Cognitive behavioural therapy and medication for treatment of adolescent depression: a network meta-analysis.

BACKGROUND: Cognitive behavioural therapy (CBT) and medication are widely accepted and useful interventions for individuals with depression. However, a gap remains in our current understanding of how CBT directly benefits adolescents with depression. AIMS: The purpose of this study was to examine the short- and long-term effectiveness of CBT only, CBT+Medication, or Medication alone in reducing the duration of major depressive episodes, lessening internalizing and externalizing symptoms and improving global functioning. METHODS: Data were extracted from 14 unique studies with a total of 35 comparisons. Network meta-analysis was conducted and p-scores, a measure of the extent of certainty that one treatment is better than another, were used to rank treatments. RESULTS: There was no significant difference between any two treatments for depression, nor internalizing or externalizing symptoms. For global functioning, CBT had significantly greater effect at the longest follow-up than CBT+Medication. CBT+Medication had the highest p-score for depression, short- and long-term effects, and internalizing and externalizing symptoms long-term effects. No indication of publication bias was found. CONCLUSIONS: Neither modality, CBT nor medication, is superior for treating adolescent depression. However, CBT was superior in improving global functioning, which is essential for meeting developmental goals.

Psychosocial determinants of adolescent suicide: A national survey.

BACKGROUND: Suicide is a global health problem with considerable variability across countries in its prevalence and correlates. The aims of this study were to: (a) explore the prevalence and psychosocial determinants of adolescent suicidal ideation, and (b) explore the perceived stigma of suicide among adolescents. METHOD: A nationally representative electronic survey was utilized to collect data from school adolescents. The Joanna Briggs Institute critical appraisal checklist for studies reporting prevalence data was used to design the survey. The study collected data on adolescents' suicidal ideation, depression, self-esteem, stigma of suicide, family functioning, educational stress, and anxiety levels. A representative sample of 647 Jordanian school adolescents was included. RESULTS: The prevalence of suicidal ideation among school adolescents was 11%. Suicidal ideation was significantly higher among respondents who were boys and enrolled in public schools, had a mental health problem, a family history of suicidal attempt, a lower self-esteem, and higher depressive symptoms. The majority of school adolescents agreed with the descriptions of people who take their own lives as being "lost" (70%), "coward" (53%), "stupid" (51%), and "lonely" (49%). CONCLUSION: There is no typical suicide victim, and there are no specific characteristics that can point out those who are suicidal. Suicide remains a complex phenomenon that is embedded in its sociocultural context. Collaborative efforts from Jordanian policy makers, healthcare providers, researchers, and educators are needed to develop culturally appropriate screening and prevention approaches to address suicide among adolescents. Nurses have a significant role in helping adolescents experiencing suicidal ideation and their families restore, maintain, and/or promote their mental health and wellbeing.

Knowledge of Human Monkeypox and Its Relation to Conspiracy Beliefs among Students in Jordanian Health Schools: Filling the Knowledge Gap on Emerging Zoonotic Viruses.

Background and Objective: The recent multi-country outbreak of human monkeypox (HMPX) in non-endemic regions poses an emerging public health concern. University students in health schools/faculties represent a core knowledgeable group that can be helpful to study from a public health point of view. As future healthcare workers, assessment of their knowledge and attitude towards emerging zoonotic viral infections can be helpful to assess their taught material and courses with potential improvement if gaps in knowledge were identified. Therefore, we aimed to evaluate the level of HMPX knowledge, conspiracy beliefs regarding emerging virus infections, as well as their associated determinants among university students studying Medicine, Nursing, Dentistry, Pharmacy, Medical Laboratory Sciences, and Rehabilitation in Jordanian health schools/faculties. In addition, we sought to evaluate the correlation between HMPX knowledge and the extent of holding conspiracy beliefs regarding emerging viral infection. Materials and Methods: A convenient sample of university students was obtained through an electronic survey distributed in late May 2022 using the chain-referral approach. Assessment of HMPX knowledge and general attitude towards emerging virus infections was based on survey items adopted from previously published literature. Results: The study sample comprised 615 students with a mean age of 20 years and a majority of females (432, 70.2%) and medical students (n = 351, 57.1%). Out of eleven monkeypox knowledge items, three were identified correctly by >70% of the respondents. Only 26.2% of the respondents (n = 161) knew that vaccination to prevent monkeypox is available. Age was significantly associated with better HMPX knowledge for a majority of items. Older age, females, and affiliation to non-medical schools/faculties were associated with harboring higher levels of conspiracy beliefs regarding emerging virus infections. Our data also indicate that lower levels of HMPX knowledge were associated with higher levels of conspiracy beliefs. Conclusion: The current study pointed to generally unsatisfactory levels of knowledge regarding the emerging HMPX among university students in Jordanian health schools/faculties. Conspiracy beliefs regarding emerging virus infections were widely prevalent, and its potential detrimental impact on health behavior should be evaluated in future studies.

