Volume 29, Issue 3

Depression is among the most common psychological disorders of adolescents. Its management is based on pharmacological treatment, psychological therapy, or a combination thereof. Cognitive behavioral therapy (CBT) is the most extensively tested intervention for adolescent depression. A PubMed search was conducted for randomized controlled trials (RCT) of the efficacy of CBT in treating adolescents with depressive symptoms published in 2005–2015. Keywords were “cognitive behavioral therapy”, “group therapy”, “depression” and “adolescent”. Of the 23 papers that were retrieved, only six met all inclusion criteria. Three of them reported a significant reduction in depressive symptom severity after either individual or group (G)-CBT compared with the control group, even with a small number of CBT sessions (six rather than 10–12), with a medium or medium-to-large effect size. One study reported improved self-awareness and a significantly greater increase in perceived friend social support compared with bibliotherapy and check with brochure. Two studies reported clinical symptom reduction without significant differences compared with the control group (activity contrast). This review highlighted primarily that very few RCT have applied CBT in adolescents; moreover, it confirmed the effectiveness of G-CBT, especially as psychotherapy, although it was not always superior to other interventions (e.g. other activities in prevention programs). Comparison showed that G-CBT and group interpersonal psychotherapy were both effective in reducing depressive symptoms. Successful G-CBT outcomes were related to the presence of peers, who were an important source of feedback and support to observe, learn, and practice new skills to manage depressive symptoms and improve social-relational skills.

Parental alienation is defined as a mental state in which a child, usually one whose parents are engaged in a high-conflict separation or divorce, allies himself strongly with one parent (the preferred parent) and rejects a relationship with the other parent (the alienated parent) without legitimate justification. Parental alienation may affect men’s mental health: a) parental alienation negatively influences mental health of male children and adolescents who are victims of parental alienation. Alienated children/adolescents display guilt, sadness, and depressed mood; low self-esteem and lack of self-confidence; distress and frustration; lack of impulse control, substance abuse and delinquent behavior; separation anxiety, fears and phobias; hypochondria and increased tendency to develop psychosomatic illness; suicidal ideation and suicide attempt; sleep and eating disorders; educational problems; enuresis and encopresis; b) parental alienation negatively affects the mental health of adult men who were victims of parental alienation when they were children and/or adolescents. Long-term effects of parental alienation include low self-esteem, depression, drug/alcohol abuse, lack of trust, alienation from own children, divorce, problems with identity and not having a sense of belonging or roots, choosing not to have children to avoid being rejected by them, low achievement, anger and bitterness over the time lost with the alienated parent; c) parental alienation negatively influences mental health of men who are alienated from their children. Fathers who have lost some or all contact with their children for months or years following separation or divorce may be depressed and suicidal.

Background: The transitional phase encompassing the physiological and psychological changes during our lifespan is termed as adolescence. Adolescents get mislead to substance use, violence related activities, dating relationships, unhealthy lifestyle. Minimal studies are conducted in India to identify the parenting factors that affect an adolescent’s mind. The aim of our study was to explore the role of parenting and social surroundings on – adolescent’s mental health and involvement in violence related activities. Methods: Cross sectional study design was adopted. Semi structured questionnaire was used. Data obtained was entered and analyzed using SPSS 15. Proportions were used to report the findings. Chi-square test was used to find associations between mental health issues, involvement in violence related activities and Interpersonal Relationship (IPR) Status. Multiple logistic regressions were done to identify independent predictors of mental health. Results: A total of 1770 adolescents participated. Proportion of adolescents with good IPR with parents reported to be having a better mental health status and low involvement in violent related activities. Schools also displayed similar effects. Neighborhood, peers did not display any significant effect on adolescent’s mental health. Most significant predictor for adolescent mental health was IPR with parents and at school. Conclusion: The study highlights the need of a cordial environment at places which does influence the adolescent’s mental health. Interventions enhancing the relationship status of adolescents with parents, at school must be carried out to observe the change in adolescent behavior.

