Undesirable Life Events Research Articles

Identification of distinct clinical profiles and trajectories in individuals at high risk of developing psychosis: A latent profile analysis of the north American prodrome longitudinal study consortium-3 dataset.

People at clinical high risk (CHR) for psychosis are a heterogeneous population in regard to clinical presentation and outcome. It is unclear, however, if their baseline clinical characteristics can be used to construct orthogonal subgroups that differ in their clinical trajectory to provide early identification of individuals in need of tailored interventions. We used latent profile analysis (LPA) to determine the number of distinct clinical profiles within the CHR population using the NAPLS-3 dataset, focusing on the clinical features incorporated in the NAPLS psychosis risk calculator (including age, unusual thought content and suspiciousness, processing speed, verbal learning and memory function, social functioning decline, life events, childhood trauma, and family history of psychosis). We then conducted a between-profile comparisons of clinical trajectories based on psychotic and depressive symptoms as well as substance use disorder (SUD) related features over time. Two distinct profiles emerged. One profile, comprising approximately 25% of the sample, was significantly older, displayed better cognitive performance, experienced more types of traumatic and undesirable life events, exhibited a greater decline in functioning in the past year, and was more likely to have relatives with psychosis. This group showed worse positive symptoms and SUD-related features over time, although groups did not differ in the proportion of individuals who developed psychosis. LPA results suggest CHRs can be segregated into two profiles with different clinical trajectories. Characterizing individuals within these clinical profiles may help understand the divergent outcomes of this population and ultimately facilitate the development of specialized interventions.

Intensity and Density of Stressful Life Events in First Suicide Attempters with Psychiatric Morbidity and Comorbidity: A Case–Control Study

Abstract Background: Stressful life events (LEs) have been pivotal to suicidal behavior in vulnerable individuals, although its quantum and clustering have remained unclear. This study aimed to estimate and compare the quantum and clustering of LEs across three time periods, three suicide intentionality–lethality categories, and three diagnostic groups in survivors of first suicide attempt (SoFSA). Materials and Methods: One hundred SoFSA were compared to 100 age- and sex-matched controls for LEs across psychiatric and/or personality comorbidity. Presumptive Stressful LE Scale, Risk-Rescue Rating Scale, Hamilton Depression- and Anxiety-Rating Scales, and structured and semi-structured clinical interviews were administered for comprehensive mental health evaluation. Results: SoFSA with age ≥30 years, male gender, schooling <10 years, middle-lower socioeconomic class, married, extended/joint family living, family history of psychiatric disorders/suicide, and concomitant depression–anxiety exhibit significantly higher undesirable, ambiguous, and total LEs across time periods. One-way analysis of variance with post hoc analysis revealed SoFSA who attempted medically serious suicide suffered higher undesirable (F[2,97] = 4.43; P = 0.014) and total (F[2,97] = 3.39; P = 0.038) LEs during recent 6 months compared to medically nonlethal group. SoFSA diagnosed with comorbid psychiatric and personality disorders experienced higher undesirable, ambiguous, and total LEs across all time periods (P < 0.0001), compared to either disorder alone. Desirable LE did not significantly differ across all time periods and diagnostic categories, but ambiguous LE was the only significant finding among SoFSA with personality disorders. Conclusion: This study sheds newer insights that quantitative estimation (intensity and density) of LEs has a potential role in suicide-risk evaluation, with clustering of total or undesirable LE (>3 within 1 year or >10 lifetimes) and ambiguous LE (≥1 within 1 year or > 3 lifetimes) posing risk for psychiatric morbidity and medically serious suicidal behavior (especially, if lifetime total LE > 10). SoFSA with comorbid psychiatric and personality disorders experience higher intensity and density of LEs than either disorder alone, across all time periods.

New media use and the belief in a just world: awareness of life events and the perception of fairness for self and injustice for others

ABSTRACT The disclosure of life events is among the most common behaviors on social media and is part of the everyday activities revealed through the use of many other new media. This paper explores the awareness of major life events through these media as they relate to a person’s belief in a just world for themselves and others. Using survey data, we find that text messaging, commenting on Facebook, and having more Facebook friends are associated with awareness of desirable events. Passive modes of communication, e.g., the use of the ‘like’ interaction on Facebook, are related to an awareness of both desirable and undesirable life events across a greater range of social ties. Awareness of undesirable events in the lives of strong ties fosters a lower perception of equity and justice for others, whereas an awareness of desirable experiences in the lives of strong ties is related to greater, perceived, personal justice. We discuss the implications of the awareness of major life events through new media in terms of the psychological benefits that can come from the vicarious joy and comfort one receives from other’s experiences; what we call mudita and comfort from others (MACO). We argue that the long-term, cumulative effects of greater awareness of undesirable life events may lend support to social movements that seek to reduce injustices experienced by disadvantaged groups.

