Biomedical subjects

J R Seeley

Publications and source records attributed to J R Seeley.

At least 55 records · Page 3Linked to original sources

PubMed1996

Cross-sectional and prospective relationships between physical morbidity and depression in older adolescents.

OBJECTIVE: To examine cross-sectional and prospective associations between major depressive disorder (MDD), physical morbidity (disease and injury), health-related reductions in activities, and functional impairment in adolescents. METHOD: Data on depression and health-related variables were available for a sample of 1,410 adolescents (aged 14 to 18 years) at point of entry into the study and approximately 1 year later. RESULTS: Girls were more likely to have been treated for a disease and to have a health-related reduction in activities, whereas boys were more likely to have been treated for an injury. The expected cross-sectional associations were found between disease, reductions in activities, functional impairment, and depression, but the association between injury and depression was not significant. Prospective analyses suggest that functional impairment and disease are risk factors for future MDD and that MDD is a risk factor for future functional impairment and disease. CONCLUSIONS: The robust prospective associations between MDD and functional impairment suggest that the impact of disease on depression is particularly strong when it disrupts important behavior patterns. Clinically, the results emphasize the importance of assessing health-related variables in depressed adolescents and of assessing depression in those with functional impairment or disease.

Adolescent↗

PubMed1996

Cigarette smoking, major depression, and other psychiatric disorders among adolescents.

OBJECTIVE: To examine cross-sectionally and prospectively relationships of cigarette smoking with major depressive disorder (MDD), controlling for comorbidity in a community sample of adolescents. METHOD: A representative sample of 1,709 adolescents (aged 14 through 18 years) was assessed by using semistructured diagnostic interviews on two occasions, approximately 1 year apart. Logistic regression analyses were used to examine cross-sectionally and prospectively the relationships between smoking and each psychiatric disorder, while statistically controlling for the other disorders. RESULTS: Cross-sectional analyses revealed significant relationships of drug abuse/dependence and disruptive behavior disorders with adolescent smoking, even after the co-occurrence of all other disorders was controlled. Prospectively, smoking was found to increase the risk of developing an episode of MDD and drug abuse/dependence, after adjusting for other disorders. Finally, only lifetime prevalence of MDD remained a significant predictor of smoking onset, after controlling for other disorders. Gender did not moderate any of the relationships between psychopathology and smoking. CONCLUSIONS: The results suggest important relationships between cigarette smoking and psychiatric disorders among adolescents, particularly with regard to MDD, drug abuse/dependence, and disruptive behavior disorders. These findings have important clinical implications, both for psychiatric care and for smoking prevention and cessation efforts with adolescents.

Adolescent↗

PubMed1996

The Life Attitudes Schedule Short Form: an abbreviated measure of life-enhancing and life-threatening behaviors in adolescents.

An abbreviated version of the Life Attitudes Schedule (LAS) was developed, consisting of 24 items, each representing one cell of the original LAS theoretical matrix (4 content categories x 2 behavior types x 2 valence). Items were retained on the basis of high correlations with LAS total score and low correlations with gender. Psychometric properties of the LAS Short Form were robust and the Short Form total score correlated .93 with the original LAS total score. As with the original LAS, boys reported more injury-related behaviors than girls. Future research and clinical directions are suggested.

Adolescent↗

PubMed1995

Symptoms versus a diagnosis of depression: differences in psychosocial functioning.

In studies of clinical depression, individuals who demonstrate elevated levels of symptoms but do not meet interview-based diagnostic criteria are typically labeled as false positive and eliminated from further consideration. However, the implicit assumption that false-positive participants differ in important ways from true-positive (i.e., diagnosed) participants has not been tested systematically. This study compared the functioning of true-positive, false-positive, and true-negative adolescents on clinical and psychosocial functioning. Although the false-positive participants manifested higher levels of current and future psychopathology than did the true-negative participants, they did not differ significantly from the true-positive participants on most of the measures of psychosocial dysfunction. "False positive," therefore, is not a benign condition.

Adolescent↗

PubMed1995

Targeted prevention of unipolar depressive disorder in an at-risk sample of high school adolescents: a randomized trial of a group cognitive intervention.

