Community-Based Prevalence of Externalizing and Internalizing Disorders among School-Aged Children and Adolescents in Four Geographically Dispersed School Districts in the United States.

The Project to Learn About Youth-Mental Health (PLAY-MH; 2014-2018) is a school-based, two-stage study designed to estimate the prevalence of selected mental disorders among K-12 students in four U.S.-based sites (Colorado, Florida, Ohio, and South Carolina). In Stage 1, teachers completed validated screeners to determine student risk status for externalizing or internalizing problems or tics; the percentage of students identified as being at high risk ranged from 17.8% to 34.4%. In Stage 2, parents completed a structured diagnostic interview to determine whether their child met criteria for fourteen externalizing or internalizing disorders; weighted prevalence estimates of meeting criteria for any disorder were similar in three sites (14.8%-17.8%) and higher in Ohio (33.3%). PLAY-MH produced point-in-time estimates of mental disorders in K-12 students, which may be used to supplement estimates from other modes of mental disorder surveillance and inform mental health screening and healthcare and educational services.

Treatment of Attention Deficit/Hyperactivity Disorder among Children with Special Health Care Needs.

OBJECTIVES: To describe the parent-reported prevalence of treatments for attention deficit/hyperactivity disorder (ADHD) among a national sample of children with special health care needs (CSHCN), and assess the alignment of ADHD treatment with current American Academy of Pediatrics guidelines. STUDY DESIGN: Parent-reported data from the 2009-2010 National Survey of Children with Special Health Care Needs allowed for weighted national and state-based prevalence estimates of medication, behavioral therapy, and dietary supplement use for ADHD treatment among CSHCN aged 4-17 years with current ADHD. National estimates were compared across demographic groups, ADHD severity, and comorbidities. Medication treatment by drug class was described. RESULTS: Of CSHCN with current ADHD, 74.0% had received medication treatment in the past week, 44.0% had received behavioral therapy in the past year, and 10.2% used dietary supplements for ADHD in the past year. Overall, 87.3% had received past week medication treatment or past year behavioral therapy (both, 30.7%; neither, 12.7%). Among preschool-aged CSHCN with ADHD, 25.4% received medication treatment alone, 31.9% received behavioral therapy alone, 21.2% received both treatments, and 21.4% received neither treatment. Central nervous system stimulants were the most common medication class (84.8%) among CSHCN with ADHD, followed by the selective norepinephrine reuptake inhibitor atomoxetine (8.4%). CONCLUSION: These estimates provide a benchmark of clinical practice for the period directly preceding issuance of the American Academy of Pediatrics' 2011 ADHD guidelines. Most children with ADHD received medication treatment or behavioral therapy; just under one-third received both. Multimodal treatment was most common for CSHCN with severe ADHD and those with comorbidities. Approximately one-half of preschoolers received behavioral therapy, the recommended first-line treatment for this age group.

Adherence to Guidelines and Federal Psychotropic Medication Labels for the Treatment of Medicaid-Insured Children With ADHD.

OBJECTIVE: This study examined adherence to clinical practice guidelines (CPGs) and U.S. Food and Drug Administration (FDA) medication labels when prescribing psychotropic medications to Medicaid-insured children with attention-deficit hyperactivity disorder (ADHD). METHODS: A retrospective analysis was conducted with 2016-2018 Medicaid claims data across 46 states for children with an ADHD diagnosis and at least one psychotropic medication prescription (N=1,236,068 children). Medications recommended for pediatric use were identified with CPGs from the American Academy of Child and Adolescent Psychiatry and the Florida Medicaid Drug Therapy Management Program for Behavioral Health. RESULTS: Across 46 states, 86.7% of children received guideline-recommended and FDA-approved medications for the treatment of ADHD and comorbid mental disorders. Antidepressants, antihistamines, and second-generation antipsychotics that were not included in CPGs were prescribed for 23.4% of children. CONCLUSIONS: High adherence to CPGs and FDA medication labels for medications prescribed for ADHD was observed, suggesting the effectiveness of guidelines in driving evidence-based care.

Improving Identification of Tic Disorders in Children.