Stressful Life Events and Subjective Well-Being in Vocational School Female Adolescents: The Mediating Role of Depression and the Moderating Role of Perceived Social Support.

Stressful life events and subjective well-being are negatively related, but there is little research in the current literature exploring the mediating and moderating mechanisms underlying this association, especially for female adolescents in vocational schools who are subjected to undesirable life events. In the present study, we examined the mediating role of depression in the association between stressful life events and female adolescents’ subjective well-being, as well as the moderating role of perceived social support in the direct and indirect relations involved. The participants were 1,096 vocational school female adolescents, who completed the questionnaires regarding stressful life events, subjective well-being, depression, and perceived social support. The results showed that depression partially mediated the relation between stressful life events and subjective well-being. Importantly, perceived social support moderated the direct link between stressful life events and subjective well-being, and the indirect link between stressful life events and depression, but not the indirect link between depression and subjective well-being. Especially, female adolescents high in perceived social support displayed higher levels of subjective well-being and lower levels of depression in facing with stressful life events than those low in perceived social support. These findings highlight the mechanisms underlying the relationship between stressful life events and subjective well-being in vocational school female adolescents.

T13. THE ASSOCIATION BETWEEN CHILDHOOD TRAUMA AND INFLAMMATION IN YOUTH AT CLINICAL HIGH RISK FOR PSYCHOSIS

Childhood adversity is strongly associated with increased risk for psychosis. Research on the relationship between childhood adversity and psychosis not only links childhood abuse and neglect to psychotic symptoms, specifically hallucinations, but also indicates that the relationship is causal, with a dose-effect. Preliminary evidence of this relationship has been replicated within the clinical high risk (CHR) population through the North American Prodrome Longitudinal Study (NAPLS) where, relative to controls, individuals at CHR reported having experienced significantly more trauma and bullying, resulting in higher levels of anxiety and depression, as well as poorer functioning. Indices of stressful life events, family history of psychotic illness, and trauma represent robust predictors for presence of CHR syndrome and are included as part of the NAPLS Individualized Risk Calculator for Psychosis. Despite clear evidence for an association between childhood trauma and psychosis, the biological mechanisms that mediate this relationship remain largely unknown. Previous research has implicated the role of hypothalamic-pituitary-adrenal (HPA) axis dysregulation in development of both physical and mental illness. The HPA axis is highly responsive to environmental adversities both in childhood and in adulthood. Further, the HPA-axis is known to be a powerful modulator of inflammatory activity, as measured by peripheral markers of inflammation, and is in turn modulated by inflammatory processes. Immune system activation and dysregulation may serve as a biological mediator between childhood trauma and vulnerability for developing psychosis. The aim of this paper is to establish whether early-life adversity is associated with a pro-inflammatory phenotype in individuals at CHR for psychosis using a validated multiplex blood assay index previously established by Perkins et al. (2014). 35 healthy controls and 62 CHR subjects (N=117) that participated in the NAPLS2 study, ages 12–35, were included. 32 of the CHR subjects later converted to psychosis. Experience of trauma was assessed using the Childhood Trauma and Abuse Scale, a semi‐structured interview used to detect the occurrence of psychological bullying, physical bullying, emotional neglect, physical abuse, psychological abuse, or sexual abuse, before the age of 16. Experience and sensitivity to stressful life events was assessed using a modified version of the Life Events Scale (LES). Subjective stress for endorsed items is coded on a 7-point Likert scale. Inflammation and oxidative stress were measured using a 15-analyte blood biomarker index previously established to reliably distinguish between healthy control subjects, CHR subjects who developed psychosis, and CHR subjects who did not develop psychosis. Across subjects, the 15-analyte index was significantly correlated with total number of unique traumas endorsed. Increased trauma exposure was associated with a higher analyte index value (r= .26, p< 0.01). Additionally, the 15-analyte index was significantly correlated with total number of reported undesirable life events (r=.20, p<0.05), as well as subjective level of stress to events (r=.26, p=0.01). Higher incidence of stressful life events, and increased level of subjective stress were associated with a higher analyte index value. These results provide preliminary evidence for an association between blood-based markers of inflammation, oxidative stress, and early-life adversity. Greater exposure to trauma, higher incidence of stressful life events, and increased levels of subjective stress to life events may be predictive of later life immune system activation.

