No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Depressive symptoms differ across Physical Activity Status based on comorbid anxiety and depression status among adolescents
Abstract
Statement of problem
Comorbid anxiety and depression is increasingly prevalent in adolescents, and comorbidity results in greater symptom severity and duration. Our previous reports support positive benefits of physical activity (PA) for depressive symptoms among adolescents (see Mcdowell, MacDonncha, & Herring, 2017). However, the impact of comorbid anxiety on PA, depressive symptoms, and their associations is unknown. It is plausible that comorbid anxiety may be an important consideration when examining associations between PA and depressive symptoms. Thus, we critically expand our previous report by investigating differences in depressive symptoms across PA status based on comorbid anxiety and depression status.
Methods
Adolescents (N = 481; 200 female) aged 15.1 ± 1.7 y self-reported PA status; low, moderate, and high PA were classified based on ≥60 min s of PA 0–2, 3–4, and ≥5 d/wk, respectively. The Quick Inventory of Depressive Symptomatology assessed depressive symptoms (≥6 classified as depressed). The Trait subscale of the State-Trait Anxiety Inventory assessed anxiety symptoms (≥50 classified as anxious). Two-way ANCOVA was followed by Bonferroni-adjusted simple effects analyses.
Results
The interaction between PA and comorbid status was statistically significant (p < 0.001). Depressive symptoms were significantly higher for comorbid anxiety with low (p ≤ 0.007) and high PA (p ≤ 0.003) compared to moderate PA, significantly higher for comorbid anxiety compared to depression-only for low (p < 0.001) and high PA (p < 0.001), and non-significantly higher for moderate PA (p > 0.30).
Conclusion
Depressive symptoms differed across PA levels based on comorbid anxiety status.
... Nevertheless, it was also documented that individuals who reported engaging in highly demanding levels of physical exertion were at a greater risk of experiencing depression. The results of Forte et al. [42] align with the findings of Gergelyfi et al. [43], which were not included in this review. The review and meta-analysis conducted by Carter et al. [44] on randomised controlled studies involving adults demonstrated that engaging in light and moderate PA had beneficial benefits for those with depression, while high levels of PA did not provide the same favourable outcomes. ...
... Articulating the exact reasons behind the unfavourable mental health outcomes shown in research linking increased levels of PA is a difficult task. Nevertheless, it is crucial to remember that the literature widely accepts the dangers of excessive PA, which may lead to the emergence of eating disorders, such as anorexia nervosa, bulimia nervosa, and binge eating disorder [42]. Given the heightened vulnerability of adolescents to negative body image, obsessive exercise can manifest as a significant issue. ...
Context
The prevalence of depression among teenagers is a significant issue worldwide, which calls for a thorough investigation of non-drug treatments. This expedited evaluation examines 24 specifically chosen studies to clarify the correlation between physical activity depression symptoms in teenagers, undertaken following PRISMA principles.
Methods
A wide range of research methods, including longitudinal studies, surveys, and cross-sectional analyses, were used in different nations to understand the intricate relationship between physical activity, sedentary behaviours, and depression symptoms. The data-gathering methods included standardised questionnaires, accelerometer measurements, and self-report instruments.
Findings
The review highlights the crucial significance of engaging in physical activity to alleviate depression symptoms. Improved self-esteem consistently acts as a crucial intermediary between participation in physical activity and decreased rates of depression. Engaging in physical activity is a safeguard, particularly for individuals with restricted access to physical activity. In contrast, a sedentary lifestyle greatly increases the probability of developing moderate to severe symptoms of depression. Gender differences are apparent, with females being disproportionately impacted by depression. There are strong connections between engaging in physical activity and reducing symptoms of depression, which can be observed in various situations, such as participating in team sports or engaging in leisure activities.
Conclusion
This study provides insight into the potential of physical activity as a non-pharmacological approach to address adolescent depression. This highlights the significant impact of physical activity, which has important implications for public health programs aimed at improving the mental well-being of adolescents by promoting physical activity. It is crucial to do additional research that considers gender-specific variations and various physical activity circumstances to enhance our comprehension of this important matter.
... Further investigation of what this subfactor represents is necessary. Reports of elevated physiological hyperarousal in depression treatment may instead be an indicator of overall distress (De Bolle et al., 2011;Forte et al., 2020;Gaspersz et al., 2017). Individuals who continue to experience physical symptoms are more likely to relapse and less likely to remit (Forte et al., 2020;Howland et al., 2008;Long et al., 2018;Trivedi, 2004). ...
... Reports of elevated physiological hyperarousal in depression treatment may instead be an indicator of overall distress (De Bolle et al., 2011;Forte et al., 2020;Gaspersz et al., 2017). Individuals who continue to experience physical symptoms are more likely to relapse and less likely to remit (Forte et al., 2020;Howland et al., 2008;Long et al., 2018;Trivedi, 2004). Indeed, previous findings from the TADS indicate that at week 12 of treatment, there is overall symptom reduction, but adolescents still exhibited significant levels of depression . ...
... [47][48][49] Furthermore, physical activity helps to reduce levels of anxiety, and depression, 50-52 sleep disturbances, 53 enhances cognitive performance, 54 and has a positive effect on the physique. [50][51][52]55 Based on the preceding explanation, the objective of this study is to obtain a comprehensive picture of the level and impact of physical activity on psychological well-being in adults. This is consistent with previous research, which indicates that the adult population is the most vulnerable to COVID-19 infection and is psychologically affected. ...
