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Background: A basic, yet untested tenet underlying alcohol control policies is that they should affect both light and heavy drinking, thereby shifting the entire population in a favourable direction. The aim of this study was to test this assumption in young Swiss men.Methods: Cross-sectional self-reported data - from 5755 young Swiss men participating in the Cohort Study on Substance Use Risk Factors (C-SURF), a large cohort study on young men living within 21 jurisdictions across Switzerland - were analysed via nested logistic regression. With this approach, a set of increasingly-heavy drinking patterns was broken down into a set of nested regression models, each one estimating the probability of heavier drinking, conditional on the lighter drinking pattern. Drinking patterns relating to heavy episodic drinking (HED), heavy volume drinking (HVD) on weekends, and workweek drinking, as well as alcohol use disorder (AUD) were examined. The explanatory variable was a previously-used alcohol policy environment index (APEI) reflecting the number of alcohol control policies implemented in each jurisdiction. Conventional and multilevel logistic regression models were tested, adjusted for age, education, linguistic region, urban/rural status, attention-deficit/hyperactivity disorder, depression, sensation seeking, antisocial personality disorder, and unobserved heterogeneity between jurisdictions.Results: For HED, weekend HVD, and AUD, negative relationships with the APEI were found, such that with a higher APEI the probability of lighter drinking patterns was increased while the probability of heavier patterns was reduced, including a reduced probability of the heaviest patterns. These relationships were non-linear, however, and tapered off towards the heavy end of the drinking spectrum. No relationship was identified between the APEI and workweek drinking patterns.Conclusion: Among young Swiss men, stricter alcohol policy environments were associated with a global shift towards lighter drinking, consistent with the basic tenet behind the universal prevention approach. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: Child sexual abuse (CSA) is one of the most serious public health problems among children and adolescents, owing to its widespread prevalence and serious health consequences. The present study aimed to assess the prevalence of, and characteristics and circumstances associated with, CSA. Methods: An epidemiological survey was conducted on a nationally representative sample of 6,787 ninth-grade students (15.5 ± .66 years of age) in Switzerland. Self-reported computer-assisted questionnaires were administered between September 2009 and May 2010. Various forms of sexual victimization were assessed using the newly developed Child Sexual Abuse Questionnaire. Results: Overall, 40.2% and 17.2% of girls and boys, respectively, reported having experienced at least one type of CSA event. Lifetime prevalence rates were 35.1% and 14.9%, respectively, for CSA without physical contact, 14.9% and 4.8% for CSA with physical contact without penetration, and 2.5% and .6% for CSA with penetration among girls and boys. The most frequently experienced event was sexual harassment via the Internet. More than half of female victims and more than 70% of male victims reported having been abused by juvenile perpetrators. Depending on the specific event, only 44.4%–58.4% of female victims and 5.8%–38% of male victims disclosed CSA, mostly to peers. Conclusions: The present study confirms the widespread prevalence of CSA. The high prevalence of CSA via the Internet and the frequent reports of juvenile perpetrators suggest emerging trends in CSA. Low disclosure rates, especially among male victims, and reluctance to disclose events to family members and officials may impede timely intervention. [Copyright &y& Elsevier]

This longitudinal, prospective study investigated associations between perceived COVID-19-related stress, coping strategies, and mental health status among adolescents during the first lockdown of the COVID-19 pandemic and one year after the lockdown in Switzerland within a large, national sample. A self-report on-line survey was completed by 553 adolescents (age-range 12–18 years in 2021) in the summers of 2020 and 2021, assessing symptoms of various mental health problems, perceived COVID-19-related stressors, and coping strategies. Overall, participants reported less COVID-19 related stress one year after the lockdown, though mental health status remained stable. 'Challenges at home or with others' were significantly associated with mental health problems in both genders, whereas 'trouble getting medical care or mental health services 'was associated with mental health problems in girls. Perceived stress and pre-existing psychiatric problem were significantly linked to all mental health outcomes at both time points. Parents' poor relationships with partners during the lockdown was associated with increased anxiety symptoms in their children. Using cognitive restructuring to cope with stress was associated with less, while negative coping was associated with more anxiety, depression, and attention deficit hyperactivity disorder (ADHD) symptoms one year post lockdown. Girls appear to have been more affected by the pandemic than boys, with youths with pre-existing psychiatric problems especially vulnerable to its detrimental effects. Healthcare and school professionals should support to identify high-risk adolescents with negative and avoidant coping strategies and train youths to use positive coping strategies. [ABSTRACT FROM AUTHOR]

: BACKGROUND The purpose of this study was to investigate attitudes towards the donation of surplus embryos among couples with cryopreserved embryos/zygotes, and to identify correlates associated with attitudes toward the destinations of surplus embryos/zygotes. : METHODS Eleven of 19 Swiss in vitro fertilization (IVF) centers in existence in 2004 participated in the survey. Questionnaires were sent to 888 eligible couples; 458 men (52%) and 468 women (53%) returned them. : RESULTS Fifty-two percent of the participants supported the donation of surplus embryos to other couples, but divided opinions on the disclosure of biological parents’ identities were identified. About 70% of participants indicated that donations of surplus embryos for medical research or therapy should be allowed, following strict regulations. Multiple logistic regression analyses revealed couples’ position on the moral status of an embryo as the strongest predictor of attitudes toward all destinations of surplus embryos. Having children due to IVF/Intra-Cytoplasmic Sperm Injection (ICSI) treatment was negatively associated with attitudes towards donations to other couples. Perceived importance of religion, age >40, being a resident of the French-speaking region and unsuccessful IVF/ICSI treatment experiences were predictive of supporting donations for medical research. : CONCLUSIONS Swiss couples with cryopreserved embryos/zygotes are open to different options related to donating, rather than discarding, surplus embryos. [ABSTRACT FROM AUTHOR]

The study aimed to identify different patterns of gambling activities (PGAs) and to investigate how PGAs differed in gambling problems, substance use outcomes, personality traits and coping strategies. A representative sample of 4989 young Swiss males completed a questionnaire assessing seven distinct gambling activities, gambling problems, substance use outcomes, personality traits and coping strategies. PGAs were identified using latent class analysis (LCA). Differences between PGAs in gambling and substance use outcomes, personality traits and coping strategies were tested. LCA identified six different PGAs. With regard to gambling and substance use outcomes, the three most problematic PGAs were extensive gamblers, followed by private gamblers, and electronic lottery and casino gamblers, respectively. By contrast, the three least detrimental PGAs were rare or non-gamblers, lottery only gamblers and casino gamblers. With regard to personality traits, compared with rare or non-gamblers, private and casino gamblers reported higher levels of sensation seeking. Electronic lottery and casino gamblers, private gamblers and extensive gamblers had higher levels of aggression-hostility. Extensive and casino gamblers reported higher levels of sociability, whereas casino gamblers reported lower levels of anxiety-neuroticism. Extensive gamblers used more maladaptive and less adaptive coping strategies than other groups. Results suggest that gambling is not a homogeneous activity since different types of gamblers exist according to the PGA they are engaged in. Extensive gamblers, electronic and casino gamblers and private gamblers may have the most problematic PGAs. Personality traits and coping skills may predispose individuals to PGAs associated with more or less negative outcomes. [ABSTRACT FROM AUTHOR]

