Body dissatisfaction, maternal appraisal, and depressive symptoms in Hong Kong adolescents.

Body dissatisfaction, its risk factors and association with depressed mood have been well investigated in the West. However, more studies are needed to examine further the relation between body dissatisfaction and depressive symptoms and the factors influencing body dissatisfaction in non-Western cultures. The present study examined in a sample of Hong Kong Chinese adolescents the relation between body dissatisfaction and depressive symptoms, and the relation of maternal appraisal of their adolescent's figure to the adolescent's body dissatisfaction and depressive symptoms. We obtained information from 379 boys and 254 girls about their body dissatisfaction and depressive symptoms. Their mothers provided information about their appraisal of their adolescent's body shape and size compared to ideal. Body dissatisfaction was related to depressive symptoms in girls (B = 2.58, p <.01), but not in boys (B = -0.08, p >.10). Negative maternal appraisal did not have direct effects on adolescents' depressive symptoms (B = 0.14, p =.75), but the association between negative maternal appraisal and body dissatisfaction was significantly stronger in adolescents whose ideal was smaller than they perceived themselves to be (B = 0.32, p <.01) than those whose ideal was larger than their own perception (B = 0.14, p < .01). Our findings suggest that maternal appraisal had indirect effects on mood, acting through adolescents' body dissatisfaction, and that body dissatisfaction may be a sex-specific risk factor for depression. This study points to the need for testing and adapting programs to reduce body dissatisfaction particularly in girls at risk for depression, and to raise mothers' awareness of the link between their negative appraisals and their adolescents' body dissatisfaction and depressive symptoms.

The association between adolescents' depressive symptoms, maternal negative affect, and family relationships in Hong Kong: cross-sectional and longitudinal findings.

This study investigated the bidirectional relationships of adolescents' and maternal mood, and the moderating effect by gender and perceived family relationships on these relationships. Data were obtained from 626 adolescent-mother dyads and follow-up data were collected one year later from a subset. Adolescents reported their depressive symptoms, and their mothers reported their negative affect. Adolescents described their perception of family relationships. Maternal negative affect and adolescents' depressive symptoms were significantly correlated at baseline. This association was moderated by gender and family relationships. The association was stronger in mother-daughter compared to mother-son dyads. In families where relationships were reported to be poor, adolescent depressive symptoms were uniformly high, regardless of maternal negative affect. However, in families where relationships were good, maternal negative affect was associated with higher adolescents' depressive symptoms. In longitudinal analyses, adolescents' mood at baseline was found to relate to maternal negative affect at follow-up. Family relationships at baseline were also associated with adolescents' depressive symptoms at follow-up. However, there was no prediction from maternal negative affect at baseline to adolescents' depressive symptoms at follow-up. Gender and quality of family relationships did not moderate the longitudinal relationships between adolescents' depressive symptoms and maternal negative affect in either direction.

Factor structure of the Center for Epidemiological Studies Depression Scale in Hong Kong adolescents.

We present data from the Center for Epidemiological Studies-Depression Scale (CES-D; Radloff, 1977) for 2 samples of Hong Kong community adolescents (combined N = 1,385). The 4 positive affect items related poorly to the remainder of the scale. Using 16 items, the data were consistent with 2 models with highly correlated factors: (a) a 2-factor model, 1 of which merged somatic and affective items, and (b) a 3-factor model separating somatic, depressed, and interpersonal items. Correlations with related constructs provide preliminary support of validity. Hong Kong adolescents are influenced both by traditional concepts of mind-body holism and Western psychological models separating psychological and somatic symptoms.

Repeat suicide attempts in Hong Kong community adolescents.

It has been well documented that a history of suicide attempts confers risk for subsequent attempts; however, efforts to explain how variables may change after a previous attempt and in turn relate to future suicide attempts are rare in the literature. This study presents longitudinal data on adolescent suicide attempts in Hong Kong, and examines whether the data support the "crescendo" model to explain repeat suicide attempts. One thousand and ninety-nine community adolescents aged 12-18 years were evaluated at two assessment points 12 months apart (T1 and T2). The study assessed (1) risk factors at T1 for a suicide attempt between T1 and T2, (2) whether a suicide attempt during the 12 months prior to T1 predicted an attempt between the two assessment points, and (3) whether the indicators of distress worsened from T1 to T2 if an attempt had taken place in the interim. The results indicated that: (1) depressive symptoms, substance use, and suicidal ideation measured at T1 were independent predictors of a suicide attempt between T1 and T2; (2) suicide attempt in the year prior to T1 predicted suicide attempt between T1 and T2 after controlling for other predictors; and (3) suicide attempt between T1 and T2 was a predictive factor for a negative change from T1 to T2 in substance use, suicidal ideation, family relationships, depression, anxiety, and life stress. These findings are consistent with the "crescendo" model proposing that the risk of repeat attempts is enhanced following a previous suicide attempt.