The COVID-19 pandemic has become a global crisis that has caused various impacts on the psychological well-being and physical activity of the community. Correspondingly, physical activity is known to have a relationship and affect psychological well-being. Therefore, this study aimed to obtain a comprehensive picture of the level and impact of the activity on psychological well-being in the adult population as well as recommendations for physical activity that could be done to improve psychological well-being during the COVID-19 pandemic. The research method used was a systematic literature review with the PRISMA (Preferred Reporting Item for Systematic Review and Meta-Analytic) analysis method. Search literature on the EBSCOhost, ProQuest, and ScienceDirect databases. Literature searches were limited to research articles published between January 1, 2020, to May 20, 2021. The initial search yielded 5,136 articles and finally found 15 articles that met the criteria. The results of the review revealed that during the COVID-19 pandemic, there was a decrease in the level of physical activity and psychological well-being, especially in the adult population, especially women and young adult groups. In addition, it was found that physical activity was either directly or indirectly associated with symptoms of depression, stress, anxiety, and positive feelings and emotions. Physical activity with moderate intensity has the most significant influence on psychological well-being. The forms of activity included lifting weights, yoga, double tennis, aerobics, muscle fitness, and explosive fitness. Based on this, it is certain that physical activity with moderate intensity has the most significant impact on psychological well-being, especially in increasing positive feelings and emotions and reducing depression, stress, and anxiety in adults.
... Moreover, a systematic review suggested that PA can have a strong beneficial effect on depression, comparable to the effects of antidepressant treatments (Dinas et al., 2011;Schuch et al., 2016), and a study observing the effects of aerobic and resistance training found that they both were effective in lowering the risk of developing depressive symptoms, as well as co-occurring depression and anxiety (Oftedal et al., 2019). Similarly, there is evidence from highincome countries on the association of PA patterns with the cooccurrence of anxiety and depression (Forte et al., 2020;Hiles et al., 2017), as well as data on how PA can have a positive effect on comorbid anxiety/depression, comparable to other kinds of psychological treatment (Ólafsdóttir et al., 2018). ...
Background
Evidence on the association of low physical activity (PA) with depression or anxiety is well established. Yet, evidence on the association between PA and comorbid anxiety/depression remains scarce, especially in low- and middle-income countries (LMICs). Thus, this study explored this relationship among adults aged ≥18 years from 46 LMICs.
Methods
Cross-sectional, community-based data were analyzed from the World Health Survey. Multivariable multinomial logistic regression analysis was conducted to examine the association between low PA and comorbid anxiety/depression with no anxiety or depression as the base category.
Results
237,023 participants [mean (SD) age = 38.4 (16.0) years; 50.8 % female] were included in the analysis. Low PA was significantly associated with depression alone (OR = 1.33; 95%CI = 1.12–1.57) and anxiety alone (OR = 1.37; 95%CI = 1.23–1.53), while the OR was highest among those with comorbid anxiety/depression (OR = 1.75; 95%CI = 1.52–2.01).
Conclusion
Low PA is associated with particularly increased odds for comorbid anxiety/depression. Increasing PA may have a beneficial effect on the prevention of comorbid anxiety/depression. However, future longitudinal research establishing the direction of this relationship is warranted.
... Furthermore, the highest association with PA was found in this study for participants with a dual anxiety and depression diagnosis. Forte et al. [74] also found that severe depression was most common among adolescents with comorbid anxiety and low PA levels. ...
Research indicates that university and college students are at higher risk of experiencing mental health problems than other populations. This study aims to examine the relationship between Physical Activity (PA) and the mental health of Ukrainian university students during the Corona Virus Disease 2019 (COVID-19) pandemic lockdown. The conventional sample consisted of 1512 students from 11 Ukrainian universities, with a mean age of 20 years (M = 20.06, SD = 3.05) and 69% of whom were female. The cross-sectional online survey was disseminated through the most popular social media channels in Ukraine (i.e., Facebook, Viber, Telegram) and included the Generalized Anxiety Disorder (GAD-7) scale to measure anxiety and the Patient Health Questionnaire (PHQ-9) to assess depression. Data were collected from 14 May to 4 June 2020 during the COVID-19 pandemic outbreak in Ukraine. Among university students, 43% were engaged in PA ≥ 150 min weekly, 24% met the criteria of GAD, and 32% met the criteria of depression. More students were involved in PA before the COVID-19 outbreak than during the national lockdown. Students with anxiety and depression were almost two times less likely to engage in PA than their counterparts without mental health disorders. The inactive group had higher scores of anxiety and depression than the physically active group. The relationship of PA with anxiety and depression was statistically significant but weak during the COVID-19 pandemic.
Keywords: anxiety; depression; PHQ-9; GAD-7; physical activity (PA); undergraduates; university students
Introduction:
depression in adolescents is a major health condition that can interfere with daily life, lead to suicidal thoughts and behavior, and affect a person throughout life. However, studies about adolescents´ depression in Morocco are scarce. The aim of this study was to determine the prevalence of depression symptoms among in-school adolescents from the region of Settat-Morocco, as well as assessing its relation to daytime sleepiness and poor academic achievement.
Methods:
the researchers conducted a cross-sectional school-based study. The sample included participants aged 12-20 years, in either urban or rural areas. We selected 722 students through a proportionate stratified sampling procedure. The participants responded to multiple questionnaires that included the Patient Health Questionnaire-9, the Epworth Sleepiness Scale, a questionnaire assessing several sociodemographic and socioeconomic variables, and finally an academic achievement questionnaire. We analyzed the collected data using descriptive statistical methods, χ2 test, and odds ratios.
Results:
forty-four point seven percent (44.7%) of the respondents had "moderately severe" to "severe depression symptoms" and 32.5% of the sample suffered from excessive daytime sleepiness. Nineteen point nine percent (19.9%) of the total sample reported having a poor academic achievement. Significant predictors for depression symptoms included "female gender" (OR = 2.06; p-value < 0.001), "having divorced parents" (OR = 6.00; p-value < 0.001), "poor academic achievement" (OR = 5.03; p-value < 0.001), and "excessive daytime sleepiness" (OR = 2.30; p-value = 0.002).
Conclusion:
this study provides important information about Morocco adolescents´ depression symptoms. These findings can help in implementing school-based mental and sleep health programs that target the promotion of mental wellness, prevention of mental health problems, and reduction of adolescent suicide risk.
Context:
Anxiety symptoms and disorders are highly prevalent and costly. Prospective studies suggest that physical activity may prevent anxiety development; however, this body of literature has not been reviewed comprehensively.
Evidence acquisition:
Studies measuring physical activity at baseline and anxiety at a designated follow-up at least 1 year later were located using MEDLINE, PsycINFO, and CINAHL Complete through June 2018.