Objective: The purpose of this study was to assess the prevalences and correlates of adverse affective states (burnout-, depression- and anxiety-related symptoms) among preclinical medical students. Methods: Self-report questionnaires were sent to all preclinical medical students of Leiden University Medical Center (n=1311). Burnout-related symptoms were measured using the Maslach Burnout Inventory-General Survey (MBI-GS), depression and anxiety-related symptoms and vitality using the Symptom Questionnaire-48 (SQ-48). Furthermore, duration of sleep, quality of life (SF-36), need for recovery, happiness and dispositional optimism were assessed and analysed in relation to affective symptoms using regression analysis. Results: Among the 433 responders (response rate=33.0%), prevalences of self-reported burnout-, depression- and anxiety-related symptoms were 46.0% (n=199), 27.0% (n=117) and 29.1% (n=126), respectively. Independent correlates for burnout-related symptoms were <6 h sleep per night (p=0.02), low happiness (p<0.001) and a high need for recovery (p<0.001). Independent correlates for both depression- and anxiety-related symptoms were low optimism (p<0.001; p<0.001, respectively), low happiness (p<0.001; p=0.001, respectively) and a high need for recovery (p=0.03; p<0.001, respectively). Conclusion: Prevalences for adverse affective states were high among preclinical medical students and mainly associated with personality trait-related factors and need for recovery, rather than work-related factors. These findings suggest that being a medical student increases one’s risk to adverse affective states, and should inspire preventative initiatives.

Background: The aim of this study was to evaluate dietary quality of adolescents by using the Healthy Eating Index (HEI) and to assess their eating attitudes by the EAT-26 Eating Attitude Test. Methods: Eight schools; four primary schools and four secondary schools were randomly selected from the school list of official website of Istanbul Education National Directorate. Five hundred and ninety-eight students who met the inclusion criteria included in the study, 24 h dietary recalls were collected to calculate their HEI scores and eating attitudes were evaluated by EAT-26 Eating Attitude Test. Their weight, height and waist circumference were measured. Results: According to HEI scores, only two (0.3%) of adolescents had high quality diet, 379 (63.4%) had diet quality that needed improvement and 217 (36.3%) had poor diet. Regarding Eating Attitude Test scores, 513 (85.8%) had normal attitudes regarding eating behaviors. Conclusion: Almost all of the participants need either development or major changes in their eating behaviors. Interventions aiming high quality diet among adolescents are strongly recommended.

Background: Contingency management (CM) interventions, which use operant conditioning principles to encourage completion of target behavioral goals, may be useful for improving adherence to behavioral skills training (BST). Research-to-date has yet to explore CM for weight loss in minority adolescents. Objective: To examine the effects of CM in improving adolescent weight loss when added to BST. Design: The study utilized an innovative experimental design that builds upon multiple baseline approaches as recommended by the National Institutes of Health. Participants/setting: Six obese African-American youth and their primary caregivers living in Detroit, Michigan, USA. Intervention: Adolescents received between 4 and 12 weeks of BST during a baseline period and subsequently received CM targeting weight loss. Main outcome measures: Youth weight. Statistical analysis performed: Linear mixed effects modeling was used in the analysis. Results: CM did not directly affect adolescent weight loss above that of BST (p=0.053). However, when caregivers were involved in CM session treatment, contingency management had a positive effect on adolescent weight loss. The estimated weight loss due to CM when caregivers also attended was 0.66 kg/week (p<0.001, [95% CI; –1.96, –0.97]) relative to the baseline trajectory. Conclusion: This study demonstrates application of a novel experimental approach to intervention development and demonstrated the importance of parent involvement when delivering contingency management for minority youth weight loss. Lessons learned from contingency management program implementation are also discussed in order to inform practice.

Background: Obesity among adolescents is escalating as a global epidemic which is associated with various lifestyle disorders in later life. Objective: To assess the factors influencing overweight and obesity among school going adolescents of Vadodara city in Western India. Methods: The study was carried out among 1050 school going adolescents from 15 schools selected by systematic random sampling after taking written informed consent from the participants. A predefined pretested semi-structured questionnaire was used to collect dietary information and physical activity. Anthropometric measurements such as height, weight, triceps skin fold thickness, waist and hip circumferences was measured using standard techniques. Adolescents were classified as overweight (>+1SD) and obese (>+2SD) with respect to their age and sex by using WHO reference charts. Factors found to be statistically significant in bivariate analysis were considered in the multiple logistic regression model. Results: Among 1050 school going adolescents, 7.8% were overweight and 2.7% were obese, making the combined prevalence of overweight and obesity as 10.5%. Among socio-demographic predictors: early and mid adolescence, male gender, English medium of instruction, positive family history of obesity were found to be the significantly associated with overweight/obesity among the study population. Whereas consumption of outside food, meal skipping habit, infrequent consumption of staple healthy food items were found to be significant diet related predictor variables for overweight/obesity. Among the physical activity predictors: sedentary activities, less outdoor games and sleep deprivation were also found to be significant predictors of overweight/obesity. Conclusion: Adolescents should be motivated to take adequate amount of healthy staple food like dal-rice at home and to engage in outdoor sports related activity to prevent overweight and obesity.