This study combines data from five studies in a quantitative modeling approach to improve identification of tics and tic disorders using two questionnaires (the Motor or Vocal Inventory of Tics and the Description of Tic Symptoms), administered to parents and children N = 1 , 307 . Combining final diagnoses (positive or negative for tic disorder) with data from recently developed questionnaires implemented to assist in the identification of tics and tic disorders in children, we investigate methods for predicting positive diagnosis while also identifying which items in the questionnaires are most predictive. Logistic regression and random forest models are compared using various summary statistics. We further discuss the differences in errors (false positives versus false negatives) in the specification of predictive model tuning parameters. Compared to logistic regression models, random forest models provided comparable and often superior predictive abilities and were also more useful in summarizing the contributions to predictions from individual questions. The combined analyses identified a subset of screener questions that were the best predictors of tic disorders; the identified questions differed based on parent or self-report. These results provide information to inform the future development of tools to screen for tics in a variety of healthcare and epidemiological settings.

Resilient, but for how long? The relationships between temperament, burnout, and mental health in healthcare workers during the Covid-19 pandemic.

Introduction: Dispositional traits of wellbeing and stress-reaction are strong predictors of mood symptoms following stressful life events, and the COVID-19 pandemic introduced many life stressors, especially for healthcare workers. Methods: We longitudinally investigated the relationships among positive and negative temperament group status (created according to wellbeing and stress-reaction personality measures), burnout (exhaustion, interpersonal disengagement), COVID concern (e.g., health, money worries), and moral injury (personal acts, others' acts) as predictors of generalized anxiety, depression, and post-traumatic stress symptoms in 435 healthcare workers. Participants were employees in healthcare settings in North Central Florida who completed online surveys monthly for 8 months starting in October/November 2020. Multidimensional Personality Questionnaire subscale scores for stress-reaction and wellbeing were subjected to K-means cluster analyses that identified two groups of individuals, those with high stress-reaction and low wellbeing (negative temperament) and those with the opposite pattern defined as positive temperament (low stress-reaction and high wellbeing). Repeated measures ANOVAs assessed all time points and ANCOVAs assessed the biggest change at timepoint 2 while controlling for baseline symptoms. Results and Discussion: The negative temperament group reported greater mood symptoms, burnout, and COVID concern, than positive temperament participants overall, and negative participants' scores decreased over time while positive participants' scores increased over time. Burnout appeared to most strongly mediate this group-by-time interaction, with the burnout exhaustion scale driving anxiety and depression symptoms. PTSD symptoms were also related to COVID-19 health worry and negative temperament. Overall, results suggest that individuals with higher stress-reactions and more negative outlooks on life were at risk for anxiety, depression, and PTSD early in the COVID-19 pandemic, whereas individuals with positive temperament traits became more exhausted and thus more symptomatic over time. Targeting interventions to reduce mood symptoms in negative temperament individuals and prevent burnout/exhaustion in positive temperament individuals early in an extended crisis may be an efficient and effective approach to reduce the mental health burden on essential workers.

The Utility of the Behavior Assessment System for Children-2 Behavioral and Emotional Screening System and Strengths and Difficulties Questionnaire in Predicting Mental Disorders in the Project to Learn About Youth-Mental Health.

We examined the predictive utility of the Behavior Assessment System for Children-2 Behavioral and Emotional Screening System (BASC-2-BESS) and Strengths and Difficulties Questionnaire (SDQ) in identifying students with a mental disorder. Data were collected in a two-stage study over 34 months with kindergarten-12th grade (K-12) students (aged 5-19 years) in four U.S. school districts. In Stage 1, teachers completed the BASC-2-BESS and the SDQ. In Stage 2, parents of 1,054 children completed a structured diagnostic interview to determine presence of a mental disorder. Results suggest that teacher versions of the BASC-2-BESS and SDQ have modest utility in identifying children meeting criteria for a mental disorder based on parent report. Area Under the Curve (AUC) statistics representing prediction of any externalizing disorder (.73 for both measures) were higher than the AUCs predicting any internalizing disorder (.58 for both measures). Findings can inform the use of teacher report in mental health screening, specifically the selection of measures when implementing screening procedures.

Surveillance of ADHD Among Children in the United States: Validity and Reliability of Parent Report of Provider Diagnosis.

