Exploratory Study of Anxiety and Depression Symptoms and Resilience of Adolescents with Internalizing and Externalizing Disorders in a Pediatric Psychiatry Emergency Department
DOI:
https://doi.org/10.61177/HISZ.2023.14.2.4Keywords:
child and adolescent psychiatry, emergency psychiatric care, resilience, emergency admission, clinical sampleAbstract
Background: Adolescence carries a high risk for anxiety and depressive disorders. However, data on anxiety and depression among adolescents treated for mental disorders in pediatric psychiatric emergency wards are still very limited.
Aim: Our objective is to analyze data regarding anxiety and depression within a clinical sample. Additionally, we investigated the influence of resilience on anxiety and depressive symptoms.
Methods: Our clinical sample consisted of 90 adolescents (50 boys, 40 girls, mean age: 13,81±2,39 years) who were admitted to the emergency psychiatric department or outpatient clinic of Heim Pál Children's Hospital (Heim Pál National Pediatric Institute) with various internalizing and externalizing psychiatric disorders. The presence of internalizing and externalizing disorders was confirmed by the Hungarian SDQ questionnaire. In addition to clinical and demographic/treatment data, DASS-21 was used to measure anxiety and depression, and 10-item Resilience Scale (CD RISK) for measuring resilience.
Results: Levels of anxiety and depression differed in terms of gender and the type of diagnosis (internalizing/externalizing). Resilience is below the normal level in our sample, and girls and internalizers showed even lower resilience. The prevalence of clinical depression and anxiety in the group is 71% and 75% respectively. Resilience correlates negatively with depression and anxiety.
Conclusion: Resilience proves to be a protective factor for both depression and anxiety. Therefore, greater awareness and early therapeutic intervention for anxiety and depressive symptoms may help to reduce symptoms, thereby improving the quality of life of the clinical population of adolescents.
References
Achenbach, T. M., Ivanova, M. Y., Rescorla, L. A., Turner, L. V., & Althoff, R. R. (2016). Internalizing/Externalizing Problems: Review and Recommendations for Clinical and Research Applications. Journal of the American Academy of Child and Adolescent Psychiatry, 55(8), 647–656. o. https://doi.org/10.1016/j.jaac.2016.05.012
Altemus, M., Sarvaiya, N., & Neill Epperson, C. (2014). Sex differences in anxiety and depression clinical perspectives. Frontiers in neuroendocrinology, 35(3), 320–330. o. https://doi.org/10.1016/j.yfrne.2014.05.004
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787
Axelson, D. A., & Birmaher, B. (2001). Relation between anxiety and depressive disorders in childhood and adolescence. Depression and anxiety, 14(2), 67–78. o. https://doi.org/10.1002/da.1048
Cabaj, J. L., McDonald, S. W., & Tough, S. C. (2014). Early childhood risk and resilience factors for behavioural and emotional problems in middle childhood. BMC pediatrics, 14, 166. https://doi.org/10.1186/1471-2431-14-166
Clayborne, Z. M., Varin, M., & Colman, I. (2019). Systematic Review and Meta-Analysis: Adolescent Depression and Long-Term Psychosocial Outcomes. Journal of the American Academy of Child and Adolescent Psychiatry, 58(1), 72–79. o. https://doi.org/10.1016/j.jaac.2018.07.896
Connor, K. M., & Davidson, J. R. (2003). Development of a new resilience scale: the Connor-Davidson Resilience Scale (CD-RISC). Depression and anxiety, 18(2), 76–82. o. https://doi.org/10.1002/da.10113
Cutler, G. J., Rodean, J., Zima, B. T., Doupnik, S. K., Zagel, A. L., Bergmann, K. R., Hoffmann, J. A., & Neuman, M. I. (2019). Trends in Pediatric Emergency Department Visits for Mental Health Conditions and Disposition by Presence of a Psychiatric Unit. Academic pediatrics, 19(8), 948–955. o. https://doi.org/10.1016/j.acap.2019.05.132
Gao, T., Ding, X., Chai, J., Zhang, Z., Zhang, H., Kong, Y., & Mei, S. (2017). The influence of resilience on mental health: The role of general well-being. International journal of nursing practice, 23(3), 10.1111/ijn.12535. https://doi.org/10.1111/ijn.12535
Gili, M., Castellví, P., Vives, M., de la Torre-Luque, A., Almenara, J., Blasco, M. J., Cebrià, A. I., Gabilondo, A., Pérez-Ara, M. A., A, M. M., Lagares, C., Parés-Badell, O., Piqueras, J. A., Rodríguez-Jiménez, T., Rodríguez-Marín, J., Soto-Sanz, V., Alonso, J., & Roca, M. (2019). Mental disorders as risk factors for suicidal behavior in young people: A meta-analysis and systematic review of longitudinal studies. Journal of affective disorders, 245, 152–162. o. https://doi.org/10.1016/j.jad.2018.10.115
Goodman, A., Lamping, D. L., & Ploubidis, G. B. (2010). When to use broader internalising and externalising subscales instead of the hypothesised five subscales on the Strengths and Difficulties Questionnaire (SDQ): data from British parents, teachers and children. Journal of abnormal child psychology, 38(8), 1179–1191. o. https://doi.org/10.1007/s10802-010-9434-x
Hampel, P. (2007). Brief report: Coping among Austrian children and adolescents. Journal of adolescence, 30(5), 885–890. o. https://doi.org/10.1016/j.adolescence.2007.04.005
Jámbori S., & Bálint Á. (2021). A szociálisprobléma-megoldás, nevelési stílus és reziliencia vizsgálata magyar és japán szülők körében. Magyar Pedagógia, 121(3), 259–280. o. https://doi.org/10.17670/MPed.2021.3.259
Járai R., Vajda D., Hargitai R., Nagy L., Csókási K., & Kiss E. Cs. (2015). A Connor-Davidson Reziliencia Kérdőív 10 itemes változatának jellemzői. Alkalmazott Pszichológia, 15(1), 129–136. o. https://doi.org/10.17627/ALKPSZICH.2015.1.129
Kapornai K., Vetró Á. (2015): Pszichiátriai sürgősség a gyermekgyógyászatban. Gyermekgyógyászat, 66(3), 185-192. o.
