Mood And Feelings Questionnaire Research Articles

Discriminative validity and interpretability of the mood and feelings questionnaire

BackgroundUsing the Mood and Feelings Questionnaire (MFQ) to differentiate between depression severity levels remains unexplored. We explored the discriminative validity of the MFQ to identify an optimal cut-off MFQ score to distinguish between subthreshold-to-mild and moderate-to-severe depression severity levels. MethodsAn observational cross-sectional design was used in a sample (N = 67) of help-seeking youth (ages 13 to 18, inclusive) experiencing depressive symptoms. The MFQ was administered verbatim to youth by a research analyst over the phone. Youth were then grouped into subthreshold-to-mild or moderate-to-severe depression severity categories based on scores received on the Kiddie Schedule for Affective Disorders and Schizophrenia-Depression Rating Scale. Receiver Operating Characteristic curve analyses were conducted, with area under the curve (AUC) and Youden Index (J) as primary indices. We hypothesized that the lower limit of the 95 % confidence interval for the area under the curve would be ≥0.70. ResultsThe primary analysis yielded an AUC of 0.85 (95 % CI: 0.763–0.947) and an optimal cut-off of ≥43 (J = 0.60, positive predictive value = 91.4 %, negative predictive value = 62.5 %, sensitivity = 72.7 %, specificity = 87.0 %). LimitationsOur study collected a small sample, and as such cannot identify how subgroup classification (e.g., based on race or gender) may moderate outcomes. Further, unknown measurement error of the predictor and reference variable measures can bias the estimates. ConclusionsOur preliminary findings highlight the potential for the MFQ to support clinical decision-making relevant to adolescents experiencing varying severities of depressive symptoms in secondary care settings.

Clinical effectiveness and cost-effectiveness of a brief accessible cognitive behavioural therapy programme for stress in school-aged adolescents (BESST): a cluster randomised controlled trial in the UK

Depression and anxiety are increasingly prevalent in adolescents. The Brief Educational Workshops in Secondary Schools Trial investigated the effectiveness of a brief accessible stress workshop programme for 16-18-year-olds. We aimed to investigate the clinical effectiveness and cost-effectiveness of the DISCOVER cognitive behavioural therapy (CBT) workshop on symptoms of depression in 16-18-year-olds at 6 months compared with treatment-as-usual. We conducted a multicentre, cluster randomised controlled trial in UK schools or colleges with sixth forms to evaluate clinical effectiveness and cost-effectiveness of a brief CBT workshop (DISCOVER) compared with treatment-as-usual. We planned to enrol 60 schools and 900 adolescents, using a self-referral system to recruit participants. Schools were randomised in a 1:1 ratio for participants to receive either the DISCOVER workshop or treatment-as-usual, stratified by site and balanced on school size and index of multiple deprivation. Participants were included if they were 16-18 years old, attending for the full school year, seeking help for stress, and fluent in English and able to provide written informed consent. The outcome assessors, senior health economist, senior statistician, and chief investigator were masked. People with lived experience were involved in the study. The primary outcome was depression symptoms measured with the Mood and Feelings Questionnaire (MFQ) at 6-month follow-up, in the intention-to-treat population of all participants with full covariate data. The trial was registered with the ISRCTN registry (ISRCTN90912799). 111 schools were invited to participate in the study, seven were deemed ineligible, and 47 did not provide consent. Between Oct 4, 2021, and Nov 10, 2022, 933 students at 57 schools were screened for eligibility, seven were not eligible for inclusion, and 26 did not attend the baseline meeting and assessment, resulting in 900 adolescents participating in the study. The DISCOVER group included 443 participants (295 [67%] female and 136 [31%] male) and the treatment-as-usual group included 457 participants (346 [76%] female and 92 [20%] male). 468 (52%) of the 900 participants were White, and the overall age of the participants was 17·2 years (SD 0·6). 873 (97%) adolescents were followed up in the intention-to-treat population. The primary intention-to-treat analysis (n=854) found an adjusted mean difference in MFQ of -2·06 (95% CI -3·35 to -0·76; Cohen's d=-0·17; p=0·0019) at the 6-month follow-up, indicating a clinical improvement in the DISCOVER group. The probability that DISCOVER is cost- effective compared with treatment-as-usual ranged from 61% to 78% at a £20 000 to £30 000 per quality-adjusted life-year threshold. Nine adverse events (two of which were classified as serious) were reported in the DISCOVER group and 14 (two of which were classified as serious) were reported in the treatment-as-usual group. Our findings indicate that the DISCOVER intervention is modestly clinically effective and economically viable and could be a promising early intervention in schools. Given the importance of addressing mental health needs early in this adolescent population, additional research is warranted to explore this intervention. National Institute for Health and Care Research Health Technology Assessment Programme.

