The effects of peer ridicule on depression and self-image among adolescent females with Turner syndrome.

PURPOSE: This study attempted to examine the effects of body image, height dissatisfaction, and peer ridicule on depression and self-image among adolescent females with Turner syndrome. METHODS: A prospective, cross-sectional survey examined 59 subjects' responses to standardized measures of depression, self-image, body image, height perception, and teasing. RESULTS: Descriptive statistics found the mean age of subjects to be 14.8 years (range: 13-19). Approximately 30% reported cardiac defects and 17% indicated kidney anomalies. Only five experienced spontaneous menses and 61% indicated they were receiving estrogen replacement therapy. Linear regression analyses examined the effects of body image, height perceptions, and peer ridicule on depression and self-image scores. The first regression analysis found a five-step model to account for 39% of the variance, with peer ridicule of general appearance being the most important variable. The second linear regression (R2 = .3248, P < .0004) also found peer teasing of general appearance to be significantly associated with self-image scores. Discrepancy scores between ideal versus current body shape or height, as well as teasing about these issues, appeared to be unrelated to depression and self-image among our subjects. CONCLUSION: These data suggest that peer ridicule is a domain that requires ongoing assessment by health care providers, as it appears to be an important contributor to mental health problems. Social skill interventions that emphasize strategies to manage teasing, assertively respond to negative statements, and teach effective coping skills are key variables to minimize the emotional discomfort these young women may experience.

Health care utilization and perceptions of health among adolescents and adults with Turner syndrome.

We surveyed women aged 12 years and older who are members of the Turner Syndrome Society of the United States in regard to their health history, current health status, and health care utilization practices to identify the range of health problems and health care practices in this group. The mean age at diagnosis was 10.8 years, and an endocrinologist (41%) or pediatrician (35%) was most likely to make the initial diagnosis. Individuals over age 35 years were diagnosed with Turner syndrome and begun on estrogen replacement therapy at a significantly older age than those who were in younger age groups. Seventy-five percent of the respondents had required some type of surgical procedure, and 14% had been hospitalized within the previous year. Ninety-four percent of women rated their overall health as good to excellent, while 6% rated it fair to poor. In the 12-17-year age group, 89% of the young women were either currently taking or had previously taken growth hormone. The prevalence of major depressive symptoms was slightly higher than the general population for adolescents but similar to the general population for adults. For adult respondents, ratings of fair to poor health were significantly associated with increased outpatient visits. Growth hormone use was significantly associated with increased visits in the adolescent population. Based on these data, it appears that the clinical care of individuals with Turner syndrome has improved, but that they continue to have relatively high hospitalization rates and utilization of subspecialty services. Despite these health problems, most respondents demonstrated good adjustment as determined by standardized mental health measures.

Maternal influence on the decision to adopt Norplant.

PURPOSE: To examine maternal influence and related variables on adolescents' decision to adopt Norplant. METHODS: A prospective study of 121 adolescent females who received Norplant through a hospital-based outpatient adolescent gynecology service. Each patient completed self-report questionnaires about her decision process, sexual behaviors and standardized measures of depression and anxiety at their insertion appointment or first-follow-up appointment. RESULTS: Almost 40% of the sample reported that their mother significantly influenced their decision to use Norplant and 61% of all patients stated that they had informed their mother of their choice of this contraceptive method. Through logistic regression, six variables were found to be significantly associated with mother as the most important decision source. These included: obtaining information about Norplant from a parent, maintaining the same sexual partner, past pill use, and not knowing other adolescents who boast about using the Norplant system. CONCLUSION: These data suggest that when parental consent is not required, adolescent females disclose sensitive information regarding choice-making to their mothers when they decided to adopt Norplant.

PIP: A prospective study of 121 Norplant acceptors 12-21 years old recruited from a hospital-based adolescent gynecology service in Arkansas confirmed the importance of maternal influence on the acceptance process, even when state law does not mandate parental consent. These adolescents completed a questionnaire indicating the relative roles of various significant others in providing information about Norplant and influencing the decision-making process. The adolescent's mother was cited as the most important decision source by 45 (37%) young women; another 33 (27%) identified a health care provider. Although Arkansas does not require parental notification, 74 (63%) had told their mother of their decision to use Norplant. Maternally influenced adolescents were significantly more likely than those who identified health care professionals, girlfriends, and boyfriends as decisive to have obtained specific information about Norplant from their mother, to be former oral contraceptive users, and to have a consistent sexual partner. Overall, 99 (82%) adolescents reported they intended to use Norplant for at least two years. Although 44 (36%) expressed concerns about Norplant's cost, only two indicated this was a factor in their decision. The findings of this study offer reassurance to health care providers who seek to protect patient confidentiality yet encourage parent-teen communication about reproductive health.

