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A short-term longitudinal examination of young adolescent functioning following divorce: the role of family factors.

The purposes of this study were to examine young adolescent functioning over a 2-year period after divorce and to assess the role of two family factors, interpersonal conflict and the parent-adolescent relationship, in predicting such functioning. One hundred and twelve young adolescents, their mothers, and their social studies teachers served as participants. One-half of the adolescent were from recently divorced families and one-half were from married families. Mothers completed measures concerning interparental conflict and the parent-adolescent relationship, adolescents completed a measure of the relationship, and teachers completed measures assessing four areas of adolescent functioning. The results indicated that adolescents from divorced families were functioning less well than those from married families. There were no changes in adolescent functioning and the parent-adolescent relationship from the first to second year postdivorce. High levels of interparental conflict in divorced families were associated with more parent-adolescent relationship problems. In turn parent-adolescent relationships problems served as the best predictor of concurrent and subsequent difficulty in adolescent functioning.

Adolescent↗

Adolescent abuse and the development of personal sense of control.

The link between adolescent abuse, the adolescent's psychological functioning, and locus of control orientation is explored. Maltreated adolescents experience such problems as low self-esteem, antisocial behavior, and suicidal tendencies. It is argued that the adolescent's locus of control orientation, deriving from his/her experiences in the home, may determine the extent to which the adolescent exhibits problematic behavior and personal maladjustment. Although locus of control in abused adolescents has not been investigated, studies show that individuals who experience the same types of problems evidenced by abused adolescents are more likely to have perceptions of external control. The nature of the relationship between locus of control and abuse may depend upon the duration of the abuse (i.e., long- versus short-term abuse). For example, adolescents who have experienced abusive behavior throughout childhood are expected to be more externally oriented than those adolescents who have been abused for a shorter time. Thus, long-term abused adolescents will be more likely to have perceptions of external control than nonabused adolescents, with short-term abused adolescents falling in the middle. The distinction between short- and long-term abuse in the context of locus of control may be important to consider when designing treatment programs for abused adolescents.

Achievement↗

Physician attitudes and preferences about combined Tdap vaccines for adolescents.

BACKGROUND: Combined tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap) boosters for adolescents are a new strategy to prevent pertussis. We examined the current practices of pediatricians and family physicians regarding adolescent tetanus and diphtheria toxoids (Td) vaccine immunizations and providers' potential adherence to new Tdap recommendations for adolescents. METHODS: Using a brief survey instrument sent to a random sample of pediatricians and family physicians in January 2005, we assessed providers' patterns of administration of Td boosters, barriers to Td boosters, and agreement that pertussis vaccination of adolescents is warranted. Results of analyses in February 2005 were presented to the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention (CDC) to inform its deliberations regarding adolescent Tdap vaccination. RESULTS: The overall response rate was 56% (57% pediatricians, 55% family physicians). Among 297 respondents (154 pediatricians, 143 family physicians) eligible for analysis because they provide care to adolescents, pediatricians (77%) were significantly more likely than family physicians (51%, p < 0.0001) to report that they routinely administer Td at preventive care visits for adolescents aged 11 to 12 years, but otherwise the specialties were similar in their Td practices. Forty-four percent of respondents cited infrequency of adolescent visits as a barrier to Td immunization. Slightly more than half the sample (57%) agreed or strongly agreed that pertussis is serious enough to warrant replacing Td with Tdap for adolescents; pediatricians (70%) were significantly more likely than family physicians (42%, p < 0.0001) to endorse this statement. CONCLUSIONS: This national survey indicates moderate willingness, stronger among pediatricians than among family physicians, to support recommendations for Tdap among adolescents. In February 2006, CDC released recommendations that adolescents aged 11 to 18 (preferred age 11 to 12) receive a single dose of Tdap in place of Td if they have not already received the latter. Near-term efforts regarding Tdap recommendations must address providers' concerns about infrequent routine visits for adolescents and convince more physicians of the importance of pertussis booster immunization during adolescence.

Adolescent↗

Interparental conflict and risk behaviors among Mexican American adolescents: a cognitive-emotional model.

