline, 1-year incidence rates were 1.3% for attempts and 1.7% each for plans and ideation. Increasing family cohesion was protective for suicide attempts (odds ratio [OR] = 0.9). Female subjects were more likely than males to report plans (OR = 8.9) and ideation (OR = 4.1). Increasing impulsivity (OR = 2.3), prior suicidal behavior (OR = 10.6), and undesirable life events (OR = 1.1) were significant predictors of plans. CONCLUSIONS While there are a number of predictors of suicidal behaviors, the false-positive rate is high. Focusing on proximal risk factors, particularly stressors in adolescent development, may overlook the fundamental role of underlying mental disorder and familial factors--both biological and environmental. Suicide and suicidal behaviors are the result of a constellation of adverse factors requiring a range of interventions for prevention.