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PubMed2000

Adolescent patients--healthy or hurting? Missed opportunities to screen for suicide risk in the primary care setting.

CONTEXT: Adolescent suicide rates have increased dramatically in recent decades. Suicide is the third leading cause of mortality among persons aged 10 to 19 years. Several official guidelines recommend screening for suicidal behavior in the primary care setting. OBJECTIVES: To determine the prevalence of adolescent suicidal behavior known to primary care providers and to determine the knowledge, attitudes, and practice of primary care physicians in Maryland regarding screening for risk factors for adolescent suicide. DESIGN: Cross-sectional study using mailed survey. SETTING: Maryland from May to July 1995. PARTICIPANTS: All pediatrician (n = 816) and family physician (n = 592) members of the state chapter of the American Academy of Pediatrics and the American Academy of Family Physicians, respectively, who were actively providing ambulatory care. MAIN OUTCOME MEASURES: Adolescent suicidal behavior known to primary care providers and predictors of routine screening for risk factors for adolescent suicide. RESULTS: The response rate was 66%. Three hundred twenty-eight physicians (47%) reported that 1 or more adolescent patients attempted suicide in the previous year, but only 158 (23%) either frequently or always screened adolescent patients for suicide risk factors. Significant factors correlating with routine screening for suicide risk factors included frequently or always counseling about the safer storage of firearms in the home (odds ratio [OR], 5.3; 95% confidence interval [CI], 2.8-10.2); agreeing or strongly agreeing that they were sufficiently trained and knew how to screen for risk factors (OR, 3.2; 95%/CI, 1.7-6.3); agreeing or strongly agreeing that they had enough time during the well visit to screen for mental health problems (OR, 2.9: 95% CI, 1.6-5.3); frequently or always counseling about child passenger safety (OR, 2.7; 95% CI, 1.6-4.7); spending more than 5 minutes in anticipatory guidance during the well visit (OR, 2.7: 95% CI, 1.5-4.6); practicing in an urban setting (OR, 2.3; 95)% CI, 1.2-4.7); agreeing or strongly agreeing that physicians can be effective in preventing adolescent suicide and that what they do during an office visit may help prevent adolescent suicide (OR, 2.0; 95% CI, 1.2-3.4); and female sex (OR. 1.9; 95% CI, 1.1-3.2). CONCLUSION: Despite the substantial proportion of primary care providers who encountered suicidal adolescent patients, most providers still do not routinely screen their patients for suicidality or associated risk factors. More training is needed and desired by the survey respondents. Patient confidentiality issues must be addressed. Development and widespread use of a short, easily administered, reliable, and valid screening tool are recommended to help busy clinicians obtain more complete information during all visits.

Adolescent↗
PubMed2000

Maternal expectations, mother-child connectedness, and adolescent sexual debut.

BACKGROUND: This study examined 3 hypotheses: (1) adolescents who perceive maternal disapproval of sexual activity will initiate sexual intercourse later than other adolescents; (2) adolescents who feel highly connected to their mothers will initiate sexual intercourse later than others; and (3) adolescents who perceive maternal disapproval of sexual intercourse are more likely than others to experience high levels of connectedness to their mothers, and to have mothers who state strong disapproval and talk more frequently with them about sex. DESIGN/SETTING: The National Longitudinal Study of Adolescent Health (Add Health), a longitudinal study of US students in grades 7 through 12. The Add Health core in-home sample consisted of 12,105 students who completed in-school and in-home surveys at wave 1). Members of this sample completed a second in-home survey 9 to 18 months later at wave 2. PARTICIPANTS: Wave 1 and wave 2 in-home surveys were completed by 3322 core sample members who had reported being virgins at wave 1, and had resident mothers who completed wave 1 surveys. MAIN OUTCOME MEASURES: Time to first sexual intercourse, adolescents' wave 2 reports of month/year of first sexual intercourse. RESULTS: Adolescents' perceptions of maternal disapproval and high levels of mother-child connectedness were directly and independently associated with delays in first sexual intercourse. Adolescents were most likely to perceive maternal disapproval if their mothers reported strong disapproval and if they reported being highly connected to their mothers. CONCLUSION: Perceived maternal disapproval of sexual intercourse, along with mother-child relationships characterized by high levels of warmth and closeness, may be important protective factors related to delay in adolescents' first sexual intercourse. Arch Pediatr Adolesc Med. 2000;154:809-816

Adolescent↗
PubMed1996

The role of community health centers in providing preventive care to adolescents.