Brief Educational Workshops in Secondary Schools Trial (BESST trial), a school-based cluster randomised controlled trial of the DISCOVER workshop for 16–18-year-olds: recruitment and baseline characteristics

BackgroundThe Brief Educational Workshops in Secondary Schools Trial (BESST) is an England-wide school-based cluster randomised controlled trial assessing the clinical and cost-effectiveness of an open-access psychological workshop programme (DISCOVER) for 16–18-year-olds. This baseline paper describes the self-referral and other recruitment processes used in this study and the baseline characteristics of the enrolled schools and participants.MethodWe enrolled 900 participants from 57 Secondary schools across England from 4th October 2021 to 10th November 2022. Schools were randomised to receive either the DISCOVER day-long Stress workshop or treatment as usual which included signposting information. Participants will be followed up for 6 months with outcome data collection at baseline, 3-month, and 6-month post randomisation.ResultsSchools were recruited from a geographically and ethnically diverse sample across England. To reduce stigma, students were invited to self-refer into the study if they wanted help for stress. Their mean age was 17.2 (SD = 0.6), 641 (71%) were female and 411 (45.6%) were from ethnic minority groups. The general wellbeing of our sample measured using the Mood and Feelings Questionnaire (MFQ) found 314 (35%) of students exhibited symptoms of depression at baseline. Eighty percent of students reported low wellbeing on the Warwick Edinburgh Mental Wellbeing Scale (WEMWBS) suggesting that although the overall sample mean is below the cut-off for depression, the self-referral approach used in this study supports distressed students in coming forward.ConclusionThe BESST study will continue to follow up participants to collect outcome data and results will be analysed once all the data have been collected.Trial registrationISRCTN registry ISRCTN90912799. Registered on 28 May 2020.

A Chinese adaptation of the Patient Health Questionnaire for Adolescents (PHQ-A): factor structure and psychometric properties

BackgroundTo examine the factor structure and psychometric properties of the Patient Health Questionnaire for Adolescents (PHQ-A) in Chinese children and adolescents with major depressive disorder (MDD).MethodsA total of 248 MDD patients aged between 12 and 18 years were recruited and evaluated by the Patient Health Questionnaire for Adolescents (PHQ-A), the Center for Epidemiological Survey Depression Scale (CES-D), the Mood and Feelings Questionnaire (MFQ), and the improved Clinical Global Impression Scale, Severity item (iCGI-S). Thirty-one patients were selected randomly to complete the PHQ-A again one week later. Confirmatory factor analysis (CFA) was used to test the construct validity of the scale. Reliability was evaluated by Macdonald Omega coefficient. Pearson correlation coefficient was used to assess the item-total correlation and the correlation of PHQ-A with CES-D and MFQ respectively. Spearman correlation coefficient was used to assess test-retest reliability. The optimal cut-off value, sensitivity, and specificity of the PHQ-A were achieved by estimating the Receiver Operating Characteristics (ROC) curve.ResultsCFA reported adequate loadings for all items, except for item 3. Macdonald Omega coefficient of the PHQ-A was 0.87. The Spearman correlation coefficient of the test-retest reliability was 0.70. The Pearson correlation coefficients of the PHQ-A with CES-D and MFQ were 0.87 and 0.85, respectively (p < 0.01). By taking the iCGI-S as the remission criteria for MDD, the optimal cut-off value, sensitivity and specificity of the PHQ-A were 7, 98.7%, 94.7% respectively.ConclusionThe PHQ-A presented as a unidimensional construct and demonstrated satisfactory reliability and validity among the Chinese children and adolescents with MDD. A cut-off value of 7 was suggested for remission.

