Socioeconomic inequalities in general and psychological health among adolescents: a cross-sectional study in senior high schools in Greece

<p>Abstract</p> <p>Background</p> <p>Socioeconomic health inequalities in adolescence are not consistently reported. This may be due to the measurement of self-reported general health, which probably fails to fully capture the psychological dimension of health, and the reliance on traditional socio-economic indicators, such as parental education or occupational status. The present study aimed at investigating this issue using simple questions to assess both the physical and psychological dimension of health and a broader set of socioeconomic indicators than previously used.</p> <p>Methods</p> <p>This was a cross-sectional survey of 5614 adolescents aged 16-18 years-old from 25 senior high schools in Greece. Self-reported general and psychological health were both measured by means of a simple Likert-type question. We assessed the following socio-economic variables: parents' education, parents' employment status, a subjective assessment of the financial difficulties experienced by the family and adolescents' own academic performance as a measure of the personal social position in the school setting.</p> <p>Results</p> <p>One out of ten (10%) and one out of three (32%) adolescents did not enjoy good general and psychological health respectively. For both health variables robust associations were found in adolescents who reported more financial difficulties in the family and had worse academic performance. The latter was associated with psychological health in a more linear way. Father's unemployment showed a non-significant trend for an association with worse psychological health in girls only.</p> <p>Conclusions</p> <p>Socioeconomic inequalities exist in this period of life but are more easily demonstrated with more subjective socioeconomic indicators, especially for the psychological dimension of health.</p

Explainable AI-based identification of contributing factors to the mood state change in children and adolescents with pre-existing psychiatric disorders in the context of COVID-19-related lockdowns in Greece

The COVID-19 pandemic and its accompanying restrictions have significantly impacted people’s lives globally. There is an increasing interest in examining the influence of this unprecedented situation on our mental well-being, with less attention towards the impact of the elongation of COVID-19-related measures on youth with a pre-existing psychiatric/developmental disorder. The majority of studies focus on individuals, such as students, adults, and youths, among others, with little attention being given to the elongation of COVID-19-related measures and their impact on a special group of individuals, such as children and adolescents with diagnosed developmental and psychiatric disorders. In addition, most of these studies adopt statistical methodologies to identify pair-wise relationships among factors, an approach that limits the ability to understand and interpret the impact of various factors. In response, this study aims to adopt an explainable machine learning approach to identify factors that explain the deterioration or amelioration of mood state in a youth clinical sample. The purpose of this study is to identify and interpret the impact of the greatest contributing features of mood state changes on the prediction output via an explainable machine learning pipeline. Among all the machine learning classifiers, the Random Forest model achieved the highest effectiveness, with 76% best AUC-ROC Score and 13 features. The explainability analysis showed that stress or positive changes derived from the imposing restrictions and COVID-19 pandemic are the top two factors that could affect mood state

Bullying behaviour in schools, socioeconomic position and psychiatric morbidity: a cross-sectional study in late adolescents in Greece

<p>Abstract</p> <p>Background</p> <p>Bullying is quite prevalent in the school setting and has been associated with the socioeconomic position and psychiatric morbidity of the pupils. The aim of the study was to investigate the association between bullying and socioeconomic status in a sample of Greek adolescents and to examine whether this is confounded by the presence of psychiatric morbidity, including sub-threshold forms of illness.</p> <p>Methods</p> <p>5,614 adolescents aged 16-18 years old and attending 25 senior high schools were screened and a stratified random sample of 2,427 were selected for a detailed interview. Psychiatric morbidity was assessed with a fully structured psychiatric interview, the revised Clinical Interview Schedule (CIS-R), while bullying was assessed with the revised Olweus bully/victim questionnaire. The following socio-economic variables were assessed: parental educational level and employment status, financial difficulties of the family and adolescents' school performance. The associations were investigated using multinomial logit models.</p> <p>Results</p> <p>26.4% of the pupils were involved in bullying-related behaviours at least once monthly either as victims, perpetrators or both, while more frequent involvement (at least once weekly) was reported by 4.1%. Psychiatric morbidity was associated with all types of bullying-related behaviours. No socioeconomic associations were reported for victimization. A lower school performance and unemployment of the father were significantly more likely among perpetrators, while economic inactivity of the mother was more likely in pupils who were both victims and perpetrators. These results were largely confirmed when we focused on high frequency behaviours only. In addition, being overweight increased the risk of frequent victimization.</p> <p>Conclusions</p> <p>The prevalence of bullying among Greek pupils is substantial. Perpetration was associated with some dimensions of adolescents' socioeconomic status, while victimization showed no socioeconomic associations. Our findings may add to the understanding of possible risk factors for bullying behaviours in adolescence.</p