The Behavioural Inhibition System/Behavioural Activation System scales (BIS/BAS scales) constitute one of the most prominent questionnaires to assess individual differences in sensitivity to punishment and reward. However, some studies questioned its validity, especially that of the French and German translations. The aim of the present study was to re-evaluate the psychometric characteristics of the BIS/BAS scales in a large sample of French- and German-speaking young Swiss men ( N = 5872). Results showed that factor structures previously found in the literature did not meet the standards of fit. Nine items had to be removed to achieve adequate fit statistics in confirmatory factor analysis, yielding a shortened version with four factors: one BIS factor comprising five items and three BAS factors, namely Reward Reactivity, Drive and Fun Seeking, each comprising two items. Convergent validity and group invariance analyses suggest that the shortened BIS/BAS scales constitute a valid and reliable instrument. Researchers interested in assessing individual differences in BIS and BAS reactivity in French- and German-speaking individuals should avoid using the BIS/BAS scales as originally specified. The shortened version may be a sound alternative at least in samples of young adults. Its shorter format may be particularly suited for surveys with constraints on questionnaire length. Copyright © 2015 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The extent and quality of social support provided to young survivors of sexual abuse (SA) have only rarely been examined. This qualitative study aimed to investigate adolescent perspectives on social support received in the aftermath of SA. A total of 26 sexually victimized adolescents (15-18 years old) participated in a qualitative face-to-face, in-depth interview that focused on perceived social support. Qualitative content analysis was conducted as per Mayring () using the qualitative data analysis program ATLAS.ti. In addition, quantitative correlational analyses were conducted to identify characteristics of SA and their associations with perceived social support. Although participants perceived parental support as the most necessary type of support, they were much more satisfied with support from peers. In particular, adolescents stated that they wished they had received more emotional support from their parents in order to better cope with the abuse. About half of participants reported having received counseling, and counseling was seen as very helpful in dealing with the consequences of SA. Only a few adolescents mentioned their school as a source of support. Intra-familial abuse, younger victim age at the time of abuse, an adult perpetrator, and severe abuse were all negatively associated with satisfaction with perceived support. Our results suggest that support for young survivors of SA needs to be improved. Prevention of SA needs particular focus on improving parental reactions to SA, facilitating access to professional support, and raising teacher awareness of the importance of their role in the provision of support for sexually victimized children. [ABSTRACT FROM AUTHOR]

Background: Previous research has demonstrated a preventive effect of the alcohol policy environment on alcohol consumption. However, little is known about the heterogeneity of this effect. Our aim was to examine the extent of heterogeneity in the relationship between the strictness of alcohol policy environments and heavy drinking and to identify potential moderators of the relationship.Methods: Cross-sectional data from 5986 young Swiss men participating in the cohort study on substance use risk factors (C-SURF) were analysed. The primary outcome was self-reported risky single-occasion drinking in the past 12 months (RSOD, defined as 6 standard drinks or more on a single occasion at least monthly). A previously-used index of alcohol policy environment strictness across Swiss cantons was analysed in conjunction with 21 potential moderator variables. Random forest machine learning captured high-dimensional interaction effects, while individual conditional expectations captured the heterogeneity induced by the interaction effects and identified moderators.Results: Predicted subject-specific absolute risk reductions in RSOD risk ranged from 16.8% to - 4.2%, indicating considerable heterogeneity. Sensation seeking and antisocial personality disorder (ASPD) were major moderators that reduced the preventive relationship between stricter alcohol policy environments and RSOD risk. They also were associated with the paradoxical observation that some individuals displayed increased RSOD risk in stricter alcohol policy environments.Conclusion: Whereas stricter alcohol policy environments were associated with reduced average RSOD risk, additionally addressing the risk conveyed by sensation seeking and ASPD would deliver an interlocking prevention mix against young Swiss men's RSOD. [ABSTRACT FROM AUTHOR]

Purpose: To examine parent-child agreement regarding a child's health-related quality of life (HRQOL) among three health status groups. Methods: Parent-child agreement was evaluated for three health status groups of a population-based sample: (1) children with mental health problems ( N = 461), (2) children with physical health problems ( N = 281), and (3) healthy controls ( N = 699). The KIDSCREEN-27 was used to assess HRQOL. The children were 9-14 years of age. Results: Intraclass correlation coefficients were mostly good across all HRQOL scores and health status groups. This relatively high level of agreement was also reflected by the following findings: first, the AGREE group was the largest in three out of five HRQOL subscales in all health status groups; second, when disagreement occurred, it was often minor in magnitude. Despite this relatively high level of agreement, the means of self-ratings were significantly higher for all HRQOL scores and health status groups than the means of proxy ratings. These higher self-ratings were especially pronounced among children with mental health problems in certain HRQOL domains. Conclusions: Even though the level of parent-child agreement regarding a child's HRQOL is relatively high, it should be considered that children (especially those with mental health problems) often report better HRQOL than their parents. It is, therefore, highly recommended that both proxy- and self-ratings are used to evaluate a child's HRQOL comprehensively. [ABSTRACT FROM AUTHOR]

Purpose: To systematically review studies about the quality of life (QOL) of children with various mental disorders relative to healthy controls and to describe limitations in these studies. Methods: Relevant articles were searched using different databases, by checking reference lists and contacting experts. We included articles that either compared children with mental disorders to healthy controls/norm values or made such a comparison possible. Results: Sixteen out of 4,560 articles met the pre-defined inclusion criteria. These studies revealed that the QOL of children with various mental disorders is compromised across multiple domains. The largest effect sizes were found for psychosocial and family-related domains and for the total QOL score, whereas physical domains generally were less affected. The most important limitations in the existing literature include the lack of study samples drawn from the general population, the failure to use self-ratings, not considering item overlap between measuring QOL and assessing for the presence of a particular mental disorder, and not determining whether the children were receiving medication for their mental disorder. Conclusions: Children with mental disorders experience a considerable reduction in QOL across various domains. Research studies that avoid previous limitations are crucial to fill existing knowledge gaps. [ABSTRACT FROM AUTHOR]