Kaufman, J., & Charney, D. (2000). Comorbidity of mood and anxiety disorders. Depression and anxiety, 12 Suppl. 1, 69–76. o. https://doi.org/10.1002/1520-6394(2000)12:1+<69::AID-DA9>3.0.CO;2-K
Lamers, F., van Oppen, P., Comijs, H. C., Smit, J. H., Spinhoven, P., van Balkom, A. J., Nolen, W. A., Zitman, F. G., Beekman, A. T., & Penninx, B. W. (2011). Comorbidity patterns of anxiety and depressive disorders in a large cohort study: the Netherlands Study of Depression and Anxiety (NESDA). The Journal of clinical psychiatry, 72(3), 341–348. o. https://doi.org/10.4088/JCP.10m06176blu
Lewinsohn, P. M., Hoberman, H. M., & Rosenbaum, M. (1988). A prospective study of risk factors for unipolar depression. Journal of abnormal psychology, 97(3), 251–264. o. https://doi.org/10.1037//0021-843x.97.3.251
Lewinsohn, P. M., Roberts, R. E., Seeley, J. R., Rohde, P., Gotlib, I. H., & Hops, H. (1994). Adolescent psychopathology: II. Psychosocial risk factors for depression. Journal of abnormal psychology, 103(2), 302–315. o. https://doi.org/10.1037//0021-843x.103.2.302
Lovibond, P. F., & Lovibond, S. H. (1995). The structure of negative emotional states: comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behaviour research and therapy, 33(3), 335–343. o. https://doi.org/10.1016/0005-7967(94)00075-u
Mandleco, B. L., & Peery, J. C. (2000). An organizational framework for conceptualizing resilience in children. Journal of child and adolescent psychiatric nursing: official publication of the Association of Child and Adolescent Psychiatric Nurses, Inc., 13(3), 99–111. o. https://doi.org/10.1111/j.1744-6171.2000.tb00086.x
Masten A. S. (2001). Ordinary magic. Resilience processes in development. The American psychologist, 56(3), 227–238. o. https://doi.org/10.1037//0003-066x.56.3.227
Mineka, S., & Oehlberg, K. (2008). The relevance of recent developments in classical conditioning to understanding the etiology and maintenance of anxiety disorders. Acta psychologica, 127(3), 567–580. o. https://doi.org/10.1016/j.actpsy.2007.11.007
Monroe, S. M., Bromet, E. J., Connell, M. M., & Steiner, S. C. (1986). Social support, life events, and depressive symptoms: a 1-year prospective study. Journal of consulting and clinical psychology, 54(4), 424–431. o. https://doi.org/10.1037//0022-006x.54.4.424
Mosheva, M., Hertz-Palmor, N., Dorman Ilan, S., Matalon, N., Pessach, I. M., Afek, A., Ziv, A., Kreiss, Y., Gross, R., & Gothelf, D. (2020). Anxiety, pandemic-related stress and resilience among physicians during the COVID-19 pandemic. Depression and anxiety, 37(10), 965–971. o. https://doi.org/10.1002/da.23085
Muris, P., Steerneman, P., Merckelbach, H., Holdrinet, I., & Meesters, C. (1998). Comorbid anxiety symptoms in children with pervasive developmental disorders. Journal of anxiety disorders, 12(4), 387–393. o. https://doi.org/10.1016/s0887-6185(98)00022-x
Muuss, R. & Porton, H. (1998). Theories of adolescence. (7th ed.) New York: McGraw-Hill.
Newcomb, A. F., & Bagwell, C. L. (1996). The developmental significance of children's friendship relations. In W. M. Bukowski, A. F. Newcomb, & W. W. Hartup (Eds.), The company they keep: Friendship in childhood and adolescence, 289–321. o. Cambridge: Cambridge University Press.