Evaluating the development and well-being assessment (DAWBA) in pediatric anxiety and depression

Enhancing screening practices and developing scalable diagnostic tools are imperative in response to the increasing prevalence of youth mental health challenges. Structured lay psychiatric interviews have emerged as one such promising tool. However, there remains limited research evaluating structured psychiatric interviews, specifically their characterization of internalizing disorders in treatment-seeking youth. This study evaluates the relationship between the Development and Well-Being Assessment (DAWBA), a structured psychiatric interview, and established measures of pediatric anxiety and depression, including the Screen for Child Anxiety Related Disorders (SCARED), the Pediatric Anxiety Rating Scale (PARS), and the Mood and Feelings Questionnaire (MFQ). The study comprised two independent clinical samples of treatment-seeking youth: sample one included 55 youth with anxiety and 29 healthy volunteers (HV), while sample two included 127 youth with Major Depressive Disorder and 73 HVs. We examined the association between the DAWBA band scores, indicating predicted risk for diagnosis, the SCARED and PARS (sample one), and the MFQ (sample two). An exploratory analysis was conducted in a subset of participants to test whether DAWBA band scores predicted the change in anxiety symptoms (SCARED, PARS) across a 12-week course of cognitive behavioral therapy. The results revealed that the DAWBA significantly predicted the SCARED, PARS and MFQ measures at baseline; however, it did not predict changes in anxiety symptoms across treatment. These findings suggest that the DAWBA may be a helpful screening tool for indexing anxiety and depression in treatment-seeking youth but is not especially predictive of longitudinal trajectories in symptomatology across psychotherapy.

Secondary outcomes of enhanced cognitive behavioral therapy (eCBT) for children and adolescents with obsessive-compulsive disorder.

Obsessive-compulsive disorder (OCD) is a debilitating mental health condition usually presenting with a high degree of comorbid symptoms in the majority of cases. Although face-to-face cognitive-behavioral therapy (CBT) is considered the therapeutic golden standard for pediatric OCD, its accessibility, availability, and consistency in delivery are still limited. To address some of these challenges, an enhanced CBT (eCBT) package was created and introduced. This study explored eCBT's broad-based impact on OCD-related comorbid symptoms, functional impairment, quality of life and family accommodation among youth with OCD. This open trial involved 25 pediatric patients with OCD (7-17 years), assessed between January 2018 to February 2020. All patients received eCBT for 14 weeks. Secondary outcomes were assessed at baseline, post-treatment, and 3-, 6-, and 12-month follow-up co-occurring symptoms were evaluated using the Strengths and Difficulties Questionnaire (SDQ), Screen for Child Anxiety-Related Emotional Disorders (SCARED), and Mood and Feelings Questionnaire (MFQ). Quality of life was measured using the KINDL-R, functional impairment through the Child Obsessive-Compulsive Impact Scale Revised (COIS-R), and family accommodation by the Family Accommodation Scale (FAS). Linear mixed-effects models were applied to analyze treatment effects. Results indicated a significant decrease in OCD-related comorbid symptoms post-treatment, with SDQ mean reduce of 3.73 (SE = 1.10, child) and 4.14 (SE = 1.19, parent), SCARED mean reduce of 10.45 (SE = 2.52, child) and 8.40 (SE = 2.82, parent), MFQ mean reduce of 3.23 (SE = 1.11, child) and 2.69 (SE = 1.18, parent). Family accommodation declined with clinician scored FAS mean reduction of 13.25 (SE = 2.31). Quality-of-Life improved significantly post-treatment, with KINDL mean increase of 8.15 (SE = 2.87, children), and 10.54 (SE = 3.07, parents). These positive improvements were further amplified at the 3-month follow-up and remained consistent at the 12-month follow-up. A significant reduction was observed in all secondary outcomes employed and OCD-related functional impairments from baseline to post-treatment, which was maintained through 12-month follow-up. These results imply that after receiving eCBT, children and adolescents experienced substantial decrease in the negative impacts of OCD-related symptoms on their daily life, including home, school, and social interactions.

Stigma and its impact on disclosure and mental health secrecy in young people with clinical depression symptoms: A qualitative analysis.

Clinical depression ranks as a leading cause of disease and disability in young people worldwide, but it is widely stigmatized. The aim of this qualitative research was to gather young people's experiences of depression stigma and its impact on loneliness, social isolation, and mental health disclosure and secrecy. This novel information can then be used to guide psychosocial interventions for young people with depression. This qualitative study included N = 28 young people aged 18-25 years (Mage = 21.30). Participants were recruited from the community who had high symptoms of depression (assessed through a pre-screen using the Mood and Feelings Questionnaire (MFQ) with a benchmark score > 27) or had been recently diagnosed with depression by a medical professional. Semi-structured interviews were based on conceptual model drawings created by participants and analyzed using thematic analysis. Four main themes emerged: 1) Depression secrecy: positive and negative aspects; 2) Depression disclosure: positive and negative aspects; 3) The solution is selective disclosure; and 4) Participants' recommendations do not align with personal preferences. In particular, the young people described non-disclosure as a way to be in control, but that secrecy prevented authentic engagement with others. Young people also described disclosure as eliciting more stigma but as necessary to gain help. Finally, the young people described struggling with knowing how much to disclose in relation to their mental health and with whom they could disclose. This study provides new evidence of how young people with depression experience stigma and its effects on disclosure and mental health secrecy. Knowing how young people struggle with these issues can allow us to develop interventions to encourage them to come forward and discuss their mental health in order to receive appropriate support and treatment. We recommend young people be signposted and have access to mental health champions or nominated teachers in their schools or universities.