Background: Common mental disorders (CMDs) are highly prevalent and contribute significantly to the global burden of disease, yet there is evidence of a large treatment gap. We aimed to quantify this gap among young adults with symptoms of CMDs and examine the relationship between substance use and perceived need for care and mental health service utilization.Methods: In a nationally representative, cross-sectional survey of young Swiss adults' mental health and wellbeing, we assessed symptoms of anxiety, depression, and attention deficit hyperactivity disorder (ADHD) with widely used screening instruments and asked about participant suicidal ideation, suicide attempts, mental health-related quality of life, alcohol and drug use, perceived need for mental health care, and mental health service utilization. We used these variables to calculate the treatment gap and weighted all analyses according to the stratified sampling plan.Results: Around a quarter of young adults screened positive for at least one CMD. Participants who screened positive for anxiety and/or depression reported significantly more suicidal ideation and lifetime suicide attempts and reported worse mental health-related quality of life than participants who did not screen positive for a disorder. Women's prevalence of anxiety and depression symptoms was significantly higher than men's, while men were more likely to report most types of risky drug use. Among those with a CMD, only around half perceived lifetime need for care, and less than 20% reported currently utilizing mental health services. Young adults with a CMD reporting risky weekly use of alcohol were less likely to be currently using services.Conclusion: The high prevalence of CMD symptoms could reflect a rising prevalence of these disorders mirroring increasing trends observed in other countries. To address the large treatment gap, interventions promoting mental health literacy and more research on additional barriers to inform further interventions are needed. [ABSTRACT FROM AUTHOR]

Background: Attention deficit/hyperactivity disorder (ADHD), conduct disorder (CD), and sensation seeking (SS) have been consistently related to a higher risk of substance use (SU) and substance use disorder (SUD).Objectives: To investigate the relationship between ADHD and prevalence rates in males at age 20 and age 25, the initiation of SU and SUD after age 20, and the escalation of SU from age 20 to age 25, and to explore the role of CD and SS in the relation of ADHD with SU and SUD initiation and escalation.Method: Data were obtained as part of the Cohort Study on Substance Use Risk Factors (C-SURF), which focused on young Swiss men aged 20 years at baseline and 25 years at follow-up.Results: Participants who screened positive for ADHD at baseline exhibited a higher rate of SU and SUD than participants who screened negative. The presence of ADHD symptoms at age 20 predicted initiation of all SU between age 20 and age 25, except for alcohol and smoking. After controlling for self-reported CD and SS, ADHD still predicted this late initiation of use of hallucinogens, meth-/amphetamines, and ecstasy/MDMA; non-medical use of ADHD medication and sedatives, and alcohol use disorder (AUD). No escalation of weekly drinking and smoking or annual cannabis use was observed from age 20 to age 25.Conclusion: Screened-positive ADHD is an independent predictor of late SU and AUD, along with self-reported CD and SS. From a public health perspective, identifying ADHD is not only important in childhood and adolescence but also in early adulthood to guide specific interventions to lower risks of drug use initiation and the development of AUD in early adulthood. [ABSTRACT FROM AUTHOR]

We investigated whether adult attention-deficit/hyperactivity disorder (ADHD) predicts risky substance use and substance use disorders (SUDs), and its impact on the course of these problematic substance use patterns. Our sample included 4975 Swiss men (mean age 20 ± 1.2 years) who participated in the baseline and 15-month follow-up assessments of the Cohort Study on Substance Use Risk Factors. We examined: (1) the contribution of ADHD, as assessed at baseline, on the risky use of alcohol, nicotine and cannabis, and their corresponding use disorders (AUD, NUD, CUD) at follow-up; and (2) the association between ADHD and the course of outcomes (i.e., absence, initiation, maturing out, persistence) over 15 months. All analyses were adjusted for socio-demographics and co-morbidity. Men with ADHD were more likely to exhibit persistent risky alcohol and nicotine use, and to mature out of risky cannabis use. ADHD at baseline was positively linked to AUD and negatively to CUD at follow-up, but not to NUD. For all SUDs, ADHD had a positive association with use persistence and maturing out. Comparing these two trajectories revealed that early age of alcohol use initiation distinguished between persistence and maturing out of AUD, while the course of NUD and CUD was related to ADHD symptoms and SUD severity at baseline. Already in their early twenties, men with ADHD are especially likely to exhibit persistent problematic substance use patterns. Substance-specific prevention strategies, particularly implemented before early adulthood, may be crucial to reducing the development and persistence of pathological patterns in such individuals. [ABSTRACT FROM AUTHOR]

Introduction: There are few recent longitudinal studies on smokeless tobacco (SLT) products and smoking outside the United States or European Nordic countries. The present longitudinal study tests whether Swedish-type snus and nasal snuff use decreases smoking incidence and prevalence in a central European country.Methods: The sample consisted of 5198 Swiss men (around 20 years of age). Retention rate was 91.5% over 15 months. Regression models, adjusting for a variety of psychosocial, smoking-related, and other risk factors, assessed whether no, low (less than weekly), and high (weekly or more) use baseline groups showed changes or maintenance in snus and snuff use related to smoking initiation, cessation, and reduction.Results: Among baseline nonsmokers, snus initiators (OR = 1.90, p = .003) and low baseline maintainers (OR = 4.51, p < .001) were more likely to start smoking (reference: persistent nonusers of snus). Among baseline smokers, initiators (OR = 2.79, p < .001) and low baseline maintainers (OR = 2.71, p = .005) more often continued smoking, whereas snus quitters less frequently continued smoking (OR = 0.57, p = .009). High baseline maintainers were non-significantly less likely to continue smoking (OR = 0.71, p = .315). Among continuing smokers, only snus quitters significantly reduced the number of cigarettes smoked per day (b = -1.61, p = .002) compared with persistent nonusers of snus. Results were similar for snuff.Conclusions: SLT use did not have any significant beneficial effects on young men in Switzerland but significantly increased the likelihood of smoking initiation and continuation, independent of whether the substance is legally sold (snuff) or not (snus). This does not exclude that there may be beneficial effects at older ages.Implications: Our research provides evidence that SLT use has no benefits for cigarette smoking initiation, cessation, or reduction among young men in a central European country, where SLT is not highly promoted or receives tax incentives. This is true for both legally sold nasal snuff and Swedish-type snus that cannot be legally sold. Results indicate that without incentives for using it, among young people shifts from smoking to SLT use are questionable and confirms the need for country-specific studies before the global public health community engages in promoting SLT. [ABSTRACT FROM AUTHOR]