Piko, B. F., & Fitzpatrick, K. M. (2003). Depressive symptomatology among Hungarian youth: a risk and protective factors approach. The American journal of orthopsychiatry, 73(1), 44–54. o. https://doi.org/10.1037/0002-9432.73.1.44
Pourpashang, M., & Mousavi, S. (2021). The Effects of Group Schema Therapy on Psychological Wellbeing and Resilience in the Clients under Substance Dependence Treatment. Journal of Client-Centered Nursing Care, 7(2), 159-166. o. http://dx.doi.org/10.32598/JCCNC.7.2.366.1
Regalla, M. A., Guilherme, P., Aguilera, P., Serra-Pinheiro, M. A., & Mattos, P. (2015). Attention deficit hyperactivity disorder is an independent risk factor for lower resilience in adolescents: a pilot study. Trends in psychiatry and psychotherapy, 37(3), 157–160. o. https://doi.org/10.1590/2237-6089-2015-0010
Reinherz, H. Z., Stewart-Berghauer, G., Pakiz, B., Frost, A. K., Moeykens, B. A., & Holmes, W. M. (1989). The relationship of early risk and current mediators to depressive symptomatology in adolescence. Journal of the American Academy of Child and Adolescent Psychiatry, 28(6), 942–947. o. https://doi.org/10.1097/00004583-198911000-00021
Ruiz, M. A., & Edens, J. F. (2008). Recovery and replication of internalizing and externalizing dimensions within the personality assessment inventory. Journal of personality assessment, 90(6), 585–592. o. https://doi.org/10.1080/00223890802388574
Scheck Zs., & Földes A. (2015). A depresszió gyakorisága a serdülőkori diákok körében. Orvostudományi értesítő, 88(1), 43 – 47. o.
Shorey, S., Ng, E. D., & Wong, C. H. J. (2022). Global prevalence of depression and elevated depressive symptoms among adolescents: A systematic review and meta-analysis. The British journal of clinical psychology, 61(2), 287–305. o. https://doi.org/10.1111/bjc.12333
Southwick, S. M., Bonanno, G. A., Masten, A. S., Panter-Brick, C., & Yehuda, R. (2014). Resilience definitions, theory, and challenges: interdisciplinary perspectives. European journal of psychotraumatology, 5, 10.3402/ejpt.v5.25338. https://doi.org/10.3402/ejpt.v5.25338
Stauder A., & Konkoly Thege B. (2006). Az észlelt stressz kérdőív (PSS) magyar verziójának jellemzői. Mentálhigiéné és Pszichoszomatika, 7(3), 203 – 216. o. https://doi.org/10.1556/mental.7.2006.3.4
Susánszky É., & Szántó Z. (2008). Ifjúság és egészség. Új Ifjúsági Szemle: Ifjúságelméleti Folyóirat, 4(nyár/ősz), 87–96. o.
Turi E., Gervai J., Áspán N., Halász J., Nagy P., & Gádoros J. (2013). A Képességek és Nehézségek Kérdőív (SDQ-Magy) validálása serdülőkorú klinikai populációban [Validation of the Hungarian version of the Strengths and Difficulties Questionnaire in an adolescent clinical population]. Psychiatria Hungarica: A Magyar Pszichiátriai Társaság tudományos folyóirata, 28(2), 165–179. o.
Zemplényi A., Józwiak-Hagymásy J., Kovács S., Erdősi D., & Vörös V. (2021). Major depresszív zavarban szenvedő betegek rTMS kezelésének egészség-gazdaságtani elemzése. Letöltve: 29. 13. 2023. 03. Forrás: https://hta.pte.hu/sites/hta.pte.hu/files/inline-files/rTMS%20CEA_PTE_20211025_new%20version_0.pdf
Tringer L. (2003) Sürgősségi ellátás a pszichiátriában, Budapest: Medicina.
R Core Team. (2022). R: A Language and Environment for Statistical Computing. Vienna, Austria: R Foundation for Statistical Computing. https://www.R-project.org/
Sófi Gy., & Törő K. (in press). Viselkedéses eltérések [Behavioral abnormalities]. In Nagy A., & Bognár Zs. (szerk.), Sürgősségi gyermekgyógyászat [Emergency Pediatric Medicine]. Budapest, Hungary: Medicina.
Szokolszky Á., & V Komlósi A. (2015). A „reziliencia-gondolkodás” felemelkedése–ökológiai és pszichológiai megközelítések. Alkalmazott pszichológia, 15(1), 11-26. o.
Watson, D., Clark, L. A., & Tellegen, A. (1988). Development and validation of brief measures of positive and negative affect: the PANAS scales. Journal of personality and social psychology, 54(6), 1063–1070. o. https://doi.org/10.1037//0022-3514.54.6.1063
World Health Organization. (2022). Infant and young child feeding.
Downloads
Published
Issue
Section
License
Copyright (c) 2023 Krisztina Törő, Gábor Csikós, Gergely Fliegauf, Judit Mokos, Gyula Sófi

This work is licensed under a Creative Commons Attribution 4.0 International License.