Identification of structural brain alterations in adolescents with depressive symptomatology

IntroductionDepressive symptoms can emerge as early as childhood and may lead to adverse situations in adulthood. Studies have examined structural brain alternations in individuals with depressive symptoms, but findings remain inconclusive. Furthermore, previous studies have focused on adults or used a categorical approach to assess depression. The current study looks to identify grey matter volumes (GMV) that predict depressive symptomatology across a clinically concerning sample of adolescents. MethodsStructural MRI data were collected from 338 clinically concerning adolescents (mean age = 15.30 SD=2.07; mean IQ = 101.01 SD=12.43; 132 F). Depression symptoms were indexed via the Mood and Feelings Questionnaire (MFQ). Freesurfer was used to parcellate the brain into 68 cortical regions and 14 subcortical regions. GMV was extracted from all 82 brain areas. Multiple linear regression was used to look at the relationship between MFQ scores and region-specific GMV parameter. Follow up regressions were conducted to look at potential effects of psychiatric diagnoses and medication intake. ResultsOur regression analysis produced a significant model (R2 = 0.446, F(86, 251) = 2.348, p < 0.001). Specifically, there was a negative association between GMV of the left parahippocampal (B = −0.203, p = 0.005), right rostral anterior cingulate (B = −0.162, p = 0.049), and right frontal pole (B = −0.147, p = 0.039) and a positive association between GMV of the left bank of the superior temporal sulcus (B = 0.173, p = 0.029). Follow up analyses produced results proximal to the main analysis. ConclusionsAltered regional brain volumes may serve as biomarkers for the development of depressive symptoms during adolescence. These findings suggest a homogeneity of altered cortical structures in adolescents with depressive symptoms.

Effects of mental health stigma on loneliness, social isolation, and relationships in young people with depression symptoms

BackgroundMajor depressive disorder (MDD) is the most prevalent affective disorder and the leading cause of illness and disability among young people worldwide. Besides being more susceptible to the onset of depression, young people have a higher risk of loneliness, and their personal and social development is impacted by social relationships during this time. It is thought that mental health stigma can undermine both help-seeking and longer-term outcomes for disorders like depression in young people. However, how stigma (i.e., related to depression) might affect young people’s feelings of loneliness, social isolation, and relationships is unclear. Using qualitative research methods, this study aimed to explore the subjective experiences of public and internalized stigma and its effects on loneliness, social isolation, and relationship quality in young people with depression symptoms.MethodsWe carried out in-depth, semi-structured interviews with N = 22 young people aged 17–25 (Mage = 22 years) who reported high symptoms of depression (Mood and Feelings Questionnaire (MFQ) score > 27) (i.e., community sample, N = 9) or had been previously diagnosed with depression by a medical professional (i.e., clinical sample, N = 13). Data were analysed using thematic analysis. We explored the subjective effects of depression stigma on loneliness, social isolation, and relationships.ResultsParticipants described both public stigma (i.e., initiated by others) and internalized stigma (i.e., self-imposed) as disrupting social relationships and eliciting loneliness, isolation, and depressive symptomology. Four main themes about young people's subjective experiences of stigma were identified: 1) Others’ Misunderstanding of Mental Health Disorders and the Impact Misunderstanding has on Relationships; 2) Effects of Stigma on the Self and Wellbeing; 3) Stigma Fosters Secrecy Versus Disclosure; and 4) Stigma Increases Loneliness Driven by Avoidance of Social Contexts.ConclusionsYoung people's accounts revealed a wide range of consequences beyond their depression diagnosis. Participants often felt discriminated against, misunderstood, and judged by others as a result of public stigma; they discussed internalizing these attitudes. They suggested that a lack of understanding from others, for example from their partners, family, and peers, and unreliable and/or absent support systems resulted in increased feelings of loneliness and social isolation and reduced the quality and quantity of relationship formation, social bonds, and interactions. Stigma also reduced their self-esteem and confidence, which in turn fostered secrecy and a reluctance to disclose their depression. Despite depression's stigma, most participants reported having long-term goals and aspirations to reconnect with others. These goals stood in contrast to feeling hopeless and unmotivated during periods of depression. Overall, we reveal how stigma can impact feelings of loneliness, social isolation, and relationships among young people with depression, which could lead to targeted interventions to lessen the impact of stigma in this population.