Voicing Jordanian Adolescents' Suicide.

BACKGROUND: Studies focusing on adolescent suicide in Arab countries are particularly scarce, with the few available undertaken from within an epidemiological paradigm. OBJECTIVE: This study aimed to understand Jordanian adolescents' perceptions, beliefs, and attitudes toward suicide. METHODS: A qualitative design using 12 dual-moderator focus group discussions was conducted in public schools. Participants were selected from the three main regions of the country (rural southern, urban central, and suburban northern). Participants included Jordanian adolescent boys and girls, aged 14-17 years, who reported experiencing mild to moderate depressive symptoms. A relational content analysis approach was used for coding data, and a content analysis was used to identify salient thematic categories. Data were analyzed using NVivo software. RESULTS: Four themes emerged, including perceived risk factors, perceived protective factors, active and passive suicidal ideations, and e-games and Internet influences. Main risk factors were depression; anxiety; stigma, shame, and isolation; family issues; life pressures; and guilt. Conversely, religiosity, perceived positive family functioning, and availability of long-term goals seemed to confer resilience to adolescents' suicidal ideation and behavior. Passive suicidality (having death wishes without any plans to complete suicide) was noticed most among participants who feared jeopardizing the family's reputation if they committed suicide. Several boys with active suicidal ideations used the Blue Whale Challenge e-game to learn how to complete suicide and relinquish their problems. DISCUSSION: Suicide is a multifactorial problem requiring multimodal strategies. Evidence from this research suggests that those most passionate about the outcome of interest are encouraged to redouble efforts to reduce modifiable risk factors, enrich protective factors, target the underlying psychiatric illness that informs suicidal ideations and behavior, and research the effect of social media and Internet activity more deeply. Parents are advised to monitor the online activities of their children and familiarize themselves with the digital applications they use.

Barriers related to COVID-19 testing intention.

OBJECTIVES: Although vaccination against the COVID-19 disease has recently become available, individuals are expressing fear and hesitancy towards receiving it. As a result, testing for COVID-19 is still considered a vital method to contain infection. For testing to be effective, barriers towards testing intention need to be investigated; and available literature on the challenges are scarce. This study aimed to investigate barriers of COVID-19 testing among a sample of Jordanian adults and predict testing intention within the context of these barriers. METHODS: A cross-sectional, descriptive, and predictive design was employed in this study among a sample of 1074 Jordanian adults. RESULTS: Three clusters of barriers predicted testing intention; perceived discrimination at work, concerns of individual's privacy, and having negative feelings towards testing. While perceived discrimination at work and privacy concerns were negatively associated with individuals' intention for testing, experiencing negative feelings towards COVID-19 testing was a positive predictor. CONCLUSION: Within the context of the study findings, public health nurses need to promote safety at the workplace, protect an individual's privacy, and eliminate negative feelings towards testing uptake through the provision of accurate and up-to-date information regarding the COVID-19 disease.

Adverse events in Malaysia: Associations with nurse's ethnicity and experience, hospital size, accreditation, and teaching status.

PURPOSE: In Malaysia, private healthcare sector has become a major player in delivering healthcare services alongside the government healthcare sector. However, wide disparities in health outcomes have been recorded, and adverse events in these contexts have yet to be explored. The purpose of this study was to explore associations between nurse's ethnicity and experience, hospital size, accreditation, and teaching status with adverse events in Malaysian private hospitals. METHODS: A cross-sectional survey was conducted in 12 private hospitals in Malaysia. A total of 652 (response rate = 61.8%) nurses participated in the study. Data were collected using self-administered questionnaire on nurses' characteristic, adverse events and events reporting, and perceived patient safety. RESULTS: Patient and family complaints events were the most common adverse events in Malaysian private hospitals as result of increased cost of care (3.24 ± 0.95) and verbal miscommunication (3.52 ± 0.87). CONCLUSION: Hospital size, accreditation status, teaching status, and nurse ethnicity had a mixed effect on patient safety, perceived adverse events, and events reporting. Policy makers can benefit that errors are related to several human and system related factors. Several system reforms and multidisciplinary efforts were recommended for optimizing health, healthcare and preventing patient harm.

Acute stress disorder, coping self-efficacy and subsequent psychological distress among nurses amid COVID-19.

