Depressed Adolescent Inpatients Research Articles

Impact of physical exercise on depression and anxiety in adolescent inpatients: A randomized controlled trial

BackgroundPhysical exercise therapy is of proven efficacy in the treatment of adults with depression, but corresponding evidence is lacking in depressed adolescent inpatients. The aim of this study was to document the effect of add-on treatment with structured physical exercise in a clinical population of adolescents hospitalized for depression and anxiety in a psychiatric hospital. MethodsA group of 52 adolescent inpatients was randomly assigned to a physical exercise or control program three to four times per week over a six-week period (20 hours in total). The primary outcome was the Hospital Anxiety Depression Scale (HADS) for evaluation of depression and anxiety symptoms. Secondary outcomes were psychological self-assessments, diagnostic interviews, and physical examinations. ResultsSix participants were lost in each group, leaving 20 inpatients each in the intervention and control groups. A linear mixed model with F-test revealed a significant interaction in favor of physical exercise in reducing the mean depression score (HADS-D) by 3.8 points [95% (CI), range 1.8 to 5.7], compared to a mean reduction score of 0.7 [95% (CI), range -0,7 to 2.0] in the control group. No significant interaction was found for anxiety symptoms (HADS-A). LimitationsThe investigation was limited to the six-week hospital window and the small sample size prevented exploring differences in social characteristics. ConclusionStructured physical exercise add-on therapy integrated into the psychiatric hospitalization of adolescents has led to a reduction in their depressive symptoms, demonstrating its effectiveness in the care of adolescent inpatients with depression.

Depressed adolescents’ exposure to suicide attempts and suicide loss

This study explored depressed adolescent inpatients’ (N = 158) experiences of exposure to friends’ and family members’ suicidal behaviors. Most of the participants (n = 102, 64.6%) reported exposure to suicide-related behavior. Teens exposed to suicide were more likely than non-exposed peers to report experiencing physical abuse, sexual abuse, and suicide attempts. No differences were observed between those exposed to only suicide attempts and those exposed to both suicide attempts and deaths in clinical characteristics or suicidal behaviors. Exposure to any form of suicide-related behavior may be associated with multiple forms of adversity in childhood.

Emotional intelligence moderates perceived stress and suicidal ideation among depressed adolescent inpatients

Because it remains one of the third leading causes of death among adolescents around the world, suicide is a major public health concern. This study was designed in response to this concern by examining the relationships among perceived stress, emotional intelligence, and suicidal ideation and to test the moderating role of emotional intelligence in the relationship between perceived stress and suicidal ideation. A sample of depressed adolescents (n=202) was recruited from five hospitals in Tehran, Iran, and then asked to complete measures of patient health, suicidal ideation, perceived stress, and emotional intelligence. Structural Equation Modeling showed that depressed adolescent in-patients with high levels of perceived stress and low levels of emotional intelligence were more likely to report suicidal ideation. Multi-group analysis indicated that depressed in-patients high in both perceived stress and emotional intelligence had less suicidal ideation than others. The findings support the notion that perceived stress acts as a vulnerability factor that increase suicidal ideation among depressed inpatients. Suicidal history moderated the relationship between emotional intelligence and suicidal ideation. These findings also highlight the importance of emotional intelligence as a buffer in the relationship between perceived stress and suicidal ideation.

Emotional intelligence as a mediator between rumination and suicidal ideation among depressed inpatients: The moderating role of suicidal history

Suicide is a substantial public health problem, and it remains a serious cause of death in the world. Therefore, this study was designed to examine the relationships between brooding, reflection, emotional intelligence (assessed by performance-based test), and suicidal ideation; the mediation role of emotional intelligence on the relationships between brooding and reflection with suicidal ideation; and the moderating role of suicidal history on the relationships between brooding, reflection, and emotional intelligence with suicidal ideation among Iranian depressed adolescents. The study consisted of a cross-sectional sample of 202 depressed adolescent inpatients from five public hospitals in Tehran, Iran completed measures of depression, rumination, emotional intelligence, and suicide attempt history as indices of suicidal ideation. Structural Equation Modelling estimated that depressed adolescent inpatients with high levels of brooding and reflective rumination, and low levels of emotional intelligence were more likely to report suicidal ideation. Moreover, emotional intelligence partially mediated the relationships between brooding and reflective rumination with suicidal ideation. Suicidal history moderated the relationships between brooding, reflection, and emotional intelligence with suicidal ideation. These findings reinforce the importance of emotional intelligence as an influencing factor against the deleterious effects of rumination styles and suicidal ideation. The results indicate that brooding and reflection have detrimental effects on suicidal ideation in depressed inpatients.