Evidence synthesis:
Data were analyzed July-December 2018. Study quality was assessed using Q-Coh. Among studies of adults, a random-effects meta-analysis was conducted for crude and the most fully adjusted models for three outcomes: self-reported anxiety symptoms, a diagnosis of any anxiety disorder, and a diagnosis of generalized anxiety disorder. As there were few studies with diverse samples and outcome measures, findings were elaborated with a critical narrative review of all studies. Twenty-four studies (median follow-up, 4.75 years) of >80,000 unique individuals were included in the systematic review; thirteen were included in the meta-analyses. Six studies were assessed as low quality, nine as acceptable, and nine as good. From adjusted models, odds of elevated anxiety symptoms (OR=0.8742, 95% CI=0.7731, 0.9886, n=9), any anxiety disorder (OR=0.6626, 95% CI=0.5337, 0.8227, n=3), and generalized anxiety disorder specifically (OR=0.5438, 95% CI=0.3231, 0.9153, n=3) were significantly lower after physical activity exposure.
Conclusions:
Available evidence suggests that engaging in physical activity protects against anxiety symptoms and disorders. However, notable challenges in the current evidence base include issues regarding exposure and outcome measures, consistent adjustment for putative confounders, representativeness of samples, and attrition bias, which warrant further research.
Follow up to the original Children's Sport Participation and Physical Activity Study (2010). This surveillance study provides updated information of children's and adolescent's participation in physical activity, Physical Education and sport, as well as information on sedentary behaviour and active travel, across the entire island of Ireland.
Physical activity (PA) can improve sleep quality, low energy, and fatigue. Though poor sleep quality may induce feelings of low energy and fatigue, the potential moderating effect of sleep quality on associations between PA and feelings of energy and fatigue among adolescents is unknown. Thus, this study examined the moderating effect of sleep quality on associations between PA frequency and feelings of energy and fatigue among adolescents in Ireland. Adolescents (N = 481; 281 males, 200 females) aged 15.1 ± 1.7 years self-reported PA frequency, feelings of energy and fatigue, and sleep quality (September to December 2015). Two-way ANCOVAs examined variation in feelings of energy and fatigue according to the interaction of PA and sleep quality. Standardized mean difference (d) quantified the magnitude of differences. Poor sleepers with low PA reported greater feelings of fatigue compared to normal sleepers with low PA (d = 1.02; 95% CI 0.60, 1.44), and poor sleepers with moderate PA reported greater feelings of fatigue compared to normal sleepers with moderate PA (d = 0.50; 0.17, 0.82). Poor sleepers with low PA reported greater feelings of fatigue compared to both poor sleepers with moderate PA (d = 0.44; 0.05, 0.83) and poor sleepers with high PA (d = 0.87; 0.46, 1.28). Poor sleepers with moderate PA reported greater feelings of fatigue compared to poor sleepers with high PA (d = 0.52; 0.14, 0.91). Poor sleep did not moderate the association between PA and feelings of energy. Sleep quality moderates the association between PA frequency and feelings of fatigue. Fatigue symptoms improve as PA frequency increases among adolescents with poor sleep quality.
Introduction
Depressive disorder is common in children and adolescents, with important consequences and serious impairments in terms of personal and social functioning. While both pharmacological and psychological interventions have been shown to be effective, there is still uncertainty about the balance between these and what treatment strategy should be preferred in clinical practice. Therefore, we aim to compare and rank in a network meta-analysis (NMA) the commonly used psychological, pharmacological and combined interventions for depressive disorder in children and adolescents.
Methods and analysis
We will update the literature search of two previous NMAs for the identification of trials of antidepressant and psychotherapy alone for depressive disorder in children and adolescents. For identification of trials of combination interventions, seven databases (PubMed, EMBASE, CENTRAL (Cochrane Central Register of Controlled Trials), Web of Science, PsycINFO, CINAHL, LiLACS) will be searched from date of inception. We will also search ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform and check relevant reports on the US Food and Drug Administration website for unpublished data. Building on our previous findings in the field, we will include any commonly prescribed oral antidepressants and any manualised or structured psychotherapies, as well as their combinations. Randomised controlled trials assessing any active intervention against active comparator or pill placebo/psychological controls in acute treatment for depressive disorder in children and adolescents will be included. The primary outcomes will be efficacy (mean change in depressive symptoms), and acceptability of treatment (dropout rate due to any cause). The secondary outcomes will be remission rate, tolerability of treatment (dropouts for adverse events), as well as suicide-related outcomes (suicidal behaviour or ideation). We will perform Bayesian NMAs for all relative outcome measures. Subgroup analyses and sensitivity analyses will be conducted to assess the robustness of the findings.
Dissemination
This NMA will provide the most up to date and clinically useful information about the comparative efficacy and acceptability of antidepressants, psychological intervention and their combination in the acute treatment of children and adolescents with depressive disorder. This is the newest NMA and therefore these results are very important in terms of evidence-based medicine. The results will be disseminated through peer-reviewed publication.
Protocol registration
PROSPERO CRD42015020841.
Much biomedical research is observational. The reporting of such research is often inadequate, which hampers the assessment of its strengths and weaknesses and of a study's generalisability. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) initiative developed recommendations on what should be included in an accurate and complete report of an observational study. We defined the scope of the recommendations to cover three main study designs: cohort, case-control, and cross-sectional studies. We convened a 2-day workshop in September, 2004, with methodologists, researchers, and journal editors to draft a che-cklist of items. This list was subsequently revised during several meetings of the coordinating group and in e-mail discussions with the larger group of STROBE contributors, taking into account empirical evidence and methodological considerations. The workshop and the subsequent iterative process of consultation and revision resulted in a checklist of 22 items (the STROBE statement) that relate to the title, abstract, introduction, methods, results, and discussion sections of articles. 18 items are common to all three study designs and four are specific for cohort, case-control, or cross-sectional studies. A detailed explanation and elaboration document is published separately and is freely available on the websites of PLoS Medicine, Annals of Internal Medicine, and Epidemiology. We hope that the STROBE statement will contribute to improving the quality of reporting of observational studies.