This study used a cognitive-emotional model to examine the relations between multiple dimensions of interparental conflict and health risk behaviors among young adolescents. Participants were 151 Mexican American adolescents and their parents. At initial individual interviews, parents reported on conflict with their spouses, and adolescents reported on their parents' conflict, their appraisals of the conflict, their emotional distress, and their acculturation level. At 6-month follow-ups, adolescents reported on their risk behaviors, including substance use and sexual activity. In general, adolescents' acculturation level was not related to their risk behaviors. More frequent conflict, more conflict about the adolescent, more adolescent involvement in the conflict, and poor conflict resolution were related to greater emotional distress. More conflict about the adolescent, mothers being more demanding/dominating during conflict, and more adolescent involvement in the conflict were related to greater risk behaviors. Adolescents' cognitions mediated the link between two dimensions of parental conflict, frequency and resolution, and emotional distress. Adolescents' emotional distress mediated the association between adolescent involvement in parental conflict and adolescents' risk behaviors.

Acculturation↗

Male-specific volume expansion of the human hippocampus during adolescence.

To clarify the developmental brain changes during adolescence, brain morphology was compared between healthy younger adolescent and elder adolescent subjects using both voxel-based morphometry (VBM) and volumetric region-of-interest (ROI) analysis of magnetic resonance imaging (MRI). High-resolution three-dimensional MRI scans were acquired in 23 (10 males and 13 females) younger adolescent subjects (13-14 years) and 30 (15 males and 15 females) elder adolescent subjects (19-21 years). Whole-brain analysis by VBM revealed that the elder adolescent subjects had significantly more gray matter in the left medial temporal regions than the younger adolescent subjects and significantly less gray matter in the left medial frontal region (Brodmann area 6). In the volumetric analysis, significantly less cerebral gray matter volume and significantly greater cerebral white matter volume were found in elder adolescents compared with younger adolescents. The volume of the hippocampus was significantly larger in male elder adolescents than in male younger adolescents. The volume of the parahippocampal gyrus did not differ between younger and elder adolescent subjects. These results suggest a robust maturational process ongoing in the human hippocampus during adolescence, especially in males. The possible relevance of these findings to progress in myelination and implications in psychiatric disorders were discussed.

Adolescent↗

Suicide among children and younger and older adolescents in Norway: a comparative study.

OBJECTIVE: To compare characteristics and risk factors of suicide in early adolescence (younger than age 15 years) and in late adolescence. The authors examined whether differences in risk factors or resilience might explain the different suicide rates in the two age groups. METHOD: Information about all registered suicides of young people in Norway from 1990 through 1992 was gathered from several professional informants. Children younger than 15 years old who committed suicide (n = 14) were compared with late-adolescent suicides (15 through 19 years) (n = 115) and with controls (n = 889). RESULTS: Younger compared with older adolescent suicides more often hanged themselves (93% versus 35%). Suicidal ideation (7% versus 39%) and precipitating events were described less frequently (29% versus 49%). Older adolescents more often had psychiatric disorders (77% versus 43%). Compared with controls, the risk factors for suicide were affective disorders (young adolescents: odds ratio [OR] = 23.8, 95% confidence interval [CI] = 2.3 to 1,183; older adolescents: OR = 19.6, CI = 10.6 to 38.8); disruptive disorders (young adolescents: OR = 3.4, CI = 0.0 to 340; older adolescents: OR = 6.1, CI = 3.0 to 12.7); and not living with two biological parents (young adolescents: OR = 3.1, CI = 0.6 to 14.7; older adolescents: OR = 2.5, CI = 1.6 to 3.8). CONCLUSION: Children and young adolescents completing suicide were less exposed to known risk factors than older adolescents. The increased suicide risk was similar for both groups when they were compared with community controls. The low suicide incidence in childhood may be related to fewer risk factors, rather than to resilience to risk factors.

Adolescent↗

School health nurses and substance use among adolescents - towards individual identification and early intervention.