Background: Research has identified several correlates of suicidal behaviors including depressive symptoms, alcohol use and coping drinking motives. However, their associations and their role as possible causal mechanisms in the prediction of suicide attempt are not well understood. This study examined, both cross-sectionally and longitudinally, the potential pathways from alcohol use, drinking coping motives, and depression to suicide attempts.Methods: Participants (N = 4617) were young Swiss men (mean age = 19.95) participating in the Cohort Study on Substance Use Risk Factors. Measures of depressive symptoms, alcohol use (total drinks per week, heavy episode drinking) and coping drinking motives were used from the baseline and/or 15-month follow-up assessments to predict follow-up suicide attempt.Results: Main findings showed indirect associations through depressive symptoms, such that coping drinking motives were positively associated with depressive symptoms, which were in turn positively related to suicide attempts over time (for total drinks per week models, cross-sectional model: B = 0.130, SE = 0.035, 95% CI = 0.072, 0.207; longitudinal model: B = 0.039, SE = 0.013, 95% CI = 0.019, 0.069). Alcohol use was not significantly related to suicide attempt.Limitations: Main limitation includes a low prevalence rate for suicide attempt potentially reducing power effects in the analyses and our focus on distal-yet not proximal, role of alcohol use on suicide attempt.Conclusions: Findings of this study suggest that young men with depressive symptoms and/or those who use alcohol to cope with negative affect may benefit from programs targeting suicidal behaviors. [ABSTRACT FROM AUTHOR]

Objectives Surprisingly little is known on the decision to refer sexually-victimized children to psychotherapy. Previous research on service provisions for victims of child maltreatment has analyzed the impact of case characteristics, like child or caregiver functional levels, lack of social support, and socioeconomic status. Findings, however, show that the decision to provide services is not only needs-driven, but also affected by external factors like provincial legislation, institutional policies, and the availability and accessibility of services. By analyzing characteristics behind the decision to refer sexually-victimized children to psychotherapy at the case and institutional level, we aimed to disentangle the complex interplay of factors driving this decision. Methods The data for this analysis were drawn from the first nationally-representative agency survey on reported child sexual victimization (CSV) in Switzerland. Over a 6-month data-collection period, 165 child protective services, 87 penal authorities and 98 agencies in the health and social sector documented a total of 911 incidents of CSV. Multilevel logistic regression was applied to analyze factors at both the case and contextual level. Results The main finding was that the severity of consequences was strongly associated with the probability of psychotherapeutic service referrals (OR = 10.4; p < 0.001). However, one bias was identified at the individual level: sexually-victimized children born in Switzerland were more likely to be referred to psychotherapy than immigrant children. Institutional disparities in the decision to refer a sexually-victimized child to psychotherapy were large (median OR = 3.83), with penal authorities referring significantly fewer cases to psychotherapy than specialized agencies in the health and social sector. What exactly was driving the difference between psychotherapy referral in different types of agency remains largely unexplained. Conclusions Future research should invest in scrutinizing contextual factors of child protective service decisions. As we operationalize the need for psychotherapy as proxy-rated consequences of victimization, routine screening for mental health needs using standardized measures for children in contact with child protection agencies should be implemented, to help frontline workers to identify the psychotherapeutic needs of victimized children. [ABSTRACT FROM AUTHOR]

Aim To estimate the statistical interactions between alcohol policy strength and the person-related risk factors of sensation-seeking, antisocial personality disorder and attention-deficit/hyperactivity disorder related to heavy alcohol use. Design Cross-sectional survey. Setting Young Swiss men living within 21 jurisdictions across Switzerland. Participants A total of 5701 Swiss men (mean age 20 years) participating in the Cohort Study on Substance Use Risk Factors (C-SURF). Measurements Outcome measures were alcohol use disorder (AUD) as defined in the DSM-5 and risky single-occasion drinking (RSOD). Independent variables were sensation-seeking, antisocial personality disorder (ASPD), attention-deficit/hyperactivity disorder (ADHD) and an index of alcohol policy strength. Findings Alcohol policy strength was protective against RSOD [odds ratio (OR) = 0.91 (0.84-0.99)], while sensation-seeking and ASPD were risk factors for both RSOD [OR = 1.90 (1.77-2.04); OR = 1.69 (1.44-1.97)] and AUD [OR = 1.58 (1.47-1.71); OR = 2.69 (2.30-3.14)] and ADHD was a risk factor for AUD [OR = 1.08 (1.06-1.10)]. Significant interactions between alcohol policy strength and sensation-seeking were identified for RSOD [OR = 1.06 (1.01-1.12)] and AUD [OR = 1.06 (1.01-1.12)], as well as between alcohol policy strength and ASPD for both RSOD [OR = 1.17 (1.03-1.31)] and AUD [OR = 1.15 (1.02-1.29)]. These interactions indicated that the protective effects of alcohol policy strength on RSOD and AUD were lost in men with high levels of sensation-seeking or an ASPD. No interactions were detected between alcohol policy strength and ADHD. Conclusion Stronger alcohol legislation protects against heavy alcohol use in young Swiss men, but this protective effect is lost in individuals with high levels of sensation-seeking or having an antisocial personality disorder. [ABSTRACT FROM AUTHOR]

A long-standing belief in the literature on sex offenders is that sexually victimized youths are at increased risk of becoming sex offenders themselves. The present study tested the link between past sexual abuse, either with or without contact, and sexually offending behavior in a representative sample of male and female adolescents while controlling for other types of abuse, mental health problems, substance use, and non-sexual violent behaviors. Self-reported data were collected from a nationally representative sample of 6,628 students attending 9th grade public school in Switzerland (3,434 males, 3,194 females, mean age = 15.50 years, SD = 0.66 years). Exposure to contact and non-contact types of sexual abuse was assessed using the Child Sexual Abuse Questionnaire and sexually offending behavior by the presence of any of three behaviors indicating sexual coercion. Two-hundred-forty-five males (7.1 %) and 40 females (1.2 %) reported having sexually coerced another person. After controlling for non-sexual abuse, low parent education, urban versus rural living, mental health problems, substance use, and non-sexual violent behavior, male adolescents who were victims of contact sexual abuse and non-contact sexual abuse were significantly more likely to report coercive sexual behaviors. Females who experienced contact or non-contact sexual abuse were also found at increased risk of committing sexual coercion after controlling for covariates. The present findings demonstrate a strong relationship between past sexual abuse, with and without physical contact, and sexual-offending behavior in male and female adolescents. Reducing exposure to non-contact sexual abuse (like Internet-based sexual exploitation) should become a new area of sexual violence prevention in youths. [ABSTRACT FROM AUTHOR]