The purpose of this study is to investigate associations between physical activity (PA), depression, and anxiety among adolescents in Ireland. Adolescents (N = 481; 281 male, 200 female) aged 15.1 ± 1.7y self-reported PA level, depression, and anxiety. Approximately 21% of adolescents were high trait anxious, and ∼37% reported scores indicating probable depression. Anxiety and depressive symptoms were higher for low PA (60 min/d, 0-2 d/wk) compared to moderate (60 min/d, 3-4 d/wk) and high (60 min/d, 5-7 d/wk) PA. After adjustment for relevant covariates, reduced odds of depression were 30% and 56% for moderate and high PA, respectively; reduced odds of high trait anxiety were 46% and 47% for moderate and high PA, respectively. These findings support the need for adolescents to engage in moderate PA, with potential for increased benefits with increased PA. To conclude, moderate and high PA are inversely associated with anxiety and depressive symptoms, and risk of depression and high trait anxiety in adolescents.
In this cross-sectional study, physical activity, sport participation and associations with well-being, anxiety and depressive symptoms were examined in a large representative sample of European adolescents. A school-based survey was completed by 11,110 adolescents from ten European countries who took part in the SEYLE (Saving and Empowering Young Lives in Europe) study. The questionnaire included items assessing physical activity, sport participation and validated instruments assessing well-being (WHO-5), depressive symptoms (BDI-II) and anxiety (SAS). Multi-level mixed effects linear regression was used to examine associations between physical activity/sport participation and mental health measures. A minority of the sample (17.9 % of boys and 10.7 % of girls; p < 0.0005) reported sufficient activity based on WHO guidelines (60 min + daily). The mean number of days of at least 60 min of moderate-to-vigorous activity in the past 2 weeks was 7.5 ± 4.4 among boys and 5.9 days ± 4.3 among girls. Frequency of activity was positively correlated with well-being and negatively correlated with both anxiety and depressive symptoms, up to a threshold of moderate frequency of activity. In a multi-level mixed effects model more frequent physical activity and participation in sport were both found to independently contribute to greater well-being and lower levels of anxiety and depressive symptoms in both sexes. Increasing activity levels and sports participation among the least active young people should be a target of community and school-based interventions to promote well-being. There does not appear to be an additional benefit to mental health associated with meeting the WHO-recommended levels of activity.
This article summarizes characteristics of major depressive disorder (MDD) in the Oregon Adolescent Depression Project, using data from 816 participants (56% female; 89% White). Contrasting four developmental periods (childhood, 5.0–12.9 years of age; adolescence, 13.0–17.9; emerging adulthood, 18.0–23.9; adulthood, 24–30), we examine MDD incidence/recurrence, gender, comorbidity, duration, and suicide attempts across periods. MDD first incidence was lower in childhood compared to subsequent periods and higher in emerging adulthood than in adulthood. Cumulative incidence was 51%. Recurrence was lower during childhood than remaining periods, which did not differ. Female gender predicted first-incident MDD in all four periods but was unassociated with recurrence. Comorbidity rates were comparable across periods. MDD duration was greater in childhood than in remaining periods. Suicide attempt rates were significantly higher during adolescence than during either emerging adulthood or adulthood. Depression research should focus on MDD during emerging adulthood, adolescent suicidal behavior, the continuing role of gender into adulthood, and the ubiquity of MDD.
Although it has been hypothesized that the association of physical activity with depressive and anxiety symptoms is bidirectional, few studies have examined this issue in a prospective setting. We studied this bidirectional association using data on physical activity and symptoms of anxiety and depression at three points in time over 8 years. A total of 9,309 participants of the British Whitehall II prospective cohort study provided data on physical activity, anxiety and depression symptoms and 10 covariates at baseline in 1985. We analysed the associations of physical activity with anxiety and/or depression symptoms using multinomial logistic regression (with anxiety and depression symptoms as dependent variables) and binary logistic regression (with physical activity as the dependent variable). There was a cross-sectional inverse association between physical activity and anxiety and/or depressive symptoms at baseline (ORs between 0.63 and 0.72). In cumulative analyses, regular physical activity across all three data waves, but not irregular physical activity, was associated with reduced likelihood of depressive symptoms at follow-up (OR = 0.71, 95 % CI 0.54, 0.99). In a converse analysis, participants with anxiety and depression symptoms at baseline had higher odds of not meeting the recommended levels of physical activity at follow-up (OR = 1.79, 95 % CI 1.17, 2.74). This was also the case in individuals with anxiety and/or depression symptoms at both baseline and follow-up (OR = 1.70, 95 % CI 1.10, 2.63). The association between physical activity and symptoms of anxiety and/or depression appears to be bidirectional.
There is evidence that heart rate variability (HRV) is reduced in major depressive disorder (MDD), although there is debate about whether this effect is caused by medication or the disorder per se. MDD is associated with a two to fourfold increase in the risk of cardiac mortality, and HRV is a robust predictor of cardiac mortality; determining a direct link between HRV and not only MDD, but common comorbid anxiety disorders, will point to psychiatric indicators for cardiovascular risk reduction.
To determine in physically healthy, unmedicated patients whether (1) HRV is reduced in MDD relative to controls, and (2) HRV reductions are driven by MDD alone, comorbid generalized anxiety disorder (GAD, characterized by anxious anticipation), or comorbid panic and posttraumatic stress disorders (PD/PTSD, characterized by anxious arousal).
A case-control study in 2006 and 2007 on 73 MDD patients, including 24 without anxiety comorbidity, 24 with GAD, and 14 with PD/PTSD. Seventy-three MDD and 94 healthy age- and sex-matched control participants were recruited from the general community. Participants had no history of drug addiction, alcoholism, brain injury, loss of consciousness, stroke, neurological disorder, or serious medical conditions. There were no significant differences between the four groups in age, gender, BMI, or alcohol use.
HRV was calculated from electrocardiography under a standardized short-term resting state condition.
HRV was reduced in MDD relative to controls, an effect associated with a medium effect size. MDD participants with comorbid generalized anxiety disorder displayed the greatest reductions in HRV relative to controls, an effect associated with a large effect size.