OBJECTIVES: This investigation attempted to prevent unipolar depressive episodes in a sample of high school adolescents with an elevated risk of depressive disorder. METHOD: Adolescents at risk for future depressive disorder by virtue of having elevated depressive symptomatology were selected with a two-stage case-finding procedure. The Center for Epidemiologic Studies-Depression Scale (CES-D) was administered to 1,652 students; adolescents with elevated CES-D scores were interviewed with the Schedule for Affective Disorders and Schizophrenia for School-Age Children. Subjects with current affective diagnoses were referred to nonexperimental services. The remaining 150 consenting subjects were considered at risk for future depression and randomized to either a 15-session cognitive group prevention intervention or an "usual care" control condition. Subjects were reassessed for DSM-III-R diagnostic status after the intervention and at 6- and 12-month follow-up points. RESULTS: Survival analyses indicated a significant 12-month advantage for the prevention program, with affective disorder total incidence rates of 14.5% for the active intervention, versus 25.7% for the control condition. No differences were detected for nonaffective disorders across the study period. CONCLUSION: Depressive disorder can be successfully prevented among adolescents with an elevated future risk.

Adaptation, Psychological↗

PubMed1995

Adolescent psychopathology: III. The clinical consequences of comorbidity.

OBJECTIVE: To describe the clinical consequences associated with the lifetime occurrence of comorbid psychiatric disorders. METHOD: In a community sample of 1,507 older adolescents (aged 14 through 18 years), subjects with "pure" and comorbid forms of four major psychiatric disorders (depression, anxiety, substance use, and disruptive behavior) were compared on six clinical outcome measures. RESULTS: The impact of comorbidity was strongest for academic problems, mental health treatment utilization, and past suicide attempts; intermediate on measures of role functioning and conflict with parents; and nonsignificant on physical symptoms. The greatest incremental impact of comorbidity was on anxiety disorders; the least was on substance use disorders. Although some patterns of comorbidity were much more common in boys (e.g., substance use and disruptive behavior disorder) or in girls (e.g., depression and anxiety), the impact of specific comorbid disorders on the clinical measures was not different for females and males. The effect of comorbidity was not due to current psychopathology. CONCLUSIONS: The significance of comorbidity differs across specific comorbid disorders and across outcome measures, with some comorbid disorders being much more detrimental, and some outcome measures much more affected, than others.

Adolescent↗

PubMed1995

Adolescent psychopathology: IV. Specificity of psychosocial risk factors for depression and substance abuse in older adolescents.

OBJECTIVE: To determine the specificity to major depressive disorder (MDD) of a wide array of psychosocial risk factors in older adolescents (aged 14 through 18 years). METHOD: Diagnostic and psychosocial assessments were conducted with 1,507 randomly selected high school students at T1 and after approximately 1 year (T2). Three diagnostic groups were compared: those who had an episode of MDD during that year (n = 90), those who had an episode of substance use disorder during that year (SUD) (n = 42), and a control group with no disorder (n = 1,189). RESULTS: Risk factors specific to MDD were stress (minor and major events), emotional reliance, physical symptoms and disease, history of suicide attempt, and a past episode of depression or anxiety disorder. Risk factors specific to SUD were tobacco use, academic difficulties, and a past episode of SUD. Risk factors that were shared were current depression symptoms, internalizing and externalizing behavior problems, coping skills, interpersonal conflict with parents, and dissatisfaction with grades. CONCLUSIONS: By determining the number of risk factors for MDD, for SUD, or those that are general to both disorders, clinicians can make informed predictions concerning the probable future onset of a full-fledged episode of MDD and/or SUD in individual cases. The results of this study allow for the identification of adolescents who are at elevated risk for MDD and SUD. The results also have implications for the design of interventions aimed at preventing the occurrence of these disorders. Such interventions should target change on risk factors of the type identified in this study.

Achievement↗

PubMed1995

Continuity of psychopathology in a community sample of adolescents.

OBJECTIVE: To examine the continuity between the primary (first) diagnosis and secondary (second) diagnosis of those adolescents who have more than one episode of psychiatric disorder. Data were examined to determine whether the second episode "breeds true" (i.e., remains within the same diagnostic category as the first) or involves a different disorder. METHOD: The sample consisted of 236 youngsters selected from the larger (n = 1,507) population of adolescents (aged 14 through 18 years) from the Oregon Adolescent Depression Project who had been assessed on two occasions, approximately 1 year apart. RESULTS: Results support the continuity hypothesis for the categories of disorder studied (major depression, anxiety, disruptive, substance use), with the exception of dysthymia. Primary dysthymia did not result in the diagnosis of secondary dysthymia, because most adolescents who had dysthymia had not recovered within the time frame of the study and were chronic cases, often with secondary anxiety. Also presented are data on age of onset of disorder (lowest for anxiety and highest for substance use) and information on remission intervals between episodes (well time) (lowest for substance use and highest for anxiety). CONCLUSIONS: The findings are interpreted as providing support for the "breed true" hypothesis, although clearly not all second episodes are identical with the first. While the psychosocial factors examined did not predict the nature of the second disorder, this clearly needs further study.

