Risk factors for depressive symptoms in late adolescence: a longitudinal community study.

In a longitudinal study, following a community sample (N = 386) from age 5, early risk factors for depressive symptomatology at age 18 were examined separately for females and males. For females, predictors included low birthweight and death of a parent; for males, they included emotional dependency and internalizing behavior problems. Depressive symptomatology at age 15 emerged as an important risk factor for both genders. Clinical implications are discussed, and areas for further research are proposed.

Traumas and posttraumatic stress disorder in a community population of older adolescents.

OBJECTIVE: The prevalence of DSM-III-R traumas and posttraumatic stress disorder (PTSD) and their impact on psychosocial functioning were examined in a community population of older adolescents. METHODS: Subjects were 384 adolescents participating in an ongoing longitudinal study. When subjects were aged 18 years, the NIMH Diagnostic Interview Schedule, Version IIIR, was used to identify lifetime traumatic events and diagnoses of PTSD, major depression, phobias, and substance dependence. Behavioral, emotional, and academic functioning in later adolescence was evaluated through self-report measures and school records. RESULTS: More than two fifths of adolescents experienced at least one DSM-III-R trauma by age 18 years; PTSD developed in 14.5% of these affected youths or 6.3% of the total sample. Youths with PTSD demonstrated widespread impairment at age 18, including more overall behavioral-emotional problems, interpersonal problems, academic failure, suicidal behavior, and health problems, as well as an increased risk for additional disorders. An equally striking finding was that youths who experienced traumas but did not develop PTSD also showed deficits in many of these areas when compared with their peers who had not experienced traumas. CONCLUSIONS: The substantial risk faced by youths in community settings for experiencing traumas and PTSD, along with associated impairments in later adolescence, underscores the need for programs of prompt intervention.

Early psychosocial risks for adolescent suicidal ideation and attempts.

OBJECTIVE: An ongoing, 14-year, longitudinal community study examined psychosocial risks for adolescent suicidal ideation and attempts, as well as the link between earlier suicidal behavior and later functioning. METHOD: Nearly 400 youths were followed between the ages of 5 and 18 years. Suicidal ideation was assessed at age 15 and lifetime suicide attempts were determined at age 18. Risk factors covered developmental periods from birth to age 15, and most were measured prospectively using multiple informants. Late-adolescent functioning (at age 18) was based on both self-reports and school records. RESULTS: For both genders, the early onset (by age 14) of psychiatric disorders significantly increased the risk for suicidal ideation at age 15 and suicide attempts by age 18. Early gender-specific risks for suicidal ideation included preschool behaviors that are counter to typical gender norms, such as aggressive behavior in females and dependence in males. Suicidal ideation at age 15 and suicide attempts were both associated with deficits in later adolescence (at age 18) in behavioral and social-emotional functioning. CONCLUSIONS: Suicidal ideation at age 15 was a marker of distress with long-term implications for later functioning. The early gender-specific risk factors for suicidal behavior identified in this study can aid in developing strategies for prevention and early intervention.

Ages of onset of psychiatric disorders in a community population of older adolescents.

OBJECTIVE: Ages of onset of psychiatric disorders, as well as the link between early onset and later psychosocial functioning, were examined in a community population of older adolescents. METHOD: Subjects were 386 adolescents who were participants in an ongoing 14-year longitudinal study. At age 18, lifetime diagnoses and ages of onset of major depression, phobias, post-traumatic stress disorder, and substance disorders were assessed using the NIMH Diagnostic Interview Schedule, Revised Version. Behavioral, emotional, and academic functioning in later adolescence were evaluated through self-report measures and school records. RESULTS: Almost one fourth of the adolescents met criteria for at least one disorder by age 14. Simple phobias emerged earliest (by early childhood), whereas for major depression and substance disorders the peak risk periods for onset were midadolescence. The early onset (by age 14) of disorders was associated with continued impairments in behavioral and emotional functioning in late adolescence (at age 18). Furthermore, the early onset of disorders, compared to later onset (ages 15 through 18), increased the risk for additional co-occurring disorders. CONCLUSIONS: The striking levels of early psychopathology and associated long-term deficits in functioning found in this community population underscore the need for programs of early intervention.

