Satoko Sasagawa

Gender differences in the developmental course of depression

BACKGROUND There is ample evidence for female preponderance of major depressive disorder (MDD) in adolescence and adulthood. This study examined gender differences in the developmental course (i.e., incidence, duration, number of depressive episodes, and recovery rates) of MDD in non-referred adolescents and young adults. METHODS Data from the Oregon Adolescent Depression Project were used to examine gender differences in the developmental course of MDD. Gender differences in the onset, duration, number of depressive episode and rate of recovery from MDD were examined in a population-based sample of the same individuals (participants: N=773) during adolescence (age 14 to 17) and at age 30. RESULTS Compared to males, females have higher incidence rates of MDD and had a more chronic course. Difference in duration of depressive episodes is marginally significant between male and female, with females having longer episodes. Lower onset age correlates significantly with more number of episodes in both genders; however, lower onset age predicts a worse course of depression only in females. LIMITATIONS The sample was from a single region of the country and consisted mostly of White adolescents. CONCLUSIONS Childhood depression may be a more serious risk factor for girls than for boys.

Prevention of anxiety symptoms in children: results from a universal school-based trial.

The present study evaluated the effectiveness of a universal school-based cognitive behavior prevention program (the FRIENDS program) for childhood anxiety. Participants were 638 children, ages 9 to 12 years, from 14 schools in North Rhine-Westphalia, Germany. All the children completed standardized measures of anxiety and depression, social and adaptive functioning, coping strategies, social skills, and perfectionism before and after the 10-week FRIENDS program and at two follow-up assessments (6 and 12 months) or wait period. Children who participated in the FRIENDS program exhibited significantly fewer anxiety and depressive symptoms, and lower perfectionism scores than children in the control group at 12-month follow-up. Younger children (9-10-year-olds) displayed treatment gains immediately after the intervention, whereas older children (11-12-year-olds) showed anxiety reduction only at 6- and 12-month follow-up. Perfectionism and avoidant coping acted as mediators of pre- to postintervention changes in anxiety scores. This study provides empirical evidence for the utility of the FRIENDS program in reducing anxiety and depressive symptoms among German children.

Anxiety disorder symptoms in Japanese children and adolescents

This study investigated anxiety symptoms in Japanese children and adolescents. Students 9-15 years old (N=2275) completed the Spence Childrens Anxiety Scale (SCAS). The internal consistency and test-retest reliability of the SCAS were satisfactory. Scores for overall anxiety symptoms and each subscale were similar between Japan and other countries. Girls reported more anxiety symptoms than boys, and adolescents presented with fewer anxiety symptoms than younger children, as in previous studies. The items most frequently endorsed by Japanese students were different from those endorsed by Western students, although lower frequency symptoms were almost the same. Factor analyses using multi-group analysis supported a common model of anxiety for children and adolescents. Clinical applicability and research implications are discussed.

Psychometric properties of the Spence Child Anxiety Scale with adolescents from five European countries

This study examined the factor structure, reliability, and validity of the original Spence Child Anxiety Scale (SCAS) and its four translations (German, Cypriot Greek, Swedish, Italian). A total of 2558 adolescents from five European countries (Germany = 495; Cyprus = 611; UK = 469; Sweden = 484; Italy = 499), ages 12-17 years, participated in the study. In addition to the SCAS, all participants completed the Strengths and Difficulties Questionnaire, a measure of general difficulties and positive attributes. The internal consistency and validity (convergent and discriminant) of the SCAS were excellent. Multiple group confirmatory factor analysis provided strong support for the generalizability of a 6-factor inter-correlated model across five European countries. Adolescents in the UK had significantly higher anxiety levels than adolescents in four other European countries. Our findings suggest that the SCAS is suitable for assessing anxiety disorder symptoms in adolescents in Germany, the UK, Cyprus, Sweden, and in Italy.

The facets of anxiety sensitivity in adolescents

This study examined the factor structure, reliability, and validity of the German translation of the Childhood Anxiety Sensitivity Index (CASI). A total of 1292 adolescents participated in the study. Analyses using the Schmid-Leiman solution showed the CASI to have one higher order factor and three orthogonal lower order factors. CASI scores correlated significantly with anxiety symptoms and with general difficulties. Hierarchical multiple regression showed CASI to make a significant contribution in predicting anxiety even after controlling for variance due to general difficulties, thus giving further support to the incremental validity of the CASI. The CASI is a potentially useful measure to include in longitudinal studies that examine the development of childhood and adolescent anxiety disorders.

Developmental Epidemiology of Social Anxiety and Social Phobia in Adolescents

This chapter reports on the prevalence of social anxiety disorder (SAD) and social fears in Western and non-Western countries, onset and course characteristics, mental and physical comorbidities, as well as risk factor constellations based on findings from clinical and population-based samples in children, adolescents, and adults. SAD represents one of the most common mental disorders: About one-fifth of the population reports unreasonably strong social fears, ranging from pervasive shyness to more or less isolated social fears; another 13 % of the population meets the diagnostic criteria for social anxiety disorder at some point in their life. Childhood and adolescence have emerged as developmentally sensitive time windows for first onset, with considerable persistence but also substantial fluctuations in symptom severity around the diagnostic threshold up to adulthood. Remission is rare, posing affected youth at risk for secondary complications such as depressive and substance use disorders and somatic conditions. Risk factors that have been implicated in the development of SAD include deficits in social skills and negative peer status, as well as family-related factors such as parental psychopathology, heritability estimates and temperament, anxiogenic parenting, and transmission of interpretation bias. Future studies may benefit from such a family-oriented perspective to depict the divergent developmental sequence, to provide a comprehensive model in promoting epidemiological understanding of SAD, and to delineate targeted prevention and early interventions.

