Low Sense of Coherence (SOC) is a mirror of general anxiety and persistent depressive symptoms in adolescent girls - a cross-sectional study of a clinical and a non-clinical cohort

<p>Abstract</p> <p>Background</p> <p>The Sense of Coherence (SOC) scale is assumed to measure a distinct salutogenic construct separated from measures of anxiety and depression. Our aim was to challenge this concept.</p> <p>Methods</p> <p>The SOC-scale, Beck's Depression Inventory (BDI), Beck's Anxiety Inventory (BAI) , the emotional subscale of the Strengths and Difficulties Questionnaire (SDQ-em) and self-assessed health-related and physiological parameters were collected from a sample of non-clinical adolescent females (n = 66, mean age 16.5 years with a range of 15.9-17.7 years) and from female psychiatric patients (n = 73), mean age 16.8 years with a range of 14.5-18.4 years), with diagnoses of major depressive disorders (MDD) and anxiety disorders.</p> <p>Results</p> <p>The SOC scores showed high inverse correlations to BDI, BAI and SDQ-em. In the non-clinical sample the correlation coefficient was -0.86 to -0.73 and in the clinical samples -0.74 to -0.53 (p < 0.001). Multiple regression models showed that BDI was the strongest predictor of SOC in the non-clinical (beta coefficient -0.47) and clinical sample (beta coefficient -0.52). The total degree of explanation of self assessed anxiety and depression on the SOC variance estimated by multiple R²= 0.74, adjusted R²= 0.73 in the non-clinical sample and multiple R²= 0.66, adjusted R²= 0.65 in the clinical sample.</p> <p>Multivariate analyses failed to isolate SOC as a separate construct and the SOC-scale, BDI, BAI and SDQ-em showed similar patterns of correlations to self-reported and physiological health parameters in both samples. The SOC-scale was the most stable measure over six months.</p> <p>Conclusions</p> <p>The SOC-scale did not appear to be a measure of a distinct salutogenic construct, but an inverse measure of persistent depressive symptoms and generalized social anxiety similar to the diagnostic criteria for major depressive disorder (MDD), dysthymic disorder, generalized anxiety disorder (GAD) or generalized social anxiety disorder (SAD) according to DSM-IV. These symptoms were better captured with SOC than by the specialized scales for anxiety and depression. Self-assessment scales that adequately identify MDD, dysthymic disorder, GAD and SAD need to be implemented. Comorbidity of these disorders is common in adolescent females and corresponds to a more severe symptomatology and impaired global function.</p

Latent Classes of Symptoms related to Clinically Depressed Mood in Adolescents

The diagnosis of major depressive disorder (MDD), according to the Diagnostic and Statistical Manual of Mental Disorders, is based only on adult symptomatology of depression and not adapted for age and gender. This may contribute to the low diagnostic specificity and validity of adolescent MDD. In this study, we investigated whether latent classes based on symptoms associated with depressed mood could be identified in a sample of adolescents seeking psychiatric care, regardless of traditionally defined diagnostic categories.Self-reports of the Strengths and Difficulties Questionnaire and the Development and Well-Being Assessment were collected consecutively from all new patients between the ages of 13 and 17 years at two psychiatric outpatient clinics in Stockholm, Sweden. Those who reported depressed mood at intake yielded a sample of 21 boys and 156 girls. Latent class analyses were performed for all screening items and for the depression-specific items of the Development and Well-Being Assessment.The symptoms that were reported in association with depressed mood differentiated the adolescents into two classes. One class had moderate emotional severity scores on the Strengths and Difficulties Questionnaire and mainly symptoms that were congruent with the Diagnostic and Statistical Manual of Mental Disorders criteria for MDD. The other class had higher emotional severity scores and similar symptoms to those reported in the first class. However, in addition, this group demonstrated more diverse symptomatology, including vegetative symptoms, suicidal ideation, anxiety, conduct problems, body dysmorphic symptoms, and deliberate vomiting. The classes predicted functional impairment in that the members of the second class showed more functional impairment.The relatively small sample size limited the generalizability of the results of this study, and the amount of items included in the analysis was restricted by the rules of latent class analysis. No conclusions about gender differences between the classes could be could be drawn as a result of the low number of boys included in the study.Two distinct classes were identified among adolescents with depressed mood. The class with highest emotional symptom severity score and the most functional impairment had a more diverse symptomatology that included symptoms that were not congruent with the traditional diagnostic criteria of MDD. However, this additional symptomatology is clinically important to consider. As a result, the clinical usefulness of the Diagnostic and Statistical Manual of Mental Disorders during the diagnostic process of adolescent depression is questioned