A study of stressful life events in an urban setting

Background: Life events may be desirable, undesirable or ambiguous and will trigger highly individualistic reactions. These events, depending upon the nature of their occurrence, might propel an individual into working in a more productive way or they may negatively affect the person. Hence studying these life events, their interplay with human emotions is important.Methods: This is a community based cross sectional study done in the urban field practice area of a tertiary care hospital. Participants were included in the study using systematic random sampling.Results: Going on a pleasure trip or pilgrimage was the most commonly reported life event, followed by appearing for examination or interview. Financial problem was the most common undesirable life event as experienced by the participants.Conclusions: Total number of life events and undesirable events are major contributors to psychological distress.

Undesirable stressful life events, impact, and correlates during midlife: observations from the Seattle midlife women\u2019s health study

PurposeTo examine the undesirable stressful life events midlife women experience, including: 1) which life events midlife women reported most frequently; 2) which life events women rated as most undesirable; and 3) whether age, years of education, income, employment, race/ethnicity, marital status, being a parent, and the menopausal transition stage were associated with the impact scores of the life event categories.BackgroundIn addition to the menopausal transition, midlife is a time of increased responsibilities for women related to multiple roles such as taking care of children, caring for elderly parents, managing households, and working outside the home. These multiple roles put midlife women at risk for increased stress with little time for themselves in order to relieve stress.MethodsThe sample used in this study is part of a larger longitudinal study, The Seattle Midlife Women’s Health Study. Women (N = 380 for Occasion 1) completed the 77-item Life Events Scale on four occasions during the course of the SMWHS: Occasion 1 (1990), Occasion 2 (1992), Occasion 3 (1997), and Occasion 4 (2000). In addition to descriptive analyses of frequency of life events and the undesirable impact of life events, demographic correlates (age, education, income, employment, being a parent as well as marital status, race/ethnicity, and menopausal transition stages) were examined in relation to the stressful life event scores.ResultsHighest scores of undesirable life events were for categories of both Financial and Family/Friends over 3 of the 4 occasions. Health and Crime/Legal scores were among the highest for 2 occasions. Impact of the undesirable stressful life events was greatest for categories of Family/Friends; Personal/Social; Work; and, Health. Age, income, marital status, being a parent, and menopausal transition stage were each associated with specific categories of the stressful event impact scores.ConclusionMost commonly reported undesirable life events were not those women described as having the greatest impact. Impact of life event stress reflected women’s social roles and connections as seen in the categories with the highest impact scores: Family/Close Friends, Personal/Social, and Work. Menopausal transition stages were related only to undesirable health events.

Stressful life events and psychiatric comorbidity in acne–a case control study

Possibility of a causal influence of emotional stress, on the course of various skin diseases, has been postulated. However, it is still inconclusive about the role of stressful life events in acne. In this background, the present study was carried out to know its role in acne. Consecutive one hundred patients who were diagnosed with acne vulgaris in the age group of 12 to 45 years were included. Age and sex matched controls were taken. A semistructured proforma was used to collect sociodemographic details. Stressful life events were assessed using presumptive stressful life event scale. Anxiety was evaluated using Hamilton Anxiety Rating scale and Depression by Hamilton Depression Rating Scale. There was no difference in total stressful life events in past one year between patients and controls. The undesirable life event was present in 65 patients and 50 controls, this difference was statistically significant. Getting married or appearing for exams were the most common stressful life event in patients. Forty patients had comorbid psychiatric illness whereas in controls comorbidity was in 24 and this difference was statistically significant. The undesirable stressful life events and psychiatric comorbidity were more in acne patients than in controls.