Aims: To assess seasonal, weekday, and public holiday effects on alcohol-related road accidents and drinking diaries among young Swiss men. Methods: Federal road accident data (35,485 accidents) from Switzerland and drinking diary data from a large cohort of young Swiss men (11,930 subjects) were analysed for temporal effects by calendar week, weekday and public holiday (Christmas, New Years, National Day). Alcohol-related accidents were analysed using rate ratios for observed versus expected numbers of accidents and proportions of alcohol-related accidents relative to the total number. Drinking diaries were analysed for the proportion of drinkers, median number of drinks consumed, and the 90th percentile's number of drinks consumed. Results: Several parallel peaks were identified in alcohol-related accidents and drinking diaries. These included increases on Fridays and Saturdays, with Saturday drinking extending until early Sunday morning, an increase during the summer on workdays but not weekends, an increase at the end of the year, and increases on public holidays and the evening before. Conclusions: Our results suggest specific time-windows that are associated with increases in drinking and alcohol-related harm. Established prevention measures should be enforced during these time-windows to reduce associated peaks. [ABSTRACT FROM AUTHOR]

Background Alcohol consumption—in particular drinking volume (DV) and risky single occasion drinking (RSOD)—has been related to a wide range of negative consequences and health problems. Previous studies also suggested that drinking in certain locations may be more strongly associated with the occurrence of alcohol-related harm than drinking in others. However, they were conducted in countries culturally and legally different from European countries and were limited to cross-sectional designs. This study investigates the cross-sectional and longitudinal associations of alcohol-related harm with DVs in different locations in a sample of young Swiss men. Methods A representative sample of 4536 young Swiss male drinkers completed baseline and 15-month follow-up questionnaires. These assessed DVs in 11 locations, alcohol-related harm (i.e. number of alcohol-related consequences and alcohol use disorder criteria) and frequency of RSOD. Cross-sectional and longitudinal associations of alcohol-related harm with DVs in each location were tested using regression models, with and without adjustment for frequency of RSOD. Results Both cross-sectional and longitudinal analyses showed significant positive associations between alcohol-related harm and DVs at friends’ homes, in discos/nightclubs and in outdoor public places, when controlling for frequency of RSOD. In contrast, the contribution of DVs at one's own home and in restaurants was consistently not significant when adjusted for frequency of RSOD. When controlling for RSOD, associations between alcohol-related harm and DVs in bars/pubs, when playing sports, during other leisure activities, at cinemas/theatres, during sporting events, and during special events were not consistent between cross-sectional and longitudinal analyses. Conclusion Results suggest that prevention interventions should not only target reducing the overall volume of alcohol consumed and the frequency of RSOD in general, but they should additionally focus on limiting alcohol consumption in outdoor public places, discos/nightclubs, and in friends’ homes in particular, or at least on preventing harm occurring in these occasions. [ABSTRACT FROM AUTHOR]

Purpose: To compare children with mental and physical health problems regarding (1) perceived disease severity; (2) the impact of their condition on their families; (3) their utilization of health care services (including satisfaction with care); and (4) parents' health literacy about their child's condition and its treatment. Furthermore, we examined whether parents' health literacy differs between types of mental health condition. Methods: Parental reports about their 9- to 14-year-old children with mental ( n = 785) or physical health problems ( n = 475) were analyzed from the population-based National Survey of Children with Special Health Care Needs in Switzerland. Results: Mental health problems were perceived as being more severe ( p < 0.001) and exerting a larger impact upon the family (e.g., financial impact) than physical health problems. Furthermore, fewer parents of children with a mental health problem mentioned having a particular person or place to contact if they needed information or advice regarding the child's condition ( p = 0.004) and were satisfied with the health care services their child received ( p < 0.001). The odds of low health literacy was higher among parents with children suffering from mental health problems vs. parents of children with physical health problems (OR in the adjusted model = 1.92; 95 % CI 1.47-2.50; p < 0.001); this finding held generally for mental health problem (although only a trend was observable for internalizing problems). Conclusions: The large impact of children's mental health conditions on themselves and their families might be reduced by adapting the provision of health care and by increasing parents' health literacy. [ABSTRACT FROM AUTHOR]

Purpose: Health benefits of sport and exercise are well documented in children, adolescents and adults, but little is known about emerging adulthood-a period of life characterized by significant demographic and developmental changes. The present study aimed to assess the health impact of changes in sport and exercise levels during that specific period of life. Methods: The analysis used baseline and 15-month follow-up data ( N = 4,846) from the cohort study on substance use risk factors. Associations between baseline exercise levels or changes in exercise levels and health indicators (i.e., health-related quality of life, depression, body mass index, alcohol dependence, nicotine dependence and cannabis use disorder) were measured using chi-squared tests and ANOVA. Direction of effects was tested using cross-lagged analysis. Results: At baseline, all health indicator scores were observed to be better for regular exercisers than for other exercise levels. At follow-up, participants who had maintained regular exercise over time had better scores than those who had remained irregular exercisers or had discontinued, but their scores for health-related quality of life and depression were close to those of participants who had adopted regular exercise after the baseline questionnaire. Cross-lagged analysis indicated that regular exercise at baseline was a significant predictor of health-related quality of life and substance use dependence at follow-up, but was itself predicted only by health-related quality of life. Conclusions: From a health promotion perspective, this study emphasizes how important it is for emerging adult men to maintain, or adopt, regular sport and exercise. [ABSTRACT FROM AUTHOR]

Background Peer pressure (PP) has been shown to play a major role in the development and continuation of alcohol use and misuse. To date, almost all the studies investigating the association of PP with alcohol use only considered the PP for misconduct but largely ignored other aspects of PP, such as pressure for peer involvement and peer conformity. Moreover, it is not clear whether the association of PP with alcohol use is direct or mediated by other factors. The aim of the present study was to investigate the association of different aspects of peer pressure (PP) with drinking volume (DV) and risky single-occasion drinking (RSOD), and to explore whether these associations were mediated by drinking motives (DM). Methods A representative sample of 5521 young Swiss men, aged around 20 years old, completed a questionnaire assessing their usual weekly DV, the frequency of RSOD, DM (i.e. enhancement, social, coping, and conformity motives), and 3 aspects of PP (i.e. misconduct, peer involvement, and peer conformity). Associations between PP and alcohol outcomes (DV and RSOD) as well as the mediation of DM were tested using structural equation models. Results Peer pressure to misconduct was associated with more alcohol use, whereas peer involvement and peer conformity were associated with less alcohol use. Associations of drinking outcomes with PP to misconduct and peer involvement were partially mediated by enhancement and coping motives, while the association with peer conformity was partially mediated by enhancement and conformity motives. Conclusions Results suggest that PP to misconduct constitutes a risk factor, while peer conformity and peer involvement reflect protective factors with regard to alcohol use. Moreover, results from the mediation analyses suggest that part of the association of PP with alcohol use came indirectly through DM: PP was associated with DM, which in turn were associated with alcohol use. [ABSTRACT FROM AUTHOR]