Anxiety and depression in adolescent females : Autonomic regulation and differentiation

The prevalence of anxiety and depression is on the increase in adolescent girls, as estimated by self-assessed symptom reports. There is a need for implementation of validated instruments to identify those in need of treatment. The concept of autonomic self-regulation may help us to elucidate possible pathophysiological pathways of anxiety disorders and depression. Heart rate variability (HRV) provides a tool to assess the descending vagal inhibitory tone, i.e. the capacity of autonomic self-regulation. This perspective gives a framework for evaluating practices of allostatic competence as possible methods for preventing and treating of anxiety disorders and depression in adolescent girls. The present work is intended to create a platform for future studies aimed in this direction. Study I demonstrated that autonomic regulation measured by HRV is decreased in adolescent female psychiatric patients with anxiety disorders and/or major depressive disorder (MDD) compared to healthy controls, which was partly explained by selective serotonin reuptake inhibitor (SSRI) medication, but not by lack of physical activity or cardiovascular risk factors. It thus seemed as if depressive and anxious symptoms contributed to impaired vagal inhibitory control in adolescent girls. Study II investigated whether lifestyle factors, that are accessible for intervention, are related to HRV in healthy adolescents and conclude that physical activity, but not eating habits, sleep pattern or smoking, was related to HRV, without contribution from gender, systolic blood pressure, plasma-glucose, body mass index or socio-demographic factors. The data provides a basis for future studies of interventional design. Study III showed that the emotional subscale of Strengths and Difficulties Questionnaire (SDQ-em) and the putative salutogenic scale of Sense of Coherence (SOC) were equivalent or even superior to the specialized self-assessment scales for anxiety and depression in their ability to differentiate cases of anxiety disorders and major depressive disorder from non-cases in adolescent girls. The study thus supports the accuracy of SDQ-em as a screening instrument for anxiety and depression and as a tool to discriminate between caseness and non-caseness of emotional disorders in adolescent girls. Study IV was an in depth investigation of the construct of Sense of Coherence (SOC) applied in adolescent girls, showing that it lacks a unique dimensionality as a salutogenic construct, but constitutes a sensitive inverse measure of persistent depressive and generalized anxiety problems similar to diagnoses such as major depressive disorder (MDD), dysthymic disorder (DD), generalized anxiety disorder (GAD) or generalized social anxiety disorder (SAD) according to DSM-IV. It was also demonstrated that a low SOC score was correlated to a decrease in HRV

Translation and validation of the Swedish version of the Self-Compassion Scale for Youth

Objective: Compassion-focused interventions for young people have started to emerge to treat depressive symptoms, and reliable and valid measures of the construct “self-compassion” is needed for this age-group in Swedish. This study aims to validate the Swedish translation of the Self-Compassion Scale for Youth (SCS-Y). Method: Self-report questionnaires were collected from students (N = 316) aged 15–20 recruited from schools in Sweden, in a cross-sectional design. Confirmatory factor analyses, internal consistency, test-retest reliability, measurement invariance and convergent and divergent validity were calculated. Results: A model with one general bi-factor and six specific factors had the best fit and confirmed the factor structure of SCS-Y. Internal consistencies were good, except for the subscale mindfulness for boys which was questionable. Three-week test-retest reliability was good. We found measurement invariance for age and no equivalence for sex. Evidence was found for convergent and divergent validity using correlations. Sex differences were found: girls scored higher on self-judgement, feelings of isolation and showed more over-identification, than boys. Conclusions: The Swedish version of SCS-Y (SCS-Y-SE) is a reliable and valid self-report questionnaire, with some limitations, to assess self-compassion in clinical practice and research

Psychometric properties of the Swedish version of the Reynolds Adolescent Depression Scale second edition (RADS-2) in a clinical sample