Taijin Kyofusho and Social Phobia Symptoms in Young Adults in England and in Japan

The main aims of the present study were to compare the frequency of social phobia and taijin kyofusho symptoms among young adults in Japan and in England and to examine the role of family environment in the development of these two conditions. A total of 927 young adults (462 in England and 465 in Japan) between the ages of 19 and 24 were investigated. They completed a set of questionnaires that were used to measure social phobia and taijin kyofusho symptoms, as well as family background. Results showed that young adults in Japan reported significantly higher levels of taijin kyofusho and social phobia symptoms than young adults in England. Family sociability had a consistent effect on both social phobia and taijin kyofusho symptoms across the two cultures, but parental rearing attitudes showed distinct patterns between the two countries. This finding suggests that cross-cultural models need to consider familial factors that may be predictive across cultures and others that may be more culturally specific.

Anxiety symptoms among adolescents in Japan and England: their relationship with self‐construals and social support

Background: Most of our knowledge about anxiety in adolescents has come from studies conducted in Western countries. Little is known about the extent to which these results can be generalized to those who live in other cultures. The main aim of this study was to compare the frequency and correlates of anxiety symptoms among adolescents in Japan and England. Method: A total of 689 adolescents (338 from England and 351 from Japan), aged 12–17 years, took part in this research. They completed a set of questionnaires which were used to measure DSM‐IV anxiety disorder symptoms, general difficulties and positive attributes, self‐construals, and social support. Results: Adolescents in England reported significantly higher levels of anxiety symptoms than adolescents in Japan. In both countries, independent self‐construal was negatively associated with anxiety symptoms, while interdependent self‐construal was positively associated with anxiety. However, the magnitude of this relationship was stronger for independent self‐construal than the interdependent self‐construal. Path analysis showed that the effect of interdependent self‐construal seemed to be weaker in Japan than in England. Conclusion: Future studies need to explore the effects of cultural context and environmental experiences such as the role of parenting styles that account for the higher levels of anxiety in English compared with Japanese adolescents. Depression and Anxiety, 2011.

A Japanese form of social anxiety (taijin kyofusho): Frequency and correlates in two generations of the same family

Background: One specific type of social anxiety, occurring primarily in Japanese culture, is called taijin kyofusho. Taijin kyofusho is characterized by an intense fear that one’s body parts or functions displease, embarrass or are offensive to others. Aim: The main aim of the present study was to compare the frequency and correlates of taijin kyofusho symptoms (TKS) in Japanese adolescents and their parents. Method: The sample included 351 adolescents, aged 12 to 17 years, and one of their parents/guardians. These adolescents were recruited from secondary schools in Miyazaki, Japan. All participants completed a set of questionnaires that were used to measure TKS, DSM-IV anxiety disorder symptoms, general difficulties and positive attributes, self-construals and social support. Results: Adolescents reported significantly more TKS than their parent/guardians. In each generational sample high TKS was significantly associated with high levels of anxiety symptoms, the strongest correlation being with social phobia. The pattern of the relationship between self-construal and TKS differed across the two generations. Among adolescents, independent self-construal was associated with lower TKS, whereas among parents, interdependent self-construal was associated with lower evaluative concerns from others. Conclusion: The present study illustrates the importance of the diverse roles that self-construals play in TKS across different generations of the same family constellation in contemporary Japanese culture.

Integrating video-feedback and cognitive preparation, social skills training and behavioural activation in a cognitive behavioural therapy in the treatment of childhood anxiety.

BACKGROUND The present study examined the effectiveness of a transdiagnostic prevention programme, Super Skills for Life (SSL), in children with anxiety problems. SSL is based on the principles of cognitive-behaviour therapy (CBT), behavioural activation, social skills training, and uses video-feedback and cognitive preparation as part of the treatment. METHODS Participants were 61 primary school children, aged 8-10 years, who were referred by their teachers as having significant anxiety problems. Children were video-recorded during a 2-min speech task in sessions 1 and 8, and during a social interaction task. All the children completed measures of anxiety symptoms, social skills, and self-esteem before and after participating in the 8-week SSL and at the 6-months follow-up assessment. RESULTS Anxiety symptoms were significantly reduced at post-test and follow-up assessments. SSL also had a positive effect on hyperactivity, conduct, and peer problems although it took longer for these effects to occur. Behavioural indicators of anxiety during the 2-min speech task decreased, indicating that the independent raters observed behavioural change in the children from pre-treatment to follow-up. Boys had higher overall behavioural anxiety during the 2-min speech task at all three assessment periods, specifically showing higher lip contortions and leg movement than girls. LIMITATIONS The present study used an open clinical trial design, had small sample size, and did not use structured diagnostic interview schedules to assess anxiety disorders. CONCLUSIONS This study provides preliminary empirical support for the effectiveness of SSL in children with anxiety problems.