Search

Objective: The authors present prevalence data for adolescents in a large metropolitan area and examine the association of DSM-IV diagnoses with functional impairment and selected demographic correlates among European Americans (EA), African Americans (AA), and Mexican (MA) Americans. Method: The authors sampled 4,175 youths ages 11 to 17 years whose households were enrolled in large health maintenance organizations. Data were collected using questionnaires, the Diagnostic Interview Schedule for Children-IV and the Children's Global Assessment Scale. The data were collected in the Houston Metropolitan area in 1998-2000. Data on psychiatric disorders were derived from interviews with youths only. Results: AA had a lower prevalence of mood disorders, substance use disorders, and any disorders adjusted for Diagnostic Interview Schedule for Children-IV impairment or Children's Global Assessment Scale score than did others. EA had greatest prevalence of substance use disorders, whereas AA were lowest. After adjusting for covariates, EA had a higher risk for some disorders than AA. Effects of gender, age, parent education, family income, and marital status were not consistent across groups. Family income was protective only for EA. Conclusions: There appear to be few systematic differences between majority and minority adolescents at risk for psychiatric disorders. MA are not at increased risk contrasted to EA. AA had lower risk for some disorders, but adjusting for impairment and covariates eliminated most differences. Thus, multivariate analyses support the hypothesis that initial ethnic differences appear to be a function of factors associated with disadvantaged minority status rather than to distinctive ethnic culture. A noteworthy finding was that disadvantaged social status did not appear to increase the risk for disorders among minority youths. (Contains 4 tables.)

Background: There have been few prospective studies on the association between anxiety disorders and adolescent obesity; none examine potential reciprocal effects.Purpose: The purpose of this paper is to examine the prospective association between anxiety disorders and obesity among adolescents.Methods: Using data from a two-wave, prospective study of 3134 adolescents, we examined reciprocal effects between body weight and DSM-IV anxiety disorders.Results: Weight status did not increase future risk of anxiety disorders nor did anxiety disorders at baseline increase risk of future obesity in the overall sample. Stratifying by gender revealed an increased risk of overweight and obesity in males with anxiety disorders, but not for females. Major depression did not mediate these associations.Conclusion: Similar to prospective studies of depression, it appears anxiety disorders may increase risk of obesity. However, more research is needed on the role of psychopathology in adolescent obesity, in particular anxiety disorders and possible moderators (such as gender) and mediators. [ABSTRACT FROM AUTHOR]

Examines the characterization of fatalism in risk of adolescent depression based on a survey conducted in Houston, Texas. Risk factors for suicide serious attempts; Analysis on several measures of life stress or stressors; Variety of socioeconomic status distinction in adolescent depression and suicidal behaviors.

Objective: To examine the risk of suicidal plans and ideation, depression, and other factors (low self-esteem, loneliness, fatalism, pessimism) among adolescents with a lifetime history of attempted suicide.Method: A self-administered questionnaire was used in a school-based survey of five middle schools (grades 6 through 8) enrolling 6,400 students. Usable questionnaires were obtained from 5,423 (85.3%). Data were obtained on a wide range of constructs including recent and lifetime suicide attempts, recent and lifetime suicide plans, recent ideation, symptoms of DSM-IV major depression, self-esteem, pessimism, loneliness, and fatalism.Results: Data on crude prevalence showed thoughts about death, wishing to be dead, thoughts of suicide, and suicide plans were all significantly higher among youths with a history of attempts. Suicidal thinking was related to being more lonely, more fatalistic, and more pessimistic, and to less self-esteem, in addition to depression and a history of attempts. Multivariate analyses revealed the strongest factors associated with current suicidal thinking were history of attempts (odds ratio [OR] = 3.50), depression (OR = 5.34), and recent life stress (OR = 2.64). Compared with youths with none of the factors examined, those with six or more were at extreme risk (OR = 67.87).Conclusions: The strong association between history of suicide attempts, current ideation, and depression indicates that past suicide attempts occur in the context of other signs of psychosocial dysfunction. Given the paucity of epidemiological data on the natural history of suicidal behaviors among youths, more epidemiological studies of the antecedents and consequences of the range of suicidal behaviors among children and adolescents are needed. Given the high risk of subsequent suicidal behaviors by youths who have attempted but not completed suicide, this constitutes a high-risk population on which future research should focus. [ABSTRACT FROM AUTHOR]