Background and Aims To test prospective associations between cannabis disorder symptoms/frequency of cannabis use and health issues and to investigate stability versus transience in cannabis use trajectories. Design Two waves of data collection from the longitudinal Cohort Study on Substance Use Risk Factors ( C- SURF). Setting A representative sample of young Swiss men in their early 20s from the general population. Participants A total of 5084 young men (mean age 19.98 ± 1.19 years at time 1). Measurements Cannabis use (life-time use, frequency of use, cannabis disorder symptoms) and self-reported measures of health issues (depression, mental/physical health, health consequences) were assessed. Significant changes in cannabis use were tested using t-test/ Wilcoxon's rank test for paired data. Cross-lagged panel models provided evidence regarding longitudinal associations between cannabis use and health issues. Findings Most of the participants (84.5%) remained in the same use category and cannabis use kept to similar levels at times 1 and 2 ( P = 0.114 and P = 0.755; average of 15 ± 2.8 months between times 1 and 2). Cross-lagged panel models showed that cannabis disorder symptoms predicted later health issues (e.g. depression, β = 0.087, P < 0.001; health consequences, β = 0.045, P < 0.05). The reverse paths from health issues to cannabis disorder symptoms and the cross-lagged panel model between frequency of cannabis use and health issues were non-significant. Conclusions Patterns of cannabis use showed substantial continuity among young Swiss men in their early 20s. The number of symptoms of cannabis use disorder, rather than the frequency of cannabis use, is a clinically important measure of cannabis use among young Swiss men. [ABSTRACT FROM AUTHOR]

Background: Studies about beverage preferences in a country in which wine drinking is relatively widespread (like Switzerland) are scarce. Therefore, the main aims of the present study were to examine the associations between beverage preferences and drinking patterns, alcohol-related consequences and the use of other substances among Swiss young men. Methods: The analytical sample consisted of 5399 Swiss men who participated in the Cohort Study on Substance Use Risk Factors (C-SURF) and had been drinking alcohol over the preceding 12 months. Logistic regression analyses were conducted to study the associations between preference for a particular beverage and (i) drinking patterns, (ii) negative alcohol-related consequences and (iii) the (at-risk) use of cigarettes, cannabis and other illicit drugs. Results: Preference for beer was associated with risky drinking patterns and, comparable with a preference for strong alcohol, with the use of illicit substances (cannabis and other illicit drugs). In contrast, a preference for wine was associated with low-risk alcohol consumption and a reduced likelihood of experiencing at least four negative alcohol-related consequences or of daily cigarette smoking. Furthermore, the likelihood of negative outcomes (alcohol-related consequences; use of other substances) increased among people with risky drinking behaviours, independent of beverage preference. Conclusions: In our survey, beer preference was associated with risky drinking patterns and illicit drug use. Alcohol polices to prevent large quantities of alcohol consumption, especially of cheaper spirits like beer, should be considered to reduce total alcohol consumption and the negative consequences associated with these beverage types. [ABSTRACT FROM AUTHOR]

Purpose: To examine the associations between substance use and other health-risk behaviors and quality of life (QOL) among young men. Methods: The analytical sample consisted of 5,306 young Swiss men who participated in the Cohort Study on Substance Use Risk Factors. Associations between seven distinct self-reported health-risk behaviors (risky single-occasion drinking; volume drinking; cigarette smoking; cannabis use; use of any other illicit drugs; sexual intercourse without a condom; low physical activity) were assessed via chi-square analysis. Logistic regression analyses were conducted to study the associations between each particular health-risk behavior and either physical or mental QOL (assessed with the SF-12v2) while adjusting for socio-demographic variables and the presence of all other health-risk behaviors. Results: Most health-risk behaviors co-occurred. However, low physical activity was not or negatively related to other health-risk behaviors. Almost all health-risk behaviors were associated with a greater likelihood of compromised QOL. However, sexual intercourse without a condom (not associated with both physical and mental QOL) and frequent risky single-occasion drinking (not related to mental QOL after adjusting for the presence of other health-risk behaviors; positively associated with physical QOL) differed from this pattern. Conclusions: Health-risk behaviors are mostly associated with compromised QOL. However, sexual intercourse without a condom and frequent risky single-occasion drinking differ from this pattern and are therefore possibly particularly difficult to change relative to other health-risk behaviors. [ABSTRACT FROM AUTHOR]

Introduction: We examined the positive and negative subjective feelings associated with initial tobacco and cannabis use as well as the role of these experiences in regular use. Additionally, we investigated the effect of the first substance experienced on initial subjective experiences and later regular use. Methods: Baseline data from a representative sample of young Swiss men were obtained from an ongoing Cohort Study on Substance Use Risk Factors, which includes 2,321 lifetime tobacco and cannabis users. We assessed the age of first tobacco and cannabis use along with the subjective experiences associated with initial use. Additionally, subjective experiences related to regular use of both substances were analyzed. Results: The initial subjective experiences were divided into positive and negative for each substance, and we found that the feelings associated with first use of tobacco and cannabis were similar. Moreover, the participants who used cannabis before tobacco reported fewer negative experiences associated with first tobacco use, whereas the participants who initially used tobacco reported more negative experiences related to first cannabis use. Also, we identified that regular use was encouraged by positive experiences and that negative experiences were more adverse for regular use of cannabis compared with tobacco. Conclusions: Taken together, these results indicate that similar subjective experiences were associated with the first use of tobacco and cannabis. Also, the use of cannabis before tobacco, which occurred in only a minority of users, had the potential to enhance the effects of initial tobacco use. [ABSTRACT FROM PUBLISHER]

The article focuses on a study regarding the effects of child sexual abuse (CSA) on physical and mental health and the quality of life in contact and non-contact situations in Switzerland; and mentions (CSA) defined by the World Health Organization (WHO) as a violation of laws. Topics discussed include the analysis of adolescents being the victims of CSA.