The association between bullying and early stages of suicidal ideation in late adolescents in Greece

<p>Abstract</p> <p>Background</p> <p>Bullying in schools has been associated with suicidal ideation but the confounding effect of psychiatric morbidity has not always been taken into account. Our main aim was to test the association between bullying behavior and early stages of suicidal ideation in a sample of Greek adolescents and to examine whether this is independent of the presence of psychiatric morbidity, including sub-threshold symptoms.</p> <p>Methods</p> <p>5614 pupils 16-18 years old and attending 25 senior high schools were screened in the first phase and a stratified random sample of 2431 were selected for a detailed interview at the second phase. Psychiatric morbidity and suicidal ideation were assessed with the revised Clinical Interview Schedule (CIS-R) while bullying was assessed with the revised Olweus bully/victim questionnaire.</p> <p>Results</p> <p>Victims of bullying behavior were more likely to express suicidal ideation. This association was particularly strong for those who were bullied on a weekly basis and it was independent of the presence of psychiatric morbidity (Odds Ratio: 7.78; 95% Confidence Interval: 3.05 - 19.90). In contrast, being a perpetrator ("bullying others") was not associated with this type of ideation after adjustment. These findings were similar in both boys and girls, although the population impact of victimization in the prevalence of suicidal ideation was potentially higher for boys.</p> <p>Conclusions</p> <p>The strong cross-sectional association between frequent victimization and suicidal ideation in late adolescence offers an opportunity for identifying pupils in the school setting that are in a higher risk for exhibiting suicidal ideation.</p

Bullying escolar: um fenômeno multifacetado

School bullying can involve children in different ways, making them play different roles, among them, victims, bullies and bully-victims. The aim of this study was to describe how bullying occurs in high social vulnerability schools of Florianópolis metropolitan area and the roles played by students in this phenomenon. Overall, 409 children and adolescents from the 3rd to 5th grades and of two public elementary schools aged 8-16 years (X = 11.14) participated in this study. As a tool, the Olweus Questionnaire adapted to the Brazilian population was used. For data analysis, descriptive statistics and inferential statistics were applied by the Mann Whitney and Kruskal Wallis tests. As for results, 29.8% of boys and 40.5% of girls reported being victims; 32.3% of boys and 24.6% of girls reported being bullies. Victims were the most willing to help a colleague who is suffering from bullying (X = 1.54; p> 0.001), even if they do not know the victims (X = 1.57; p> 0.004). Bullies are differentiated from the group that does not participate (X = 1.73) and the group of victims (X = 2.34), being those who felt less alone (x = 1.47; p> 0.001). It was concluded that the information obtained in this study is indispensable in the search for alternatives to reduce school bullying. The strengthening of relations between school and students and a better preparation of teachers and school staff are extremely necessary to try to minimize the effects of risk factors to which these children are exposed and consequently violence at school.O bullying escolar pode envolver crianças de diferentes maneiras, fazendo com que essas assumam papéis diferenciados. Dentre estes, têm-se vítimas, agressores e vítimas-agressoras. O objetivo deste estudo foi descrever como ocorre o bullying em escolas de alta vulnerabilidade social da Grande Florianópolis e os papéis assumidos pelos alunos nesse fenômeno. Quanto ao método, participaram 409 crianças e adolescentes do terceiro ao quinto ano e da quarta à sexta série do ensino fundamental, de duas escolas públicas municipais, com idades entre 8 e 16 anos (X=11,14). Como instrumento, utilizou-se o Questionário de Olweus adaptado à população brasileira. Para a análise dos dados, empregaram-se a estatística descritiva e estatística inferencial por meio dos testes Mann Whitney e Kruskal Wallis. Quanto aos resultados, 29,8% dos meninos e 40,5% das meninas relataram terem sido vítimas; já 32,3% dos meninos e 24,6% das meninas relataram terem sido agressores. As vítimas foram as que se mostraram mais dispostas a ajudar como podem um colega que esteja sofrendo agressão (X=1,54; p>0,001), mesmo que não o conheçam (X=1,57; p>0,004). Em contrapartida, os agressores se diferenciaram do grupo que não participa (X=1,73) e do grupo das vítimas (X=2,34), sendo aqueles que menos se sentiram sozinhos (X=1,47; p>0,001). Concluiu-se que as informações obtidas neste estudo são indispensáveis na busca de alternativas para redução do bullying escolar. O fortalecimento das relações entre escola e alunos, e um maior preparo dos professores e funcionários são extremamente necessários para tentar minimizar os efeitos dos fatores de risco a que essas crianças estão expostas e consequentemente a violência na escola.CAPES - Proc. nº 0815/14-4CIEC - Centro de Investigação em Estudos da Criança, IE, UMinho (UI 317 da FCT)Projeto Estratégico da FCT: UID/CED/00317/201