Adolescents and Norplant: preliminary findings of side effects.

PURPOSE: The purpose of this study was to investigate side effects such as menstrual irregularities, weight gain, and blood pressure changes among adolescent females who had been implanted with Norplant eight or more months. METHOD: A retrospective chart review was completed on adolescents who received care through an outpatient adolescent gynecology service. Subjects (n = 110) with an average age of 17.2 years were implanted with Norplant between March 1991 and February 1992. The mean length of time since implantation was 12.7 months and 64% were African-American. Data collected included: dates of all medical visits; presence of acne, mood changes, and menstrual patterns following implantation. Measurements of blood pressure and weight were taken at implantation and at all subsequent visits. RESULTS: Weights for Caucasian females at the last visit were significantly higher than at baseline (P < .02). With regard to the African-American females' weight, significant differences were found between baseline weight and each follow-up visit. Although we could not determine the bleeding patterns in 22% of our study sample, almost 40% of the adolescent females followed reported their bleeding to be light as well as regular and cyclic. CONCLUSION: Weight gain was the most frequently observed side-effect of Norplant in adolescents in this study.

PIP: To learn more about the side effects associated with Norplant use in adolescence, the charts of 110 women 13-21 years of age (average, 17.2 years) who received the implants through hospital-based adolescent gynecology clinics in Arkansas were reviewed. The implants were inserted between March 1991 and February 1993; the mean length of time since insertion was 12.7 months (range, 8-19 months). 64% of Norplant acceptors were African-American. Weight and blood pressure measurements were obtained at baseline and at three follow-up periods: 1-4 months, 5-7 months, and 8 or more months. Overall, the average weight gain was 3.3 kg, but there were significant racial differences. At follow-up one, African-American females showed an average weight gain of 1.4 kg compared to no gain among White females. At follow-up three, the mean weight gain was 5.4 kg for African Americans and 2.6 kg for White youth. 37% of all participants reported no change in menstrual patterns, 28% experienced irregular (mainly light) bleeding, and 13% were amenorrheic; no data were available for the remaining 22%. There were no significant changes over time in blood pressure, and acne and depression were each recorded in only one chart. Three women requested Norplant removal during the study period. Overall, the findings of this study suggest that Norplant-related side effects may be less severe among adolescents than adult women, most notably the incidence of bleeding irregularities (82% in adult Norplant acceptors). To ensure Norplant continuation, however, adolescents should be counseled about the possibility of slight weight gain and light bleeding.

Outcome findings from a multidisciplinary clinic for children with epilepsy.

Children with chronic or intractable epilepsy are at higher risk for medical and social difficulties. A multidisciplinary clinic was established to improve medical management and address psychosocial issues. The purposes of the present study were to describe the multidisciplinary clinic, retrospectively examine the referral patterns for children served by the clinic, and analyze factors significantly predictive of parental satisfaction with the multidisciplinary approach. The Epilepsy Clinic Satisfaction Questionnaire was sent to all patients seen in the clinic over a 2-year period. Outcome findings were based on 136 respondents. A stepwise regression analysis indicated that the best predictor of parental rating of clinic quality was the amount of information given concerning the diagnosis and treatment of epilepsy. Staff attitude was also significantly related to parental satisfaction.

Adolescents and colposcopy: the use of different procedures to reduce anxiety.

OBJECTIVE: Two consecutively occurring studies examined whether using a video colposcope to view this procedure or allowing the female adolescent to watch music videos would reduce anxiety and related body movements. STUDY DESIGN: Female adolescents who underwent colposcopy were randomly assigned to one of two groups, experimental and control. In study 1, 27 female adolescents were randomly assigned either to view the procedure on a television monitor or to be part of a control group (no visual distraction). In study 2, 30 female adolescents were randomly assigned either to a music video group or to a control group. Studies were completed in a consecutive manner and used the same measures, colposcopic equipment, and professional staff, including physician. Multiple measures of anxiety were used (heart rate, behavior observation, and paper and pencil) before, during, and after the procedure. During each colposcopy the subject's behavior across 10 dimensions was observed and coded. Data were analyzed by chi 2, analysis of variance, and Student t tests. RESULTS: Study 1 found no significant differences in body movements and anxiety ratings between the video colposcope group and controls. In study 2, subjects who were allowed to watch the music videos demonstrated significantly fewer body movements indicative of pain, required less physician reassurance, and received fewer procedural explanations (p < 0.05). CONCLUSION: Results suggest that allowing a female adolescent to watch music videos during a colposcopic examination appears to decrease body movements associated with discomfort.