Biomedical subjects

Marjorie Kleinman

Publications and source records attributed to Marjorie Kleinman.

7 recordsLinked to original sources

PubMed2007

Bullying, depression, and suicidality in adolescents.

OBJECTIVE: To assess the association between bullying behavior and depression, suicidal ideation, and suicide attempts among adolescents. METHOD: A self-report survey was completed by 9th- through 12th-grade students (n = 2342) in six New York State high schools from 2002 through 2004. Regression analyses were conducted to examine the association between being victimized and bullying others with depression, ideation, and attempts. RESULTS: Approximately 9% of the sample reported being victimized frequently, and 13% reported bullying others frequently. Frequent exposure to victimization or bullying others was related to high risks of depression, ideation, and suicide attempts compared with adolescents not involved in bullying behavior. Infrequent involvement in bullying behavior also was related to increased risk of depression and suicidality, particularly among girls. The findings indicate that both victims and bullies are at high risk and that the most troubled adolescents are those who are both victims and bullies. Psychopathology was associated with bullying behavior both in and away from school. CONCLUSIONS: Victimization and bullying are potential risk factors for adolescent depression and suicidality. In evaluations of students involved in bullying behavior, it is important to assess depression and suicidality.

Adolescent↗

PubMed2006

Item and scale differential functioning of the Mini-Mental State Exam assessed using the Differential Item and Test Functioning (DFIT) Framework.

OBJECTIVES: To illustrate the application of the Differential Item and Test Functioning (DFIT) method using English and Spanish versions of the Mini-Mental State Examination (MMSE). SUBJECTS: Study participants were 65 years of age or older and lived in North Manhattan, New York. Of the 1578 study participants who were administered the MMSE 665 completed it in Spanish. MEASURES: : The MMSE contains 20 items that measure the degree of cognitive impairment in the areas of orientation, attention and calculation, registration, recall and language, as well as the ability to follow verbal and written commands. RESEARCH DESIGN: After assessing the dimensionality of the MMSE scale, item response theory person and item parameters were estimated separately for the English and Spanish sample using Samejima's 2-parameter graded response model. Then the DFIT framework was used to assess differential item functioning (DIF) and differential test functioning (DTF). RESULTS: Nine items were found to show DIF; these were items that ask the respondent to name the correct season, day of the month, city, state, and 2 nearby streets, recall 3 objects, repeat the phrase no ifs, no ands, no buts, follow the command, "close your eyes," and the command, "take the paper in your right hand, fold the paper in half with both hands, and put the paper down in your lap." At the scale level, however, the MMSE did not show differential functioning. CONCLUSIONS: Respondents to the English and Spanish versions of the MMSE are comparable on the basis of scale scores. However, assessments based on individual MMSE items may be misleading.

Aged↗

PubMed2006

Identification of differential item functioning using item response theory and the likelihood-based model comparison approach. Application to the Mini-Mental State Examination.

BACKGROUND: An important part of examining the adequacy of measures for use in ethnically diverse populations is the evaluation of differential item functioning (DIF) among subpopulations such as those administered the measure in different languages. A number of methods exist for this purpose. OBJECTIVE: The objective of this study was to introduce and demonstrate the identification of DIF using item response theory (IRT) and the likelihood-based model comparison approach. METHODS: Data come from a sample of community-residing elderly who were part of a dementia case registry. A total of 1578 participants were administered either an English (n = 913) or Spanish (n = 665) version of the 21-item Mini-Mental State Examination. IRT was used to identify language DIF in these items with the likelihood-based model comparison approach. RESULTS: : Fourteen of the 21 items exhibited significant DIF according to language of administration. However, because the direction of the identified DIF was not consistent for one language version over the other, the impact at the scale level was negligible. CONCLUSIONS: IRT and the likelihood-based model comparison approach comprise a powerful tool for DIF detection that can aid in the development, refinement, and evaluation of measures for use in ethnically diverse populations.

Aged↗

PubMed2006

Youth suicide risk factors and attitudes in New York and Vienna: a cross-cultural comparison.

The prevalence of suicide risk factors and attitudes about suicide and help-seeking among New York and Viennese adolescents were compared in order to explore possible cross-cultural differences. Viennese adolescents exhibited higher rates of depressive symptomatology than their New York counterparts and had more first-hand experience with suicidal peers. More attribution of suicide to mental illness was reported in Vienna; yet Viennese youth were less likely than New York adolescents to recognize the seriousness of suicide threats. Help-seeking patterns of Viennese adolescents were influenced by their setting a high value on confidentiality. These cross-cultural differences may reflect the limited exposure of Austrian youth to school-based suicide prevention programs. The findings highlight the need of taking the sociocultural context into consideration in the planning of youth suicide prevention strategies.

Adolescent↗

PubMed2005

Evaluating iatrogenic risk of youth suicide screening programs: a randomized controlled trial.