Adolescents' health is today threatened by the use of alcohol and other psychoactive substances. It is therefore important to develop interventions related to substance use in school health care. The aim of this study was to examine the empowering or risk background factors related to substance use among adolescents, and the ability of school nurses (PHN) to identify these factors and to provide needed individual early intervention. The data were collected by semistructured questionnaires completed by 14- to 18-year-old adolescents (n = 326, response rate 79) and PHNs (n = 10) in 2004. The adolescent questionnaire consisted of items related to the respondents' background and Adolescents' Substance Use Measurement (ADSUME). Following individual consent, adolescents' ADSUME responses were sent to the PHNs for intervention. The PHNs assessed the adolescents' empowering background factors and intervention using the questionnaire, and 70% (n = 228) of their answers matched the adolescents' answers. The data were analysed with the SPSS software using the chi-squared test, Fisher's exact test, kappa coefficient and agreement percentages. Substance use among adolescents was associated with parental support, mother's education and smoking, the adolescents' knowledge about substances, peer support and hobbies. The PHNs' assessments regarding supportive background were not in agreement with the assessments of adolescents who were using hazardous substances. One-fifth of the adolescents received the brief intervention, although many of them might have needed extra support and follow-up on the basis of their ADSUME results. The research findings can be generalized only for alcohol use, because only 3% of the study informants used substances other than alcohol. Further research is warranted concerning PHNs' ability to identify hazardous substance use and to ensure preventive early intervention and requisite support among substance-using adolescents in order to improve evidence-based health promotion.

Adolescent↗

Coping with the stress of parental depression II: adolescent and parent reports of coping and adjustment.

This study examined associations between adolescents' self-reports and parents' reports of adolescents' exposure to family stress, coping, and symptoms of anxiety/depression and aggression in a sample of 78 adolescent offspring of depressed parents. Significant cross-informant correlations were found between adolescents' reports of family stress, their stress responses, and their coping and parents' reports of adolescents' symptoms of anxiety/depression and aggression, but not between parents' reports of adolescents' stress and coping and adolescents' self-reported symptoms. Adolescents' reports of secondary control engagement coping and involuntary engagement stress responses mediated the relation between adolescents' reports of parental stress and parents' reports of adolescents' anxiety/depression symptoms. Moderate levels of correspondence were found in the correlations between parent and adolescent reports of adolescents' exposure to stress, coping, stress responses, and symptoms even after controlling for parents' current depressive symptoms. However, depressed parents reported higher levels of symptoms of anxiety/depression and aggression and more family stress than did their adolescent offspring. Implications for future research on coping and adjustment in offspring of depressed parents are highlighted.

Adaptation, Psychological↗

Personality trait profiles of missionary adolescents.

BACKGROUND: The study objective was to compare the Taylor-Johnson Temperament Analysis secondary population norms for adolescents, to test results of Assemblies of God missionary adolescents, and determine if the mission's experience had significant impact on personality traits. METHODS: A retrospective record review study of Taylor-Johnson Temperament Analysis test results administered to all missionary adolescents aged 13- to 18-years-old, having attended a yearly school of missions from 1986 to 1994, was performed. A two-sample, two-tailed t-test was used for statistical analysis. Test results were compared with standard adolescent and adult norms. Initial, and second test results when available, were compared for significant personality trait changes in adolescents over a 2-3 year interval, while in the mission's program. Subpopulation norms were calculated for the study group. RESULTS: Initial tests from 438 study group adolescents demonstrated significant differences in 7 of 9 personality trait categories for males, and 8 of 9 for females, compared with test adolescent norms. Initial, and second test comparisons were performed in 67 adolescents, and showed no significant changes in the personality trait scores in males and females. Personality trait profiles for females more closely resembled adult than adolescent norms, with 8 of the 9 personality trait categories showing no significant difference between adult female norms and study females. CONCLUSION: Clinicians and mission's sending agencies should be aware of the unique Taylor-Johnson Temperament Analysis test patterns for missionary adolescents, and that Taylor-Johnson Temperament Analysis norm tables for adolescents seem inadequate in evaluating missionary adolescents. Appropriate subpopulation norms are likely necessary. The impact of missions on personality trait categories of missionary adolescents seems negligible, but needs further research with methods that assure follow-up testing. These considerations could apply to other subpopulations and psychological tests.

Adolescent↗

Depression among Australian adolescents.