PURPOSE: Health care professionals, particularly nurses, are considered a vulnerable group to experience acute stress disorder (ASD) and subsequent psychological distress amid COVID-19 pandemic. This study aims to establish the prevalence of acute stress disorder and predictors of psychological distress among Jordanian nurses. METHODS: A quantitative, cross-sectional, descriptive and comparative design was used. Data were collected using a Web-based survey. A total of 448 Jordanian nurses (73% females) completed and returned the study questionnaire. RESULTS: The majority of nurses (64%) are experiencing ASD due to the COVID-19 pandemic and thus are at risk for PTSD predisposition. More than one-third of nurses (41%) are also suffering significant psychological distress. Among our sample, age, ASD and coping self-efficacy significantly predicted psychological distress. More specifically, younger nurses are more prone to experience psychological distress than older ones. While higher scores on ASD showed more resultant psychological distress, coping self-efficacy was a protective factor. CONCLUSION: Given that individuals who suffer from ASD are predisposed to PTSD, follow-up with nurses to screen for PTSD and referral to appropriate psychological services is pivotal. Coping self-efficacy is found to ameliorate the effect of psychological distress on nurses' traumatic experience. Such findings warrant intensive efforts from health care institutions to provide psychosocial support services for nurses and ongoing efforts to screen them for traumatic and psychological distress symptoms. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing leaders and managers are in the forefront of responding to the unique needs of their workforces during the COVID-19 crisis. They need to implement stress-reduction strategies for nurses through providing consecutive rest days, rotating allocations of complex patients, arranging support services and being accessible to staff. They also need to ensure nurses' personal safety through securing and providing personal safety measures and undertake briefings to ensure their staff's physical and mental well-being, as well as providing referrals to appropriate psychological services.

Developing an Understanding of Adolescents' Knowledge, Attitudes, and Practices Toward COVID-19.

Adolescents are more likely to engage in risky health practices related to COVID-19. Their compliance with infection control measures is a key factor to mitigate the spread of the disease. The purpose of this study was to explore the knowledge, attitudes, and practices toward COVID-19 and their correlates among Jordanian adolescents. An online cross-sectional survey was utilized. A total of 1,054 Jordanian adolescents aged 12-18 completed and returned the survey. Overall, Jordanian adolescents showed a good base of knowledge regarding COVID-19 (regardless of their demographic characteristics) and tended to hold positive attitudes toward the country's curfew and other protective measures. The majority of adolescents reported that television and social media were their main source of information on COVID-19, while few reported receiving such information from their schools. The majority reported practicing effective health protective behaviors to prevent the spread of COVID-19, which was significantly predicted by their knowledge and attitudes toward these measures. However, there was a relatively small, yet clinically significant, percentage of adolescents who showed poor knowledge on COVID-19, had negative attitudes toward protective measures, and reported being engaged in risky practices related to infection spread. Tailored efforts are needed to improve the levels of knowledge, attitudes, and practices among adolescents. Raising awareness and promoting positive attitudes are vital to change adolescents' health practices. Policy makers should ensure that school nurses are available in all schools and working to their full scope. School nurses are the eyes and ears of public health and primary care. They are essential members on pandemic preparedness, reopening and reentry planning teams, and can lead health care in schools and practice in a holistic culturally competent proactive manner to address the needs of students.

Social Determinants of Resilience Among Syrian Refugees in Jordan.

The current study explores the level and social determinants of resilience among Syrian refugees residing in Jordan. Having high levels of resilience can help refugees positively adapt to challenges and cope with the burden of stressors associated with warfare, turmoil, and displacement. A sample of 151 Syrian refugees ages 18 to 69 residing in Jordan completed the Arabic version of the Connor-Davidson Resilience Scale. Resilience scores among Syrian refugees in Jordan were generally low. Refugees' place of residence, educational level, employment status, and monthly income were significantly associated with lower resilience scores and together explain approximately 37% of variance in resilience scores. Tailored resilience-building and educational programs are needed to help Syrian refugees develop the ability to withstand, adapt to, and recover from stress and adversity, and maintain or return to healthy mental states. Future research involving longitudinal assessment of resilience is needed to fully understand the role and determinants of resilience in this population. [Journal of Psychosocial Nursing and Mental Health Services, 58(8), 31-38.].

Sexual Satisfaction Among Infertile Couples: Demographics and Psychosocial Health Factors.