CONTEXT: Universal screening for mental health problems and suicide risk is at the forefront of the national agenda for youth suicide prevention, yet no study has directly addressed the potential harm of suicide screening. OBJECTIVE: To examine whether asking about suicidal ideation or behavior during a screening program creates distress or increases suicidal ideation among high school students generally or among high-risk students reporting depressive symptoms, substance use problems, or suicide attempts. DESIGN, SETTING, AND PARTICIPANTS: A randomized controlled study conducted within the context of a 2-day screening strategy. Participants were 2342 students in 6 high schools in New York State in 2002-2004. Classes were randomized to an experimental group (n = 1172), which received the first survey with suicide questions, or to a control group (n = 1170), which did not receive suicide questions. MAIN OUTCOME MEASURES: Distress measured at the end of the first survey and at the beginning of the second survey 2 days after the first measured on the Profile of Mood States adolescent version (POMS-A) instrument. Suicidal ideation assessed in the second survey. RESULTS: Experimental and control groups did not differ on distress levels immediately after the first survey (mean [SD] POMS-A score, 5.5 [9.7] in the experimental group and 5.1 [10.0] in the control group; P = .66) or 2 days later (mean [SD] POMS-A score, 4.3 [9.0] in the experimental group and 3.9 [9.4] in the control group; P = .41), nor did rates of depressive feelings differ (13.3% and 11.0%, respectively; P = .19). Students exposed to suicide questions were no more likely to report suicidal ideation after the survey than unexposed students (4.7% and 3.9%, respectively; P = .49). High-risk students (defined as those with depression symptoms, substance use problems, or any previous suicide attempt) in the experimental group were neither more suicidal nor distressed than high-risk youth in the control group; on the contrary, depressed students and previous suicide attempters in the experimental group appeared less distressed (P = .01) and suicidal (P = .02), respectively, than high-risk control students. CONCLUSIONS: No evidence of iatrogenic effects of suicide screening emerged. Screening in high schools is a safe component of youth suicide prevention efforts.

Adolescent↗

PubMed2004

Teenagers' attitudes about coping strategies and help-seeking behavior for suicidality.

OBJECTIVE: To identify youths' attitudes about coping and help-seeking strategies for suicidal ideation/behavior and examine their demographic and clinical correlates. METHOD: A self-report survey was completed by high school students (N = 2,419) in six New York State schools from 1998 through 2001. The relationship between suicide attitudes and gender, depression, substance problems, serious suicidal ideation/behavior, and first-hand experience with a suicidal peer was examined. RESULTS: Two factors that approximate avoidance and approach coping responses, maladaptive coping strategies and help-seeking strategies, respectively, were identified. Boys scored higher than girls (t = 7.96, df = 2341, p < .001), and depressed youths (t = 15.56, df = 2323, p < .001), students with substance problems (t = 11.07, df = 2340, p < .001), and suicidal youths (t = 15.14, df = 2341, p < .001) scored significantly higher than their healthy counterparts on the maladaptive coping strategies factor. Students with first-hand experience with a suicidal peer scored significantly higher on the maladaptive coping strategies factor than those without this experience (t = 7.95, df = 2321, p < .001). Lower risk groups scored significantly higher on an adaptive help-seeking strategies factor. CONCLUSIONS: High-risk adolescents' attitudes are characterized by core beliefs that support the use of maladaptive coping strategies in response to depression and suicidal thoughts and behaviors. Targeting such attitudes is a recommended component of youth suicide prevention efforts.

Adaptation, Psychological↗

PubMed2002

Seeking help from the internet during adolescence.

OBJECTIVE: To assess the prevalence and demographic and psychological correlates of Internet use as a help-seeking resource for emotional problems in a community sample of adolescents. METHOD: A self-report survey was completed by 9th-through 12th-grade students ( = 519) enrolled in health courses in six New York State high schools in the fall/winter of 1999. The relationship between Internet help-seeking behavior and demographic characteristics, hopelessness, functional impairment, and use of various treatment services was examined. RESULTS: Nearly one fifth (18.2%) of the adolescents sought help on the Internet for emotional problems in the previous year. The proportions of males and females seeking help on the Internet did not significantly differ (15.6% and 20.8%, respectively). Internet help-seekers were significantly more likely than non-help-seekers to score above the clinical threshold on the Columbia Impairment Scale (34% versus 20.6%; chi(2)(1) = 7.4, <.01) or Beck Depression Inventory (16.1% versus 9.1%; chi(2)(1) = 3.8, <.05). These at-risk youths tended to combine Internet help-seeking with other sources of help, rather than substituting it for other resources. More than 20% of Internet help-seekers were dissatisfied with the help they received, and only 14% thought it had helped them very much. CONCLUSIONS: For the Internet to realize its potential as an effective resource for teenagers struggling with emotional problems, further development is needed.

Adolescent↗