The objective is to examine incidence, prevalence, and persistence of restricted or short sleep among adolescents and associated risk factors. Data are from a sample of 4,175 youths aged 11 to 17 at baseline and 3,134 followed up 1 year later. Restricted sleep was defined as 6 hr or less per night. Prevalence was 20%, 1-year incidence was 17%, and chronicity was 54%. Analyses identified few independent predictors: female, older age, schoolwork, extracurricular activities, and life stress. Odds ratios for incidence of sleep restriction on weeknights were 10 for 8 or more factors and 17 for persistence with 8 or more risk factors. This prospective study documents that incidence of sleep restriction was high. Restricted sleep also was prevalent and chronic and, like many other health problems, has multifactorial origins. Having multiple risk factors substantially increased risk of restricted sleep. Given the importance of sleep in this population, more focus is clearly needed, both clinically and epidemiologically.

Introduction: Disturbed sleep is a public health problem, but few studies describe the prevalence of sleep problems among Hispanic adolescents. We estimated the prevalence of disturbed sleep and associated factors among ninth graders living on the Texas-Mexico border., Methods: We used probabilistic sampling to conduct 2 cross-sectional, school-based surveys: 1 during the 2000-2001 school year in the Lower Rio Grande Valley, Texas (n = 4,901), and 1 during the 2002-2003 school year in Matamoros, Tamaulipas, Mexico (n = 669). We assessed disturbed sleep during the 4 weeks before the survey., Results: The prevalence of disturbed sleep in Matamoros was 36% and in the Lower Rio Grande Valley was 28%. Factors associated with disturbed sleep in both populations were smoking cigarettes, having ever used cocaine, having been forced to have sex, considering attempting suicide, feeling sad, and going without eating for 24 hours or more., Conclusion: This study revealed a high prevalence of disturbed sleep in high school students living on the Texas-Mexico border. This public health issue should be further investigated in both communities.

Background: We have few data on incidence of psychiatric disorders among adolescents. This study examined first incidence of disorders among adolescents and baseline factors which increased or decreased risk of new onset cases a year later., Methods: Data were analyzed from Teen Health 2000 (TH2K), a probability sample of 4,175 youths 11-17 and their parents assessed at baseline and 3,134 of these youth-parent dyads followed up a year later. Disorders examined were anxiety, mood, attention deficit hyperactivity disorder (ADHD), disruptive, and substance abuse/dependence disorders in the past year. Risk and protective factors were assessed from three domains: status factors, personal and social resources, and stressors. Logistic regression models were used to estimate odds of incident disorders for each risk and protective factor., Results: Incidence rates were 2.8% for anxiety, 1.5% for mood, 1.2% for ADHD, 2.5% for disruptive, 2.9% for substance abuse/dependence, and 7.5% for one or more DSM-IV disorders. Multivariate analyses identified few independent predictors of incidence. The most consistent factors across disorders involved indicators of stress. The role of adverse family context was particularly noteworthy, predicting incidence of every disorder examined. Personal resources such as mastery consistently enhanced resilience to onset of first episodes. The presence of multiple risk factors, cumulative burden, substantially increased risk of first incidence of all disorders examined., Conclusions: The incidence of any disorder of 7.5% was similar to two earlier studies using DSM-III-R criteria (8.9 and 10.6, respectively). This is the first study to estimate incidence of DSM-IV disorders for a range of diagnostic categories, and with the exception of substance use disorders, the rates are quite different from one earlier study using DSM-II-R criteria. A clear pattern emerged from the analyses. That is, psychiatric disorders, like other chronic diseases, are the product of multiple factors and these factors in turn have effects on multiple disorders.

