Different stressors, different strategies, different outcomes: how domain-specific stress responses differentially predict depressive symptoms among adolescents.

As a time of notably increased stress and a marked rise in depressive symptoms, adolescence is a key period in which to examine how stress is related to mental health outcomes. Many studies examine stress as a unitary construct; however, research suggests that how adolescents respond to stress within different domains may differentially predict depression. The current study used an 8-week weekly diary design to assess how adolescents' cognitive appraisals, rumination, and co-rumination in response to dependent, independent, social, and nonsocial stressors differentially predicted depressive symptoms. Participants were 111 high school students (72% female) ages 14-19 years (mean age 16.4). Results indicated that rumination and co-rumination about dependent and social events, rather than independent or nonsocial events, prospectively predicted depressive symptoms. Negative cognitive appraisals prospectively predicted depressive symptoms regardless of domain. This study provides support for the hypothesis that adolescents' responses to stress in different domains differentially predict depressive symptoms.

Toward instituting a chaperone policy in outpatient pediatric clinics.

OBJECTIVES: We sought to evaluate child, parent and medical provider preferences for chaperones for outpatient encounters and to evaluate the acceptability and frequency of utilization following institution of a chaperone policy. Secondarily, we sought to understand what medical history and examinations teens consider "sensitive." DESIGN: We conducted an observational study 1 month before and 1 month after institution of outpatient clinic chaperone policy. Post clinic questionnaires were used for patients > or =12 years old, parents, and clinicians. A research assistant observed chaperone use. SETTING: Adolescent Medicine, Urology, and Rehabilitation Clinics at a regional, tertiary-care pediatric hospital, in a major metropolitan area were studied. PARTICIPANTS: Convenience sample: 117 clinic patients during control period and 119 after policy implementation. MAIN OUTCOME MEASURES: Preferences for and satisfaction with chaperone use were documented. RESULTS: Although non-parent chaperones were usually declined (99.6%), offers were appreciated. Non-parent chaperone use increased modestly (5.3-18.1%). Most patients preferred not to have non-parent chaperones. This preference was greater among older patients (88%), than early teens (52%). After experiencing sensitive examinations, more young adolescent patients (89%) wished their parent had been present than older patients (38%). Patients' opinions about what constitutes "sensitive" questions and examinations and chaperone preferences varied widely. Providers often did not recognize issues patients and parents considered sensitive questioning (21% agreement), but recognized sensitive physical examinations better (74% agreement). Providers felt chaperones had been a detriment to examination and exams would have gone better without one only 1% of the time. CONCLUSIONS: Although usually declined, offers of chaperones were appreciated and use of non-parent chaperones increased modestly. Offering chaperones for sensitive examinations may remind providers about appropriate, respectful patient encounters. Implications for children's hospitals' patient safety and satisfaction, and institutional staff protection and costs are significant. PRACTICE IMPLICATIONS: Questions and examinations which patients consider sensitive vary widely. Asking patients for their preferences for examination chaperones may reassure them about the appropriateness of examinations, remind staff to conduct respectful examinations and protect providers from accusations of impropriety. Since most chaperone offers are declined, the cost of asking is likely to be minimal.