Aim: The aim of this study was to identify the primary reasons why male Iranian adolescents enter into other-gender friendships. Methods: A qualitative study was conducted with a sample of 21 male adolescents recruited in public places in Tehran, Iran. Information about each boy’s experiences with other-gender friends was collected via semi-structured interviews whose contents were analyzed with a conventional qualitative content analysis approach. Results: Five reasons were identified for engaging in other-gender friendships: (a) for the purpose of entertainment, (b) financial benefits, (c) increased popularity with peers, (d) sensation seeking and (e) sexual experiences. Conclusion: This study revealed that adolescent males do not follow appropriate goals for communicating with the other-gender. In many cases, these goals could endanger their own health and the health of their other-gender friends. Future researchers must focus on identifying and understanding the factors that influence an adolescent to enter into an other-gender friendship.

Background: Globally, the youths constitute a major segment of most societies particularly in developing countries. This study was undertaken to assess the perception and practices related to youth friendly health services (YFHS) by in-school adolescents in a rural community of Lagos, Nigeria. Methods: A descriptive cross-sectional survey was conducted on 400 proportionately selected consenting respondents from the senior classes of the three secondary schools in Agbowa community. A pre-tested interviewer-administered questionnaire was used for data collection and analysis was done with the aid of statistical software. Results: Most of the respondents were in the age range of 12–15 years with mean age being 15.33±1.54 years. About half (46.8%) of the respondents correctly described adolescents as persons between the ages of 10 and 19 years. The majority (83.2%) of the respondents first heard about the Youth Friendly Health facilities from parents, guardians and friends. However, only few of the respondents had ever visited a Youth Friendly Center. A good location, convenient hours and comfortable surroundings were the most appealing aspects of YFHS. The provision of a seminar room and educational materials (60.8% and 70.8%, respectively) are important to the respondents. Reproductive health (56.8%) was the most preferred health education topic chosen by the respondents. Conclusion: Sensitization of the youths in the Agbowa community about youth friendly health services and provision of such services would be useful in reducing risky practices and improving their health.

Background: Substance use is a leading adolescent health problem globally, but little is known regarding associated factors for adolescent substance use in Nigeria. This study compared the prevalence of substance use among in-school adolescents in urban and rural areas of Osun State, Nigeria, and identified risk and protective factors. Methods: This cross-sectional study involved 600 randomly selected adolescents (aged 10–19 years) from rural and urban areas of Osun State, Nigeria. Data were collected using the facilitated self-completed questionnaire method. Binary logistic regression was used to examine the association of individual, peer, and parental factors with adolescent substance use. Adjusted odds ratio (OR) and 95% confidence interval (CI) were obtained. Results: About two-thirds of respondents had used substances in both rural (65.7%) and urban areas (66.0%) (p=0.93). Logistic analysis showed private school attendance as a risk factor for substance use (OR=2.32, 95% CI=1.20–4.46) and adolescent disapproval of adult substance use as a protective factor (OR=0.47, 95% CI=0.27–0.82) in rural areas. For urban areas, having friends who use substances (OR=4.04, 95% CI=1.39–11.6) and a mother having had tertiary education (OR=3.34, 95% CI=1.06–10.4) were risk factors while parental disapproval of substance use (OR=0.50, 95% CI=0.28–0.90) was a protective factor. Conclusion: Lifetime prevalence of substances is high among in-school adolescents in Osun State. The risk and protective factors for adolescent substance use somewhat differ for rural and urban areas, and these have implications for designing effective intervention strategies.