Prevalence of depression symptoms among female adolescents in Saudi Arabia.

Epidemiological studies on the prevalence of elevated depression symptoms among female adolescents in Saudi Arabia report a wide variation, ranging from 13.9% to 80.2%. However, different methods of assessment and sampling have been used. The aim of the current study is to estimate the prevalence of elevated depression symptoms amongst female adolescents in Saudi Arabia using a gold-standard self-report measure, the Mood and Feelings Questionnaire (MFQ). A cross-sectional study was conducted with 515 female students aged 13-18 years, recruited from public schools. Participants completed the Arabic versions of the MFQ, Rosenberg Self-Esteem Scale and Multidimensional Scale of Perceived Social Support. Mean MFQ score for this sample was 26.35 and almost half of participants (48.2%) had scores above the cut-off. Severity of depression varied with age, with those aged 13 showing reduced symptoms, and was negatively correlated with self-esteem and perceived social support. There were no associations with other demographic factors. Elevated levels of depression symptoms were common in this sample. This highlights the need to improve public mental health in this community and to improve methods of identifying and treating depression in female adolescents.

Psychometric properties of the Sindhi version of the Mood and Feelings Questionnaire (MFQ) in a sample of early adolescents living in rural Pakistan.

There is a need for reliable and valid screening tools that assess depressive symptoms in adolescents in Pakistan. To address this need, the present study examined the psychometric properties and factor structure of a Sindhi-translated and adapted version of the child-report Mood and Feelings Questionnaire (MFQ-C) and the Short Mood and Feelings Questionnaire (SMFQ-C) in a community sample of adolescents living in Matiari, Pakistan. Questionnaires were translated into Sindhi and administered by study psychologists to 1350 participants (52.3% female) 9.0 to 15.9 years old. Measurement structure was examined using confirmatory factor analysis. Internal consistency was estimated, and convergent and divergent validity were explored using subscales from the Strengths and Difficulties Questionnaire and the Screen for Child Anxiety Related Emotional Disorders. The unidimensional structure of the MFQ-C was found to be adequate, but a four-factor structure comprising core mood, vegetative, cognitive and agitated distress symptoms best fit the data (CFI = 0.97, TLI = 0.97, RMSEA = 0.05). The original unidimensional structure of the SMFQ-C was supported (CFI = 0.97, TLI = 0.96, RMSEA = 0.07). The MFQ-C and the SMFQ-C respectively showed excellent (α = 0.92) and good internal consistency (α = 0.87) as well as satisfactory construct validity with some differences observed across the MFQ-C subscales. The SMFQ-C and the adapted MFQ-C appear to be reliable and valid measures of depressive symptoms among early adolescents living in rural Pakistan. Both total and subscale scores can be derived from the MFQ-C to assess general and specific dimensions of depressive symptoms in this population.

Anxiety, depression and PTSD in children and adolescents following the Beirut port explosion

BackgroundOn August 4, 2020, Beirut's port experienced one of the strongest non-nuclear explosions in history, killing approximately 200 people, displacing 300,000 persons, and injuring more than 1000 children. MethodsAn online anonymous survey assessed the prevalence of probable mental health disorders (MHDs) and impact of blast-related and other factors controlling for sociodemographics in 801 children aged 8 to 17 years old. ResultsAbout two thirds (64%) were screened positive for probable anxiety using the Screen for Childhood Anxiety Related Disorder, 52% for probable PTSD using CRIES-13, and 33% for probable depression using the Mood and Feelings Questionnaire (MFQ). Children who resided farthest way from the explosion site or were not in Beirut during blast had a significantly lower odds of anxiety and PTSD. Children who sustained any physical injury (vs. none) or witnessed casualties (vs. not) were at higher odds for PTSD. Children of parents who reported that their homes sustained minor damages (vs. no damages at all) were at higher odds for anxiety and PTSD, and temporary displacement (vs. none) increased odds of PTSD only. Poorer perceived economic status, poorer academic performance, having a family member injured in the blast, and prior mental health care seeking were associated with higher odds for all MHDs. ConclusionOur study, the only one to document the mental health impact of the Beirut Port explosion on children, highlights the critical need for an emergency mental health response, prioritizing disadvantaged communities and children with prior mental health problems.

