Exposure to violence and mental health of adolescents: South African Health and Well-being Study.

BACKGROUND: Material and social environmental stressors affect mental health in adolescence. Protective factors such as social support from family and friends may help to buffer the effects of adversity. AIMS: The association of violence exposure and emotional disorders was examined in Cape Town adolescents. METHOD: A total of 1034 Grade 8 high school students participated from seven government co-educational schools in Cape Town, South Africa. Exposure to violence in the past 12 months and post-traumatic stress disorder (PTSD) symptoms were measured by the Harvard Trauma Questionnaire, depressive and anxiety symptoms by the Short Moods and Feelings Questionnaire and the Self-Rating Anxiety Scale. RESULTS: Exposure to violence was associated with high scores on depressive (odds ratio (OR)=6.23, 95% CI 4.2-9.2), anxiety (OR=5.40, 95% CI 2.4-12.4) and PTSD symptoms (OR=8.93, 95% CI 2.9-27.2) and increased risk of self-harm (OR=5.72, 95% CI 1.2-25.9) adjusting for gender and social support. CONCLUSIONS: We found that high exposure to violence was associated with high levels of emotional disorders in adolescents that was not buffered by social support. There is an urgent need for interventions to reduce exposure to violence in young people in this setting. DECLARATION OF INTEREST: None. COPYRIGHT AND USAGE: © The Royal College of Psychiatrists 2017. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license.

Mental Health Inequalities in Adolescents Growing Up in Post-Apartheid South Africa: Cross-Sectional Survey, SHaW Study.

BACKGROUND: South Africa is one of the most 'unequal' societies in the world. Despite apartheid ending more than 20 years ago, material inequalities remain interwoven with ethnic/racial inequalities. There is limited research on the prevalence/predictors of common mental disorders (CMD) among young people. Adolescence is a unique time-point during which intervention may lead to improved mental health and reduced social problems later. The study objective was to assess mental health disparities in a representative sample of adolescents growing up in South Africa. METHODS: Cross-sectional associations of race/ethnicity and material disadvantage with CMD and Post Traumatic Stress Disorder (PTSD) were assessed in a stratified random sample representative of school-attendees, aged 14-15 years, in a large metropolitan area of Cape Town. Validated instruments assessed mental disorders; these included: Harvard Trauma Questionnaire (PTSD); Short Moods and Feelings Questionnaire (depression); Zung self-rated anxiety scale (anxiety). Self-ascribed ethnicity was determined using procedures similar to the South African census and previous national surveys. RESULTS: Response rate was 88% (1034 of 1169 individuals). Adolescents experienced a high prevalence of depression (41%), anxiety (16%) and PTSD (21%). A gradient between material disadvantage and CMD/ PTSD was evident across all ethnic/racial groups. Respondents self-identifying as 'black' or 'coloured' were disadvantaged across most indicators. After adjusting for confounders, relative to white children, relative risk (RR) of CMD in black children was 2.27 (95% CI:1.24, 4.15) and for PTSD was RR: 2.21 (95% CI:1.73, 2.83). Relative risk of CMD was elevated in children self-identifying as 'coloured' (RR: 1.73, 95% CI:1.11, 2.70). Putative mediators (violence, racially motivated bullying, social support, self-esteem) partially accounted for differences in CMD and fully for PTSD. CONCLUSIONS: Adolescent mental health inequalities in Cape Town are associated with material disadvantage and self-identification with historically disadvantaged groups.

Neighbourhood risk factors for Common Mental Disorders among young people aged 10-20 years: a structured review of quantitative research.

We present a critical review of research concerning the vulnerability of mental health of young people in the 10-20 year age range to neighbourhood factors that are theoretically associated with increased risk of Common Mental Disorders (CMDs). We interpreted 'neighbourhood factors' as attributes and processes in the local social and physical environment that young people inhabit, beyond the immediate household. We conducted an extensive search, and a structured method of assessment of the research papers that met our search criteria. We draw conclusions about the research evidence on this topic and identify issues needing further discussion and investigation. We focus particularly on quantitative research that aims to measure these relationships. We note that parallel to this research, a significant body of qualitative research on the geographical experiences of young people (though not specifically on their mental health) offers a rich source of background information to illuminate the statistical findings. We conclude with some reflections on the future challenges for research in this field.

Diet quality and mental health problems in adolescents from East London: a prospective study.