OBJECTIVES: To (1) compare preventive health visits by poor and nonpoor adolescents, (2) describe adolescent users of community health centers (CHCs), (3) investigate adolescent preventive visits to CHCs, and (4) determine factors independently associated with timely preventive visits. DESIGN: Analysis of the nationally representative sample of 6635 adolescents aged 11 to 17 years in the Child Health Supplement to the 1988 National Health Interview Survey. RESULTS: Overall, 4% of US adolescents used CHCs for routine health care, and the percentage was higher for poor compared with nonpoor adolescents (11% vs 3%, P < .01). Although CHC users were more likely to be poor (41% vs 10%, P < .001), uninsured (23% vs 10%, P < .001), and to have behavior (16% vs 9%, P = .02) and school problems (56% vs 43%, P < .001), they were as likely to have had timely preventive visits (83% vs 81%, P = .61) as adolescents who used private practices. Using logistic regression, timely adolescent preventive visits were independently associated with having a source for routine care (odds ratio, 4.1; 95% confidence interval, 3.3-5.2), a chronic health condition (odds ratio, 1.2; 95% confidence interval, 1.0-1.5), and the use of seat belts all or most of the time (odds ratio, 1.4; 95% confidence interval, 1.2-1.6), but no independent association was observed between poverty status and timely preventive visits. CONCLUSIONS: Community health centers are an important source of preventive care for impoverished adolescents. Although those who use CHCs have greater psychosocial problems, they seek preventive care as regularly as those using private practices. Thus, periodic comprehensive visits may be an effective strategy for CHCs to provide preventive services to adolescents.

Adolescent↗
PubMed1997

Relationship between cigarette smoking and health risk and problem behaviors among US adolescents.

OBJECTIVE: To examine whether sociodemographic factors and health risk and problem behaviors explain the prevalence of cigarette smoking among US adolescents. DESIGN: Probability survey. PARTICIPANTS: A nationally representative sample of US adolescents. MAIN OUTCOME MEASURES: Weighted prevalence, adjusted odds ratio (OR), and 95% confidence intervals (CIs) for current smoking status by health risk and problem behaviors. RESULTS: The prevalence of smoking was highest among adolescents who were white, older, and who had a high school education or lived in the Northeast. When we adjusted for sociodemographic factors and health risk and problem behaviors, smoking was associated with marijuana use (OR, 3.7; 95% CI, 2.7-5.1), binge drinking (OR, 2.1; 95% CI, 1.6-2.8), and fighting (OR, 1.4; 95% CI, 1.1-1.7) among white adolescent males. Similar associations between each of these 3 behaviors and cigarette smoking were found among white adolescent females and African American and Hispanic adolescent males and females. Cigarette smoking was also associated with using smokeless tobacco, having multiple sexual partners, and not using bicycle helmets among white adolescent males and females, having multiple sexual partners among Hispanic adolescent females, and carrying weapons among Hispanic adolescent males. CONCLUSIONS: Marijuana use, binge drinking, and fighting are correlates of cigarette smoking among US adolescents. These associations, which vary by sex and race or ethnicity, suggest clustering to form a risk behavior syndrome.

Adolescent↗
PubMed1981

The mental health professional's concept of the normal adolescent.

This article presents empirical evidence, based on the Offer Self-Image Questionnaire, comparing the self-image of normal adolescents, psychiatrically disturbed adolescents, and juvenile delinquents, with adolescent self-image as seen by 62 mental health professionals. The latter group was asked to complete the test the way they believed a normal, mentally healthy adolescent would complete it. Similar data were gathered from graduate students in psychology. In seven of ten scales, the mental health professionals viewed the normal adolescent as significantly more disturbed than the normal adolescent views himself or herself. The professionals saw the normal adolescents as having more problems than were reported either by the psychiatrically disturbed or the delinquent adolescents. These findings are important in terms of psychodynamic theory of adolescence and diagnostic problems encountered in work with adolescents.

Adolescent↗
PubMed2002

Childhood adversities, interpersonal difficulties, and risk for suicide attempts during late adolescence and early adulthood.