Psychopathology in Children and Adolescents in Lebanon Study (PALS): a national household survey.

IntroductionPsychiatric disorders are among the leading causes of disability in children and adolescents globally. In Lebanon, a country that has endured a prolonged history of conflict and economic and political uncertainty, mental health surveys in children and adolescents have been limited to specific disorders or specific settings or cities. PALS (Psychopathology in Children and Adolescents in Lebanon Study) is the first study to screen a nationally representative sample of children and adolescents for psychiatric disorders and estimate the national prevalence of children and adolescents at risk of having a psychiatric disorder.MethodsA nationally representative household sample of 1517 children and adolescents (aged 5 years 0 months to 17 years 11 months) was recruited through a multi-stage stratified proportionate sampling technique between February 2018 and November 2018. Parents and adolescents completed a battery of self-reported scales including the Strengths and Feelings Questionnaire (SDQ), Mood and Feelings Questionnaire (MFQ), Screen for Child Anxiety and Emotional Related Disorders (SCARED), the Peer Relations Questionnaire (PRQ), General Health Questionnaire (GHQ), and Conflict Behavior Questionnaire (CBQ), Child Revised Impact of Events Scale (CRIES), and a demographic/clinical information questionnaire. Logistic regression models were used to examine the correlates of screening positive for psychiatric disorders.ResultsAbout a third of children and adolescents (32.7%, n = 497) screened positive for at least one psychiatric disorder, of whom only 5% (n = 25) reported ever seeking professional mental health help. Academic performance, having a chronic physical illness, higher parental GHQ scores, and involvement in bullying were associated with a higher odds of screening positive for a psychiatric disorder. Higher family income was negatively associated with screening positive for a psychiatric disorder.ConclusionThis first national study shows a high prevalence of psychiatric symptoms in Lebanese children and adolescents and an alarming treatment gap. School-based primary prevention programs or screening in primary care settings are key for early detection and management of psychiatric symptoms, and prevention of psychiatric disorders.

Adolescent depression beyond DSM definition: a network analysis

Calls for refining the understanding of depression beyond diagnostic criteria have been growing in recent years. We examined the prevalence and relevance of DSM and non-DSM depressive symptoms in two Brazilian school-based adolescent samples with two commonly used scales, the Patient Health Questionnaire (PHQ-A) and the Mood and Feelings Questionnaire (MFQ). We analyzed cross-sectional data from two similarly recruited samples of adolescents aged 14–16 years, as part of the Identifying Depression Early in Adolescence (IDEA) study in Brazil. We assessed dimensional depressive symptomatology using the PHQ-A in the first sample (n = 7720) and the MFQ in the second sample (n = 1070). We conducted network analyses to study symptom structure and centrality estimates of the two scales. Additionally, we compared centrality of items included (e.g., low mood, anhedonia) and not included in the DSM (e.g., low self-esteem, loneliness) in the MFQ. Sad mood and worthlessness items were the most central items in the network structure of the PHQ-A. In the MFQ sample, self-hatred and loneliness, two non-DSM features, were the most central items and DSM and non-DSM items in this scale formed a highly interconnected network of symptoms. Furthermore, analysis of the MFQ sample revealed DSM items not to be more frequent, severe or interconnected than non-DSM items, but rather part of a larger network of symptoms. A focus on symptoms might advance research on adolescent depression by enhancing our understanding of the disorder.