Background: Conduct disorder is characterized by aggressive behaviors, deceitfulness or theft, destruction of property and serious violations of rules prior to age 18 years. The object relations theory provides an integrative model to understand the problems of conduct disorder, and proposes that child-caregiver relationships develop the internal working models of self and others. The aim of this study was to explore the relationship difficulties of Iranian adolescents with conduct disorder. Methods: This study was a qualitative directed content analysis research. The in-depth interview was conducted with nine male adolescents aged 12–17 years who had conduct disorder with or without substance use disorder at the reformatory in Tehran. All tape-recorded data were fully transcribed and analyzed. Results: The relations with different objects including parents, siblings, relatives, friends, peers, teachers, other school members, colleagues and employers were analyzed, and four themes were extracted: 1) Object relations based on insecurity and fear; 2) Object relations based on inability and abjection; 3) Object relations based on pessimism and mistrust; 4) Object relations based on non-maintenance of boundaries and limits. Conclusion: The importance of object relations and attachment problems in adolescents with conduct disorder, and their need to participate in special intervention programs should be reconsidered.

Aims: Using a population-based sample of Finnish 12–17 year olds, this study explored gambling behaviour limits for potential problem gambling [South Oaks Gambling Screen – revised for adolescents (SOGS-RA)]. Methods: Data were obtained from the Youth Gambling Survey 2006, which is a cross-sectional survey of a nationally representative random sample of 5000 adolescents. Adolescents who participated in gambling at least once a month were selected from the data (n=1827, 25.1% were girls). The limits for gambling behaviour were detected using receiver operating characteristic (ROC) analysis. Logistic regression was used to study associations between these behavioural limits and potential problem gambling. Results: For each of the gambling behaviour indicators plotted, the risk curves showed similar trends among boys and girls. The risk of being a potential problem gambler increased noticeably with increasing gambling intensity. The ROC analysis showed that the optimal behavioural cut-off values among 12–14 year olds for frequency was gambling more than 2–3 times a month, spending more than €2 per week on gambling, spending more than €8 in any 1 day on gambling, and gambling on more than two different games per year. For 15–17 year olds, cut-off values were gambling more than once a week, spending more than €4 per week and spending more than €12 in any 1 day on gambling. Cut-off for number of game types was same as it was for younger adolescents. Of the behavioural indicators those associated with money were the most robust. Conclusion: Behavioural indicators can be used as initial markers of possible problem gambling.

Background: Youth physical activity engagement is a key component of contemporary health promotion strategies. Parents have potential to influence the physical activity behaviours of their children. The purpose of this study was to explore associations between adolescent self-reported physical activity, parent physical activity and perceptions of parental influence as measured by the Children’s Physical Activity Correlates (CPAC) questionnaire. Methods: This investigation included a total of 146 adolescents and their parents. Self-reported measures of physical activity were obtained using the International Physical Activity Questionnaire for Adolescents and International Physical Activity Questionnaire for adolescents and their parents respectively. Adolescent perceptions of parental role modelling, support, and encouragement were measured with the parental influences scales of the CPAC. Results: Ordinary least squares regression indicated that perceptions of parental role modelling (β=197.41, 95% CI 34.33–360.49, p=0.031) was positively associated with adolescent self-reported moderate-to-vigorous physical activity with the overall model accounting for a small amount of the variance (R 2 =0.076). Conclusion: These results are in agreement with previous research indicating that parents play a small, albeit vital role in the physical activity engagement of their children. Public health campaigns with the aim of promoting youth physical activity should endeavour to incorporate parents into their interventions.

Background/Aim: Sports-related concussions are now recognized as a major public health concern. However, despite the association of concussion with short- and long-term health consequences, many young athletes still lack basic knowledge about concussion and seem to believe that concussions may be “toughed out” and do not require medical attention. This study assessed self-reported practice of playing in training or a match while concussed among Gaelic Athletic Association (GAA) athletes in Ireland aged 13–25 years old (M=19.19, SD=3.54). This study also assessed knowledge about and attitudes towards sports-related concussion in GAA players in Ireland. Methods: Using a self-report questionnaire, data were captured electronically on GAA athletes aged 13–25 years old (n=80) regarding knowledge about the detection, assessment and management of sports-related concussion, as well as participant’s attitudes towards concussion and self-reported practice of playing in training or a match while concussed. Data were collected from June to August 2013. Results: This study revealed that approximately one in four athletes reported having played while concussed in practice or during a match. Males were significantly more likely to play while concussed than females (40.9% and 17.2%, respectively). Results from this study indicated participants lack a complete understanding of concussion, as common misconceptions about concussion prevailed. Analyses revealed that participants generally have safe attitudes towards concussion and concussion management. Conclusion: Generating awareness of the potential short- and long-term health consequences of concussion, coupled with the promotion of safer attitudes towards this injury, could minimize the number of players who return-to-play pre-maturely and promote a more safety-conscious sports culture in Ireland.