OBJECTIVE: To evaluate the appropriateness of parent-reported diagnosis of ADHD as a surveillance tool. METHOD: We assessed agreement over time and concordance of parent-reported diagnosis against Diagnostic and Statistical Manual (DSM)-based criteria. We compared concordance of diagnosis and DSM-based criteria by child characteristics, including treatment. RESULTS: Among parents who reported their child had ADHD, 95.7% reported it again 2 years later. Comparing diagnosis with DSM-based criteria, specificity and negative predictive value were high, sensitivity was moderate, and positive predictive value was low. Most children with an ADHD diagnosis who did not meet DSM-based criteria met sub-threshold criteria or took medication for ADHD. Concordance differed by child characteristics and treatment. CONCLUSION: Parent-reported diagnosed ADHD is reliable over time. Although differences in parent-reported diagnosis and DSM-based criteria were noted, these may reflect children with milder symptoms or treated ADHD. Parent-report of child ADHD ever diagnosis may be a good single-item indicator for prevalence.

Protective and risk factors associated with substance use coping among healthcare workers during the COVID-19 pandemic.

Background: Healthcare workers (HCWs) experienced high levels of stress and mental health consequences associated with the COVID-19 pandemic, which may have contributed to unhealthy coping behaviors, such as substance use coping (SUC). This study aimed to understand the extent of and predictors of SUC. Methods: The sample consisted of 263 HCWs in North Central Florida. Univariable and multivariable logistic regression analyses investigated whether moral injury and other work risk factors, protective factors, and clinically relevant symptoms (i.e., work exhaustion, interpersonal disengagement, depression, anxiety, and/or PTSD) were associated with likelihood of SUC. Results: Clinically relevant levels of interpersonal disengagement and anxiety increased the likelihood of SUC. Mediational analyses found that interpersonal disengagement and anxiety explained 54.3% of the relationship between Self Moral Injury and SUC and explained 80.4% of the relationship between professional fulfillment and SUC. Conclusion: Healthcare supervisors should be aware that providers who are experiencing moral injury and less professional fulfillment may be experiencing significant interpersonal disengagement and anxiety, which could lead to SUC. Future studies should examine the effects of implementing targeted prevention and treatment interventions, along with longitudinal outcomes related to SUC behaviors.

Physical activity and self-concept: the SEARCH for diabetes in youth case control study.

In this study, the relationship between physical activity (PA) and 3 self-concept constructs (physical abilities, physical appearance, and general self-concept) was examined. Youth with type 1 diabetes (n = 304), type 2 diabetes (n = 49), and nondiabetic controls (n = 127) aged 10-20 years wore pedometers over 7 days. Youth completed the Self-Description Questionnaire and correlation coefficients were calculated. Mean steps/day were 7413 ± 3415, 4959 ± 3474 and 6870 ± 3521 for type 1, type 2 and control youth, respectively. Significant correlations were found between steps/day and perception of physical abilities (r = .29; r = .31; r = .31) for type 1, type 2, and control youth, respectively. The other correlations were not significant. Among youth with type 2 diabetes, steps/day were significantly correlated with physical appearance (r = .46). The positive correlation between PA and physical abilities suggests a reciprocal relationship between behavior and perception.

Increased Autonomic Reactivity and Mental Health Difficulties in COVID-19 Survivors: Implications for Medical Providers.