PURPOSE: In this study, we aimed to examine the relationship between diet quality and depression in a prospective study of adolescents from varied ethnic and cultural backgrounds. DESIGN: In this prospective cohort study, data were collected at two time points (2001 and 2003) from nearly 3,000 adolescents, aged either 11-12 years or 13-14 years, participating in RELACHS, a study of ethnically diverse and socially deprived young people from East London in the UK. Diet quality was measured from dietary questionnaires, and mental health assessed using the Strengths and Difficulties Questionnaire (SDQ) and the Short Mood and Feelings Questionnaire (SMFQ). RESULTS: In cross-sectional analyses, we found evidence for an association between an unhealthy diet and mental health problems. Compared to those in the lowest quintile of Unhealthy diet score, those in the highest quintile were more than twice as likely to be symptomatic on the SDQ (OR 2.10, 95 %CI 1.38-3.20) after taking all identified confounders into account. There was also some evidence for a cross-sectional inverse association between a measure of healthy diet and mental health problems. A prospective relationship between the highest quintiles of both Healthy (OR 0.63, 95 %CI 0.38-1.05) and Unhealthy (OR 1.75, 95 %CI 1.00-3.06) diet scores and SDQ scores at follow-up was also evident, but was attenuated by final adjustments for confounders. CONCLUSION: This study is concordant with previous observational studies in describing relationships between measures of diet quality and mental health problems in adolescents.

Family social support, community "social capital" and adolescents' mental health and educational outcomes: a longitudinal study in England.

PURPOSE: To examine the associations between family social support, community "social capital" and mental health and educational outcomes. METHODS: The data come from the Longitudinal Study of Young People in England, a multi-stage stratified nationally representative random sample. Family social support (parental relationships, evening meal with family, parental surveillance) and community social capital (parental involvement at school, sociability, involvement in activities outside the home) were measured at baseline (age 13-14), using a variety of instruments. Mental health was measured at age 14-15 (GHQ-12). Educational achievement was measured at age 15-16 by achievement at the General Certificate of Secondary Education. RESULTS: After adjustments, good paternal (OR = 0.70, 95% CI 0.56-0.86) and maternal (OR = 0.65, 95% CI 0.53-0.81) relationships, high parental surveillance (OR = 0.81, 95% CI 0.69-0.94) and frequency of evening meal with family (6 or 7 times a week: OR = 0.77, 95% CI 0.61-0.96) were associated with lower odds of poor mental health. A good paternal relationship (OR = 1.27, 95% CI 1.06-1.51), high parental surveillance (OR = 1.37, 95% CI 1.20-1.58), high frequency of evening meal with family (OR = 1.64, 95% CI 1.33-2.03) high involvement in extra-curricular activities (OR = 2.57, 95% CI 2.11-3.13) and parental involvement at school (OR = 1.60, 95% CI 1.37-1.87) were associated with higher odds of reaching the educational benchmark. Participating in non-directed activities was associated with lower odds of reaching the benchmark (OR = 0.79, 95% CI 0.70-0.89). CONCLUSIONS: Building social capital in deprived communities may be one way in which both mental health and educational outcomes could be improved. In particular, there is a need to focus on the family as a provider of support.

Structural and socio-psychological influences on adolescents' educational aspirations and subsequent academic achievement.

Previous literature indicates that educational aspirations are an important predictor of achievement at school and beyond. This paper examines the factors that are associated with high educational aspirations. It also looks at the relationship between aspirations and achievement at the General Certificate of Secondary Education in a deprived area of London. The results show that educational aspirations are associated with individual characteristics. Girls were more likely than boys to express a wish to remain in education beyond the age of 16. For the most academic route post-16, there were substantial ethnic differences, with minority ethnic groups generally being more likely to state a desire to follow this path. Students who were eligible for free school meals tended to have lower aspirations. Socio-psychological variables were also shown to be of importance, particularly self-esteem and psychological distress. Importantly, educational aspirations had a strong association with actual achievement at age 16, remaining associated even after controlling for a number of other variables, including prior achievement. These findings are discussed in light of previous research and potential intervention strategies.

Reliability of self report questionnaires for epidemiological investigations of adolescent mental health in Cape Town, South Africa.

OBJECTIVE: This study aimed to assess the reliability of a number of self report questionnaires for epidemiological investigations of adolescents' mental health in Cape Town, South Africa. The scales used were: the Short Mood and Feelings Questionnaire (SMFQ), Zung Self-rating Anxiety Scale (SAS), Self-esteem Questionnaire (SEQ), Harvard Trauma Questionnaire (HTQ) and Multi-Dimensional Scale of Perceived Social Support (MSPSS). METHOD: The self-report questionnaire (available in Afrikaans, English and isiXhosa) was administered to 237 grade 8 students (14-15 years) on 2 occasions in metropolitan Cape Town high schools. The mean interval between first and second administration of the questionnaire was 8.3 days. Test-retest reliability was assessed using Cohen's kappa and observed agreement. Pearson's correlation coefficients were used to assess consistency across total scores between occasion 1 and occasion 2. Cronbach's alpha was used to assess the internal consistency of each scale. RESULTS: All items had at least fair test-retest reliability (kappa > 0.20) apart from two items on the Self-rating Anxiety Scale and one item on the Harvard Trauma questionnaire. Test-retest reliability was strong for the HTQ (Pearson's correlation coefficient >0.75), moderate for the SAS, SEQ and MSPSS (0.50-0.74) and weak for the SMFQ (0.25-0.49). Cronbach's alpha for all scales was acceptable (>0.60). Analysis by the different language versions (Afrikaans/English and isi-Xhosa/ English) of the questionnaire indicated good internal consistency for most measures for all three languages. CONCLUSIONS: The results indicate that many of these instruments may be used reliably in South Africa to assess adolescent mental health and that the different language versions of the instruments used in the questionnaire are generally reliable for use in South African schools. However, some caution is required with the use of the SAS and SEQ in different language groups.