Life events in past one year in alcohol-dependent patients presenting with relapse

ABSTRACTObjective: Stressful life events may be an important factor in relapse in alcohol-dependent patients. This study was carried out to examine the life events in past one year in alcohol-dependent patients presenting with relapse.Methods: Thirty consecutive patients, aged 18 to 60 years, ICD-10 Diagnostic Criteria for Research for alcohol dependence syndrome, with current relapse were assessed on Severity Alcohol Dependence Questionnaire (SADQ) to measure alcohol dependence severity level and Presumptive Stressful Life Events Scale (PSLES) to identify life events in past one year prior to the relapse.Results: The mean number of life events among patients in past one year was 3.06 (SD 1.81). The mean number of undesirable life events was significantly higher than desirable events (p < .001). The most common life event was financial loss or problems (43%), followed by large loan and marital conflict (27%).Conclusion: There were a mean of three life events in the year preceding relapse in patients with alcohol dependence. Psychosocial treatment targeting stressful life events could be useful adjunct in the management of alcohol dependence.

Self-concept dialectical transformation: A study in a women's prison

Abstract The present study investigated incarceration as a possible triggering factor of self-concept transformations. Self-concept consists of a set of multiple dimensions organized hierarchically functioning as cognitive schemas. It is a structural complex product of reflective activity, and it is susceptible to changes as the individual encounters new situations, life transitions, and social roles. To investigate the transformations in the self-concept structure, 150 incarcerated women responded to the Feminine Inventory of the Self-Concept's Gender Schemas, Self-Concept Clarity Scale and Situational Self-Awareness Scale. The results showed dynamic and multidimensional organization of self-concept in the women investigated, including various categories of the self. The elements analyzed indicate that prison, an undesirable life event in adulthood, is a driver of transformations in the dynamics of self-concept.

Study of Life Events and Personality Dimensions in Generalized Anxiety Disorder.

Life events, recognized as stressors, due to their unanticipated nature, can cause psychiatric illness. Also there is some line of continuity between neurotic illness and antecedent personality traits. To study generalized anxiety disorder in relation to Life events and personality dimensions. Certain hypotheses were tested in two groups, namely 30 Generalized Anxiety Disorder patients (GAD) and 30 matched controls, by utilizing assessment tools. These include: GAD patients experience more undesirable Life events than normal; GAD patients with high level of anxiety experience more undesirable Life events; Neuroticism is related to the severity of anxiety; Extroverts experience more anxiety; Level of anxiety in females is higher; GAD patients with higher education level experience more anxiety, while those with lower education level somatize more. The group differences were examined using Chi-Square test, Student t-test and ANOVA. Pearson's Correlation Co-efficient was used to find the correlation between anxiety and the undesirable Life events. The level of statistical significance was set at p<0.05. GAD patients experienced significantly more undesirable Life events than the matched controls. Patients with high level of anxiety experienced more undesirable Life events, with the coefficient of correlation being quite high. A significant association between Neuroticism scale and GAD was observed. The study suggests a possible causative link between the undesirable Life events and GAD; and a significant association between Neuroticism dimension and the anxiety disorder. Role of environmental stressors and personality traits in treatment outcome among GAD patients awaits further, prospective studies.

Depression in children and young people: identification and management in primary, community and secondary care (NICE guideline CG28)

The National Institute for Health and Care Excellence (NICE) guideline CG28 ‘Depression in children and young people: Identification and management in primary, community and secondary care’ was recently updated and...

Hard Times and Common Mental Health Disorders in Developing Countries: Insights from Urban Ghana

Over the past century, the world has rapidly become urbanized, meaning more people now live in urban areas and cities than in rural areas. The mass movement of the rural poor to urban centers and cities has also changed the dynamics of poverty. Scarce employment opportunities, lack of assets, and sudden changes in economic conditions have been proposed as increasing the stress level for most urban residents, especially the poorer ones. Using a face-to-face household survey that included a six-item non-specific psychometric instrument, the data revealed how psychological distress may be patterned by socioeconomic status among urban residents in Ghana during difficult times characterized by food and fuel price hikes. The data collected in interviews of 1,158 adults (49% males and 51% females) who were 18years and above were analyzed using multinomial logit regressions. The results confirmed previous findings and showed negative links between socioeconomic status, adverse life events, and psychological distress. Specifically, low income, low level of education, large household size, undesirable life events and being employed in agriculture was found to be associated with psychological disorders. The outcomes of this research project are consistent with previous findings-that people in lower socioeconomic strata and those who have suffered adverse events are more likely to suffer psychological distress. The implications of these results for behavioral health are discussed.