The epidemiology of common mental disorders in adolescence

Background: The burden of mental health problems in adolescence is high. Among the various psychiatric disorders, anxiety and depression, which are often described as “common mental disorders”, emerge as a highly significant public health issue. Several studies in the past have examined the structure and characteristics of anxiety and depressive symptoms but more evidence is needed from other settings and with different methods. Depressive disorders are common in adolescents worldwide and several studies show associations with a number of sociodemographic and socioeconomic factors. Socioeconomic health inequalities are not consistently reported in adolescence. This may be due to the measurement of self-reported general health, which probably fails to fully capture the psychological dimension of health, and the reliance on traditional socio-economic indicators, such as parental education or occupational status. A further major public health issue in adolescence is suicidality, since it is one of the leading causes of mortality in youth. Suicidal ideation has been often associated with bullying but the confounding effect of psychiatric morbidity has not always been taken into account.Aims: The aim of the present dissertation was the investigation of some interesting issues in a sample of adolescents in Greece: the characteristics of common anxiety and depressive symptoms; the prevalence, comorbidity and sociodemographic and socioeconomic associations of depression and depressive symptoms, as well as the relevant health services use; the inconsistencies regarding socioeconomic health inequalities investigated through simple questions, which assess both the physical and psychological dimension of health, and a broader set of socioeconomic indicators than previously used; the association between bullying behavior and early stages of suicidal ideation and the question whether this is independent of the presence of psychiatric morbidity, including sub-threshold symptoms.Methods: The data of the present dissertation were derived from the study “The Epirus School Project”, which was a two-stage cross-sectional school study. 5,614 adolescents aged 16-18 years old and attending 25 senior high schools were screened and a stratified random sample of 2,431 were selected for a detailed interview. Psychiatric morbidity and suicidal ideation was assessed with a fully structured psychiatric interview, the revised Clinical Interview Schedule (CIS-R). The use of substances, such as alcohol, nicotine and cannabis, and several sociodemographic and socioeconomic variables have been also assessed. Βullying was assessed with the revised Olweus bully/victim questionnaire. Self-reported general and psychological health were both measured by means of a simple Likert-type question.Results: In our sample the most common symptoms were fatigue, irritability and worry. All symptoms were significantly more prevalent in female subjects, with the exception of compulsions and sleep problems. The prevalence rates of depression in youth were 5.67% for the depressive episode according to ICD-10 and 17.43% for a broader definition of depressive symptoms. 49.38% of the adolescents with depressive episode had at least one comorbid anxiety disorder. Only 17.08% of the adolescents with depression have visited a doctor due to a psychological problem during the previous year. Anxiety disorders, substance use, female gender, older age, having one sibling, and divorce or separation of the parents were all associated with depression. In addition, the presence of financial difficulties in the family was significantly associated with an increased prevalence of both depression and depressive symptoms. On the other hand, one out of ten (10%) and one out of three (32%) adolescents did not enjoy good general and psychological health respectively. For both health variables