3.4 Prevalence and Correlates of Anxiety Disorders Among Lebanese Children and Adolescents: Results From the PALS Study

Anxiety disorders (AD) are among the most common mental health conditions in children and adolescents; however, their prevalence and correlates in Lebanese children and adolescents remains an area that is yet to be understood. A nationally representative household sample of 1517 children and adolescents were recruited in Lebanon using probability sampling technique as part of the Pittsburgh ADHD Longitudinal Study (PALS). Of those, 1287 participants aged 8 to 17 years, 11 months and their parents completed the Screen for Child Anxiety Related Emotional Disorders (SCARED), Mood and Feelings Questionnaire (MFQ), Strengths and Difficulties Questionnaire (SDQ), the Peer Relations Questionnaire (PRQ), and the Children's Revised Impact of Event Scale (CRIES). Parents completed a sociodemographic questionnaire and the General Health Questionnaire (GHQ). Among our sample, 290 participants (22.58%) had a probable AD. Their average age was 11.32 years, and 167 were females (57.49%). Among those with a probable AD, 127 (43.71%) screened positive for PTSD, 82 (28.22%) screened positive for suicidal ideation, 62 (21.35%) screened positive for depression, 28 (9.65%) screened positive for conduct disorder, and 25 (8.63%) screened positive for a hyperactivity disorder. In the logistic regression model, compared to children without AD, those with a probable AD were more likely to be females (OR = 1.705; 95% CI, 1.027-1.061), have acceptable (OR = 1.54; 95% CI, 1.029-2.306) or suboptimal school performance (OR = 2.653; 95% CI, 1.214-5.800), be a victim of bullying only (OR = 4.074; 95% CI, 2.508-6.616), be a bully only (OR = 2.173; 95% CI = 1.385-3.408), be both a victim and a bully (OR = 4.471; 95% CI, 2.418-8.269), have a chronic physical illness (OR = 1.730; 95% CI, 1.066-2.809), and higher parental total score on the GHQ (OR = 1.044; 95% CI, 1.027-1.061). Also, compared to those without AD, children and adolescents with probable AD were less likely to be in the middle-income range (OR = 0.505; 95% CI, 0.344-0.741) or higher income range (OR = 0.418; 95% CI, 0.222-0.788). Only 20 (6.97%) of those with probable AD ever sought mental health help. Anxiety disorders among Lebanese children and adolescents are highly prevalent; however, only a minority of this population is seeking mental health help. The burden of AD and its correlates must inform public and private efforts to help mitigate the huge treatment gap.

Psychometric properties of the Thai Mood and Feelings Questionnaire (MFQ) for adolescent depression

BackgroundThe Mood and Feelings Questionnaire (MFQ) is a widely used screening tool for child and adolescence depression but has not been validated with young people in Thailand. This study aimed to assess the reliability and validity and to determine the optimal clinical cut-off of the Thai MFQ.MethodsThe Thai MFQ was evaluated in two parts. In part 1, The MFQ was translated and back translated into the Thai language and piloted on a small number of Thai adolescents. Then 1275 young people aged 12–18 years from three secondary schools in Thailand completed the MFQ and related measures of depression. In part 2, 138 students were invited to take part in a structured diagnostic interview (the Thai translation of the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children -Present and Lifetime Version (the K-SADS-PL). Of those, 103 students were interviewed and completed the Thai MFQ a second time to assess test–retest reliability. Receiver Operating Characteristics (ROC) analyses were conducted to evaluate diagnosis accuracy and examine the optimal cut-off score of the Thai MFQ.ResultsThe Thai MFQ had excellent internal consistency (α = 0.92) and good to moderate test–retest reliability in 2-week and 4-week intervals. The Thai MFQ also had good convergent validity with related measures of depression. The ROC analyses demonstrated that the Thai MFQ also had excellent accuracy distinguishing between depressed and non-depressed adolescents [AUC = 0.95, 95% CI [0.92, 0.99]. A total score of 28 on the Thai MFQ was the optimal cut-off score (sensitivity was 0.97 and specificity was 0.83).DiscussionThe Thai MFQ demonstrated excellent psychometric properties and accurately distinguished between depressed and non-depressed adolescents. It is appropriate to use as a screening measure to identify adolescents with depression in community settings in Thailand.

Associations between baseline cortisol and trajectory of symptom improvement in depressed adolescents receiving psychological therapy

BackgroundCortisol hypersecretion in depressed adolescents and adults is associated with more persistent illness and may signal a lower response to psychological therapies. A meta-analysis of small and heterogenous studies demonstrated that higher pre-treatment basal cortisol levels were associated with poorer response specifically to psychological therapy for depression. The objective of this study was to investigate the relationship between both morning and evening salivary cortisol levels and response to psychological therapy in depressed adolescents participating in one large randomised controlled trial. MethodsWe tested the association between morning and evening salivary cortisol levels at baseline and improvement in depressive symptoms in response to psychological therapies in depressed adolescents at 6 time points: baseline, 6, 12, 36, 52- and 86-weeks post-randomisation, using the self-reported Mood and Feelings Questionnaire (MFQ). ResultsHigh evening cortisol was associated with a slower initial decline in depressive symptoms (cortisol x quadratic time p = .022); however it was not associated with total change in depressive symtoms over the whole course of the study. Morning cortisol was not associated with change in depressive symptoms. These effects were not significantly different across the three psychological therapies. LimitationsResults may not generalize to adolescents receiving other treatments (medication) or no treatment, and may not generalize to adults. Only a minority of eligible participants collected valid cortisol samples. ConclusionsHigher pretreatment evening cortisol may impair a depressed adolescent's ability to use psychological therapy.