Background: Because there is a relationship between mental health (MH) and medical adversity and autonomic dysregulation, we hypothesized that individuals infected with COVID-19 would report greater current autonomic reactivity and more MH difficulties (emotional distress, mindfulness difficulties, and posttraumatic stress). We also hypothesized that individuals diagnosed with COVID-19 who are experiencing difficulties related to their prior adversity and those providing medical care to COVID-19 patients would be more negatively impacted due to their increased stress and infection rates. Method: US participants (N = 1,638; 61% female; Age M = 46.80) completed online self-report measures of prior adversity, current autonomic reactivity and current MH difficulties, and COVID-19 diagnosis history. Participants diagnosed with COVID-19 (n = 98) were more likely to be younger and providing medical care to COVID-19 patients. Results: Individuals diagnosed with COVID-19 reported increased current autonomic reactivity, being more negatively impacted by their prior MH/medical adversities, and currently experiencing more MH difficulties with an increased likelihood of clinically-significant PTSD and depression (p < 0.01 - p < 0.001). Current autonomic reactivity mediated 58.9% to 85.2% of the relationship between prior adversity and current MH difficulties; and COVID-19 diagnosis moderated and enhanced the effect of prior adversity on current autonomic reactivity (p < 0.01). Being a medical provider was associated with increased current autonomic reactivity (p < 0.01), while moderating and enhancing the relationship between current autonomic reactivity and emotional distress and posttraumatic stress symptoms (p < 0.05). Combining COVID-19 diagnosis with being a medical provider increased likelihood of clinically-significant PTSD and depression (p < 0.01). Conclusion: Individuals diagnosed with COVID-19, particularly medical providers, have increased current autonomic reactivity that is associated with their prior adversities and current MH difficulties.

Morally Distressing Experiences, Moral Injury, and Burnout in Florida Healthcare Providers during the COVID-19 Pandemic.

Because healthcare providers may be experiencing moral injury (MI), we inquired about their healthcare morally distressing experiences (HMDEs), MI perpetrated by self (Self MI) or others (Others MI), and burnout during the COVID-19 pandemic. Participants were 265 healthcare providers in North Central Florida (81.9% female, Mage = 37.62) recruited via flyers and emailed brochures that completed online surveys monthly for four months. Logistic regression analyses investigated whether MI was associated with specific HMDEs, risk factors (demographic characteristics, prior mental/medical health adversity, COVID-19 protection concern, health worry, and work impact), protective factors (personal resilience and leadership support), and psychiatric symptomatology (depression, anxiety, and PTSD). Linear regression analyses explored how Self/Others MI, psychiatric symptomatology, and the risk/protective factors related to burnout. We found consistently high rates of MI and burnout, and that both Self and Others MI were associated with specific HMDEs, COVID-19 work impact, COVID-19 protection concern, and leadership support. Others MI was also related to prior adversity, nurse role, COVID-19 health worry, and COVID-19 diagnosis. Predictors of burnout included Self MI, depression symptoms, COVID-19 work impact, and leadership support. Hospital administrators/supervisors should recognize the importance of supporting the HCPs they supervise, particularly those at greatest risk of MI and burnout.

Editorial: Relative Immaturity or Attention-Deficit/Hyperactivity Disorder: A Diagnostic Dilemma?

Attention-deficit/hyperactivity disorder (ADHD) is among the most common disorders of childhood1 and causes significant morbidity throughout the life span.2 Appropriate diagnosis and treatment of ADHD are thus critically important. The diagnosis of ADHD, however, is not straightforward. Clinicians must rely on parent and teacher reports of the child's behavior in comparison to other children the same age.3 Although various tests or procedures may be helpful in the diagnosis of ADHD, none of them obviates the need to rely on parent and teacher reports. Making matters more complicated, the agreement between parent and teacher reports of a child's ADHD-like behavior is low.4.

ADHD and Psychiatric Comorbidity: Functional Outcomes in a School-Based Sample of Children.

Objective: Investigate the prevalence and impact of psychiatric comorbidities in community-based samples of schoolchildren with/without ADHD. Method: Teachers and parents screened children in South Carolina (SC; n = 4,604) and Oklahoma (OK; n = 12,626) for ADHD. Parents of high-screen and selected low-screen children received diagnostic interviews (SC: n = 479; OK: n = 577). Results: Psychiatric disorders were increased among children with ADHD and were associated with low academic performance. Conduct disorder/oppositional defiant disorder (CD/ODD) were associated with grade retention (ODD/CD + ADHD: odds ratio [OR] = 3.0; confidence interval [CI] = [1.5, 5.9]; ODD/CD without ADHD: OR = 4.0; CI = [1.7, 9.7]). School discipline/police involvement was associated with ADHD alone (OR = 3.2; CI = [1.5, 6.8]), ADHD + CD/ODD (OR = 14.1, CI = [7.3, 27.1]), ADHD + anxiety/depression (OR = 4.8, CI = [1.6, 14.8]), and CD/ODD alone (OR = 2.8, CI = [1.2, 6.4]). Children with ADHD + anxiety/depression had tenfold risk for poor academic performance (OR = 10.8; CI = [2.4, 49.1]) compared to children with ADHD alone. This should be interpreted with caution due to the wide confidence interval. Conclusion: Most children with ADHD have psychiatric comorbidities, which worsens functional outcomes. The pattern of outcomes varies by type of comorbidity.