Purpose: To estimate prevalence and chronicity of insomnia and the impact of chronic insomnia on health and functioning of adolescents., Methods: Data were collected from 4175 youths 11-17 at baseline and 3134 a year later sampled from managed care groups in a large metropolitan area. Insomnia was assessed by youth-reported DSM-IV symptom criteria. Outcomes are three measures of somatic health, three measures of mental health, two measures of substance use, three measures of interpersonal problems, and three of daily activities., Results: Over one-fourth reported one or more symptoms of insomnia at baseline and about 5% met diagnostic criteria for insomnia. Almost 46% of those who reported one or more symptoms of insomnia in Wave 1 continued to be cases at Wave 2 and 24% met DSM-IV symptom criteria for chronic insomnia (cases in Wave 1 were also cases in Wave 2). Multivariate analyses found chronic insomnia increased subsequent risk for somatic health problems, interpersonal problems, psychological problems, and daily activities. Significant odds (p < .05) ranged from 1.6 to 5.6 for poor outcomes. These results are the first reported on chronic insomnia among youths, and corroborate, using prospective data, previous findings on correlates of disturbed sleep based on cross-sectional studies., Conclusions: Insomnia is both common and chronic among adolescents. The data indicate that the burden of insomnia is comparable to that of other psychiatric disorders such as mood, anxiety, disruptive, and substance use disorders. Chronic insomnia severely impacts future health and functioning of youths. Those with chronic insomnia are more likely to seek medical care. These data suggest primary care settings might provide a venue for screening and early intervention for adolescent insomnia.

We present prevalence data for adolescents in a large metropolitan area in the US and the association of DSM-IV diagnoses to functional impairment and selected demographic correlates. We sampled 4175 youths aged 11-17 years from households enrolled in large health maintenance organizations. Data were collected using questionnaires and the Diagnostic Interview Schedule for Children, Version IV (DISC-IV). Impairment was measured using the Child Global Assessment Scale and diagnostic specific impairment in the DISC-IV. 17.1% of the sample met DSM-IV criteria for one or more disorders in the past year; 11% when only DISC impairment was considered and 5.3% only using the CGAS. The most prevalent disorders were anxiety (6.9%), disruptive (6.5%), and substance use (5.3%) disorders. The most prevalent specific disorders were agoraphobia, conduct and marijuana abuse/dependence, then alcohol use and oppositional defiant disorder. Younger youths and females had lower odds for any disorder, as did youths from two parent homes. There was increased odds associated with lower family income. Females had greater odds of mood and anxiety disorders, males of disruptive and substance use disorders. There were greater odds of mood and disruptive disorders for older youths. Prevalences were highly comparable to recent studies using similar methods in diverse non-metropolitan populations. We found associations with age, gender, and to a lesser extent, socioeconomic status reported in previous studies. The inclusion of both diagnosis-specific impairment and global impairment reduced prevalence rates significantly. Our results suggest commonality of prevalences and associated factors in diverse study settings, including urban and rural areas.

This paper extends our knowledge of comorbidity of substance use disorders (SUDs) and other psychiatric disorders by examining comorbidity of specific types of SUDs and risk of comorbidity separately for abuse and dependence. The research question is whether there is specificity of risk for comorbidity for different SUDs and whether greater comorbidity is associated with dependence. Data are presented from a probability sample of 4175 youths aged 11-17 assessed with the NIMH DISC-IV and self-administered questionnaires. SUDs outcomes are alcohol, marijuana and other substances in past year. Mean number of other comorbid disorders ranged from 1.9 for marijuana abuse to 2.2 for other substance abuse and 1.9 for marijuana dependence to 2.8 for other substance dependence. None of the abuse SUDs does not increase risk of anxiety disorders, but dependence does. Both abuse and dependence increased risk of comorbid mood disorders. Similar results were observed for disruptive disorders. Patterns of comorbidity varied by substance, by abuse versus dependence, and by category of other psychiatric disorders. In general, there was greater association of comorbidity with other disorders for dependence versus abuse. Marijuana is somewhat less associated with other disorders than alcohol or other substances. The strongest association is for comorbid disruptive disorders, regardless of SUDs category. Having SUDs and comorbid other psychiatric disorders was associated with substantial functional impairment. Females with SUDs tended to have higher rates of comorbid disorders, as did older youths. There were no differences observed among ethnic groups. When comorbidity of SUDs with other disorders was examined, controlling for other non-SUDs disorders for each specific disorder examined, the greater odds for dependence versus abuse essentially disappeared for all disorders except disruptive disorders, suggesting larger number of comorbid non-SUDs in part account for the observed effects for dependence.