Environmental risk and protective factors of adolescents’ and youths’ mental health: differences between parents’ appraisal and self-reports

We investigated the effect of parents' mental health, life events, and home life (among other factors) on adolescents'/youths' mental health, whether such an effect varies when several variables are assessed jointly, and also whether the informant source of the mental health problem modifies the estimations. We studied a representative sample of 454 Spanish adolescents/youths studied longitudinally (2 assessments, 3years apart). We considered factors associated with adolescents'/youths' mental health (conduct, emotional, and hyperactivity scores [SDQ]): risk factors (parents' mental health and life events) and mediators (social and financial support). Structural equation modeling was applied. We constructed two models: (a) with parents' SDQ responses and (b) with self-reported SDQ responses (in a subsample of N=260). Model fit was adequate for parents' appraisal. Parents' mental health (p<0.05) and undesirable life events (p<0.05) were the most important risk factors. The same model showed poorer fit when self-reported measures were used. Home life exerted a stronger protective effect on adolescents'/youths' mental health when reported by adolescents/youths. The negative effect of parents' mental health was significantly protected by home life in emotional [-0.14 (0.07)] and hyperactivity scores [-0.2 (0.08)]. Even in the presence of other factors, parents' mental health has an important effect on adolescents'/youths' mental health. Good levels of home life are protective, especially when adolescents'/youths' mental health is self-reported.

Effect on Health-related Quality of Life of changes in mental health in children and adolescents

BackgroundThe objective of the study was to assess the effect of changes in mental health status on health-related quality of life (HRQOL) in children and adolescents aged 8 - 18 years.MethodsA representative sample of Spanish children and adolescents aged 8-18 years completed the self-administered KIDSCREEN-52 questionnaire at baseline and after 3 years. Mental health status was measured using the Strengths and Difficulties Questionnaire (SDQ). Changes on SDQ scores over time were used to classify respondents in one of 3 categories (improved, stable, worsened). Data was also collected on gender, undesirable life events, and family socio-economic status. Changes in HRQOL were evaluated using effect sizes (ES). A multivariate analysis was performed to identify predictors of poor HRQOL at follow-up.ResultsResponse rate at follow-up was 54% (n = 454). HRQOL deteriorated in all groups on most KIDSCREEN dimensions. Respondents who worsened on the SDQ showed the greatest deterioration, particularly on Psychological well-being (ES = -0.81). Factors most strongly associated with a decrease in HRQOL scores were undesirable life events and worsening SDQ score.ConclusionsChanges in mental health status affect children and adolescents' HRQOL. Improvements in mental health status protect against poorer HRQOL while a worsening in mental health status is a risk factor for poorer HRQOL.

Longitudinal Study of Stressful Life Events and Daily Stressors Among Adolescents at High Risk for Psychotic Disorders

Psychosocial stress preceding the onset or recurrence of psychotic symptoms has been identified in patients with schizophrenia; yet there is limited understanding of the effects of stress in typically developing adolescents or those who show behavioral signs of risk for schizophrenia spectrum disorders. This study examined the developmental course of symptom progression as a function of stressful life events and daily hassles in adolescents with schizotypal personality disorder (SPD), other personality disorders, or no Axis II disorder. In this prospective longitudinal study, life events and daily stressors were assessed in adolescents aged 12 to 18 years. Results revealed that adolescents with SPD and other personality disorders reported significantly greater total, independent, and undesirable life events than individuals with no Axis II disorders. Youth with SPD report daily hassles to cause more distress compared to peers. Correlational analyses and hierarchal linear regression was used to evaluate the relationship of life events and daily stressors with psychiatric symptoms measured concurrently and 1 year later. Across diagnostic groups, the incidence of independent and undesirable life events were associated with current prodromal symptoms, while the frequency of daily stressors predicted a significant increment in positive, but not negative, prodromal symptoms over time. Therefore, adolescents who report greater daily stressors exhibit an increase in prodromal symptoms over a 1 year period. Psychosocial stress has been implicated in the etiology of schizophrenia, and these findings suggest the importance of life events and daily hassles as potential risk factors in the onset of psychotic symptoms during adolescence.

