Anxiety, Sleep Problems, and Vigorous Physical Activity: Bidirectional Associations from Early Adolescence to Early Adulthood in Swedish Adolescents.

Anxiety symptoms and sleep problems typically emerge during adolescence and are frequently intertwined. However, there is a dearth of knowledge concerning their reciprocal influence and whether physical activity might play a protective role in this relationship. The present study aims at filling this gap exploring also the moderating role of sex. 915 13-year-old Swedish adolescents (56% girls) answered a survey conducted four times: at ages 13 (T1), 16 (T2), 19 (T3), and 22 (T4). A random intercept cross-lagged panel model was used. At within-levels, sleep problems and anxiety symptoms had a bidirectional positive association in middle adolescence. Vigorous physical activity and anxiety symptoms showed a reciprocal negative association from middle adolescence. Vigorous physical activity and sleep problems were reciprocally associated only in late adolescence. Associations were the same for girls and boys. This study demonstrated that the relations between anxiety symptoms, sleep problems, and vigorous physical activity cannot be understood without adopting a developmental perspective and that middle adolescence is a crucial period to plan interventions to reduce anxiety symptoms and sleep problems.

The Montgomery and Åsberg Depression Rating Scale - self-assessment for use in adolescents: an evaluation of psychometric and diagnostic accuracy.

Background: The Montgomery-Åsberg Depression Rating Scale - Self Assessment (MADRS-S) is used to assess symptom severity in major depressive disorder (MDD) among adolescents, but its psychometric properties and diagnostic accuracy are unclear.Aim: The aim of this study was to explore psychometric properties, including diagnostic accuracy, of the MADRS-S in adolescent psychiatric outpatients.Method: Adolescent psychiatric outpatients (N = 105, mean age 16 years, 46 boys) completed the MADRS-S and were interviewed using the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS).Results: In principal component analysis, two components with eigenvalues of 4.6 and 1.3 explained 51.1% and 14.4% of the variance, respectively. On the first component loaded items assessing Mood, Feelings of unease, Appetite, Initiative, Pessimism, and Zest for life. On the second component loaded items assessing Sleep, Ability to concentrate, and Emotional involvement. Cronbach's alpha (internal consistency) for all items was 0.87. Spearman's rho was 0.68 for concurrent validity (correlation between total MADRS-S-score and K-SADS MDD severity score). In receiver-operating characteristic analysis, the area under the curve was 0.86 (95% confidence interval 0.78-0.93, p < .001). For all the participants, the highest combined sensitivity and specificity were reached using cut-offs of 15 and 16 (sensitivity 0.82, specificity 0.86). Optimizing sensitivity for MDD, with specificity still ≥0.5, cut off for all was 9, for boys 7 and for girls 10.Conclusion: Psychometric properties of MADRS-S showed good reliability and validity as well as satisfying diagnostic accuracy, indicating good to excellent properties for MDD screening of adolescent psychiatric patients.

Diagnostic accuracy of the Montgomery-Åsberg Depression Rating Scale parent report among adolescent psychiatric outpatients.

BACKGROUND: The diagnostic accuracy of the parent report of the Montgomery-Åsberg Depression Rating Scale (MADRS-P) for the screening of major depressive disorder (MDD) in adolescents has not been evaluated. AIM: The aim was to explore the psychometric properties and diagnostic accuracy of the MADRS-P in general child and adolescent psychiatric outpatient services in Sweden. METHOD: The study was a validation and a diagnostic accuracy study. Consecutive adolescent psychiatric patients (n = 101, 45 males, mean age 15 years) were assessed with a diagnostic interview, the Kiddie Schedule of Affective Disorders and Schizophrenia for School-Age Children - Present and Lifetime version (K-SADS-PL), as a reference test. Thereafter, their parents reported on the MADRS-P. Both categorical MDD diagnoses and dimensional MDD symptom severity scores were obtained from the K-SADS-PL. RESULTS: The internal consistency of the MADRS-P, measured with Cronbach's alpha, was 0.846. The concurrent validity, assessed by Spearman's rho as a correlation between the K-SADS MDD symptom severity score and the MADRS-P score, was 0.580. The area under the curve in a receiver operating characteristic analysis for all participants was 0.786 (95% confidence interval 0.694-0.877, p < .001). At a cut-off of 10, sensitivity was 0.86, specificity 0.54, positive predictive value 0.59 and negative predictive value 0.84. CONCLUSIONS: The parent-rated MADRS-P showed similar psychometric properties as previously shown for the self-rated MADRS-S in adults. Although the MADRS-P has acceptable diagnostic accuracy for screening for MDD in adolescents in a general psychiatric setting, it cannot be used alone for diagnosing MDD.