Spirituality Moderates Hopelessness, and Suicidal Ideation among Iranian Depressed Adolescents

To examine the moderating role of spirituality between hopelessness, spirituality, and suicidal ideation, 202 Iranian depressed adolescent inpatients completed measures of patient health, suicidal ideation, hopelessness, and core spiritual experience. Structural equation modelling indicated that depressed inpatients high in hopelessness, but also high in spirituality, had less suicidal ideation than others. These findings reinforce the importance of spirituality as a protective factor against hopelessness and suicidal ideation.

Aggression in Inpatient Adolescents

Differences in aggressive behavior were examined in a primarily White sample of 84 thirteen- to seventeen-year-old depressed and nondepressed adolescent inpatients. Results indicate that depression and gender interact significantly; females with depression demonstrated more physical aggression than nondepressed females, and males with depression demonstrated less aggression than nondepressed males. These results indicate that depression is a greater risk factor for physical aggression in treatment-seeking female, compared to male, adolescents.

Depression, Hopelessness, and Self‐Esteem: Accounting for Suicidality in Adolescent Psychiatric Inpatients

The present study was designed to examine depression, hopelessness, and self-esteem as related to suicidal behavior in three groups of depressed adolescent psychiatric inpatients. Depressed adolescents who had never attempted suicide were compared to depressed adolescents who had attempted suicide once and to depressed adolescents who had attempted suicide on several different occasions. Results showed that suicidal adolescents experienced significantly greater depression and hopelessness than did the nonsuicidal adolescents. However, all three groups of depressed adolescents reported similar low levels of self-esteem. Measures of depression and hopelessness were useful in classifying the adolescents based on their suicidal behavior. Results suggest that the treatment of suicidal adolescents could benefit from strategies that focus on reducing feelings of depression and hopelessness.

Correlates of suicide risk in adolescent inpatients who report a history of childhood abuse

The study objective was to examine correlates of suicide risk in psychiatrically hospitalized adolescents with a reported history of childhood abuse. Predictors of suicide risk were examined in 74 subjects who reported a history of childhood abuse and 53 depressed subjects who did not report a history of childhood abuse. Subjects completed a battery of psychometrically well-established self-report instruments to assess childhood abuse, suicide risk, and internalizing and externalizing psychopathology. Correlational analyses showed that higher levels of depression, self-criticism, and hopelessness were significantly associated with suicide risk in both study groups and violence was significantly associated with suicide risk in the childhood abuse group. For the childhood abuse group, multiple regression analyses with seven predictor variables accounted for 54% of the variance in suicide risk; depression and alcohol problems made significant independent contributions, while violence and self-criticism were independent predictors at the trend level. For the depressed/nonabused group, multiple regression analyses with the seven predictor variables accounted for 60% of the variance in suicide risk; depression, hopelessness, and self-criticism were independent predictors. Our findings suggest that both internalizing (i.e., depression or self-criticism) and externalizing (i.e., violence or alcohol) factors predict suicide risk in adolescent inpatients who report childhood abuse. This profile appears different from the more internalizing pattern (i.e., depression, self-criticism, and hopelessness) observed for the depressed adolescent inpatients who reported no history of childhood abuse.

The Association Between Humor and Depression in Adolescent Psychiatric Inpatients and High School Students

Humor may be an important coping skillfor dealing with emotional difficulties during adolescence. The relations between humor and symptoms of depression in high school students and in depressed adolescent psychiatric inpatients were examined in the present study. Assessment of humor included measures of humor appreciation, humor creativity, and humor coping. Professional comedians rated humor creativity. Depression was assessed with self-report measures of depressed mood, self-esteem, and hopelessness. Results indicated that humor can be measured reliably and that humor and depression are related. Specifically, using humor to cope with emotional difficulties was related to depression more than was the ability to appreciate or create humorous material. Although the adolescent inpatients reported more emotional distress than did the high school participants, the two groups did not differ on the humor measures. Further research examining the role of humor in coping with depression among adolescents is indicated.

Depressed Adolescents with a History of Sexual Abuse: Diagnostic Comorbidity and Suicidality

To determine the nature of comorbid psychopathology and suicidality associated with a history of sexual abuse in depressed adolescents. Twenty-four depressed adolescent inpatients with a history of sexual abuse were compared with a matched control group of 24 depressed adolescent inpatients on measures of depression, suicidal ideation and behavior, and posttraumatic stress disorder (PTSD) symptoms. Depressed adolescents with a history of sexual abuse had a higher prevalence of comorbid PTSD than did those without such a history. Chronicity and severity of abuse were significant contributors to a PTSD diagnosis. No differences were found in depression severity, specific depressive symptoms, or suicidal behavior. Comorbidity of depressive disorders and PTSD are common among adolescent inpatients with a history of chronic sexual abuse. The need for thorough assessment of depression and PTSD with appropriate interventions for sexually abused adolescents is clear.