BACKGROUND: Data from a community-based longitudinal study were used to investigate the association between childhood adversities, interpersonal difficulties during adolescence, and suicide attempts during late adolescence or early adulthood. METHODS: A community sample of 659 families from Upstate New York was interviewed in 1975, 1983, 1985 to 1986, and 1991 to 1993. During the 1991-1993 interview, the mean age of the offspring was 22 years. RESULTS: Maladaptive parenting and childhood maltreatment were associated with an elevated risk for interpersonal difficulties during middle adolescence and for suicide attempts during late adolescence or early adulthood after age, sex, psychiatric symptoms during childhood and early adolescence, and parental psychiatric symptoms were controlled statistically. A wide range of interpersonal difficulties during middle adolescence were associated with risk for suicidal behavior after the covariates were controlled. Profound interpersonal difficulties during middle adolescence mediated the association between maladaptive parenting or childhood maltreatment and suicide attempts during late adolescence or early adulthood. CONCLUSIONS: Maladaptive parenting and childhood maltreatment may be associated with a risk for severe interpersonal difficulties during adolescence. These interpersonal difficulties may play a pivotal role in the development of suicidal behavior. Youths who are at an elevated risk for suicide may tend to be in need of mental health services that can help them to cope with an extensive history of profound interpersonal difficulties, beginning in childhood and continuing through adolescence.

Adolescent↗
PubMed1999

Foregone health care among adolescents.

CONTEXT: No annual national population estimates exist of the numbers of adolescents who think they need but do not receive health care or their risk of health problems. OBJECTIVE: To describe the proportion of adolescents who report foregone health care each year and the influence of sociodemographic factors, insurance status, past health care, and health risks/behaviors on foregone care. DESIGN: Cross-sectional analyses of data from wave 1 of the National Longitudinal Study of Adolescent Health, conducted during 1995. SETTING: In-home interviews conducted throughout the United States. PARTICIPANTS: Of 27000 adolescents in grades 7 through 12 who were invited to participate, 20746 (76.8%) completed the in-home interview. MAIN OUTCOME MEASURE: Reported foregone health care in the preceding year by individual and family characteristics, insurance status, past health care, health/behavior risk factors, and symptoms. RESULTS: On average, 2268 (18.7%) of 12 079 adolescents reported foregone health care within the past year. Factors associated with decreased risk of foregone care included continuous private or public insurance (adjusted relative risk [95% confidence interval], 0.64 [0.50-0.82] to 0.82 [0.70-0.96]), and having a physical examination within the past year (0.87 [0.78-0.97] for male and 0.79 [0.70-0.88] for female adolescents). Factors associated with increased risk of foregone care included older age (1.12 [1.06-1.15] for male), minority race/ethnicity (1.25 [1.06-1.46] to 1.50 [1.30-1.73]), single-parent home (1.31 [1.18-1.46] for female), and disability (2.03 [1.61-2.52] for male and 1.66 [1.20-2.10] for female). Adolescents participating in the following behaviors were more likely to report foregone care than those who did not: daily cigarette use (26.0% vs 16.8%; 1.34 [1.16-1.55]), frequent alcohol use (30.3% vs 18.1%; 1.34 [1.11-1.62] for male), and sexual intercourse (25.1% vs 15.1%; 1.23 [1.09-1.39] for male and 1.39 [1.23-1.56] for female). From 32.4% to 38.2% of adolescents with symptoms suggesting health problems reported foregone care (1.61 [1.13-2.26] to 2.03 [1.81-2.28]). CONCLUSIONS: Our study suggests that adolescents who forego care are at increased risk of physical and mental health problems. Efforts to improve adolescent health through health care should address factors influencing foregone care.

Adolescent↗
PubMed1999

Comparison of high-calorie, low-nutrient-dense food consumption among obese and non-obese adolescents.

OBJECTIVE: The purpose of this study was to determine whether obese adolescents eat more high-calorie low-nutrient-dense foods than non-obese adolescents. RESEARCH METHODS AND PROCEDURES: Using a cross-sectional design, 22 non-obese and 21 obese adolescents kept 14-day food records. Records provided estimates of total daily energy intake and caloric intake from five categories of high-calorie, low-nutrient-dense (HC) foods: candy, chips, soda, baked goods, and ice cream. Body composition was determined by 18O dilution and daily energy expenditure by doubly labeled water. Percentage of energy intake reported (%report) was calculated as the ratio of reported energy intake to measured energy expenditure (x 100%). RESULTS: Both groups underreported energy intake, but the percentage reported was significantly greater in the non-obese group (78.2+/-20.5% non-obese vs. 55.5+/-21.8% obese, p<0.001). Consumption of calories from chips and soda was similar among non-obese and obese adolescents. However, total energy intake from all HC foods was higher in the non-obese group than among the obese (617+/-356 kcal/day vs. 362+/-223 kcal/day; p<0.01) and represented 27.2+/-10.5% and 19.9+/-9.6% of reported energy intake in the non-obese and obese groups, respectively. After adjustment for under-reporting, the percentage of calories provided by each of the HC foods was similar in the obese and non-obese groups except for ice cream, which remained significantly greater in the non-obese group (p<0.05). DISCUSSION: Our findings suggest that both non-obese and obese adolescents consume a substantial portion of reported calories from HC foods and that obese adolescents do not consume more calories from these foods than non-obese adolescents. These data offer no evidence to support the widespread notion that obese adolescents eat more "junk food" than non-obese adolescents. Health professionals who treat obese adolescents must be aware that the excess calories in their diets may come from a variety of food sources and not solely from high-calorie snack foods.