robust associations were found in adolescents who reported more financial difficulties in the family and had worse academic performance. The latter was associated with psychological health in a more linear way. Father’s unemployment showed a non-significant trend for an association with worse psychological health in girls only. Finally, victims of bullying behavior were more likely to express suicidal ideation. This association was particularly strong for those who were bullied on a weekly basis and it was independent of the presence of psychiatric morbidity. In contrast, being a perpetrator ("bullying others”) was not associated with this type of ideation after adjustment. Conclusions: Psychiatric symptoms, such as fatigue, irritability and worries, are common in Greek adolescents, especially among girls. Prevalence and comorbidity rates of depression in this population are substantial, however only a small minority of depressed adolescents seeks professional help. Significant associations between depression and financial difficulties are reported. Moreover, socioeconomic inequalities exist in this period of life but are more easily demonstrated with more subjective socioeconomic indicators, especially for the psychological dimension of health. Finally, the strong cross-sectional association between frequent victimization and suicidal ideation in late adolescence offers an opportunity for identifying pupils in the school setting that are in a higher risk for exhibiting suicidal ideation.Εισαγωγή: H εφηβεία είναι μια περίοδος με υψηλή ψυχιατρική νοσηρότητα. Μεταξύ των διαφόρων ψυχιατρικών διαταραχών ιδιαίτερη είναι η σημασία του άγχους και της κατάθλιψης, που συχνά αναφέρονται ως «κοινές ψυχιατρικές διαταραχές». Αρκετές μελέτες στο παρελθόν έχουν εξετάσει τη δομή και τα χαρακτηριστικά του άγχους και της κατάθλιψης, ωστόσο επιπλέον ενδείξεις απαιτούνται προερχόμενες από διαφορετικά πλαίσια και τη χρήση διαφορετικών μεθόδων. Οι καταθλιπτικές διαταραχές είναι συχνές στους εφήβους διεθνώς, ενώ παρουσιάζουν αρκετές συσχετίσεις με μια σειρά κοινωνικο-δημογραφικών και κοινωνικο-οικονομικών παραγόντων. Από την άλλη πλευρά, η συσχέτιση της υγείας των εφήβων με διάφορους κοινωνικοοικονομικούς δείκτες δεν αποτελεί σταθερό εύρημα των διαφόρων μελετών, με αποτέλεσμα να μην εμφανίζεται εικόνα συμφωνίας στη σχετική βιβλιογραφία. Το γεγονός αυτό μπορεί να οφείλεται στον τρόπο μέτρησης της αυτό-αναφερόμενης υγείας, ο οποίος πιθανώς δεν αντικατοπτρίζει πλήρως την ψυχολογική διάσταση της υγείας, καθώς και στη χρήση παραδοσιακών κοινωνικο-οικονομικών δεικτών, όπως η εκπαίδευση ή η επαγγελματική κατάσταση των γονέων. Επιπρόσθετα, ένα ιδιαίτερα σημαντικό ζήτημα με όρους δημόσιας υγείας στην εφηβεία είναι η αυτοκτονικότητα, δεδομένου ότι είναι μια από τις κύριες αιτίες θνησιμότητας στην ηλικία αυτή. Ο αυτοκτονικός ιδεασμός έχει συχνά συσχετιστεί με τη σχολική επιθετικότητα, αλλά η πιθανώς συγχυτική επίδραση της ψυχιατρικής νοσηρότητας στην παραπάνω συσχέτιση δεν έχει διερευνηθεί πλήρως.Στόχοι: Στόχοι της παρούσας διατριβής ήταν η διερεύνηση ορισμένων ζητημάτων με ιδιαίτερο ενδιαφέρον σε ένα δείγμα εφήβων μαθητών στην Ελλάδα, όπως: τα χαρακτηριστικά των κοινών συμπτωμάτων άγχους και κατάθλιψης; ο επιπολασμός, η συννοσηρότητα και οι κοινωνικο-δημογραφικές και κοινωνικοοικονομικές συσχετίσεις της κατάθλιψης και των καταθλιπτικών συμπτωμάτων, καθώς και η σχετιζόμενη χρήση υπηρεσιών υγείας; οι κοινωνικοοικονομικές ανισότητες υγείας στην εφηβεία μέσω της χρήσης απλών ερωτήσεων, οι οποίες θα εκτιμούν τόσο τη σωματική, όσο και την ψυχολογική διάσταση της υγείας και ενός ευρύτερου συνόλου κοινωνικοοικονομικών δεικτών και τέλος η συσχέτιση ανάμεσα στις συμπεριφορές σχολικής επιθετικότητας και τα πρώτα στάδια του αυτοκτονικού ιδεασμού και το ερώτημα, εάν αυτή είναι ανεξάρτητη από την παρουσία ψυχιατρικής νοσηρότητας, συμπεριλαμβανομένων των υπο-ουδικών συμπτωμάτων.