Objective: Observed and predicted increases in the global burden of disease caused by major depressive disorder (MDD) highlight the need for psychometrically robust multi-dimensional measures to use for clinical and research purposes. Reynolds Adolescent Depression Scale second edition (RADS-2) is an internationally well-validated scale measuring different dimensions of adolescent depression. The Swedish version has previously only been evaluated in a normative sample. Methods: We collected data from patients in child and adolescent psychiatry and primary care and performed: (1) Confirmatory factor analysis (CFA) to evaluate the established four-factor structure, (2) Analyses of reliability and measurement invariance, (3) Analyses of convergent and discriminant validity using the Montgomery–Asberg Depression Rating Scale, the depression subscales of the Beck Youth Inventories and the Revised Child Anxiety and Depression Scale, as well as the Patient Reported Outcome Measurements Information System, peer-relationships and physical activity item banks. Results: Recruited participants (n = 536, 129 male and 407 female, mean age 16.45 years, SD = 2.47, range 12 − 22 years) had a variety of psychiatric diagnoses. We found support for the four-factor structure and acceptable to good reliability for the subscale and total scores. Convergent and discriminant validity were good. Measurement invariance was demonstrated for age, sex, and between the present sample and a previously published normative sample. The RADS-2-scores were significantly higher in the present sample than in the normative sample. In this clinical study, the Swedish RADS-2 demonstrated good validity and acceptable to good reliability. Our findings support the use of RADS-2 in Swedish clinical and research contexts

Screening for depressed mood in an adolescent psychiatric context by brief self-assessment scales -- testing psychometric validity of WHO-5 and BDI-6 indices by latent trait analyses

BACKGROUND: Major depressive disorder is prevalent in the adolescent psychiatric clinical setting and often comorbid with other primary psychiatric diagnoses such as ADHD or social anxiety disorder. Systematic manual-based diagnostic procedures are recommended to identify such comorbidity but they are time-consuming and often not fully implemented in clinical practice. Screening for depressive symptoms in the child psychiatric context using brief, user-friendly and easily managed self-assessment scales may be of clinical value and utility. The aim of the study is to test the psychometric validity of two such scales, which may be used in a two-step screening procedure, the WHO-Five Well-being Index (WHO-5) and the six-item version of Beck’s Depression Inventory (BDI-6). METHOD: 66 adolescent psychiatric patients with a clinical diagnosis of major depressive disorder (MDD), 60 girls and 6 boys, aged 14–18 years, mean age 16.8 years, completed the WHO-5 scale as well as the BDI-6. Statistical validity was tested by Mokken and Rasch analyses. RESULTS: The correlation between WHO-5 and BDI-6 was −0.49 (p=0.0001). Mokken analyses showed a coefficient of homogeneity for the WHO-5 of 0.52 and for the BDI-6 of 0.46. Rasch analysis also accepted unidimensionality when testing males versus females (p > 0.05). CONCLUSIONS: The WHO-5 is psychometrically valid in an adolescent psychiatric context including both genders to assess the wellness dimension and applicable as a first step in screening for MDD. The BDI-6 may be recommended as a second step in the screening procedure, since it is statistically valid and has the ability to unidimensionally capture the severity of depressed mood

Increase of internalized mental health symptoms among adolescents during the last three decades

Background: Previous studies suggest an overall increase of adolescent mental health symptoms globally since the 1980s until today, especially an increase of internalizing symptoms in girls. Due to methodological limitations of these studies, further studies are warranted to obtain a more solid knowledgebase. Methods: This study was cross-sectional and compared two separate but geographically identical groups of adolescents in a middle-sized industrial municipality in Northern Sweden at two time-points [(i) 1981, n = 1083, (505 girls, 577 boys), response rate 99.7%; (ii) 2014, n = 682, (338 girls, 344 boys), response rate 98.3%]. All students in their last year of compulsory school were included. The same self-report questionnaire, consisting of four sub-scales (functional somatic-, anxiety-, depressive symptoms and conduct problems), was used at both occasions. Data were analyzed with descriptive statistics, two-way ANOVA and general linear model. Results: Symptoms of anxiety and depression and functional somatic symptoms, increased among both boys and girls from 1981 until 2014 (P &lt; 0.001 for all subscales), and the increase of these symptoms was higher in girls. Conduct problems were significantly higher in boys in 1981 and decreased over time so that in 2014 there was no longer a significant difference between boys and girls regarding conduct problems (P = 0.286). Conclusion: In this population-based study spanning over 30 years, both girls and boys showed increasing internalizing problems, while conduct problems decreased. To halt this trend, we need a deeper understanding of the impact of the major societal changes that have occurred during the last three decades