Adipose Tissue↗
PubMed1986

Preventing adolescent pregnancy: meeting the comprehensive range of needs.

Too often, the problem of the pregnant adolescent is approached as if it existed in isolation, disconnected from the remainder of the adolescent's biological and psychosocial environment. Such an approach fails to recognize the interconnectedness of all issues within the adolescent's world, therefore, impeding a successful therapeutic response. In order to administer complete and comprehensive treatment of the problem of teenage pregnancy, the total needs of the pregnant adolescent, the potentially pregnant adolescent and the adolescent male must be addressed. These needs vary with the different stages of adolescent development. During this time in which children learn how to become adults by observing their world and taking cues from the environment, the varying needs are: Early Adolescence--to develop the ability to perceive the long range consequences of their current actions and decisions; to define the boundaries of their independence while relying on major authority figures; and to make important decisions and develop the operational connection between the sex act and birth control. Mid Adolescence--to achieve emancipation from the family and all other authority; to identify with a chosen peer group; to develop an identified sexual identity; and to apply an appreciation for the connection between the sex act and pregnancy to themselves. Late adolescence--to plan for the future and to establish some kind of family. This psychological and social maturational process occurs immediately before, during and after the pubertal growth period. In the United States today, it usually occupies the years between 12 and 21 years.

Adolescent↗
PubMed2001

A survey of pediatric nephrologists on adolescent sexual health.

Chronic renal disease often has an adverse effect on adolescent physiologic and psychosocial development. The severity of the disease may necessitate that the pediatric nephrologist be the adolescent's main medical provider and the most available physician to screen for adolescent health risk behaviors. The purpose of this study was to determine pediatric nephrologists' practices of sexual history taking and diagnosis and treatment of sexually transmitted infections in their adolescent patients. A survey was performed on a convenience sample of 66 pediatric nephrologists attending an educational seminar on adolescent care at the 1997 national meeting of the American Society of Pediatric Nephrology. The outcome measures included physicians' reports of interviewing adolescents alone and screening for sexually transmitted infections. Fifty-six percent reported interviewing adolescents alone, 55% routinely ask female adolescents about sexual intercourse (53% ask males) and 10% routinely perform pelvic exams. Current practice in this selected sample of pediatric nephrologists, who by their attendance at the seminar may represent those most motivated to do screening, still leaves adolescents with chronic renal disease potentially at risk for sexually transmitted infections and pregnancy. Educational efforts should be directed at increasing routine confidential sexual history taking for adolescents with chronic renal disease.

Adolescent↗
PubMed1992

Parent and adolescent perceptions of family functioning: a comparison of clinic and non-clinic families.

In this paper two studies are reported which compare (a) the perceptions of family functioning held by clinic and non-clinic adolescents, and (b) the perceptions of family functioning held by adolescents and their mothers in clinic and non-clinic families. In Study 1, matched group of clinic and non-clinic adolescents were compared on their responses to a 30-item scale (ICPS) designed to measure three factors of family functioning: Intimacy (high vs. low), Parenting Style (democratic vs. controlled) and Conflict (high vs. low). Clinic and non-clinic adolescents were also compared on their responses to a multi-dimensional measure of adolescent self-concept. Although there was little difference between the two groups of adolescents in terms of their perceptions of family functioning, there were strong relationships between the self-concept variables and the family functioning variables. In Study 2, comparisons were made between the perceptions of family functioning held by mothers and adolescents for both clinical and non-clinic families. There were no differences between the two groups of adolescents in terms of their perceptions of family functioning, although there were clear differences between the two groups of mothers. In addition, clinic adolescents and their mothers did not differ in their perceptions of the family, whereas adolescents in the non-clinic group saw their families significantly as less intimate and more conflicted than did their mothers.