Symptom centrality and infrequency of endorsement identify adolescent depression symptoms more strongly associated with life satisfaction

Although depression symptoms are often treated as interchangeable, some symptoms may relate to adolescent life satisfaction more strongly than others. To assess this premise, we first conducted a network analysis on the Mood and Feelings Questionnaire (MFQ) in a large (N = 1,059), cross-sectional sample of community adolescents (age M = 14.72 ± 1.79). The most central symptoms of adolescent depression, as indexed by strength, were self-hatred, loneliness, sadness, and worthlessness while the least frequently endorsed symptoms were self-hatred, anhedonia, feeling like a bad person, and feeling unloved. Moreover, the more central a depression symptom was in the network (i.e., higher strength), the more variance it shared with life satisfaction (r = 0.59, 95% CI: 0.27, 0.76). How frequently a symptom was endorsed was negatively associated with the variance symptoms shared with life satisfaction (r = -0.48, 95% CI: -0.63, -0.21). Cross-validated, prediction focused models found central symptoms were expected to predict more out of fold variance in life satisfaction than peripheral symptoms and frequently endorsed symptoms, but not the least frequently endorsed symptoms. These findings show certain depression symptoms may be more strongly associated with life satisfaction in adolescence and these symptoms can be identified by multiple symptom-level metrics. Limitations include use of cross-sectional data and utilizing a community sample. Better understanding which symptoms of depression share more variance with important outcomes like life satisfaction could help us develop a more fine-grained understanding of adolescent depression.

Health-related quality of life (HRQoL) in children and adolescent with post-traumatic stress symptom: A comparison of 16D and condition-specific instruments

The objective of this study was to compare Health-Related Quality of Life (HRQoL) as measured by the 16D instrument with four condition-specific instruments in children and adolescents with significant post-traumatic stress disease (PTSD), to assess the validity of the 16D instrument. In addition, we test for differences in health for the PTSD population compared to a representative sample of Finnish schoolchildren. The study included 156 children and adolescents with trauma-related symptoms in Norway. The condition-specific instruments included were; Child PTDS Symptom Scale (CPSS); Mood and Feelings Questionnaire (MFQ); Screen for Child Anxiety Related Emotional Disorders (SCARED), and; Strengths and Difficulties Questionnaire (SDQ). We found that the 16D HRQoL score was significantly correlated with all condition-specific instruments (CPSS, SCARED, MFQ, and SDQ), where SCARED had the highest correlation with the 16D (-0.659, p &lt; 0.01). Several of the corresponding items (sleep, distress, discomfort and symptoms, mental functioning, and school and hobbies) of the condition-specific instruments were correlated above the threshold (convergent validity, ρ &gt; 0.4). Children and adolescents with symptoms of post-traumatic stress experienced a significant health loss of 0.177 compared to a representative sample of Finnish 12 to 15-years-old schoolchildren with a Cohen’s d of 1.07, and the health difference was significant for all 16 dimensions. These findings support the use of the 16D to measure health outcomes in cost-utility analysis. More studies are needed to examine the responsiveness.&#x0D; Published: Online August 2020.

The Reliability and Validity of the Korean Version of the Mood and Feelings Questionnaire for Depression in Youth: A Cross-Cultural Perspective.

We aimed to assess cross-cultural differences in depressive symptoms and the validity of the Korean version of the Mood and Feelings Questionnaire (MFQ). Four hundred and sixty-four children and adolescents (aged 7-19, 278 girls) with any psychiatric diagnosis, 290 of whom had major depressive disorder, were included. The levels of depressive symptoms in children and adolescents were evaluated by children/adolescents and their parents. We conducted Pearson's r and Cronbach's α, confirmative factor analysis and item response theory tests. The Korean version of the MFQ demonstrated excellent criterion validity and discriminant validity. There were no cultural differences in the clinical manifestations of depression in youth from Western countries and Korea. Korean youths with depression were more likely to complain of cognitive and emotional symptoms than somatic symptoms. The Korean version of the MFQ demonstrated promising psychometric properties in a clinical sample of children and adolescents.