Unmedicated, physically healthy MDD patients with and without comorbid anxiety had reduced HRV. Those with comorbid GAD showed the greatest reductions. Implications for cardiovascular risk reduction strategies in otherwise healthy patients with psychiatric illness are discussed.
[Clin Psychol Sci Prac 17: 293–306, 2010]
The high level of concurrent and sequential comorbidity between anxiety and depression in children and adolescents may result from (a) substantial overlap in both the symptoms and items used to assess these putatively different disorders, (b) common etiologic factors (e.g., familial risk, negative affectivity, information-processing biases, neural substrates) implicated in the development of each condition, and (c) negative sequelae of anxiety conferring increased risk for the development of depression. Basic research on their various common and unique etiologic mechanisms has guided the development of efficacious treatments for anxiety and depressive disorders in youth. Potential processes through which the successful treatment of childhood anxiety might prevent subsequent depression are described.
The assessment of physical activity is an essential part of understanding patterns and influences of behaviour, designing interventions, and undertaking population surveillance and monitoring, but it is particularly problematic when using self-report instruments with young people. This study reviewed available self-report physical activity instruments developed for use with children and adolescents to assess their suitability and feasibility for use in population surveillance systems, particularly in Europe.
Systematic searches and review, supplemented by expert panel assessment.
Papers (n=437) were assessed as potentially relevant; 89 physical activity measures were identified with 20 activity-based measures receiving detailed assessment. Three received support from the majority of the expert group: Physical Activity Questionnaire for Children/Adolescents (PAQ-C/PAQ-A), Youth Risk Behaviour Surveillance Survey (YRBS), and the Teen Health Survey.
Population surveillance of youth physical activity is strongly recommended and those involved in developing and undertaking this task should consider the three identified shortlisted instruments and evaluate their appropriateness for application within their national context. Further development and testing of measures suitable for population surveillance with young people is required.
Previous studies have suggested that physical activity may have antidepressant and/or anti-anxiety effects.
To examine the bidirectional relationship between physical activity and common mental disorders and establish the importance of context, type and intensity of activity undertaken.
A clinical examination of 40 401 residents of Norway was undertaken. Participants answered questions relating to the frequency and intensity of both leisure-time and workplace activity. Depression and anxiety were measured using the Hospital Anxiety and Depression Scale (HADS). Biological and social data were also collected.
There was an inverse relationship between the amount of leisure-time physical activity and case-level symptoms of depression. This cross-sectional association was only present with leisure-time (as opposed to workplace) activity and was not dependent on the intensity of activities undertaken. Higher levels of social support and social engagement were important in explaining the relationship between leisure activity and depression. Biological changes such as alterations to parasympathetic vagal tone (resting pulse) and changes to metabolic markers had a less important role.
Individuals who engage in regular leisure-time activity of any intensity are less likely to have symptoms of depression. The context and social benefits of exercise are important in explaining this relationship.
To develop a reliable and valid physical activity screening measure for use with adolescents in primary care settings.
We conducted 2 studies to evaluate the test-retest reliability and concurrent validity of 6 single-item and 3 composite measures of physical activity. Modifications were based on the findings of the 2 studies, and a best measure was evaluated in study 3. Accelerometer data served as the criterion standard for tests of validity.
In study 1 (N = 250; mean age, 15 years; 56% female; 36% white), reports on the composite measures were most reliable. In study 2 (N = 57; mean age, 14 years; 65% female; 37% white), 6 of the 9 screening measures correlated significantly with accelerometer data. Subjects, however, had great difficulty reporting bouts of activity and distinguishing between intensity levels. Instead, we developed a single measure assessing accumulation of 60 minutes of moderate to vigorous physical activity. Evaluated in study 3 (N = 148; mean age, 12 years; 65% female; 27% white), the measure was reliable (intraclass correlation, 0.77) and correlated significantly (r = 0.40, P<.001) with accelerometer data. Correct classification (63%), sensitivity (71%), and false-positive rates (40%) were reasonable.
The "moderate to vigorous physical activity" screening measure is recommended for clinical practice with adolescents.
Summary findings and full report are available on www.myworldsurvey.ie
Objectives: Evidence concerning physical activity and mental health remains less well documented for children and adolescents. An updated review of systematic reviews and meta-analyses was undertaken concerning physical activity and mental health in children and adolescents, and to judge the extent to which associations can be considered causal. Methods: Systematic reviews and meta-analyses were identified to update our previous review of reviews (Biddle & Asare, 2011), with papers identified between November 2010 and the end of 2017. Criteria were used to judge causality (Hill, 1965), including strength of association, dose-response association, and experimental evidence. Results: Since 2011, the quantity (k = 42 reviews) and quality of research has increased in depression (evidence from 10 reviews), self-esteem (10 reviews) and cognitive functioning (25 reviews). Anxiety had only three new, small, reviews. Intervention effects for depression are moderate in strength while observational data show only small or null associations. Variable effect sizes are evident from interventions for the reduction of anxiety and improvement in self-esteem. Higher or improved fitness and physical activity are associated with better cognitive health and performance. There was partial support for a causal association with depression, a lack of support for self-esteem, but support for cognitive functioning. Conclusions: There are significant increases in research activity concerning physical activity and depression, self-esteem, and cognitive functioning in young people. The strongest evidence for a causal association appears to be for cognitive functioning, and there is partial evidence for depression.
Background:
Physical inactivity has been identified as a risk factor for depression and, less often, as a long-term consequence of depression. Underexplored is whether similar bi-directional longitudinal relationships are observed for anxiety disorders, particularly in relation to three distinct indicators of activity levels - sports participation, general physical activity and sedentary behavior.
Method:
Participants were from the Netherlands Study of Depression and Anxiety (NESDA; N = 2932, 18-65 years old; 57% current anxiety or depressive disorder, 21% remitted disorder, 22% healthy controls). At baseline, 2, 4, and 6 years, participants completed a diagnostic interview and self-report questionnaires assessing psychopathology symptom severity, physical activity indicators, and sociodemographic and health covariates.