Can social support protect bullied adolescents from adverse outcomes? A prospective study on the effects of bullying on the educational achievement and mental health of adolescents at secondary schools in East London.

This paper investigates the extent to which social support can have a buffering effect against the potentially adverse consequences of bullying on school achievement and mental health. It uses a representative multiethnic sample of adolescents attending East London secondary schools in three boroughs. Bullied adolescents were less likely to achieve the appropriate academic achievement benchmark for their age group and bullied boys (but not girls) were more likely to exhibit depressive symptoms compared to those not bullied. High levels of social support from family were important in promoting good mental health. There was evidence that high levels of support from friends and moderate (but not high) family support was able to protect bullied adolescents from poor academic achievement. Support from friends and family was not sufficient to protect adolescents against mental health difficulties that they might face as a result of being bullied. More active intervention from schools is recommended.

Physical activity and depressive symptoms in adolescents: a prospective study.

BACKGROUND: The frequency of mental illness amongst adolescents and its potential long-term consequences make it an important topic to research in relation to risk and protective factors. Research on the relationship between physical activity and depressive symptoms in adolescents is limited. There is a particular lack of evidence from longitudinal studies. This study examines the relationship between depression and physical activity using the Research with East London Adolescents: Community Health Survey (RELACHS). METHODS: This was a prospective cohort study. Participants were recruited from three Local Education Authority boroughs in East London in 2001 from year 7 (aged 11-12) and year 9 (aged 13-14) and were followed-up in 2003. All pupils in the 28 schools that took part were eligible for the study. Of the total 3,322 pupils eligible for the survey the overall response rate was 84% (2,789 pupils). A total of 2,093 (75%) pupils were also followed-up in 2003. The sample was multiethnic (73% of respondents were non-white) and deprived. Just under half of the sample was male (49%). Depressive symptoms were measured using the Short Moods and Feelings Questionnaire (SMFQ). Logistic regression analyses were used to examine the association between physical activity and depressive symptoms both cross-sectionally and longitudinally. RESULTS: After adjustments, there was evidence for a cross-sectional association between physical activity and depressive symptoms for both boys and girls at baseline, with a decrease in the odds of depressive symptoms of about 8% for each additional hour of exercise undertaken per week (boys: odds ratio (OR) = 0.92, 95% CI 0.85 to 0.99; girls: OR = 0.92, 95% CI 0.85 to 1.00). There was no evidence for an association between a change in physical activity from baseline to follow-up and depressive symptoms at follow-up. CONCLUSIONS: This study provides some evidence for an association between level of physical activity and decreased depressive symptoms in adolescents. Further longitudinal research of these associations is required before physical activity can be recommended as an intervention for depression in adolescents.

The impact of psychological distress on the educational achievement of adolescents at the end of compulsory education.

BACKGROUND: Poor academic performance at school can have a substantial effect on opportunities in adult life and as such it is imperative that researchers establish the chief causes of underachievement. This paper examines performance at the General Certificate of Secondary Education (GCSE), examined at age 16, with reference to psychological distress and depressive symptoms as measured at age 13-14. METHODS: The data come from a school based prospective epidemiological study of a representative multiethnic sample of adolescents attending East London secondary schools in Tower Hamlets, Hackney, and Newham. Logistic regression analysis was carried out using STATA to test for differences in the impact of different types of psychological distress on achievement. RESULTS: The overall score for psychological distress, as measured by the Strengths and Difficulties Questionnaire (SDQ), was negatively associated with achievement at GCSE for both boys (OR = 0.41, 95% CI 0.24-0.69) and girls (OR = 0.60, 95% CI 0.41-0.87). There was evidence for an association between achievement and depressive symptoms, as measured by the Short Moods and Feelings Questionnaire (SMFQ), for boys only (OR = 0.58, 95% CI 0.43-0.79). There was weak evidence for an interaction between ethnicity and SMFQ for girls. Results from a subset of analyses adjusting for prior achievement suggested that the association between psychological distress at age 13-14 and GCSE achievement could not be explained simply by achievement at age 13-14. CONCLUSIONS: The results suggest that psychological distress is associated with educational achievement. Low achievement at school can have a substantial effect on opportunities in adult life. This implies a greater need for support within the school for children with psychological difficulties in order to achieve the best possible outcomes in the long term.