Psychosocial risks for major depression in late adolescence: a longitudinal community study.

OBJECTIVE: An ongoing 14-year longitudinal study examined psychosocial antecedents of major depression in late adolescence in a community population. METHOD: Subjects were 385 adolescents followed between the ages of 5 and 18 years. Early health, familial, behavior, academic, and environmental risks for major depression were identified using data collected at ages 5, 9, 15, and 18 years. At age 18, a lifetime diagnosis of major depression was assessed using the NIMH Diagnostic Interview Schedule (DIS-III-R). RESULTS: For males, neonatal health problems, dependence problems at age 5 years, perceived unpopularity and poorer perceptions of their role in the family at age 9 years, remarriage of a parent, early family discord, and anxiety at age 15 years significantly increased the risk of developing major depression. Females with major depression, compared with nondepressed females, had older parents and came from larger families, and at age 9 years had greater perceived unpopularity and anxiety, lower self-esteem, and poorer perceptions of their role in the family. Depressed females also reported more stressful life events, including death of parent and pregnancy. CONCLUSIONS: Underscoring the importance of early psychosocial factors in the later development of major depression and pointing to specific risks, our findings can aid in developing strategies for prevention and early intervention.

Prevalence of psychiatric disorders in a community population of older adolescents.

In a community study of 386 Caucasian working-class older adolescents, a sizeable proportion met lifetime criteria for selected DSM-III-R diagnoses. Alcohol abuse/dependence had the highest lifetime prevalence rate (32.4%), followed by phobias (22.8%), drug abuse/dependence (9.8%), major depression (9.4%), and, least commonly, post-traumatic stress disorder (6.3%) and obsessive compulsive disorder (2.1%). Significant gender differences were found for major depression, post-traumatic stress disorder, and alcohol abuse/dependence, whereas socioeconomic differences occurred in major depression, phobias, and drug abuse/dependence. Adolescents with specific psychiatric disorders had significantly poorer functioning on measures of behavioral problems, interpersonal problems, self-esteem, and school performance. Results suggest the importance of identifying psychiatric disorder in adolescence, and the need for preventive strategies and prompt treatment.

Multi-facility earthquake preparedness program

This paper report on the experience of developing a disaster plan and establishing a multi . facility emergency managment system for a very large, complex, geographically dispersed health maintenance organization that delivers health careservices to nearly 2.5 million members in Northern California through fi1 medical centers, thrirty - six mulñtiple provider medical offices, and four multi - building regional support office complexes. These services are delivered by approximately 3000 physicians and 30000 health care and administrateive support staff (AU)

The effects of marital disruption on adolescents: time as a dynamic.

As part of an ongoing ten-year longitudinal research project, 382 15-year-olds from a white, working-class community were studied. Findings indicate that those who experienced parental separation more recently were most likely to be adversely affected, and that girls from recently disrupted families were more likely than boys to experience problems in emotional and behavioral functioning and were likely to express dissatisfaction with available levels of social support.

The relationship of early risk and current mediators to depressive symptomatology in adolescence.

In an ongoing 10-year longitudinal study in a lower-middle-class community, 21% of 378 fifteen-year-olds studied through interviews and questionnaires reported high levels of depressive symptoms on the Children's Depression Inventory. Girls were twice as likely to express depressive symptoms as boys. Early risk factors for high levels of depressive symptomatology included serious preschool illness, anxiety expressed at age 9, and death of a parent for girls but not boys. Mediators of high depressive symptoms at adolescence consisted of family cohesiveness and satisfactory social supports as well as adolescents' positive self-perceptions of popularity, attractiveness, and intellectual competence.