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PubMed2006

Exercise in prevention and treatment of anxiety and depression among children and young people.

BACKGROUND: Depression and anxiety are common psychological disorders for children and adolescents. Psychological (e.g. psychotherapy), psychosocial (e.g. cognitive behavioral therapy) and biological (e.g. SSRIs or tricyclic drugs) treatments are the most common treatments being offered. The large variety of therapeutic interventions give rise to questions of clinical effectiveness and side effects. Physical exercise is inexpensive with few, if any, side effects. OBJECTIVES: To assess the effects of exercise interventions in reducing or preventing anxiety or depression in children and young people up to 20 years of age. SEARCH STRATEGY: We searched the Cochrane Controlled Trials Register (latest issue available), MEDLINE, EMBASE, CINAHL, PsycINFO, ERIC and Sportdiscus up to August 2005. SELECTION CRITERIA: Randomised trials of vigorous exercise interventions for children and young people up to the age of 20, with outcome measures for depression and anxiety. DATA COLLECTION AND ANALYSIS: Two authors independently selected trials for inclusion, assessed methodological quality and extracted data. The trials were combined using meta-analysis methods. A narrative synthesis was performed when the reported data did not allow statistical pooling. MAIN RESULTS: Sixteen studies with a total of 1191 participants between 11 and 19 years of age were included.Eleven trials compared vigourous exercise versus no intervention in a general population of children. Six studies reporting anxiety scores showed a non-significant trend in favour of the exercise group (standard mean difference (SMD) (random effects model) -0.48, 95% confidence interval (CI) -0.97 to 0.01). Five studies reporting depression scores showed a statistically significant difference in favour of the exercise group (SMD (random effects model) -0.66, 95% CI -1.25 to -0.08). However, all trials were generally of low methodological quality and they were highly heterogeneous with regard to the population, intervention and measurement instruments used. One small trial investigated children in treatment showed no statistically significant difference in depression scores in favour of the control group (SMD (fixed effects model) 0.78, 95% CI -0.47 to 2.04). No studies reported anxiety scores for children in treatment. Five trials comparing vigorous exercise to low intensity exercise show no statistically significant difference in depression and anxiety scores in the general population of children. Three trials reported anxiety scores (SMD (fixed effects model) -0.14, 95% CI -0.41 to 0.13). Two trials reported depression scores (SMD (fixed effects model) -0.15, 95% CI -0.44 to 0.14). Two small trials found no difference in depression scores for children in treatment (SMD (fixed effects model) -0.31, 95% CI -0.78 to 0.16). No studies reported anxiety scores for children in treatment. Four trials comparing exercise with psychosocial interventions showed no statistically significant difference in depression and anxiety scores in the general population of children. Two trials reported anxiety scores (SMD (fixed effects model) -0.13, 95% CI -0.43 to 0.17). Two trials reported depression scores (SMD (fixed effects model) 0.10, 95% CI-0.21 to 0.41). One trial found no difference in depression scores for children in treatment (SMD (fixed effects model) -0.31, 95% CI -0.97 to 0.35). No studies reported anxiety scores for children in treatment. AUTHORS' CONCLUSIONS: Whilst there appears to be a small effect in favour of exercise in reducing depression and anxiety scores in the general population of children and adolescents, the small number of studies included and the clinical diversity of participants, interventions and methods of measurement limit the ability to draw conclusions. It makes little difference whether the exercise is of high or low intensity. The effect of exercise for children in treatment for anxiety and depression is unknown as the evidence base is scarce.

Adolescent↗
PubMed1978

Adolescent parent education: a maturational model.

Health care, educational and social programs are frequently required to assist increasing numbers of adolescent mothers to meet their own needs and those of their babies. This paper presents a maturational rationale for development of a comprehensive parent education program. Some pertinent aspects of adolescent psychological development are first presented to provide a perspective for understanding the models illustrating the teenage mother's responses to her child. Barriers are then delineated which commonly restrict the young mother from attaining the mature relationship with her baby presented in a maturational model. Specific recommendations are offered in the areas of program development, content, and structure.