Life Events Associated With Major Depression in Ugandan Primary Healthcare (PHC) Patients: Issues of Cultural Specificity

The study compared life events experienced by depressed patients seen at primary healthcare (PHC) centres with those among healthy community controls. Data was collected from 74 depressed patients and 64 unmatched controls from village locales of patients. Interview instruments included the depression module of the Mini International Neuropsychiatric Interview (MINI) and Interview for Recent Life Events (IRLE). Associations between type of respondent and demographic variables were examined. Statistical comparisons were done for the two groups on other variables. Most depressed patients were single by marital status, lacked formal employment and had less post-primary education.They had experienced more life events; job changes, discomforting working hours, unfavourable working conditions, and job losses; personal health problems; loss of valuables; difficulties with intimate partners and family members' marital problems. Independent life events were more among depressed patients and clustered around work, health, bereavement and marriage. Most events reported by depressed patients had high negative impact ratings compared to controls. Compared to healthy community controls, depressed patients reported more undesirable life events. The relationship between life events and depression implies that in PHC settings of poor countries, deploying mental health-oriented workers to manage life events may lessen escalation of distress.

Temperament, life events, and psychopathology among the offspring of bipolar parents

The present study examines the relationship between temperament, recent and remote life events, and psychopathology among the offspring of parents with bipolar disorder and well comparisons. Offspring of bipolar and well parents were clinically assessed using KSADS-PL format interviews. Lifetime psychiatric diagnoses were made on a blind consensus basis in accordance with DSM-IV criteria. Depending on offspring age, either the child or their parent on their behalf, completed a semi-structured interview quantifying the number and impact of recent life events and remote permanent losses, as well as a measure of temperament. In this study, there was an association between psychopathology and the number of recent negative life events, but no association between psychopathology and the number of early losses. Emotionality was positively correlated with recent life events. However, in stepwise regression analyses, only emotionality significantly contributed to lifetime psychopathology in general and emotionality and age contributed to the risk of mood disorder in particular. These findings, replicate in a sample of offspring at high risk for bipolar disorder, previously reported associations between high emotionality and unipolar depression. In this population, any effect of undesirable life events would appear to be mediated through the association with emotionality.

Aggressive and nonaggressive rejected students: An analysis of their differences

AbstractThe present study aimed to analyze differences between aggressive and nonaggressive rejected students in four sets of variables: personal, family, school, and social. Participants in the study were 843 Spanish adolescents ranging in age from 11 to 16 years old, of whom 47% were boys. Results indicated that these two subgroups of rejected students show a different profile. Aggressive rejected students informed of lower levels of family self‐esteem, less parental support, higher levels of aggression between their parents at home, and a more offensive parent–child communication in comparison with nonaggressive rejected adolescents. Moreover, aggressive rejected students showed lower levels of academic self‐esteem, a more negative attitude toward school and studies, poorer relationships with teachers, and more academic difficulties than did adolescents in the nonaggressive rejected subgroup. Finally, aggressive rejected students indicated the presence of more undesirable life events and changes in their lives and, in general, higher levels of perceived stress. © 2006 Wiley Periodicals, Inc. Psychol Schs 43: 387–400, 2006.

Family and Psychosocial Risk Factors in a Longitudinal Epidemiological Study of Adolescents

To study the association of family and social risk factors with psychopathology in a longitudinal study of adolescents. From 1986 to 1988, 3,419 seventh through ninth graders were screened with the Center for Epidemiologic Studies Depression Scale. The top decile scorers and a random sample of the remainder were interviewed using the Schedule for Affective Disorders and Schizophrenia for School-Age Children (n = 581). Follow-up interviews were completed 6 years later (mean age = 18.65; n = 490). Baseline variables are associated with baseline and follow-up diagnoses. Diagnoses are grouped by affective, disruptive, and anxiety disorders. The frequency of psychiatric diagnosis decreased from 19.9% (baseline) to 5.7% (follow-up). In multivariable logistic regression analyses controlling for race, gender, and socioeconomic status, baseline undesirable life events and low family cohesion are associated with any disorder and affective disorder at baseline. Not living with both biological parents at baseline increases the odds ratio (OR) for affective disorder at baseline (OR 3.45; 95% confidence interval [CI] = 1.68-7.08) and follow-up (OR 4.40; CI = 1.26-15.40). At baseline and follow-up, anxiety and affective disorders are associated with being white and anxiety disorder with being female. Family structure and cohesion and stressful life events are associated with affective disorders in adolescents.