Objective: Cross-sectional study to assess the characteristics of the risk behaviors for eating disorders (EDs) in school children between 10 and 14 years of age in the city of Recife, Pernambuco, Brazil. Methods: 1405 school-aged children were assessed, using the Eating Behaviours and Body Image Test (EBBIT) to screen for EDs. The normality of the continuing variables was tested using the Kolmogorov-Smirnov test with Lilliefors correction. They were described as medians and interquartile intervals (25 and 75th percentiles). Results: The criteria that represented a condition of anorexia and/or bulimia nervosa were considered as strong indicators of risk for EDs in school-aged children who indicated the following behaviors with scores superior to the 75th percentile on the scales: “compulsive eating” 3.0% (CI 95% 2.2–4.0); “dissatisfaction with body image/restrictive eating” 1.3% (CI 95% 0.8–2.0); children scoring superior to the 30th percentile, “compulsive eating” + “dissatisfaction with body image/restrictive eating”, 0.6% (CI 95% 0.3–1.2); and superior to the 50th percentile; “compensatory behavior for hyperphagia” 6.7% (CI 95% 5.4–8.1). In addition, greater vulnerability of the female gender was perceived, as well as an increase in the preliminary risk factors of EDs, such as advanced age, dissatisfaction with the body image linked to restrictive behaviors and the compulsive establishment of an eating pattern. Conclusion: This study shows the dimension of the problem in this ecological context and the urgent need for intervention programs, developed among different sectors, from the perspective of the adolescents’ empowerment to prevent and minimize the vulnerability factors of the eating disorders.

Background: Identification of risk and protective factors is of great importance in designing preventive and interventional programs. The aim of the present study has been to investigate peer/individual, family, school, and community risk and protective factors as predictors of tobacco and alcohol use among Iranian adolescents. Methods: In a cross-sectional population-based study, 870 Iranian adolescents aged 15–18 years old, filled out the adopted form of “Communities That Care Youth Survey”. Thirty-two risk and protective factors were entered in adjusted logistic regression analyses to predict the lifetime cigarette and alcohol use. Results: Sixteen risk and seven protective factors predicted both lifetime cigarette and alcohol use in the bivariate logistic regression analysis. In the multivariate logistic regression analysis 12 risk factors including friends’ use of drugs, interaction with antisocial peers, sensation seeking, intention to use, perceived risks of drug use, family history of drug use, poor family management, parental attitudes favorable toward drug use, family conflict, academic failure, school low commitment, perceived availability of drugs predicted both lifetime cigarette and alcohol use as well as four protective factors including religiosity, self-esteem, family rewards for prosocial involvement, and school rewards for prosocial involvement. The highest OR were related to the risk factor of “Rewards for antisocial involvement” [3.9(1.5–10)], and protective factor of “Religiosity” [0.1(0.1–0.3)]. Conclusion: The present study has produced evidences about risk and protective factors related to adolescents substance use and can help designing and implementing of preventive interventions for maintaining and promoting adolescents health.

Background: Four of every five adolescents do not meet the current physical activity (PA) recommendations. Therefore, there is a need for effective interventions that promote PA behavior among adolescents. Objective: The present study aimed to evaluate the effectiveness of an integrated theory-based intervention to promote leisure-time PA (LTPA) among adolescents over a 1-month follow-up period. Methods : Following the completion of self-reported LTPA at baseline, 316 adolescents aged 14–16 years were randomized into one of six conditions based on a 2 (outcome mental simulation: present vs. absent)×3 (action planning: standard vs. reasoning vs. absent) factorial design. The LTPA was measured again 1 month later. Results : The intervention did not change adolescents’ self-reported LTPA over a 1-month follow-up period. Participants receiving either of the intervention manipulation or combination of these intervention manipulations did not demonstrate significantly higher levels of LTPA compared with partcipants who did not receive intervention manipulations. This might be due to several reasons such as complexity of the target behavior, lack of booster sessions within the follow-up period, or seasonality issues. Conclusion : The results of this study suggest that such an integrated intervention may not yet be ready for implementation in promoting LTPA behavior among adolescents.