This study aims to address the underlying trajectories of weekly individual drinking patterns by growth models and to relate differences in drinking patterns to socio-demographic and drinking characteristics of respondents. Data came from a two-stage stratified random subsample of 747 persons aged 15 years or more from a Swiss study on alcohol consumption using a within-subject design conducted between March 1999 and July 1999. Beverage specific assessment of daily alcohol consumption was obtained by a weekly drinking diary and other characteristics via telephone interviews. The diary had to be filled out on seven consecutive days. The growth models accounted for up to 37.6% of the initial error variance and provided evidence for two distinct, negatively correlated underlying trajectories of drinking patterns. The first trajectory described an increase in consumption from Monday to Sunday. The second trajectory was about a specific weekend consumption culminating on Saturday with a significantly higher growth rate among young people and heavy episodic drinkers than in other subgroups. Therefore, young and heavy episodic drinkers may be exposed to sudden adverse consequences of alcohol consumption during the weekend. Prevention efforts which are targeted to this subgroup should take its specific drinking pattern into account. Copyright © 2008 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Introduction: Social cohesion, depression, and problematic substance use are intertwined and poorly understood.This study aimed to examine cross-sectional and longitudinal associations between social cohesion, depression and problematic substance use amongyoung men, age 21-25.Methods: We used 2nd wave (t1, 2012-2014, N = 6020) and 3rd wave (t2, 2016-2018) data from the on-going Swiss CohortStudy on Substance Use Risk Factors (C-SURF), assessing social cohesion, depression, and severity of alcohol, nicotine and cannabis use during both waves. Structural Equation Models (SEMs) were employed to examine pathways in both waves under the framework of longitudinal analysis.Results: Social cohesion was directly associated with depression and problem nicotine and cannabis use and indirectly associated with problem alcohol, nicotine and cannabis use through depression at both t1 and t2. Social cohesion exerted direct effects on nicotine use and cannabis use severity, but not on alcohol use severity. Social cohesion had indirect effects on problem use of all three substances, mediated via depression. The predictive direction was from depression to substance use, rather than vice versa.Conclusions: Higher social cohesion at an early age appears to protect young males from depression and problematic substance use later in life. However, once problematic substance use is established, the direct effect of social cohesion diminishes and is mediated through personal depression. Therefore, promoting a more cohesiveneighborhood in childhood or adolescenthood could play an important role preventing depression and more severe substance use behaviors. [ABSTRACT FROM AUTHOR]

Most of the studies that examine the effect of the COVID-19 pandemic on mental health have been restricted to pandemic mental health data alone. The aim of the current study was to estimate the pandemic's effect on young Swiss adults' mental health by comparing pandemic to pre-pandemic mental health. Longitudinal data of 1175 young Swiss adults who participated in the S-YESMH study in 2018 and were followed-up in 2020 and 2021 were analyzed. The study outcomes were self-reported symptoms of depression, generalized anxiety disorder (GAD), attention-deficit/hyperactivity disorder (ADHD), thoughts about death or self-harm, and risky single-occasion drinking (RSOD). Generalized estimation equations, logistic regression and statistical mediation analysis were used to analyze the data. Evidence was found of increased depression, GAD, and ADHD among young women and increased depression among young men, resulting from the COVID-19 pandemic. Uncertainty about the future predicted young women's depression and anxiety in 2021. COVID-19 stress in 2021 fully mediated the effect of COVID-19 stress in 2020 on depression and GAD in 2021. Young Swiss women's and men's mental health appears to have been adversely affected by the COVID-19 pandemic, especially during the second pandemic year. Uncertainty about the future and stress becoming chronic in 2021 likely explain some of the adverse effects.

Half to three-fourths of mental disorders appear during adolescence or young adulthood, and the treatment gap is mainly due to lack of knowledge, lack of perceived need, and the stigmatization of mental illness. The aims of this study were to implement and evaluate a Mental Health First Aid (MHFA) training program among undergraduates. Participants were second-year students from two universities in the French-speaking region of Switzerland ( N = 107), who were randomly assigned to an intervention group ( n = 53) or control group ( n = 54). The intervention group received a 12-h MHFA course. Online questionnaires were completed before the intervention (T0), and both 3 months (T1) and 12 months (T2) after the intervention in order to evaluate the participants' mental health knowledge, recognition of schizophrenia, and attitudes and behaviors towards mental illness. We used Generalized Estimating Equations (GEE) to examine the effects of intervention over time. After the MHFA course, the intervention group showed significantly increased basic knowledge and confidence helping others with mental illness and reduced stigmatization at both T1 and T2 compared to their baseline scores and compared to control groups. This suggests that the MHFA training program is effective and has significant short-term and long-term impacts, in terms of enhancing basic knowledge about mental health and improving attitudes towards mental illness among undergraduate students.

Objective: To treat patients with psoriasis vulgaris using Traditional Chinese Medicine (TCM), one must stratify patients into subtypes (known as TCM syndromes or Zheng) and apply appropriate TCM treatments to different subtypes. However, no unified symptom-based classification scheme of subtypes (Zheng) exists for psoriasis vulgaris. The present paper aims to classify patients with psoriasis vulgaris into different subtypes via the analysis of clinical TCM symptom and sign data., Methods: A cross-sectional survey was carried out in Beijing from 2005-2008, collecting clinical TCM symptom and sign data from 2764 patients with psoriasis vulgaris. Roughly 108 symptoms and signs were initially analyzed using latent tree analysis, with a selection of the resulting latent variables then used as features to cluster patients into subtypes., Results: The initial latent tree analysis yielded a model with 43 latent variables. The second phase of the analysis divided patients into three subtype groups with clear TCM Zheng connotations: 'blood deficiency and wind dryness'; 'blood heat'; and 'blood stasis'., Conclusions: Via two-phase analysis of clinic symptom and sign data, three different Zheng subtypes were identified for psoriasis vulgaris. Statistical characteristics of the three subtypes are presented. This constitutes an evidence-based solution to the syndromedifferentiation problem that exists with psoriasis vulgaris.