Risk factors associated with suicide attempts and other self-injury among Hong Kong adolescents.

This study examined 1,361 Chinese adolescents who reported self-injurious behaviors. Groups A and B both acknowledged deliberate self-injury, but only Group A had made a suicide attempt. Group C reported accidental self-injury. Deliberate self-injurers (Groups A and B) were more frequently girls, older, and with more suicidal ideation. Group A had more psychopathology, environmental and suicide-related risk factors than group B and C. Group C had higher depressive symptoms than noninjured controls. The study clarifies differences among self-injurious behavior groups based on expressed deliberate self-injury and self-reported suicide attempt. These three groups appear to present a continuum of risk.

Exposure to suicide and suicidal behaviors among Hong Kong adolescents.

Suicidal behaviors (deliberate self-injury with the intent to hurt or kill oneself) have been little examined outside the West. The aims of this study were to (a) determine the correlates of suicidal behaviors, and (b) examine whether depression and suicide ideation moderated the effects of exposure to completed and attempted suicide on suicidal behaviors among a community sample of Hong Kong youth ages 12-17. Adolescents responded to questions regarding self-injurious behaviors, and also indicated presence of intention to hurt or kill themselves in the past 12 months. Based on their responses, two groups of interest were formed: 96 youths reported both self-injurious behaviors and the intent to hurt or kill themselves, and formed the "suicidal behaviors" group; and, 1213 adolescents reported neither self-injurious behaviors nor intent to hurt self or die, and formed the control group. The participants also responded to questions about depressive symptoms, anxiety, suicidal ideation and attempt, alcohol/drug use, stressful life events, and family relationships. They indicated whether anyone they knew had attempted or completed suicide in the previous 12 months. Logistic regression indicated that depressive symptoms, stressful life events, suicidal ideation and exposure to suicide attempt (but not completed suicide) contributed unique variance to the presence of suicidal behaviors, after controlling for demographic variables. Depression (and at trend levels, suicidal ideation) moderated the effect of exposure to suicide attempt by others on suicidal behaviors. Our results indicate that completed suicide in the social network increases risk for suicidal behaviors, but not when other risk factors are controlled. By contrast, a suicide attempt independently increases risk for suicidal behaviors. Furthermore, those youths who experience depressive symptoms or suicidal ideation are at particularly high risk for engaging in suicidal behaviors when an exposure to suicide attempt occurs.

Depressive symptoms among Hong Kong adolescents: relation to atypical sexual feelings and behaviors, gender dissatisfaction, pubertal timing, and family and peer relationships.

A representative community sample of Hong Kong boys (n = 1,024) and girls (n = 1,403), age 14-18 years, provided information regarding same-sex attraction, gender dissatisfaction, pubertal timing, early experience with sexual intercourse, and depressive symptoms. They also rated the quality of their family and peer relationships and self-perceived attractiveness. Depressive symptoms were higher in youths reporting same-sex attraction, gender dissatisfaction, early pubertal maturation, and early sexual intercourse. Family relationships were less satisfactory for those who reported same-sex attraction, gender dissatisfaction, and early sexual intercourse, and peer relationships were also worse for those who reported gender dissatisfaction. In multivariate analyses, same-sex attraction, early sexual intercourse, and early pubertal maturation were unique and direct contributors to depressive symptoms; however, gender dissatisfaction's association with depressive symptoms was largely accounted for by shared correlations with negative family and peer relationships. The multivariate model explained 11% of the variance of depressive symptoms. These findings offer a preliminary documentation of the prevalence and correlates of atypical sexual self-assessments and behavior among adolescents in Hong Kong. Such information is important if theories of sexual identity and risk factors for depressive symptoms are to have cross-cultural utility.