The purpose of the current study was to explore sexual satisfaction among infertile couples in Jordan and its associations with psychosocial and sociodemographic factors. Using a descriptive correlational design, 248 infertile couples from outpatient clinics were recruited and filled out a questionnaire on sexual satisfaction, in addition to perceived social support, depressive symptoms, psychological stress, coping skills, optimism, life satisfaction, and sociodemographics. Sexual satisfaction was significantly and positively correlated with perceived social support, optimism, life satisfaction, and coping. Stronger association was observed between sexual satisfaction and optimism. No difference was found in sexual satisfaction in relation to participants' gender, age, working status, or education. This study highlights the importance of building mental health nurses' competence to provide education and counseling on sexuality to improve the quality of life of infertile couples and optimize their sexual wellness. The most recent guidelines for psychosocial care for infertile couples are discussed. [Journal of Psychosocial Nursing and Mental Health Services, 58(9), 40-47.].

Measuring the social impact of nursing research: An insight into altmetrics.

AIMS: The objectives of this study were to (a) identify nursing journal articles that provoked the most online activity and discussion and (b) assess the association between these articles' altmetric scores and publication characteristics, citation counts; and publishing journals metrics. BACKGROUND: Altmetrics, or alternative metrics, have recently emerged as a complementary way of measuring the societal impact of research by assessing the public engagement with research output. To date, no studies have yet investigated the online attention about scientific papers published in the nursing field. DESIGN: Integration of quantitative and qualitative synthesized evidence. DATA SOURCES AND REVIEW METHODS: InCites Journal Citation Report was used to identify a list of nursing journals indexed in the Web of Science Core Collection. Altmetric Explorer was selected as an altmetrics harvesting tool. The search in Altmetric Explorer yielded 66,608 research outputs from 118 nursing journals. The articles with the top 100 altmetric attention score (AAS) were identified and a new search, limited to only those 100 articles, was run to produce aggregate metrics specific to those articles. The articles were also exported for thematic analysis. RESULTS: The median AAS for the 100 articles was 248, ranging from 138 - 649. The articles were mostly discussed on Twitter, followed by news outlets and Mendeley. Articles indexed in the nursing journals category attracted low online attention compared with articles published in other health journal categories. Twitter remained the dominant source of attention over the years 2012-2018, followed distantly by news outlets. Most online attention came from the USA and the UK. Of the top 100 articles included in the study, the Journal of Advanced Nursing published the highest number of articles (N = 26; Median AAS = 179). The AAS was not significantly different between articles published in Q1 journals and those published in Q2 and Q3 journals. There was a significant relationship between articles' AASs and their citation counts on Scopus and Web of Science. Publication date was significantly related to citation counts on Scopus and Web of Science but not with AASs. CONCLUSION: Altmetrics will likely continue to evolve alongside the rapidly expanding use of social media and online platforms. As nursing continues to strive to have our research and scholarship inform policy, translated into practice and recognized for its scientific merit, we have to remain vigilant about the best ways to disseminate the important work we are doing. Research, such as this study, will allow nursing scholars to benchmark our progress as we adapt to the changing environment for measuring impact and quality in the digital age.

Nursing research in the Arab Region: A bibliometric analysis.

AIMS: Scientific discovery in general, and nursing research specifically, is an increasingly global effort consistent with changing demographics and the need to provide culturally competent care in a diverse society. Given that Arabs account for an increasing proportion of the populations in many Western countries, this study presents findings from the first bibliometric analysis of nursing research conducted through December 2017 in the Arab region. METHODS: We used quantitative and qualitative indicators to analyse bibliometric data from Scopus. RESULTS: We provided significant data on Arab nursing publication output and growth trends; types of published documents; publication geographic loci, focus, and subject categories; authors' collaboration patterns; core publishing journals and their impact; and citation patterns. CONCLUSIONS: Our findings highlighted the need for Arab policy makers and funding agencies to allocate research funding that supports the dissemination of Arab nursing research into the broader scientific community so that Western researchers, policymakers, and health care providers can appropriately address the health care needs of Arab individuals and families. The insights gleaned regarding the performance of journals, authors, countries, and institutions are discussed in relation to the potential impacts of the publish-or-perish culture of the current academic world.

Comparison of the performance of the Beck Depression Inventory-II and the Center for Epidemiologic Studies-Depression Scale in Arab adolescents.