Μέθοδοι: Τα δεδομένα της παρούσας διατριβής αντλήθηκαν από τη σχολική μελέτη «The Epirus School Project», η οποία ήταν μια δισταδιακή συγχρονική μελέτη. Στην πρώτη φάση της μελέτης συμμετείχαν 5,614 έφηβοι ηλικίας 16-18 ετών, που φοιτούσαν σε 25 Γενικά Λύκεια, στους οποίους χορηγήθηκαν εργαλεία ανίχνευσης. Μέσω μιας διαδικασίας τυχαίας στρωματοποιημένης δειγματοληψίας προέκυψε ένα δείγμα 2,431 εφήβων, στους οποίους χορηγήθηκε στη δεύτερη φάση της μελέτης μια λεπτομερής ψυχιατρική συνέντευξη. Η ψυχιατρική νοσηρότητα και ο αυτοκτονικός ιδεασμός εκτιμήθηκαν μέσω της πλήρως δομημένης ψυχιατρικής συνέντευξης Clinical Interview Schedule – Revised (CIS-R). Επιπρόσθετα, αντλήθηκαν δεδομένα σε σχέση με διάφορες κοινωνικοδημογραφικές και κοινωνικοοικονομικές μεταβλητές, καθώς και τη χρήση ουσιών, όπως το αλκοόλ, η νικοτίνη και η κάνναβη. Η σχολική επιθετικότητα εκτιμήθηκε με βάση το ερωτηματολόγιο «Revised Olweus bully/victim questionnaire». Η αυτό-αναφερόμενη γενική και ψυχολογική υγεία μετρήθηκαν μέσω μιας απλής ερώτησης τύπου Likert.Αποτελέσματα: Στο δείγμα μας τα πιο κοινά συμπτώματα ήταν η κόπωση, η ευερεθιστότητα και οι ανησυχίες για διάφορα καθημερινά πράγματα. Όλα τα συμπτώματα ήταν στατιστικά σημαντικά συχνότερα στα κορίτσια, με την εξαίρεση των καταναγκασμών και των δυσκολιών ύπνου. Όσον αφορά στις καταθλιπτικές διαταραχές των εφήβων, ο επιπολασμός τους ήταν 5,67% για το καταθλιπτικό επεισόδιο κατά ICD-10 και 17,43% για τα καταθλιπτικά συμπτώματα με έναν ευρύτερο ορισμό. 49.38% των εφήβων με καταθλιπτικό επεισόδιο είχαν τουλάχιστον μία συννοσηρή αγχώδη διαταραχή. Μόνο 17,08% των εφήβων με κατάθλιψη είχαν επισκεφθεί ιατρό λόγω της ψυχολογικής τους κατάστασης κατά τη διάρκεια του προηγούμενου έτους. Οι αγχώδεις διαταραχές, η χρήση ουσιών, το γυναικείο φύλο, η μεγαλύτερη ηλικία, η ύπαρξη ενός αδελφού στην οικογένεια και το διαζύγιο ή ο χωρισμός των γονέων συσχετίστηκαν με την κατάθλιψη. Επιπλέον, η παρουσία οικονομικών δυσκολιών στην οικογένεια συσχετίστηκε σημαντικά με αυξημένη συχνότητα κατάθλιψης και καταθλιπτικών συμπτωμάτων. Από την άλλη πλευρά, ένας στους δέκα (10%) και ένας στους τρεις (32%) εφήβους ανέφεραν ότι δεν απολαμβάνουν καλή γενική και ψυχολογική υγεία αντίστοιχα. Σταθερές συσχετίσεις αναδείχθηκαν και για τις δύο μεταβλητές υγείας με την ύπαρξη αρκετών οικονομικών δυσκολιών στην οικογένεια και τη χειρότερη ακαδημαϊκή επίδοση του εφήβου στο σχολείο. Η τελευταία μεταβλητή συσχετίστηκε με την ψυχολογική υγεία με ένα περισσότερο γραμμικό τρόπο. Επίσης, παρουσιάστηκε μια μη στατιστικά σημαντική τάση για συσχέτιση ανάμεσα στην ανεργία του πατέρα και τη χειρότερη ψυχολογική υγεία, μόνο για τα κορίτσια του δείγματός μας. Τέλος, όσον αφορά στη διερεύνηση της σχέσης ανάμεσα στον αυτοκτονικό ιδεασμό και τη σχολική επιθετικότητα, τα θύματα σχολικής επιθετικότητα ήταν πιο πιθανό να εκφράσουν αυτοκτονικό ιδεασμό. Η συσχέτιση αυτή ήταν ιδιαίτερα ισχυρή για τα θύματα συχνών τέτοιων συμπεριφορών (εβδομαδιαία βάση) και ήταν ανεξάρτητη από την παρουσία ψυχιατρικής νοσηρότητας. Αντίθετα, η συμπεριφορά θύτη δεν συσχετίστηκε με τον αυτοκτονικό ιδεασμό μετά τη στάθμιση για την ψυχιατρική νοσηρότητα. Συμπεράσματα: Τα κοινά ψυχιατρικά συμπτώματα είναι συχνά στον πληθυσμό των εφήβων, ιδιαίτερα μεταξύ των κοριτσιών. Η συχνότητα και η συννοσηρότητα της κατάθλιψης είναι υψηλές στον πληθυσμό αυτό, ενώ σημαντικές συσχετίσεις αναδεικνύονται ανάμεσα στην κατάθλιψη και τις οικονομικές δυσκολίες. Ωστόσο, μόνο μια μικρή μειοψηφία των καταθλιπτικών εφήβων αναζητούν εξειδικευμένη βοήθεια. Συγχρόνως, κοινωνικοοικονομικές ανισότητες υγείας υπάρχουν σε αυτήν την περίοδο της ζωής, αλλά αναδεικνύονται πιο εύκολα με πιο υποκειμενικούς κοινωνικοοικονομικούς δείκτες, ιδιαίτερα για την ψυχολογική διάσταση της υγείας. Τέλος, η ισχυρή συγχρονική συσχέτιση ανάμεσα στον αυτοκτονικό ιδεασμό και τη συχνή θυματοποίηση στην ύστερη εφηβεία παρέχει μια δυνατότητα αναγνώρισης μαθητών στο πλαίσιο του σχολείου, οι οποίοι βρίσκονται σε υψηλότερο κίνδυνο για αυτοκτονικό ιδεασμό