Adolescent↗

PubMed1995

Symptoms of DSM-III-R major depression in adolescence: evidence from an epidemiological survey.

OBJECTIVE: To examine the phenomenology of DSM-III-R major depression among adolescents diagnosed as "cases" in a community-based epidemiology study. METHOD: A representative sample (N = 1,710) of older adolescents from several Oregon communities were interviewed using structured diagnostic schedules and DSM-III-R criteria in two annual assessments. Although the focus was depression, diagnoses were made for most child and adolescent psychiatric disorders. RESULTS: Nearly 30% of the sample at baseline had at least one current symptom of DSM-III-R major depression, but only 2.6% received a diagnosis. The most prevalent symptoms at baseline were depressed mood, sleep, and thinking problems. For new, or incident cases, the most frequent symptoms involved depressed mood, anhedonia, and thinking problems. Among those adolescents who had experienced two episodes of major depression, there was low concordance across episodes for both diagnostic criteria and specific symptoms. Comparisons with six studies of adolescent patients indicate our community "cases" are phenomenologically very similar to clinical cases of major depression in treatment settings. CONCLUSIONS: The results presented, along with those from other studies of adults and children, provide strong evidence that DSM criteria for major depression are appropriate for adolescents. That is, DSM-III-R symptom criteria are manifested by both youths and adults, although the relative frequency of these criterion symptoms appear to be age-related.

Adolescent↗

PubMed1995

Bipolar disorders in a community sample of older adolescents: prevalence, phenomenology, comorbidity, and course.

OBJECTIVE: The purpose of this study was to examine the prevalence, clinical characteristics, and mental health treatment services utilization of adolescents with bipolar disorders and manic symptoms. METHODS: Structured diagnostic interviews were administered to a representative community sample of 1,709 older adolescents (aged 14 through 18 years). RESULTS: The lifetime prevalence of bipolar disorders (primarily bipolar II disorder and cyclothymia) was approximately 1%. An additional 5.7% of the sample reported having experienced a distinct period of abnormally and persistently elevated, expansive, or irritable mood even though they never met criteria for bipolar disorder ("core positive" subjects). The rate of manic symptoms in these subjects was similar to that reported in clinical samples, and the course of bipolar disorder was relatively chronic. Compared with adolescents with a history of major depression (n = 316) and a "never mentally ill" group (n = 845), the bipolar and core positive subjects both exhibited significant functional impairment and high rates of comorbidity (particularly with anxiety and disruptive behavior disorders), suicide attempts, and mental health services utilization. CONCLUSIONS: These data highlight the clinical and public health significance of even the milder and subthreshold cases of bipolar disorder in adolescence.

Adolescent↗

PubMed1995

The life attitudes schedule: a scale to assess adolescent life-enhancing and life-threatening behaviors.

The purpose of this study was to develop a questionnaire to measure suicidal and other risk-taking behaviors, the Life Attitudes Schedule (LAS), and to test a theoretical model that postulates a single domain of behaviors to which all life-threatening and life-enhancing behaviors belong. The LAS was developed and piloted on 1539 high school students and young adults. The schedule measures four different content categories: death related, health related, injury related, and self-related. Each content category includes an equal number of items designed to assess actions, thoughts, and feelings. Consistent with the theoretical model, the LAS includes positive (life-enhancing) and negative (life-threatening) behaviors. In this paper we present psychometric information for the LAS. The results are interpreted as providing support for a broad, bipolar conceptualization of suicidal and other risk-taking behavior that encompasses life-threatening and life-enhancing behaviors.

Adolescent↗

PubMed1994

Adolescent psychopathology: II. Psychosocial risk factors for depression.

In a prospective study of adolescent depression, adolescents (N = 1,508) were assessed at Time 1 and after 1 year (Time 2) on psychosocial variables hypothesized to be associated with depression. Most psychosocial variables were associated with current (n = 45) depression. Formerly depressed adolescents (n = 217) continued to differ from never depressed controls on many of the psychosocial variables. Many of the depression-related measures also acted as risk factors for future depression (n = 112), especially past depression, current other mental disorders, past suicide attempt, internalizing behavior problems, and physical symptoms. Young women were more likely to be, to become, and to have been depressed. Controlling for the psychosocial variables eliminated the gender difference for current and future but not for past depression.

Adolescent↗

PubMed1994

Psychosocial risk factors for future adolescent suicide attempts.