Limited data on ethnic group differences among young adolescents exist regarding the prevalence of mental distress, social stress, and resources. The aim of this cross-sectional study was to examine ethnic differences among African American (AA), European American (EA), Hispanic American (HA), and Asian American adolescents in mental distress, social stress, and resources. A total of 316 adolescents completed the self-administered questionnaire: The DSD, Somatic Symptom Scale, SAFE-C, FES, Coping, and Rosenberg's Self-Esteem Scale. The findings revealed that (1) Asian Americans and HAs reported significantly higher scores on social stress and mental distress and lower scores on resources than EAs; (2) Compared to EAs, AAs and HAs were more likely to experience social stress (2.2 < or = OR < or = 4.3), and HAs are more likely to have suicidal ideation (OR = 2.04; 95% CI = 1.04-3.98). Findings highlighted the importance of understanding the role of social stress in the development of adolescents' mental distress. Identified ethnic minority adolescents are vulnerable groups who require additional research and attention from health care providers.

Objective: To investigate differences in associations between physical activity and overweight for students in two adjacent areas on the border between Mexico and the United States of America: students in the city of Matamoros, Mexico, and Mexican-American students in the Lower Rio Grande Valley (LRGV) area of southern Texas. Since the extremely high prevalence of overweight among Mexican-American adolescents is well-recognized, we wanted to determine whether overweight has become a problem among Mexican adolescents as well., Methods: Students from 6 schools (n = 653), representing 11% of the ninth-grade students in Matamoros during 2002-2003, and students from 13 high schools (n = 4,736), representing 22% of the ninth-grade students in the LRGV during 2000-2001, completed questionnaires. Polytomous logistic regression was performed to estimate the risk of being at risk for overweight (> or = 85th percentile to < 95th percentile of body mass index (BMI) for age and sex) and the risk of being overweight (> or = 95th percentile of BMI-for-age and sex) versus normal weight that were associated with measures of physical activity. For simplicity, the classification of normal weight also included underweight., Results: A higher percentage of adolescents in the LRGV were at risk of overweight (17%) in comparison with adolescents from Matamoros (15%). The percentages of LRGV and Matamoros adolescents who were overweight were identical (17%). LRGV adolescent boys (OR = 0.87, 95% CI = 0.77-0.98) who participated in team sports were less likely to be at or above the 85th percentile of BMI-for-age and sex. Although of borderline significance, Matamoros and LRGV adolescent boys who participated in physical education classes were less likely to be at risk for overweight. Among neither the Matamoros students nor the LRGV students were any of the various other physical activity categories or levels associated with being at risk for overweight or being overweight., Conclusions: Nearly one-third of the students in both Matamoros and the LRGV are at risk for overweight or are overweight. Implementation of interventions on healthful dietary choices and participation in physical education classes and sports teams are essential for reducing the extremely high prevalence of overweight among students on both sides of the Texas/Mexico border.

The purpose of this study was to examine the concordance of parental and adolescent reports of adolescents having emotional and behavioral problems. Data were collected from youths (age 11-17) and adult caregivers from a community-based sample of households. The sample consisted of 4175 youths and their caregivers (37.8% European, 35.0% African, 25.4% Latino, and 1.8% other American). Indicators of emotional and/or behavioral problems were global indicators: perceived mental health, life satisfaction, happiness, interpersonal problems at home, and problems at school. Overall, parent-child concordance on the indicators of mental health was low, with a mean kappa value of 0.12. In multivariate analyses, European American parent-youth dyads were significantly more likely to be concordant on reports of perceived mental health, problems at home, and problems at school than African American and Latino dyads. Our data suggest that ethnicity is a significant factor in parental labeling and awareness of adolescent mental health problems. Future research should examine whether the extent to which greater lack of concordance on the indicators of mental health by minority parent-child dyads plays a role in entry into and retention in mental health care.

Background: Studies of dating violence among Latino men and women have found that victims who are less acculturated have lower rates of dating violence. None of these studies have focused on adolescents. We assessed acculturation, ethnic identity, and dating violence victimization among Latino ninth-grade students., Methods: Students from 13 high schools representing 24% of ninth-grade students in the Texas Lower Rio Grande Valley during 2000-2001 completed questionnaires. This analysis is restricted to students age 14 years or older who self-identified as Hispanic or Latino (n = 4,525). Logistic regression was performed to estimate the risk of dating violence associated with measures of acculturation and ethnic identity., Results: Latino female adolescents were more likely to report dating violence victimization in the past 12 months (8.7%) than were males (6.4%). Parental birthplace outside of the United States was significantly associated with a reduced likelihood of dating violence victimization among females. Reporting a great deal of ethnic discrimination was strongly associated with increased dating violence victimization among females., Conclusions: These findings suggest that greater acculturation may be associated with greater prevalence of dating violence victimization among females. Understanding those aspects of Latino culture that may impact risk of dating violence could have important public health implications.