Adolescent↗
PubMed1987

Disparities in adolescent-physician views of teen health information concerns.

To enhance communications between physicians and adolescents, 600 middle school students and 99 physicians completed written questionnaires assessing the importance of 45 items from seven subscales: smoking; physical fitness; weight control; self-actualization; comparison with others; peer opinion; and communications. Adolescents rated the importance of knowing about items from each scale. Physicians rated how much importance they attached to each scale and their perception of the adolescents' ratings. Physicians placed more importance on each scale than did the adolescents, and they did not accurately judge the importance adolescents placed on the items. Physicians and adolescents differed significantly in the ratings of all but one scale, weight. With the exception of one scale (peer opinion), physicians estimated that adolescents would place less importance on the items in each scale than the adolescents actually reported. Our results suggest the need to concurrently consider adolescent-physician views when seeking to meet adolescents' health needs.

Adolescent↗
PubMed1994

Emotional well-being among adolescents with and without chronic conditions.

PURPOSE: To investigate whether adolescents with chronic conditions differ from adolescents without chronic conditions in several psychological outcomes. An additional purpose was to explore whether adolescents with chronic conditions differ as a function of the visibility of their conditions. METHODS: By means of the Adolescent Health Survey, 1683 students (grades 7-12) with a variety of chronic conditions were compared with 1650 students without chronic conditions in regard to emotional well-being, worries and concerns, and body image. Differences in emotional well-being were examined as a function of perception of family connectedness. Comparisons were also made between adolescents with visible and invisible conditions. RESULTS: Adolescents with chronic conditions had lower emotional well-being scores, worried more about dying soon and about school or future work, and had poorer body image. For students with and without chronic conditions, higher emotional well-being scores were significantly related to higher levels of family connectedness. The best explanatory variables of emotional well-being were body image, family connectedness, concerns about school and future work, having a disability, and worry about peer relationships, accounting together for 36% of the variance in the outcome variable. No differences were found between adolescents with visible and invisible conditions. CONCLUSIONS: Although adolescents with chronic conditions do less well than adolescents without chronic conditions, having a disability is not the most influential factor on emotional well-being. Family connectedness is of fundamental importance for adolescents' emotional health.

Adolescent↗
PubMed2005

Parent-imposed limits on high-risk adolescent driving: are they stricter with graduated driver licensing?

The purpose of this study was to determine whether parent-imposed limits on 16-year-old high-risk driving are stricter in Maryland (MD), a state with graduated driver licensing (GDL) than in Connecticut (CT), a non-GDL state. In both states, parents and adolescents completed telephone surveys about the restrictions that parents placed on their adolescents' driving at night, with adolescent passengers, and at high speeds. In Maryland, surveys took place 1 month (294 parent-adolescent pairs) and 4 months (292 parent-adolescent pairs) after provisional licensure. In Connecticut, surveys took place the first month (132 pairs) and the third month (108 pairs) after adolescent licensure. The findings indicated that after controlling for demographic characteristics, Maryland parents and adolescents reported stricter parent-imposed limits for adolescent passengers, high-speed roads, weekend night driving, and overall limits. Parents in GDL states appear better able to establish and enforce adolescent driving restrictions when the licensing state stipulates, favors, and supports regulated adolescent driving.

Adolescent↗
PubMed2006

Adolescents' as active agents in the socialization process: legitimacy of parental authority and obligation to obey as predictors of obedience.

Adolescents' agreement with parental standards and beliefs about the legitimacy of parental authority and their own obligation to obey were used to predict adolescents' obedience, controlling for parental monitoring, rules, and rule enforcement. Hierarchical linear models were used to predict both between-adolescent and within-adolescent, issue-specific differences in obedience in a sample of 703 Chilean adolescents (M age=15.0 years). Adolescents' global agreement with parents and global beliefs about their obligation to obey predicted between-adolescent obedience, controlling for parental monitoring, age, and gender. Adolescents' issue-specific agreement, legitimacy beliefs, and obligation to obey predicted issue-specific obedience, controlling for rules and parents' reports of rule enforcement. The potential of examining adolescents' agreement and beliefs about authority as a key link between parenting practices and adolescents' decisions to obey is discussed.

Adolescent↗
PubMed2003

The role of social support in well-being and coping with self-reported stressful events in adolescents.