ADHD and health services utilization in the national health interview survey.

OBJECTIVE: Describe the general health, comorbidities and health service use among U.S. children with ADHD. METHOD: The 2001 National Health Interview Survey (NHIS) contained the Strengths and Difficulties Questionnaire (SDQ; used to determine probable ADHD), data on medical problems, overall health, and health care utilization. RESULTS: Asthma was two and headaches were three times more prevalent, and overall health was significantly lower, among children with SDQ ADHD. Of children with SDQ ADHD, 45% saw a mental health professional in the past year and over half were not taking medication regularly. Urban residence, age (9-13), higher family education, having health insurance, and having comorbid emotional problems were associated with mental health care utilization in children with SDQ AD/HD, while race, gender and family income were not associated. CONCLUSIONS: Children with SDQ AD/HD had more medical problems and were more likely to visit the emergency room. Treatment data suggest a problem with under-treatment of ADHD in the United States. Interventions should be targeted in rural areas, and among families with low education and without health insurance.

Adherence to Recommended Care Guidelines in the Treatment of Preschool-Age Medicaid-Enrolled Children With a Diagnosis of ADHD.

OBJECTIVE: Attention-deficit/hyperactivity disorder (ADHD) is the most common neurodevelopmental disorder of childhood. Clinical guidelines recommend behavior therapy as the first-line treatment for preschool-age children with ADHD. This study evaluated longitudinal patterns of services received by Medicaid-enrolled children ages 2 to 5 with ADHD in seven southeastern states (Alabama, Florida, Georgia, Louisiana, Mississippi, North Carolina, and South Carolina). METHODS: A discrete sequence clustering analysis was used with 2005-2012 Medicaid Analytic eXtract data to profile patient-level utilization for each state, with a focus on receipt of psychological services and medication. The model output was used to assess utilization behaviors longitudinally relative to recommended care guidelines and to characterize sources of variation in utilization patterns by demographic and ecological factors. RESULTS: Five states had a utilization profile with a high probability of receipt of psychological services before medication among children with ADHD, covering 16% of the total study population. Most young children's ADHD care experience in the seven states (65%) fit utilization profiles characterized by a high probability of receiving any ADHD medication. Black race was significantly associated with higher utilization of psychological services in three states. CONCLUSIONS: About 16% of Medicaid-enrolled preschool-age children with ADHD received care during 2005-2012 that appeared to be consistent with 2011 recommended care guidelines. State-level and subpopulation variations in utilization for ADHD-related clinical care were found. The findings indicate that there were major gaps in treatment for ADHD among young children and that the gaps are wider for some states and subpopulations of children.

The Association Between Race/Ethnicity and Socioeconomic Factors and the Diagnosis and Treatment of Children with Attention-Deficit Hyperactivity Disorder.

OBJECTIVE: Assessing race/ethnicity and socioeconomic status (SES) relationships with Attention-Deficit/Hyperactivity Disorder (ADHD) diagnosis, treatment, and access to care has yielded inconsistent results often based only on parent-report. In contrast, this study used broader ADHD diagnostic determination including case-definition to examine these relationships in a multisite elementary-school-based sample. METHOD: Secondary analysis of children with and without ADHD per parent and teacher-reported Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria evaluated SES, race/ethnicity, and other variables through simple bivariate/multivariable models within and across: parent-reported diagnosis, medication treatment, and meeting ADHD study case-definition. RESULTS: The total sample included 51.9% male, 51.3% White, and 53.1% with private insurance; 10% had parent-reported ADHD diagnoses while 8.3% met ADHD study case-definition. In multivariable models, White children had higher odds of parent-reported diagnoses than Black, Hispanic, and Other Race/Ethnicity children (p < 0.05), but only Hispanic children had lower odds of being case-positive (<0.05); males and children in single-parent households had higher odds of parent-reported diagnoses and being case-positive (p < 0.05); and children who were White, male, and had health insurance had higher odds of taking medication (p < 0.05). Among children who were case-positive, those with Medicaid, White, and 2-parent statuses had higher odds of parent-reported diagnoses (p < 0.05). CONCLUSION: Children with underlying ADHD appear more likely to have assessment/medication treatment access if they are White, male, have health insurance (particularly Medicaid), and live in 2-parent households. While boys and children raised by single parents may have higher rates of ADHD diagnoses, false-positive diagnostic risk also appeared higher, inviting further investigation.