Study Objectives: To estimate the prevalence of symptoms of insomnia among adolescents living along the United States-Mexico border and to examine whether ethnicity and birthplace affect risk for such symptoms., Design: Cross-sectional school-based survey using a version of the 2001 Youth Risk Behavior Survey, modified to elicit data on sleep problems., Setting: A probability sample of 13 high schools selected from more than 40 high schools in the 4 southernmost counties in Texas-the Lower Rio Grande Valley-contiguous with Mexico., Participants: All ninth-grade students who agreed to participate (n = 5,118)., Measurements: The sleep module consisted of queries about trouble initiating asleep, trouble maintaining sleep, early morning waking, nonrestorative sleep, quality of sleep, and amount of sleep., Results: Symptoms of insomnia were common, with 12.4% of respondents meeting symptom criteria for insomnia almost every day of the past month. Females were more likely to report insomnia, as were youths reporting lower socioeconomic status. Crude odds ratios suggested foreign-born and those who identified themselves as "Mexican" rather than "Mexican American" were at lower risk of insomnia. However, multivariate analyses eliminated these differences., Conclusions: More comparative research is needed to ascertain whether and how ethnic culture affects risk for disordered sleep.

The goal of this study was to explore whether a history of sexual abuse is associated with high-risk sexual behaviors among female adolescents attending alternative schools in a large urban city in the southwestern United States, and to examine the role of depression and substance abuse in explaining this association. One hundred eighty-four sexually active female adolescents constituted the sample for this analysis. Forty-nine (26.6%) reported that they were forced to have sex. Having a history of sexual abuse substantially increased sexual risk behaviors. Adolescents reporting a history of sexual abuse, compared to those who did not report such a history, were significantly more likely to have initiated sexual activity (intercourse) before age 14, to have had three or more sexual partners in the last 3 months, and to have had a history of sexually transmitted diseases. These associations remained significant after controlling for age, ethnicity, and family income. Depression and substance abuse did not explain the association between sexual abuse and high-risk sexual behaviors. It seems reasonable to conclude that adolescents with a history of sexual abuse have greater difficulty practicing safe sexual behaviors than do those who have not been sexually abused. Given the prevalence of child sexual abuse and the extent of its impact, it is critical that intervention strategies for adolescent females address the issue of abuse and help them adopt self-protective sexual behaviors. The findings also highlight the importance of targeting adolescents who attend alternative schools.

Of 490 middle and high school students attending alternative schools who participated in this study, 18.2% of females and 6.7% of males reported a past unwanted sexual experience. Relative to nonabused subjects, female and male adolescents who reported a forced sexual experience were more likely to exhibit externalizing problems such as sexual risk behaviors and internalizing problems such as depression and suicidal thoughts in the past two weeks. Females with a history of a coercive sexual experience also had increased odds of drug and alcohol use, and violence-related behaviors. The magnitude of these associations ranged from a twofold increase to a tenfold increase. Controlling for ethnicity, family income, and family support had less impact on the strength of associations between a forced sexual experience and sexual risk behaviors for females than for males. A forced sexual experience remained significantly associated with depression for females and suicidal thoughts for males. Alcohol use in the past 30 days was the only substance use-related problem that remained significant for females. Violence-related behaviors did not remain significant in the presence of control variables for females. Interventions focusing on adolescents with a history of a coercive sexual experience in general, and in alternative schools in particular, are suggested by these results. More research focusing on the differential impact of a coercive sexual experience on males and females is crucial.

As a first step in developing a reliable and culturally sensitive instrument to assess depression in Korean-American youths, this community-based methodological study was designed to evaluate the characteristics of the DSM Scale for Depression (DSD). A total of 104 Korean Americans, 11 to 13 years, participated in this study, and the response patterns of this group were compared with Korean- (n = 20) and Anglo- (n = 557) American youths assessed by the Teen Life Changes Survey (TLCS). Overall, Korean-American youths showed significantly higher mental distress scores than Anglos. The DSD was found to be a culturally appropriate instrument for Korean Americans with good reliability (alpha =.92) and validity demonstrated by correlating with related constructs (loneliness, self-esteem, coping, social support, mastery, and somatic symptoms). The highest correlation coefficient was observed between depression and somatic symptoms (r =.61). These findings are informative for the design of further studies of mental health of Korean-American youths.