OBJECTIVES: To examine the prevalence and factors associated with depression in Australian adolescents. DESIGN: A representative, multistage probability sample of Australian households conducted in 1998 (part of the National Survey of Mental Health and Well-being). Adolescents completed self-report questionnaires and parents were interviewed using a lay-administered, structured psychiatric interview and several questionnaires. PARTICIPANTS: 1,490 adolescents aged 13-17 years and their parent or main caregiver. MAIN OUTCOME MEASURES: Prevalence of depression in adolescents, as reported by parents and by adolescents themselves; demographic factors; health-risk behaviours; and rate of use of support services. RESULTS: Of the 1,490 adolescents originally sampled, 150 (10%) did not complete responses to questions on depression and were excluded from the analysis. Seventy of the remaining 1340 adolescents (5.2%; 95% CI, 4.0%-6.4%) met criteria for self-reported depression. Agreement between parent- and adolescent-reported depression was poor (kappa=0.27). Adolescent-reported depression was associated with increased suicide plans (odds ratio [OR], 2.83; 95% CI, 1.19-6.70) and attempts (OR, 9.05; 95% CI, 3.49-23.50) in the previous year, use of marijuana 10 or more times in the previous month (OR, 2.88; 95% CI, 1.25-6.64), having conduct disorder (OR, 4.09; 95% CI, 1.23-13.63) and use of school support services (OR, 4.71; 95% CI, 1.82-12.22). Those who used any kind of support service (24/70; 34%) used a mean of 2.9 services (mode, 2; range, 1-5). Three per cent (2/70) of depressed adolescents had been treated with antidepressants. CONCLUSIONS: Depressed adolescents exhibit higher rates of health-risk behaviours and psychosocial impairment than non-depressed adolescents, but only a small number receive appropriate treatment. Staff working in school-based services should be trained to identify adolescents with depression and facilitate referral for treatment.

Adolescent↗

Adolescent admissions to a tertiary paediatric hospital: a dynamic pattern.

INTRODUCTION: Adolescent inpatient facilities emerged in Australia in the 1980s to cater for an increasing number of young people with chronic illness and disability. Yet, there is minimal published data on the number of young people admitted to hospital within these units, their unit of admission, length of stay or reason for admission. A 12-year audit of adolescents admitted to a tertiary hospital with a dedicated adolescent unit and adolescent medicine programme in Victoria, Australia, was conducted to review the pattern of hospitalisation in young people in order to provide data to assist healthcare policy and planning agendas. MATERIALS AND METHODS: Admissions to the Royal Children's Hospital in Victoria, Australia, of adolescents aged 10 years and above were reviewed over a 12-year period from 1990 to 2001. We identified the annual number of adolescents admitted, the proportion of adolescents admitted to the Adolescent Inpatient Unit (ward) and annual admissions under the Adolescent Medicine Unit (department). RESULTS: Adolescents now constitute nearly 30% of all admissions at this children's hospital. Over this period, admissions to the Adolescent Inpatient Unit have nearly doubled and annual admissions under the Adolescent Medicine Unit rose from 38 to 288. The majority of adolescents were admitted under specialty medical and surgical units. CONCLUSIONS: The knowledge that nearly one in three admissions to this tertiary children's hospital is over 10 years old should help promote the development of planning and policy agendas that better balance both health and developmental priorities in this age group.

Adolescent↗

The perception of South African adolescents regarding primary health care services.

Most of the South African public health facilities fail to provide adolescent-friendly health services. A quantitative, descriptive research study was conducted at Stinkwater, a rural area in Hammanskraal, South Africa. The objective of the study was to describe the adolescent's preferences regarding primary health care services. A survey was conducted among 119 adolescents. It was found that adolescents wished to be involved in the planning of the activities of the adolescent health service, and that friendliness and respect for adolescents were seen as desirable characteristics of an adolescent-friendly health care service. Adolescents preferred services to be available throughout the week and to be located at the school, youth center, community center, hospital, or clinic. Health education was indicated as a priority and the health care team should include different members of a multidisciplinary team. Adolescents preferred that their health services be separated from adult services and that a male nurse be employed in the adolescent service in order to create a less feminine image. It was also recommended that all adolescents be educated about the types of services available. Understanding health care service preferences of adolescents is needed in order to deliver optimal health care to this group.

Adolescent↗

MMPI-A profiles of adolescent boys with a history of firesetting.