OBJECTIVE: This study investigated the role that social support plays in well-being and in coping after a stressful event in a group of non-clinical adolescents. Furthermore, this study aimed at replicating the finding that adolescents who reported sexual abuse reported more symptoms and less adequate coping strategies than adolescents who reported another type of stressful event or no stressful episode. METHOD: Eight hundred and twenty adolescents between 12 and 18 years of age filled out questionnaires assessing social support (Social Support Questionnaire, Sarason, Shearin, Pierce, & Sarason, 1987), trauma-related symptoms (Trauma Symptom Checklist for Children, Briere, 1996), behavior problems (Youth Self-Report, Achenbach, 1991), and coping (How I Cope Under Pressure Scale, Ayers, Sandler, West, & Roosa, 1996). RESULTS: 42% of the adolescents reported a stressful experience, and 4.4% reported sexual abuse. Sexually abused adolescents reported more stress-related symptoms and used more avoidance and fewer support-seeking coping strategies than the other adolescents. The main-effect hypothesis of social support was sustained, but social support did not moderate the relation between a stressful event and coping. Yet, a trend was found suggesting that high support from the family was associated with less avoidance coping and more support-seeking in adolescents who reported a non-sexually abusive, stressful event. CONCLUSIONS: Our findings show that a highly perceived availability of social support is directly associated with fewer trauma-related symptoms, especially in adolescents who are non-sexually abused. For adolescents who reported a sexual or another type of stressful event, social support did not play a different role in coping.

Adaptation, Psychological↗
PubMed2006

Inter- and intra-modal matching in very low birth weight and small for gestational age adolescents.

BACKGROUND: Motor problems in low birth weight children may be related to problems in sensorimotor integration processes. Specific tests of inter- and intra-modal matching have not been used in low birth weight populations. AIM: Examine whether low birth weight adolescents have poorer performance in inter- and intra-modal matching than normal birth weight adolescents. STUDY DESIGN: A population based follow up study of very low birth weight and small for gestational age children at 14 years of age. SUBJECTS: Fifty-three very low birth weight adolescents (VLBW: birth weight < or =1500 g), 59 term small for gestational age (SGA: birth weight <10th centile) and 82 adolescents with birth weight > or =10th centile at term (reference group). OUTCOME MEASURES: Inter- and intra-modal matching was assessed by a manual matching task and results were presented for the preferred and the non-preferred hand in the visual (inter-modal) and proprioceptive (intra-modal) condition. RESULTS: VLBW adolescents performed poorer in inter- and intra-modal matching compared with the reference group. However, the results were mainly due to a higher number of adolescents with cerebral palsy (CP) and a low estimated intelligence quotient (IQ(est)) in the VLBW group. SGA adolescents showed poorer performance with their non-preferred hand compared with their preferred hand in both inter- and intra-modal matching, whereas adolescents in the reference group and VLBW adolescents with normal IQ(est) and without CP performed equally well with both hands. CONCLUSION: VLBW adolescents with normal IQ(est) and without CP do not have major problems in inter- and intra-modal matching. The poorer performance with the non-preferred hand in the SGA group may suggest a specific effect of intrauterine growth retardation.

Adolescent↗
PubMed2006

Factors associated with depressive symptoms in Nigerian adolescents.

PURPOSE: To evaluate the factors associated with depressive symptoms in a sample of Nigerian 13-18-year-olds attending senior secondary schools. METHOD: Adolescents aged 13 to 18 years (n = 1095) attending senior secondary schools completed the Beck Depressive Inventory (BDI) as a measure of their depressive symptoms. The adolescents and their parents also completed various questionnaires regarding related demographic, psychosocial and family factors. RESULTS: There were 99 (9.0%) adolescents with clinically significant depressive symptoms. The factors significantly associated with adolescents' depressive symptoms include parental depressive symptoms (odds ratio [OR] 5.21, 95% confidence interval [CI] 3.48-7.81), adolescents' perception of family functioning as poor (OR 6.79, 95% CI 3.46-12.23), adolescents' problems with peers (OR 4.69, 95% CI 3.06-7.19), adolescents' low self-esteem (OR 6.63, 95% CI 2.59-16.96), adolescents' drinking (OR 3.98, 95% CI 2.37-6.69), female gender (OR 1.74, 95% CI 1.11-2.72), and large family size (OR 2.83, 95% CI 1.15-7.74). CONCLUSIONS: Child and adolescent health policy-makers should consider these factors when planning healthcare services or formulating a predictive model for adolescents' depression in low-income countries. Clinical assessment should focus on identification of these variables and nonpharmacological interventions may be of relevance in addressing some of the associated factors.

Adolescent↗