Depression has a heightened prevalence in adolescence, with approximately 15 % of adolescents experiencing a major depressive episode by age 18. Depression in adolescence also poses a risk for future distress and impairment. Despite treatment advances, many adolescents relapse after initial remission. Family context may be an important factor in the developmental trajectory of adolescent depression, and thus in enhancing treatment. This study examined concurrent change over time in adolescent and maternal depressive symptoms in the context of the Treatment of Resistant Depression in Adolescents study. Participants were 334 adolescents (mean age: 16; SD: 1.6; 70 % female, 84 % Caucasian), and their mothers (n = 241). All adolescents were clinically depressed when they entered the study and had received previous selective serotonin reuptake inhibitor (SSRI) treatment. Adolescents received acute treatment for 12 weeks and additional treatment for 12 more weeks. Adolescent depression and suicidal ideation were assessed at 0, 6, 12, 24, 48 and 72 weeks, while maternal depressive symptoms were assessed at 0, 12, 24, 48 and 72 weeks. Latent basis growth curve analyses showed a significant correlation over 72 weeks between trajectories of maternal and adolescent depressive symptoms, supporting the hypothesis of concurrent patterns of change in these variables. The trajectories were correlated more strongly in a subsample that included only dyads in which mothers reported at least one depressive symptom at baseline. Results did not show a correlation between trajectories of maternal depressive symptoms and adolescent suicidal ideation. These findings suggest that adolescent and maternal depressive symptoms change in tandem, and that treatment for adolescent depression can benefit the wider family system. Notably, most mothers in this sample had subclinical depressive symptoms. Future research might explore these trajectories in dyads with more severely depressed mothers.

Objective. The Global School-based Student Health Survey (GSHS) is an assessment for adolescent health-risk behaviors and exposures, supported by the World Health Organization. Although already widely implemented - and intended for youth assessment across diverse ethnic and national contexts - no reliability data have yet been reported for GSHS-based assessment in any ethnicity or country-specific population. This study reports test-retest reliability for GSHS content adapted for a female adolescent ethnic Fijian study sample in Fiji.Design. We adapted and translated GSHS content to assess health-risk behaviors as part of a larger study investigating the impact of social transition on ethnic Fijian secondary schoolgirls in Fiji. In order to evaluate the performance of this measure for our ethnic Fijian study sample (n = 523), we examined its test-retest reliability with kappa coefficients, % agreement, and prevalence estimates in a sub-sample (n = 81). Reliability among strata defined by topic, age, and language was also examined.Results. Average agreement between test and retest was 77%, and average Cohen's kappa was 0.47. Mean kappas for questions from core modules about alcohol use, tobacco use, and sexual behavior were substantial, and higher than those for modules relating to other risk behaviors.Conclusions. Although test-retest reliability of responses within this country-specific version of GSHS content was substantial in several topical domains for this ethnic Fijian sample, only fair reliability for the module assessing dietary behaviors and other individual items suggests that population-specific psychometric evaluation is essential to interpreting language and country-specific GSHS data.

Objective: The study aim was to identify and describe health consumer perspectives on social barriers to care for eating disorders in an ethnically diverse sample.Method: We conducted an exploratory secondary analysis of qualitative data comprising transcripts from semi-structured interviews with past and prospective consumers of eating disorder treatment (n = 32). Transcripts were inputted into NVivo 8 for coding, sorting, and quantifying thematic content of interest within strata defined by ethnic minority and non-minority participants. We then examined the influence of key social barriers including stigma and social stereotypes on perceived impact on care.Results: The majority of respondents (78%) endorsed at least one social barrier to care for an eating or weight concern. Perceived stigma (or shame) and social stereotyping identified both within social networks and among clinicians had adversely impacted care for 59% and 19% of respondents, respectively.Discussion: Social barriers to care for eating and weight related concerns may be prevalent in the U.S. and impact both ethnic minority and non-minority health care consumers. (C) 2009 by Wiley Periodicals, Inc.

OBJECTIVE:Behavioral risk assessment is critical to developing intervention strategies to promote adolescent health, but also presents logistical, ethical, and scientific challenges. This paper reports on feasibility of a school-based study of health-risk behaviors in ethnic Fijian adolescent girls.METHODS:We assessed feasibility of school-based participation and implementation of assessment in the local vernacular language by examining observational data and by calculating response rates and as well as language selection and item completion rates.RESULTS:All invited study area schools participated (n=12). Response rates were >70% for study participation among eligible study participants in the overall sample as well as the peri-urban and rural sub-samples. The majority of respondents (71.9%) selected the local Fijian vernacular language version rather than the English version (28.1%). Although 43.6% of respondents completed a questionnaire in a language not spoken as the primary language at home, only ten respondents (1.9%) were assessed as having difficulty with the language of the self-report questionnaire. Item completion rates for the primary outcomes were >90% for both study phases and in both language versions. Study participant response rate for further assessment of concerning symptoms was also very high and teachers were successfully recruited for participation in training and accepting referrals to support these students at each participating school.CONCLUSION:School-based behavioral risk data collection in the vernacular language was feasible. Evaluation and referral of individual study participants with concerning symptoms to educators for further assistance and support also appeared feasible. We suggest that close collaboration among Fiji-based and specialty consultants to address scientific, linguistic, logistical, and ethical challenges were contributing factors to study feasibility.

AbstractObjective:This article reviews literature relevant to challenges in clinical ascertainment of cognitively‐based diagnostic criteria of anorexia nervosa (AN) and bulimia nervosa (BN) to examine whether revision might enhance their clinical utility.Method:We performed a systematic literature search to identify publications relevant to clinical evaluation of cognitive symptoms of AN and BN.Results:The literature supports several reasons that individuals with an eating disorder may not endorse cognitive symptoms, despite their presence. These include limited insight, minimization, or denial, as well as intentional concealment related to perceived stigma, social desirability, or investment in maintaining behavioral symptoms. We also identified reasons that the word “refusal” in AN criterion A may render its application problematic.Discussion:We conclude that specific guidance for ascertainment of cognitive signs for AN and BN in the absence of patient disclosure or endorsement, longitudinal evaluation, and/or collateral data may improve clinical utility of these diagnostic criteria. © 2009 American Psychiatric Association. Int J Eat Disord 2009

INTRODUCTION:The HEALTHY Fiji Study examines the impact of social transition on health risk behaviors among school-going ethnic Fijian adolescent girls. The primary aim of the present study was to assess prevalence and socio-demographic correlates of three risk behaviors, alcohol use, cigarette smoking, and unsafe sexual behavior in the study population. METHODS:We used an adapted version of the Global School-based Health Survey (GSHS) to assess health risk behaviors in a school-based sample of ethnic Fijian girls (n=523) in June and July 2007. We calculated prevalence of risk behaviors and then examined their relation to socio-demographic variables in logistic regression models. RESULTS:Prevalence estimates for any current alcohol use and cigarette smoking (20.1% and 17.6%) and lifetime history of sexual intercourse (20.8%) indicate that substantial percentage of this study sample has engaged in one of these health risk behaviors. Alcohol use was associated with two other risk behaviors, recurrent cigarette smoking and lifetime history of sexual intercourse. Although prevalence of alcohol use was lower than in several other Pacific populations, it was higher than previously reported among Fijian girls. CONCLUSIONS:The prevalence of alcohol use, cigarette smoking, and unsafe sexual behaviors in this study population warrants concern. Comparison with estimates from previous health behavior surveys in Fiji suggest that mode of assessment may impact prevalence estimates for health risk behaviors.