Results:
Consistently across assessment waves, people with anxiety and/or depressive disorders had lower sports participation and general physical activity compared to healthy controls. Greater anxiety or depressive symptoms were associated with lower activity according to all three indicators. Over time, a diagnosis or greater symptom severity at one assessment was associated with poorer sports participation and general physical activity 2 years later. In the opposite direction, only low sports participation was associated with greater symptom severity and increased odds of disorder onset 2 years later. Stronger effects were observed for chronicity, with lower activity according to all indicators increasing the odds of disorder chronicity after 2 years.
Conclusions:
Over time, there seems to a mutually reinforcing, bidirectional relationship between psychopathology and lower physical activity, particularly low sports participation. People with anxiety are as adversely affected as those with depression.
Background:
Major depressive disorder is one of the most common mental disorders in children and adolescents. However, whether to use pharmacological interventions in this population and which drug should be preferred are still matters of controversy. Consequently, we aimed to compare and rank antidepressants and placebo for major depressive disorder in young people.
Methods:
We did a network meta-analysis to identify both direct and indirect evidence from relevant trials. We searched PubMed, the Cochrane Library, Web of Science, Embase, CINAHL, PsycINFO, LiLACS, regulatory agencies' websites, and international registers for published and unpublished, double-blind randomised controlled trials up to May 31, 2015, for the acute treatment of major depressive disorder in children and adolescents. We included trials of amitriptyline, citalopram, clomipramine, desipramine, duloxetine, escitalopram, fluoxetine, imipramine, mirtazapine, nefazodone, nortriptyline, paroxetine, sertraline, and venlafaxine. Trials recruiting participants with treatment-resistant depression, treatment duration of less than 4 weeks, or an overall sample size of less than ten patients were excluded. We extracted the relevant information from the published reports with a predefined data extraction sheet, and assessed the risk of bias with the Cochrane risk of bias tool. The primary outcomes were efficacy (change in depressive symptoms) and tolerability (discontinuations due to adverse events). We did pair-wise meta-analyses using the random-effects model and then did a random-effects network meta-analysis within a Bayesian framework. We assessed the quality of evidence contributing to each network estimate using the GRADE framework. This study is registered with PROSPERO, number CRD42015016023.
Findings:
We deemed 34 trials eligible, including 5260 participants and 14 antidepressant treatments. The quality of evidence was rated as very low in most comparisons. For efficacy, only fluoxetine was statistically significantly more effective than placebo (standardised mean difference -0·51, 95% credible interval [CrI] -0·99 to -0·03). In terms of tolerability, fluoxetine was also better than duloxetine (odds ratio [OR] 0·31, 95% CrI 0·13 to 0·95) and imipramine (0·23, 0·04 to 0·78). Patients given imipramine, venlafaxine, and duloxetine had more discontinuations due to adverse events than did those given placebo (5·49, 1·96 to 20·86; 3·19, 1·01 to 18·70; and 2·80, 1·20 to 9·42, respectively). In terms of heterogeneity, the global I(2) values were 33·21% for efficacy and 0% for tolerability.
Interpretation:
When considering the risk-benefit profile of antidepressants in the acute treatment of major depressive disorder, these drugs do not seem to offer a clear advantage for children and adolescents. Fluoxetine is probably the best option to consider when a pharmacological treatment is indicated.
Funding:
National Basic Research Program of China (973 Program).
Background:
A large and extensive body of research has examined comorbid anxiety and depression in adults. Children and adolescents also frequently present with comorbid anxiety and depression; however, research and treatment require unique environmental and neurodevelopmental considerations in children. As a result, our understanding of comorbid anxiety and depression in children and adolescents is limited.
Objective:
The goal of this systematic review was to examine the current literature focused on comorbid anxiety and depression in children and adolescents. The review included theoretical conceptualizations as well as diagnostic, neurobiological, prevention, and treatment considerations. In addition, a proposed algorithm for the treatment of comorbid anxiety and depression in children/adolescents is provided.
Methods:
This systematic literature review included 3 discrete searches in Ovid SP Medline, PsycInfo, and PubMed.
Results:
The review included and synthesized 115 articles published between 1987 and 2015. The available evidence suggests that anxiety and depression are common in clinical populations of children and adolescents, and that comorbidity is likely underestimated in children and adolescents. Children and adolescents with comorbid anxiety and depression have unique presentations, greater symptom severity, and treatment resistance compared with those who have either disease in isolation. A dimensional approach may be necessary for the future development of diagnostic strategies and treatments for this population. Nascent neuroimaging work suggests that anxiety and depression each represents a distinct neurobiological phenotype.
Conclusions:
The literature that is currently available suggests that comorbid anxiety and depression is a common presentation in children and adolescents. This diagnostic picture underscores the importance of comprehensive dimensional assessments and multimodal evidence-based approaches given the high disease severity. Future research on the neurobiology and the treatment of these common clinical conditions is warranted.
Much biomedical research is observational. The reporting of such research is often inadequate, which hampers the assessment of its strengths and weaknesses and of a study's generalizability. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Initiative developed recommendations on what should be included in an accurate and complete report of an observational study. We defined the scope of the recommendations to cover 3 main study designs: cohort, case-control, and cross-sectional studies. We convened a 2-day workshop in September 2004, with methodologists, researchers, and journal editors, to draft a checklist of items. This list was subsequently revised during several meetings of the coordinating group and in e-mail discussions with the larger group of STROBE contributors, taking into account empirical evidence and methodological considerations. The workshop and the subsequent iterative process of consultation and revision resulted in a checklist of 22 items (the STROBE Statement) that relate to the title, abstract, introduction, methods, results, and discussion sections of articles. Eighteen items are common to all 3 study designs and 4 are specific for cohort, case-control, or cross-sectional studies. A detailed Explanation and Elaboration document is published separately and is freely available at www.annals.org and on the Web sites of PLoS Medicine and Epidemiology. We hope that the STROBE Statement will contribute to improving the quality of reporting of observational studies.