Adolescent↗
PubMed2004

The impact of suicidal ideation in preadolescence, adolescence, and young adulthood on psychosocial functioning and psychopathology in young adulthood.

OBJECTIVE: The long-term psychopathological outcome of suicidal ideation during adolescence in community samples is largely unknown. Data from the epidemiological and longitudinal Zurich Adolescent Psychology and Psychopathology Study (ZAPPS) allowed the testing of whether transient suicidal ideation in preadolescence or adolescence has the same impact on young adult psychopathology as enduring and concomitant suicidality in young adulthood. METHOD: Using various questionnaires on psychosocial functioning and the structured Composite International Diagnostic Interview (CIDI), the following five groups were compared: preadolescent suicidal ideation only, adolescent suicidal ideation only, young adult suicidal ideation only, enduring suicidality and young adult controls matched by age and gender. RESULTS: The young adult and the enduring risk group were most abnormal in various domains of psychosocial functioning and psychopathology. Whereas these groups differed from controls and the adolescent suicidal risk group, the differentiation from the preadolescent risk group was much weaker. CONCLUSION: There is a heightened risk of abnormal psychosocial and psychopathological functioning for young adult people with enduring and concomitant suicidal ideation and for those who experienced suicidal ideation in preadolescence.

Adaptation, Psychological↗
PubMed2006

Developmental psychopathology in adolescence: findings from a Swiss study--the NAPE Lecture 2005.

OBJECTIVE: Presentations of selective findings coming from the Zurich Adolescent Psychology and Psychopathology Study with two major aims: i) the study of the prevalence, course, and correlates of mental disorders in adolescence, and ii) the study of the determinants and processes of mental disorders in adolescence. METHOD: A representative sample of n = 1964 children and adolescents was studied in the canton of Zurich in 1994. Additional waves of data collection took place in 1997 and 2000/2001. Mean ages at these three assessments were 13, 16, and 20 years. Each wave contained a two-stage procedure of assessment with screening by questionnaires and consecutive interviewing. The main constructs used were general and specific measures of psychopathology, life events, coping styles, self-related cognitions, and quality of the social network. RESULTS: Prevalence rates of any mental disorder in school-age at the time of assessment was 22.5% fitting into a transcultural range of 18-26% based on DSM-III-R criteria. Furthermore, the derivation and validation of a four-group adolescent drinker typology was demonstrated. Additionally, the prevalence and continuity of functional-somatic symptoms from adolescence to young adulthood was shown. Another piece of the research tested for the identification of risk, compensatory, vulnerability, and protective factors influencing behaviour problems and found remarkably different frequencies across the four types of moderating factors. CONCLUSION: The presented findings provide further understanding of the developmental psychology and psychopathology of adolescence and the service, intervention, and prevention needs of this age-group.

Adolescent↗
PubMed1983

Alice in Wonderland and cognitive development: teaching with examples.

Alice in Wonderland can be used to give interesting examples of many of the basic concepts of adolescent psychology. Alice's experiences can be seen as symbolic depictions of important aspects of adolescent development, such as initiation, identity formation, and physical, cognitive, moral, and social development. The psychology instructor may choose a part of the story, then point out the parallels between it and particular aspects of adolescent development. This approach enables the instructor to create and maintain a high level of student interest in the course material.

Adolescent↗
PubMed1983

[Psychological changes in adolescence].

The concept of adolescence refers to the psychological changes beginning with the first puberal transformations and ending with the maturity of the individual. Adolescence is divided into three phases: Early adolescence coincides with the period of major somatic transformations. It is characterized by maladjustment to the new situation, manifested by attitude of rebellion, great intellectual avidity, affective inestability, relative sexual ambivalence and, socially, by a tendency towards gregariousness. Middle adolescence is characterized by great intellectual capacity, replanting on philosophic, religious, etc., principles, and tendency to introversion. The final phase usually includes the sedimentation of the earlier process with progressive acquisitions of the characteristics of maturity. These three classical stages are influenced by the unifying role of mediums of communication, difficult social and economical conditions, which provoke loss of values.