An array of psychosocial risk factors for making a suicide attempt were examined in a representative sample of 1,508 older (14- to 18-year-old) high school students, 26 of whom made a suicide attempt during the year following entry into the study. Strongest predictors of future suicide attempt were history of past attempt, current suicidal ideation and depression, recent attempt by a friend, low self-esteem, and having been born to a teenage mother. The results suggest that adolescents who are depressed and those who attempt suicide share many psychosocial risk factors. The efficacy of two screeners (one consisting of 4 items and the other of 6 variables) is reported. Potential usefulness for research and communitywide prevention is discussed.

Adolescent↗

PubMed1994

Response of depressed adolescents to cognitive-behavioral treatment: do differences in initial severity clarify the comparison of treatments?

This study evaluated the impact of pretreatment depression severity and functional impairment on the response of 2 samples of older depressed adolescents to 2 group cognitive-behavioral treatments. Differences between the 2 active treatments and between active treatment and a waiting-list control condition were expected to be greater in the more severely depressed-impaired group. Variables assessing severity and impairment appeared to be best conceptualized as measures of a single factor. Improvement for the 2 active treatments in comparison to the control condition was greater in the more severely depressed group in one of the samples but not the other. The prediction that the relative effectiveness of the 2 treatments would be accentuated in the more severely depressed adolescents received no support in either sample. Implications of these findings for future psychotherapy research are discussed.

Adolescent↗

PubMed1993

Age-cohort changes in the lifetime occurrence of depression and other mental disorders.

Data from three samples of adults (Ns = 571, 472, and 989) and a sample of adolescents (N = 1,710) supported the possibility that the prevalence of major depression has been increasing in recent birth cohorts, a phenomenon labeled the age-cohort effect (ACE). A significant ACE for relapse was also found in 1 of the adult samples. In addition, early onset age in the adults (prior to age 25) tended to be associated with relapse. Adults in recent birth cohorts were also found to show an elevated prevalence of other disorders. We examined the power of 4 variables (current mood state, social desirability response bias, labeling, and time interval between the episode and the diagnostic interview) to produce these results without an actual increase in the rate of mental disorder. With 1 exception (labeling), the variables were significantly associated with reports of past episodes of disorder and with birth cohort. Controlling for their influence, however, did not reduce the ACE.

Adolescent↗

PubMed1993

Adolescent psychopathology: I. Prevalence and incidence of depression and other DSM-III-R disorders in high school students.

Data were collected on the point and lifetime prevalences, 1-year incidence, and comorbidity of depression with other disorders (Diagnostic and Statistical Manual of Mental Disorders [3rd ed., rev.]) in a randomly selected sample (n = 1,710) of high school students at point of entry and at 1-year follow-up (n = 1,508). The Schedule for Affective Disorders and Schizophrenia for School-Age Children was used to collect diagnostic information; 9.6% met criteria for a current disorder, more than 33% had experienced a disorder over their lifetimes, and 31.7% of the latter had experienced a second disorder. High relapse rates were found for all disorders, especially for unipolar depression (18.4%) and substance use (15.0%). Female subjects had significantly higher rates at all age levels for unipolar depression, anxiety disorders, eating disorders, and adjustment disorders; male subjects had higher rates of disruptive behavior disorders.

Adolescent↗

PubMed1993

Negative cognitions and attributional style in depressed adolescents: an examination of stability and specificity.

Despite recent findings that the prevalence of unipolar depression is as high in adolescents as it is in adults, relatively little is known about the applicability of cognitive theories of depression to adolescents. The present study examined the nature, specificity, and stability of cognitive dysfunction in male and female depressed, remitted, and psychiatric control adolescents. Factor analysis of a diverse set of measures yielded two factors, labelled Negative Cognitions and Attributional Style. Scores on both these factors were related to a current diagnosis of depression. Results also indicated that there may not be complete recovery of cognitive functioning (or of depressed mood) with diagnostic remission of depression. Finally, whereas elevated scores on the Negative Cognitions factor appeared to be specific to depression, the depressed and psychiatric control adolescents did not differ with respect to their scores on the Attributional Style factor.

Adolescent↗

PubMed1993

Psychosocial characteristics of adolescents with a history of suicide attempt.

The purpose of this study was to identify psychosocial risk factors uniquely associated with past suicide attempts. Data assessing a large number of variables were available from a representative sample of older adolescents (N = 1,710). Most independent variables were associated with past suicide attempts; variables that remained associated with past attempts after controlling for current depression level included externalizing and internalizing problem behaviors, past psychiatric disorders, depressotypic cognitions, coping, school problems, health problems, and gender. The probability of having made an attempt increased dramatically as a function of the number of risk factors. Females had more risk factors and showed a greater vulnerability to the factors than did males.

Achievement↗