Stress-related mental disorders in childhood cancer survivors.

BACKGROUND: This report evaluated the association between surviving pediatric cancer and receiving a diagnosis of a stress-related mental disorder (SRMD) (i.e., post-traumatic stress disorder (PTSD), acute stress disorder, or adjustment disorders). PROCEDURE: The dataset comprised a cohort of Medicaid eligible children, ages birth to 15 years during baseline years 1996-2001 and followed at least 1 year until age 19 years or the end of 2003. Childhood cancer survivors (N = 390) identified from the SC Central Cancer Registry were frequency matched within age groups at each baseline year to children with no history of malignancy (N = 1,329). Survival curves and cumulative incidence of SRMD were estimated using the Kaplan-Meier method. Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for pediatric cancer survival and selected covariates. RESULTS: The 8-year incidence of SRMD was 18.6% (95% CI: 12.47, 24.8) among childhood cancer survivors and 7.3% (5.0, 9.6) among children with no history of malignancy, HR = 3.22 (2.17, 4.76). Significant covariates for this group included race, sex, and previous mental disorder, adjusted HR = 3.00 (2.02, 4.45). Significant predictors among the childhood cancer survivors included cancer type, age group, treatment, and previous mental disorder. CONCLUSIONS: Given the potential benefit of interventions for those with prior psychopathology, that children are less likely to verbalize emotional problems, and the detrimental implications of undiagnosed mental disorders, the health evaluations of childhood cancer patients and the follow-up visits for the survivors should incorporate assessment for mental disorders, especially SRMD.

US suicide rates by age group, 1970-2002: an examination of recent trends.

US suicide rates have declined in recent years, reversing earlier trends. We examined suicide rates among 4 age groups from 1970 to 2002 and the factors that may have contributed to the decline. We paid particular attention to newer anti-depressants because of recent concerns and controversy about a possible association with suicidal behaviors. These trends warrant more extensive analysis of suicide rates among specific subgroups, including consideration of additional variables that may influence rates differentially. The relative contributions of depression diagnosis and treatment, postsuicide attempt care, and other contextual factors (e.g., overall economic conditions) also deserve attention. If the decline is associated with contextual factors, clarifying these associations will better inform public policy decisions and contribute to more effective interventions for preventing suicide.

Persistence of Parent-Reported ADHD Symptoms From Childhood Through Adolescence in a Community Sample.

OBJECTIVE: To examine ADHD symptom persistence and factors associated with elevated symptom counts in a diverse, longitudinal community-based sample. METHOD: Parents reported demographics and completed a diagnostic interview repeatedly over a 6-year period. At Time 1, 481 interviews were completed about children (5-13 years); all participants were invited to four annual follow-up interviews, and 379 (79%) completed at least one. Inattentive (IA) and hyperactive-impulsive (HI) symptom counts were modeled with logistic quantile regression, while accounting for study design complexities. RESULTS: The prevalence of seven IA symptoms remained stable from early childhood through late adolescence. The prevalence of eight HI symptoms decreased by more than half over time. After demographic adjustment, the upper quartile of HI symptom counts decreased with age (p < .01). High HI symptom counts persisted more among those with high IA symptom counts (p = .05). CONCLUSION: This study further characterizes and provides insights into ADHD symptom trajectory through adolescence.

Family and psychosocial risk factors in a longitudinal epidemiological study of adolescents.

OBJECTIVE: To study the association of family and social risk factors with psychopathology in a longitudinal study of adolescents. METHOD: 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. RESULTS: 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. CONCLUSIONS: Family structure and cohesion and stressful life events are associated with affective disorders in adolescents.