Firesetting in childhood and adolescence is associated with the more severe end of the conduct-disorder continuum and is considered to be prognostic of later pathology. The literature provides limited understanding of the pathology underlying firesetting in juveniles. This study compared the Minnesota Multiphasic Personality Assessment-Adolescent profiles of 28 psychiatric inpatient adolescent boys with a history of firesetting with the profiles of 96 psychiatric inpatient adolescent boys who do not have a history of firesetting. Using multivariate analyses, the firesetting group appeared more pathological than did the nonfiresetting group as reflected by significantly higher scores on three clinical scales: Psychasthenia (Pt), Schizophrenia (Sc), and Mania (Ma). The firesetting group also scored significantly higher than did the nonfiresetting group on eight of the content scales: Adolescent-Depression, Adolescent-Alienation, Adolescent-Bizarre Mentation, Adolescent-Anger, Adolescent-Conduct Problems, Adolescent-Family Problems, Adolescent-School Problems, and Adolescent-Negative Treatment Indicators. Taken together, these results suggest that the pathology associated with juvenile firesetting is more complex as well as more severe than that associated with nonfiresetting conduct disorder. The firesetting group's profiles suggest that their psychopathology is not merely a severe behavior disorder but rather is indicative of feelings of distress, alienation, depression, and thought disorder or poor reality testing. This degree of inner turmoil may be motivational impetus for the firesetting itself.

Adolescent↗

[Adaptation and mental-hygienic characteristics of internally displaced adolescents].

The change in socio-economic status, drastic decrease in living standards, war, and the introduction of sanctions to our country were complicated in addition by a large number of internally displaced people from Kosovo, which culminated with the 1999 NATO bombing. The aim of this investigation was to estimate the influence of internal displacement on the adaptation and mental health of adolescents. The investigation was conducted on 238 adolescents, comprising a control group of 206 adolescents from Belgrade and 32 internally displaced adolescents from Kosovo. A specific questionnaire regarding habits, behaviour, and psychosomatic state was used, as well as the Cornell Medical Index and the Eysenck Personality Questionnaire. Internally displaced adolescents from Kosovo exhibited greater difficulties in adapting and had worse school records than adolescents from Belgrade, one year after the change in their location. Immediately after the NATO bombing, both groups reacted in the same way: they often talked about the events they had survived, they were afraid of the sounds of alarm sirens and of aeroplanes, and in addition had similar dreams (no statistical variation between the groups). Emotional disturbances, one year after the bombing, were not observed in 40.6% of adolescents from Kosovo, compared to the figure of 74.8% for adolescents from Belgrade. Adolescents from Belgrade consumed alcohol significantly more often: 75.7% compared to 56.3% for adolescents from Kosovo. In addition, 20.4% of adolescents from Belgrade consumed psychoactive substances compared to 6.3% of adolescents from Kosovo. There was no significant difference between the examined groups in the total scores on the scale for neuroticism. All in all, the girls from both examined groups displayed neurotic tendencies more frequently than the boys.

Adaptation, Psychological↗

Adolescent interpersonal communication patterns.

Adolescents are admitted to psychiatric wards presenting with psychiatric problems which are essentially secondary to problematic interpersonal relationships. Successful interpersonal relationships however depend on effective interpersonal communication. Therefore the aim of research on adolescent interpersonal communication was to explore and describe the interpersonal communication patterns of adolescents and to develop an interpersonal communication skills approach to facilitate adolescent interpersonal communication skills within a training programme for adolescents. In this article however attention will be given to the description of the interpersonal communication patterns of adolescents. The target population of the research was 17 year old adolescents. The research consisted of a pre-phase where two contextual scenarios were formulated within group discussions with adolescents. During phase one of the research these scenarios were used to obtain video taped role plays from pairs of adolescents of the target population which were transcribed for data gathering purposes. Written dialogues were also obtained from each pair of adolescents on the same scenarios used for triangulation purposes. During phase two of the research the data was analysed according to Tesch's method and a literature control was done to verify the results. Guba's model for the trustworthiness of qualitative research was used. Four recurrent interpersonal communication patterns were identified, namely: Recurrent patterns of defocusing and externalizing the topic under discussion; Recurrent patterns of struggling for power; Recurrent patterns of not listening; and Recurrent patterns of focusing only on cognitive contents of messages and not on feelings. The research showed that adolescents have ineffective interpersonal communication patterns. Recommendations were made to facilitate adolescent interpersonal communication within an interpersonal communication skills approach.

Adolescent↗

Characteristics of hospitalizations among adolescents in Taiwan: population-based data.