The prevalence of different routes of administration (ROAs) of illicit drugs other than cannabis was examined in young Swiss men, in addition to the association between socio-demographics and adverse outcomes and particular ROAs. Our sample consisted of 754 men (mean age = 25.4 ± 1.2 years) who participated in the Cohort Study on Substance Use Risk Factors and reported using any of 18 illicit drugs over the last 12 months. Prevalence estimates were calculated for oral use, nasal use, smoking, injecting, and other ROAs. Associations between ROAs and socio-demographics and adverse outcomes (i.e., alcohol use disorder (AUD), suicidal ideations, and health and social consequences) were calculated for using single versus multiple ROAs. The most prevalent ROA was oral use (71.8%), followed by nasal use (59.2%), smoking (22.1%), injecting (1.1%), and other ROAs (1.7%). Subjects' education, financial autonomy, and civil status were associated with specific ROAs. Smoking was associated with suicidal ideations and adverse health consequences and multiple ROAs with AUD, suicidal ideations, and health and social consequences. The most problematic pattern of drug use among young adults appears to be using multiple ROAs, followed by smoking. Strategies to prevent and reduce the use of such practices are needed to avoid adverse outcomes at this young age.

This paper evaluates the interaction between level of parental monitoring in adolescence and individual dispositions present in early adulthood in the prediction of alcohol use disorder (AUD) in the mid-20s. Data were drawn from the Cohort Study on Substance Use Risk Factors (C-SURF), encompassing 4844 young Swiss men who were surveyed three times within a 5-year period. The outcome variable was alcohol use disorder (AUD) as defined in the DSM-5. Independent variables were sensation seeking (Brief Sensation Seeking Scale) and the coping strategies active coping and denial (Brief COPE). Low parental monitoring, high sensation seeking, and high denial were found risk factors of AUD (odds ratio (OR) = 1.21 (1.05-1.40); OR = 1.56 (1.37-1.78); OR = 1.15 (1.01-1.31)). A significant interaction effect was identified between active coping and parental monitoring; high active coping in early adulthood was found protective of AUD, only among individuals who had low parental monitoring in adolescence (OR = 0.70 (0.52-0.96)). In addition to interventions to upskill parents for improving monitoring, other interventions directed to young adults who had disadvantaged family contexts could be implemented, with the aim of enhancing the use of adaptive coping strategies such as active coping. Prevention targeting avoidant coping strategies and sensation seeking should be privileged too.

Background: Recent studies have uncovered a peculiar finding: that the strength and dimensionality of depression symptoms' inter-relationships vary systematically across study samples with different average levels of depression severity. Our aim was to examine whether this phenomenon is driven by the proportion of non-affected subjects in the sample., Methods: Cross-sectional data from the "Cohort Study on Substance Use Risk Factors" was analyzed. Self-reported depression symptoms were assessed via the Major Depressive Inventory. Symptom data were analyzed via polychoric correlations, principal component analysis, confirmatory factor analysis, Mokken scale analysis, and network analysis. Analyses were carried out across 22 subsamples containing increasingly higher proportions of non-depressed participants. Results were examined as a function of the proportion of non-depressed participants., Results: A strong influence of the proportion of non-depressed participants was uncovered: the higher the proportion, the stronger the symptom correlations, higher their tendency towards unidimensionality, better their scalability, and higher the network edge strengths. Comparing the depressed sample with the general population sample, the average symptom correlation increased from 0.29 to 0.51; variance explained by the first eigenvalue increased from 0.36 to 0.56; fit measures from confirmatory one-factor analysis increased from 0.81 to 0.97; the H coefficient of scalability increased from 0.26 to 0.48; and the median network edge increased from 0.00 to 0.07., Conclusions: Results of psychometric analyses vary substantially as a function of the proportion of non-depressed participants in the sample being studied. This provides a possible explanation for the lack of reproducibility of previous psychometric studies., Competing Interests: The authors have declared that no competing interests exist.

The 'Treatment for Adolescents with Depression Study' (TADS, ClinicalTrials.gov, identifier: NCT00006286) was a cornerstone, randomized controlled trial evaluating the effectiveness of standard treatment options for major depression in adolescents. Whereas previous TADS analyses examined primarily effect modifications of treatment-placebo differences by various patient characteristics, less is known about the modification of inter-treatment differences, and hence, patient characteristics that might guide treatment selection. We sought to fill this gap by estimating patient-specific inter-treatment differences as a function of patients' baseline characteristics. We did so by applying the 'model-based random forest', a recently-introduced machine learning-based method for evaluating effect heterogeneity that allows for the estimation of patient-specific treatment effects as a function of arbitrary baseline characteristics. Treatment conditions were cognitive-behavioural therapy (CBT) alone, fluoxetine (FLX) alone, and the combination of CBT and fluoxetine (COMB). All inter-treatment differences (CBT vs. FLX; CBT vs. COMB; FLX vs. COMB) were evaluated across 23 potential effect modifiers extracted from previous studies. Overall, FLX was superior to CBT, while COMB was superior to both CBT and FLX. Evidence for effect heterogeneity was found for the CBT-FLX difference and the FLX-COMB difference, but not for the CBT-COMB difference. Baseline depression severity modified the CBT-FLX difference; whereas baseline depression severity, patients' treatment expectations, and childhood trauma modified the FLX-COMB difference. All modifications were quantitative rather than qualitative, however, meaning that the differences varied only in magnitude, but not direction. These findings imply that combining CBT with fluoxetine may be superior to either therapy used alone across a broad range of patients., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Background: Traditional statistical analyses of clinical trials encompass the central tendency of outcomes and, hence, are restricted to a treatment's average effectiveness. Our aim was to get a more complete picture of the effectiveness of standard treatment options for adolescent depression, by analyzing treatment effects across low, middle, and high levels of response., Methods: Secondary data analysis was performed of the Treatment for Adolescents with Depression Study (TADS, ClinicalTrials.gov, NCT00006286), a randomized controlled trial comparing fluoxetine (FLX), cognitive-behavioral therapy (CBT), and their combination (COMB) against placebo treating adolescents with major depression (n = 439). The proportional change from baseline to week 12 in the Children's Depression Rating Scale-Revised was used as an index of response. Response levels were analyzed via quantile regression models, thereby estimating treatment effects across the entire response level distribution, adjusted for baseline depression, study site, and patients' treatment expectancies., Results: Whereas CBT was no more effective than placebo across response levels, COMB was more effective than FLX in that its quantile treatment effects were both larger in magnitude and spread out across a broader range of response levels, including the low end of the response level distribution. Cohen's d of the difference was 1.39 (95% confidence interval 1.33-1.45)., Limitations: Ad-hoc analysis using data from a trial that was not originally designed to accommodate such analysis., Conclusion: The combination of cognitive-behavioral therapy and fluoxetine was more effective than either treatment used alone, not just in average effectiveness, but in the breadth of patients in whom it was effective., (Copyright © 2018. Published by Elsevier B.V.)