Adolescent↗
PubMed2005

The influence of violent behavior and victimization at school on psychological distress: the role of parents and teachers.

This study examined the role of adolescents' interactions with both parents and teachers in the relationship between violent behavior/victimization at school and adolescent psychological distresss (depression and stress). Participants were 983 Spanish adolescents (mean age 13.7 years) from four public schools in the Valencian Community. Statistical analyses were carried out using structural equation modeling. Results showed victimization to be directly and positively related to psychological distress. Moreover, victimization was associated with negative father-adolescent communication, which mediated a part of the influence of victimization on distress. Regarding school-based violent behavior, no direct effect on psychological adjustment was found. Results showed, however, an indirect effect: violent behavior negatively influenced communication with parents and interaction with teachers which, in turn, was related to poor psychological adjustment. This model accounted for 47.7% of the variance in psychological distress. Findings are discussed in relation to previous research on adolescent psychosocial adjustment, and directions for future research are suggested.

Adolescent↗
PubMed2004

Is obesity a risk factor for psychopathology among adolescents?

BACKGROUND: Although several studies have documented the existence of psychopathology in obese adolescents, disagreement remains regarding the extent and nature of this psychopathology. The aim of the present study was to explore the type and frequency of psychopathology in a clinical as well as a non-clinical sample of obese adolescents, and in a normal weight control group. METHODS: The study sample consisted of a clinical study group of 30 obese adolescents, a non-clinical obese group of 30 obese adolescents, and a control group of 30 normal weight adolescents. Psychological assessment was performed using a non-structured psychiatric interview, the Child Behavior Checklist (CBCL), Children Depression Inventory (CDI), Rosenberg Self-esteem scale (SES) and the Eating Attitude Test (EAT). RESULTS: More than half of the clinical obese adolescents (16/30) had a DSM-IV diagnosis, often involving major depressive disorder (n = 10). The mean scores of anxiety-depression, social problems, social withdrawal and total problem in the CBCL scale of the clinical obese group were significantly higher than the non-clinical obese group and the normal weight control group. The mean total scores of the SES and the CDI of the clinical obese group were higher than the normal weight control group. The mean total score of EAT of the clinical obese group was significantly higher than the normal weight control group, and the mean score of EAT of the non-clinical obese group was significantly higher than the normal weight control group. CONCLUSIONS: The results support previously published reports which show a higher ratio of psychopathology (depression, behavioral problems, low-esteem) among clinical obese adolescents than among non-clinical obese adolescents. Findings provided evidence for a psychosocial at-risk population in a subgroup of obese adolescents.

Adolescent↗
PubMed1999

Love is all you need? Focusing on adolescents' life concerns from an ecological point of view.

Focal theory, in trying to explain why the majority of young people cope comparatively well with the variety of transitional tasks they are confronted with during adolescence, suggests that adolescents deal with only one issue at a time: concerns about heterosexual relationships peak around 11, concerns about peer acceptance around 15, and about relationship to and independence from parents at 15 for girls and 17 for boys. However, the model has been criticized for not taking into account economic problems and unemployment. The present study sets out to empirically test the implications of focal theory with a large Swedish sample of 1217 adolescents between 11 and 20 by means of a school-based questionnaire. Young people answered how often they worry about relationship, economic, global and other personal issues. Results show that focal theory should not be taken literally with regard to certain age-related sequences of problems. However, the main concept proposed by Coleman, i.e. that the number of problems dealt with has implications for adolescents' psychological well-being, is strongly supported by the data in this study. Finally, the notion that young people can choose how many issues they focus upon at a time is critically discussed.

Adolescent↗
PubMed1988

Sex-role attributes, perceived competence and the development of depression in adolescence.