Depression in late adolescence: a cross-sectional study in senior high schools in Greece

Background: Depression is a common mental health problem in adolescents worldwide. The aim of the present study was to investigate the prevalence, comorbidity and sociodemographic and socioeconomic associations of depression and depressive symptoms, as well as the relevant health services use in a sample of adolescents in Greece. Methods: Five thousand six hundred fourteen adolescents aged 16-18 years old and attending 25 senior high schools were screened and a stratified random sample of 2,427 were selected for a detailed interview. Psychiatric morbidity was assessed with a fully structured psychiatric interview, the revised Clinical Interview Schedule (CIS-R). The use of substances, such as alcohol, nicotine and cannabis, and several sociodemographic and socioeconomic variables have been also assessed. Results: In our sample the prevalence rates were 5.67 % for the depressive episode according to ICD-10 and 17.43 % for a broader definition of depressive symptoms. 49.38 % of the adolescents with depressive episode had at least one comorbid anxiety disorder [OR: 7.76 (5.52-10.92)]. Only 17.08 % of the adolescents with depression have visited a doctor due to a psychological problem during the previous year. Anxiety disorders, substance use, female gender, older age, having one sibling, and divorce or separation of the parents were all associated with depression. In addition, the presence of financial difficulties in the family was significantly associated with an increased prevalence of both depression and depressive symptoms. Conclusions: Prevalence and comorbidity rates of depression among Greek adolescents are substantial. Only a small minority of depressed adolescents seek professional help. Significant associations with financial difficulties are reported