To understand the adolescent health status in Taiwan, we collected hospitalization data of Taiwanese adolescents in 1997 under the execution of National Health Insurance (NHI). Then 5% of the data was selected with systematic sampling method by National Health Research Institute (NHRI) and was categorized according to age, gender, disease pattern and specialty. The results showed there were totally 160, 120 adolescent admissions in 1997, about 6.81% of total population admissions. There were more female than male admissions and more late adolescent than early adolescent admissions. In clinical disorders, injury was the leading cause of hospitalization for male adolescent and female early adolescent admissions. Delivery was the leading cause of hospitalization for female late adolescent admissions. The most common specialty admissions among early adolescents were for pediatrics, followed by surgery, and then general medicine. Among late adolescents, the most common specialty admissions were for surgery, followed by obstetrics and gynecology, and then general medicine. In conclusion, the most common reasons of adolescence hospitalization were related to behavioral factors rather than disease processes, and adolescent admissions by specialty were mostly non-professional.

Adolescent↗

Primary care providers' responsiveness to health-risk behaviors reported by adolescent patients.

OBJECTIVE: To assess clinicians' responsiveness to health-risk behaviors reported by adolescent patients during a comprehensive clinical preventive services visit. DESIGN: Nonprobability sample of adolescent patients scheduled for a routine physical examination. SETTING: Seven clinical sites in the Chicago, Ill, area. PARTICIPANTS: Fifteen primary care providers and 95 adolescent patients between 11 and 18 years of age. INTERVENTION: Providers delivered comprehensive clinical preventive services to adolescent patients using the Guidelines for Adolescent Preventive Services model. This model includes screening, guidance, a physical examination, and immunizations. Prior to the visit, adolescent patients completed a screening questionnaire that included a 52-item health-risk behavior profile. Responses on the screening questionnaire were discussed during the visit. MAIN OUTCOME MEASURES: Each provider's responsiveness to reported health-risk behaviors was determined by comparing the adolescent patient's responses on the screening questionnaire with those reported during a debriefing interview with the adolescent about whether specific subjects were discussed. Responsiveness to highly sensitive behaviors was determined by comparing the screening questionnaire and the medical record. RESULTS: On average, each adolescent patient reported 10 risk behaviors, of which 7 were discussed. The severity of the reported risk behavior, the number of reported biological health concerns, and the adolescent patient's sex were significant predictors of the provider's responsiveness. The number of reported health-risk behaviors, visit duration, provider's professional role and sex, whether the adolescent was a new patient, and the adolescent patient's age were unrelated to responsiveness. CONCLUSIONS: Providers addressed most health-risk behaviors reported during a single visit, but responsiveness declined when 3 or more biological health concerns or relatively severe problems were reported. Steps can be taken to increase providers' responsiveness.

Adolescent↗

A longitudinal evaluation of adolescent depression and adult obesity.

BACKGROUND: Prior studies have had conflicting results regarding the relationship between adolescent depression and adult obesity. OBJECTIVE: To test the hypothesis that depression in adolescence would increase the risk for obesity in early adulthood. METHODS: We used data from a longitudinal study of a birth cohort of children born between April 1, 1972, and March 31, 1973, in Dunedin, New Zealand (N = 1037). These data included regular diagnostic mental health interviews and height/weight measurements throughout childhood and adolescence. We performed logistic regression analyses to assess the relationship between major depression in early or late adolescence and the risk for obesity at 26 years of age. RESULTS: Major depression occurred in 7% of the cohort during early adolescence (11, 13, and 15 years of age) and 27% during late adolescence (18 and 21 years of age). At 26 years of age, 12% of study members were obese. After adjusting for each individual's baseline body mass index (calculated as the weight in kilograms divided by the square of height in meters), depressed late adolescent girls were at a greater than 2-fold increased risk for obesity in adulthood compared with their nondepressed female peers (relative risk, 2.32; 95% confidence interval, 1.29-3.83). A dose-response relationship between the number of episodes of depression during adolescence and risk for adult obesity was also observed in female subjects. The association was not observed for late adolescent boys or for early adolescent boys or girls. CONCLUSIONS: Depression in late adolescence is associated with later obesity, but only among girls. Future studies should address reasons for these age and sex differences and the potential for intervention to reduce the risk for adult obesity in depressed older adolescent girls.

Adolescent↗