Studies are described which investigated the relationship of sex-role traits to age trends and sex differences in depression in adolescents. Psychological masculinity was negatively related to the level of depression in males and females, and evidence which indicates that this relationship is mediated by a link between masculinity and perceived competence is presented. The level of masculinity was stable across the age ranges studied, but was related to an increasingly higher rate of depression in females than males. It is therefore argued that a sex difference in masculinity arises prior to adolescence, but interacts with other factors which influence vulnerability to depression during the teenage years, thus bringing about the sex difference in depression.

Achievement↗
PubMed2006

Factors that influence the detection of psychological problems in adolescents attending general practices.

BACKGROUND: Epidemiological studies indicate that the prevalence of psychological problems in patients attending primary care services may be as high as 25%. AIM: To identify factors that influence the detection of psychological difficulties in adolescent patients receiving primary care in the UK. DESIGN OF STUDY: A prospective study of 13-16 year olds consecutively attending general practices. SETTING: General practices, Norfolk, UK. METHOD: Information was obtained from adolescents and parents using the validated Strengths and Difficulties Questionnaire (SDQ) and from GPs using the consultation assessment form. RESULTS: Ninety-eight adolescents were recruited by 13 GPs in Norfolk (mean age = 14.4 years, SD = 1.08; 38 males, 60 females). The study identified psychological difficulties in almost one-third of adolescents (31/98, 31.6%). Three factors significant to the detection of psychological disorders in adolescents were identified: adolescents' perceptions of difficulties according to the self-report SDQ, the severity of their problems as indicated by the self-report SDQ, and whether psychological issues were discussed in the consultation. GPs did not always explore psychological problems with adolescents, even if GPs perceived these to be present. Nineteen of 31 adolescents with psychological difficulties were identified by GPs (sensitivity = 61.2%, specificity = 85.1%). A management plan or follow-up was made for only seven of 19 adolescents identified, suggesting that ongoing psychological difficulties in many patients are not being addressed. CONCLUSIONS: GPs are in a good position to identify psychological issues in adolescents, but GPs and adolescents seem reluctant to explore these openly. Open discussion of psychological issues in GP consultations was found to be the most important factor in determining whether psychological difficulties in adolescents are detected by GPs.

Adolescent↗
PubMed2001

Protective role of personal competence skills in adolescent substance use: psychological well-being as a mediating factor.

Adolescents who use a variety of cognitive and behavioral self-management strategies have been shown to report reduced rates of early-stage substance use, but little is known about how these personal competence skills may be protective. In a series of structural equation models, this study examined the association between competence skills and substance use over a 3-year period among 849 suburban junior high school students, and whether psychological distress, well-being, or both mediated this relation. Findings indicated that well-being fully mediated the relation between early competence and later substance use, but distress did not. Youth with good competence skills reported greater subsequent well-being, which in turn predicted less later substance use. Findings suggest that competence skills protect youth by enhancing well-being and that prevention programs should aim to enhance competence in order to promote resilience.

Adaptation, Psychological↗
PubMed2003

Prevalence of affective disorders in children and adolescents: findings from the Zurich Epidemiological Studies.

OBJECTIVE: Affective disorders were studied in two epidemiological studies of children and adolescents in the Canton of Zurich, Switzerland. METHOD: In the Zurich Epidemiological Study of Child and Adolescent Psychopathology Study (ZESCAP) in 1994 a representative cohort of 1964 pupils aged 7-16 years was studied. The Zurich Adolescent Psychology and Psychopathology Study (ZAPPS) included 1089 adolescents aged 15-19 years who were assessed in 1997. A two-stage approach with questionnaire screening of the entire sample in stage 1 and consecutive interviews in stage 2 was used in both studies. Diagnoses according to DSM-III-R were derived from structured parent interviews in the ZESCAP and from both parent and adolescent interviews in the ZAPPS. RESULTS: The total prevalence rate for affective disorders in the ZESCAP was 0.66% (SE 0.25) whereas it was 5.1% based on adolescent interviews and 1.2% based on parent interviews in the ZAPPS. Adolescent girls have significantly higher prevalence rates for affective disorders than boys (9.4 vs. 1.1%). CONCLUSION: These findings are in accordance with various other international epidemiological studies on affective disorders in children and adolescents.

Adolescent↗