We conducted four studies to examine the relationship between over-exercise and suicidality. Study 1 investigated whether over-exercise predicted suicidal behavior after controlling for other eating disorder behaviors in a patient sample of 204 women (144 with Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) Bulimia Nervosa [BN]). Study 2 tested the prospective association between over-exercise and acquired capability for suicide (ACS) in a sample of 171 college students followed for 3-4 weeks. Study 3 investigated whether pain insensitivity accounted for the relationship between over-exercise and ACS in a new sample of 467 college students. Study 4 tested whether ACS accounted for the relationship between over-exercise and suicidal behavior in a sample of 512 college students. In Study 1, after controlling for key covariates, over-exercise was the only disordered eating variable that maintained a significant relationship with suicidal behavior. In Study 2, Time 1 over-exercise was the only disordered eating behavior that was associated with Time 2 ACS. In Study 3, pain insensitivity accounted for the relationship between over-exercise and ACS. In Study 4, ACS accounted for the relationship between over-exercise and suicidal behavior. Over-exercise appears to be associated with suicidal behavior, an association accounted for by pain insensitivity and the acquired capability for suicide; notably, this association was found across a series of four studies with different populations.
This study aimed to determine: (1) the prevalence of depression, anxiety, and depression associated with anxiety (DA); (2) the risk factor profile of depression, anxiety, and DA; (3) the course of depression, anxiety, and DA over 24 months.
Two-year longitudinal study of 20,036 adults aged 60+ years. We used the Patient Health Questionnaire and the Hospital Anxiety and Depression Scale anxiety subscale to establish the presence of depression and anxiety, and standard procedures to collect demographic, lifestyle, psychosocial, and clinical data.
The prevalence of anxiety, depression, and DA was 4.7%, 1.4%, and 1.8%. About 57% of depression cases showed evidence of comorbid anxiety, while only 28% of those with clinically significant anxiety had concurrent depression. There was not only an overlap in the distribution of risk factors in these diagnostic groups but also differences. We found that 31%, 23%, and 35% of older adults with anxiety, depression, and DA showed persistence of symptoms after two years. Repeated anxiety was more common in women and repeated depression in men. Socioeconomic stressors were common in repeated DA.
Clinically significant anxiety and depression are distinct conditions that frequently coexist in later life; when they appear together, older adults endure a more chronic course of illness.
Young people aged 10-24 years represent 27% of the world's population. Although important health problems and risk factors for disease in later life emerge in these years, the contribution to the global burden of disease is unknown. We describe the global burden of disease arising in young people and the contribution of risk factors to that burden.
We used data from WHO's 2004 Global Burden of Disease study. Cause-specific disability-adjusted life-years (DALYs) for young people aged 10-24 years were estimated by WHO region on the basis of available data for incidence, prevalence, severity, and mortality. WHO member states were classified into low-income, middle-income, and high-income countries, and into WHO regions. We estimated DALYs attributable to specific global health risk factors using the comparative risk assessment method. DALYs were divided into years of life lost because of premature mortality (YLLs) and years lost because of disability (YLDs), and are presented for regions by sex and by 5-year age groups.
The total number of incident DALYs in those aged 10-24 years was about 236 million, representing 15·5% of total DALYs for all age groups. Africa had the highest rate of DALYs for this age group, which was 2·5 times greater than in high-income countries (208 vs 82 DALYs per 1000 population). Across regions, DALY rates were 12% higher in girls than in boys between 15 and 19 years (137 vs 153). Worldwide, the three main causes of YLDs for 10-24-year-olds were neuropsychiatric disorders (45%), unintentional injuries (12%), and infectious and parasitic diseases (10%). The main risk factors for incident DALYs in 10-24-year-olds were alcohol (7% of DALYs), unsafe sex (4%), iron deficiency (3%), lack of contraception (2%), and illicit drug use (2%).
The health of young people has been largely neglected in global public health because this age group is perceived as healthy. However, opportunities for prevention of disease and injury in this age group are not fully exploited. The findings from this study suggest that adolescent health would benefit from increased public health attention.
None.
While studies have determined the importance of physical activity in advancing health outcomes, relatively few have explored the relationship between exercise and various health behaviors of adolescents. The purpose of this study is to examine the relationship between frequency and intensity of physical activity and both health risk and health promoting behaviors of adolescents.
Data were collected from 822 students attending a large, diverse suburban high school in northeast Florida using a self-administered survey. Multivariate analysis of variance (MANOVA) and analysis of variance (ANOVA) tests examined differences on mean health behavior measures on 3 exercise frequency levels (low, medium, and high) and 2 intensity levels (vigorous physical activity [VPA] and moderate physical activity [MPA]).
Results showed adolescents engaged in high levels of VPA used marijuana less frequently (p = .05) and reported heavy use of marijuana less frequently (p = .03); consumed greater numbers of healthy carbohydrates (p < .001) and healthy fats in their diets (p < .001); used stress management techniques more frequently (p < .001); and reported a higher quality of sleep (p = .01) than those engaged in low levels of VPA. Fewer differences were found on frequency of MPA and health behaviors of adolescents.
These findings suggest that adolescents who frequently participate in VPA may be less likely to engage in drug use, and more likely to participate in a number of health promoting behaviors. Longitudinal and experimental studies are needed to determine what role frequent VPA may play in the onset and maintenance of health enhancing and protecting behaviors among adolescent populations.
Major depressive disorder (MDD) is often complicated by anxiety symptoms, and anxiety disorders occur in approximately 30% of mood cases. This study examined the influence of anxiety comorbidity on the hypothalamic-pituitary-adrenal (HPA) axis response to stress in patients with MDD.
Untreated subjects with pure MDD (n = 15), MDD with comorbid anxiety disorders (n = 18), and pure anxiety disorders (n = 15) were recruited by advertising. Age- and gender-matched control subjects were recruited for each subject with a psychiatric diagnosis (n = 48). All subjects underwent a social stressor, the Trier Social Stress Test (TSST), and blood was collected for adrenocorticotropic hormone (ACTH) and cortisol assay.
When all depressed patients (n = 33) were compared with their matched control subjects (n = 33), they showed a significantly greater ACTH response to the stressor; however, this exaggerated ACTH response was exclusively due to the depressed group with comorbid anxiety disorders. A similar but nonsignificant effect was observed in the cortisol response. Subjects with pure mood or pure anxiety disorders showed normal ACTH and cortisol responses to the TSST. All patient groups showed similar levels of TSST-induced anxiety.