The mediating role of anxiety in self-reported somatic complaints of depressed adolescents

This study examined the mediating role of anxiety in the self-reports of somatic complaints in 96 depressed adolescent inpatients. Sixty-four subjects with major depressive episodes and comorbid anxiety disorders (MDE-A) determined from the Diagnostic Interview for Children and Adolescents--Revised (DICA-R) reported significantly more somatic complaints than 32 adolescents having major depressive episodes without comorbid anxiety (MDE). An analysis of covariance demonstrated that, with anxiety symptoms controlled, MDE and MDE-A groups did not differ significantly in somatic complaints. A hierarchical multiple-regression analysis revealed that, with demographic and anxiety symptoms controlled, depressive symptoms did not contribute to the explanation or prediction of somatic complaints. The results suggest that anxious, but not depressive symptoms, are independently associated with somatic complaints. The results are discussed in light of new affective models of psychopathology.

Global Self-Worth, Specific Self-Perceptions of Competence, and Depression in Adolescents

The purpose of this research was (1) to study adolescent depression severity in relation to global self-worth and specific self-perceptions of competence, and (2) to determine whether improvement in depression during hospitalization is accompanied by improvement in global self-worth and specific self-perceptions. A within-subject longitudinal design with cross-sectional control subjects was used. Thirty depressed adolescent inpatients participated in assessments of depression severity (Hamilton Rating Scale for Depression) and self-perceptions of global self-worth and domain-specific competencies (Self-Perception Profile for Adolescents) at hospital admission and discharge (mean hospitalization: 59 days). A demographically similar group of 30 normal comparison subjects participated in the baseline assessment. Global self-worth was negatively associated with inpatients' depression severity and differentiated inpatients from normal comparison subjects. Self-perceptions of specific competencies were differentially related to depression severity, with perceived social acceptance being most clearly related to depression severity. Among the subgroup of inpatients showing clear and significant improvement in depression across hospitalization, increases in global self-worth and perceived social acceptance were also evident. Findings underscore the importance of considering global self-worth and self-perceptions of specific competencies in developmentally significant areas when assessing and treating adolescents.

The Rorschach test for predicting suicide among depressed adolescent inpatients.

With the decreasing length of psychiatric hospitalizations, identification of test indicators of suicide risk becomes critically important. This Rorschach study was designed to model a clinical decision-making scenario concerning adolescent suicide risk. Using Psychiatric Evaluation Form (PEF) scores, we selected a sample of 25 severely depressed and suicidal adolescents; 26 severely depressed, not suicidal adolescents; and 28 not suicidal, not depressed adolescent inpatients at The Sheppard and Enoch Pratt Hospital. A Rorschach Index using the Exner (1986) Comprehensive System for scoring was developed to predict group membership. Four of six of the features on this index selected 64% of suicidal subjects. This constellation included traditional affective variables (vista responses, color-shading blends, color dominated responses, and morbid content) as well as measures of cognitive distortion (inaccurately perceived human movement responses [M-] and special scores). We discuss the implications of these findings for the diagnosis and treatment of the suicidal adolescent.

Natural killer cell activity in adolescents with major depression

An increasingly large body of work in adults has shown that derangements in the immune system, a critical protector from disease, are associated with stress, bereavement, and depression (for review, see Schleifer et al 1986, Calabrese et al 1987). We (Kronfol et al 1989) and others (Mohl et al 1987; Nerozzi et al 1989; Irwin et al 1990) have reported lower natural killer (NK) cell activity, a parameter of immune function directed against virus-infected or tumor cells (Herberman and Ortaido 1981), in adults with major depression. Other investigators, however, found no difference in NK cell activity between depressed adults and controls (Schleifer et al 1989). The current study compares NK cell activity in depressed adolescent inpatients a n d a o # . n n d ~ o Y . m ~ t t ' h e d n o r m a ! r n n f r n k

Attributional Style and Self-Reported Depression Among Adolescents Inpatients

Eighteen adolescent inpatients with various diagnoses completed the Children's Depression Inventory and the Children's Attributional Style Questionnaire. The correlations between the two scales were consistent with those obtained among nonclinical samples of children and adolescents. The data were consistent with their reformulated learned helpless theory of depression. Suggestions were offered for subsequent research with depressed adolescent inpatients.