Comorbid anxiety disorders might play a role in the increased activation of the HPA axis observed in patients with major depression.
This study evaluated and compared the performance of three self-report measures: (1) 30-item Inventory of Depressive Symptomatology-Self-Report (IDS-SR30); (2) 16-item Quick Inventory of Depressive Symptomatology-Self-Report (QIDS-SR16); and (3) Patient Global Impression-Improvement (PGI-I) in assessing clinical outcomes in depressed patients during a 12-week, acute phase, randomized, controlled trial comparing nefazodone, cognitive-behavioral analysis system of psychotherapy (CBASP), and the combination in the treatment of chronic depression. The IDS-SR30, QIDS-SR16, PGI-I, and the 24-item Hamilton Depression Rating Scale (HDRS24) ratings were collected at baseline and at weeks 1-4, 6, 8, 10, and 12. Response was defined a priori as a > or =50% reduction in baseline total score for the IDS-SR30 or for the QIDS-SR16 or as a PGI-I score of 1 or 2 at exit. Overall response rates (LOCF) to nefazodone were 41% (IDS-SR30), 45% (QIDS-SR16), 53% (PCI-I), and 47% (HDRS17). For CBASP, response rates were 41% (IDS-SR30), 45% (QIDS-SR16), 48% (PGI-I), and 46% (HDRS17). For the combination, response rates were 68% (IDS-SR30 and QIDS-SR16), 73% (PGI-I), and 76% (HDRS17). Similarly, remission rates were comparable for nefazodone (IDS-SR30=32%, QIDS-SR16=28%, PGI-I=22%, HDRS17=30%), for CBASP (IDS-SR30=32%, QIDS-SR16=30%, PGI-I=21%, HDRS17=32%), and for the combination (IDS-SR30=52%, QIDS-SR16=50%, PGI-I=25%, HDRS17=49%). Both the IDS-SR30 and QIDS-SR16 closely mirrored and confirmed findings based on the HDRS24. These findings raise the possibility that these two self-reports could provide cost- and time-efficient substitutes for clinician ratings in treatment trials of outpatients with nonpsychotic MDD without cognitive impairment. Global patient ratings such as the PGI-I, as opposed to specific item-based ratings, provide less valid findings.
The aim of the present study was to examine whether early adolescent major depressive disorder was associated with negative health outcomes in young adulthood after controlling for depression at the time of follow-up. In addition, indicators of medical and social costs associated with these health consequences were measured.
A total of 705 adolescents participating in a longitudinal study of children varying in risk for depression due to maternal depression were assessed for a history of depression at age 15 years, depressive disorders at age 20, and a variety of health outcomes at age 20.
Results showed that even after controlling for the effects of concurrent depression at age 20, early adolescent depression continued to be associated with poorer interviewer-rated health, poorer self-perceived general health, higher health care utilization and increased work impairment due to physical health, although not with limitations to physical functioning or the presence of chronic medical conditions.
Depression during early adolescence has consequences for health and associated costs during young adulthood. The implications of these findings for screening and treatment of adolescent depression are discussed.
The association between self-reported symptoms and diurnal cortisol profiles was studied in post-puberty adolescents (29 boys and 29 girls, M(age)=15.06 years). The adolescents completed the Children's Depression Inventory, State Trait Anxiety Inventory, and an Aggressive behavior scale. The diurnal cortisol profile was derived from three saliva samples, collected at awakening, noon and evening on a week-end day. Univariate repeated measurement regressions revealed that depressed mood and trait anxiety were strongly and aggressive behavior was weakly related to the diurnal cortisol profile: greater emotional distress was associated with flatter diurnal cortisol profiles. Multivariate analysis, however, revealed that only trait anxiety made an independent contribution. Further analyses suggested that trait anxiety was related to elevated evening cortisol rather than to decreased awakening cortisol and that from a trait anxiety score of 38 onwards, high anxious adolescents show clearly higher evening cortisol than low anxious adolescents. These data suggest that anxiety disorder co-morbidity might explain some of the differences in HPA-axis function among depressed patients.
My world survey 2: National study of youth mental health in Ireland. Headstrong and UCD School of Psychology
- B Dooley
- C O'connor
- A Fitzgerald
- A Reilly
Dooley, B., O'Connor, C., Fitzgerald, A., & O'Reilly, A. (2019). My world survey 2:
National study of youth mental health in Ireland. Headstrong and UCD School of
Psychology. http://www.myworldsurvey.ie/full-report.
Physical activity in European adolescents and associations with anxiety, Fig. 1. Depressive symptoms by comorbidity and physical activity status
- E M Mcmahon
- P Corcoran
- G O'regan
- H Keeley
- M Cannon
- V Carli
- J Balazs
McMahon, E. M., Corcoran, P., O'Regan, G., Keeley, H., Cannon, M., Carli, V., & Balazs, J.
(2017). Physical activity in European adolescents and associations with anxiety,
Fig. 1. Depressive symptoms by comorbidity and physical activity status.
a,b,c,d,e,f,g,h,i,j Each letter represents categories that significantly differed from each other at p ≤ 0.05.
Interpretation of changes in healthrelated quality of life: The remarkable universality of a half a standard deviation
- G R Norman
- J A Sloan
- K W Wyrwich
Norman, G. R., Sloan, J. A., & Wyrwich, K. W. (2003). Interpretation of changes in healthrelated quality of life: The remarkable universality of a half a standard deviation.
Medical Care, 41(5), 582-592.
Manual for the state-trait anxiety scale
- C D Spielberger
- R L Gorsuch
- R Lushene
- P R Vagg
- G A Jacobs
Spielberger, C. D., Gorsuch, R. L., Lushene, R., Vagg, P. R., & Jacobs, G. A. (1983). Manual
for the state-trait anxiety scale. Consulting Psychologists.
Comorbid anxiety and depressive symptoms in children and adolescents: A systematic review and analysis
- Melton
Interpretation of changes in health-related quality of life: The remarkable universality of a half a standard deviation
- Norman