BACKGROUND AND PURPOSE: Few instruments have been established as valid and reliable to screen for depression among Arab adolescents. The purpose of this study was to examine and compare the performance of two of the most widely used depression screening instruments, the Beck Depression Inventory-II (BDI-II) and the Center for Epidemiologic Studies-Depression scale (CES-D), with Arab adolescents. METHODS: A nationwide school survey was conducted in Jordan. A total of 3,292 adolescents (1,766 females; 54%) aged 13-17 years completed and returned the survey that included the BDI-II, CES-D, sociodemographics, and health information. Comparisons were made between the BDI-II and CES-D on internal consistency and the reported prevalence of depression in the whole population and subgroups. Multivariate ordinary least squares and logistic regressions were used to assess factors associated with adolescent depression. Agreement regarding recommended cutoffs was also examined using Cohen's k. RESULTS: Depression prevalence was significantly higher with the CES-D compared to the BDI-II among the same set of sample subgroups. Depression scores from both instruments showed different statistical associations with established risk factors for adolescent depression. The two instruments showed a moderate agreement (kappa = 0.55), indicating that the instruments do not completely identify the same cases. Different cutoff scores of the CES-D seemed to perform better for different age groups. CONCLUSIONS: Our results varied systematically as a function of the measure used to identify depression prevalence. Caution in the interpretation of associations of depression scores with risk factors is required, as associations may be measurement artifacts. However, given the limited availability of mental health care resources in Arab countries, screening instruments like the BDI-II and CES-D may be a critical first step in preliminarily identifying cases, albeit neither can replace the clinical interview. We cautiously recommend using the CES-D with the risk of over diagnosing, but with the benefit of finding issues which are not typically addressed when there is a lack of mental health services. With the growing social and political unrest in Arab countries, increasing depression rates over time is expected to be a major public health issue. Methodical consideration for how to invest in community-based screening is warranted.

Psychometric Properties and Factor Structure of the Center for Epidemiologic Studies Depression Scale in a National Sample of Arab Adolescents.

Having valid, reliable, and culturally adapted tools to screen for adolescent depression is a crucial concern for mental health care professionals who promote preventive care. To this aim, this study tested the psychometric properties and factor structure of the Center for Epidemiologic Studies Depression (CES-D) Scale among Arab adolescents. A nationally representative sample of 3,292 Jordanian adolescents aged 13-17 completed the CES-D 20-item scale. A principal axis factoring with a varimax rotation was used to identify the factor structure of the scale on a half of the sample (n1 = 1,655), followed by a confirmatory factor analysis to assess the fitness of the factor structure to the other half of the sample (n2 = 1,637) on a variety of model-fit indices. Findings did not support the original four-factor structure. The results indicated that two factors provide a reasonably better fit: Factor 1 combined items on depressed affect, somatic complaints and interpersonal problems, and Factor 2 consisted of the remaining four positive affect items. The modified model showed high internal reliability and excellent construct validity. The results revealed that depression construct among Arab adolescents, as measured by the CES-D, differs from that in other ethnic groups. Nurses and other health professionals need to closely examine the different presentation of depressive symptoms across racial and ethnic groups to avoid diagnostic errors, inappropriate management, and poor compliance.

Family functioning moderates the impact of depression treatment on adolescents' suicidal ideations.

PURPOSE: The purpose of this study was to explore whether adolescent-perceived family functioning moderates the depression treatment effects on suicidal ideations. METHODS: This is a nonpreregistered exploratory secondary analysis of the TADS RCT, which included four treatment groups: fluoxetine, CBT, their combination, and placebo. A random coefficients regression model with posteriori CONTRAST statements was conducted to examine the effects of depression treatment on adolescents' suicidal ideations over time (N = 439). Baron and Kenny's (1986) and Kraemer et al.'s (2002) approach was followed to explore family functioning as a potential moderator of the treatment effects on suicidal ideations over time. RESULTS: Adolescents in the four treatment groups did not differ significantly in their suicidal ideations at initial status; however, those in the combination group had faster reduction in suicidality. Family functioning moderated the relationship between depression treatment and adolescents' suicidal ideations. In particular, the results revealed that for adolescents who reported positive family functioning (n = 249), treatment had a significant impact on their suicidal ideations over time. However, for adolescents who reported negative family functioning (n = 190), type of treatment did not have a differential effect on improvement in severity of suicidal ideation over time. CONCLUSION: Findings provided evidence that the process by which depression treatment impacts adolescents' suicidality is contingent upon their family environment. Family-centered approaches to adolescent depression treatment are recommended.

Psychosocial Correlates of Jordanian Adolescents' Help-Seeking Intentions for Depression: Findings From a Nationally Representative School Survey.

Little is known about help-seeking for depression among Jordanian adolescents who are a vulnerable population with high rates of depressive symptoms and few mental health services. The purpose of this study was to (1) explore Jordanian adolescents' helpseeking intentions for depression and (2) examine whether depression stigma, depression severity, or their interaction are associated with Jordanian adolescents' willingness to seek help for depression and the type of treatment they would seek. In collaboration with the Jordanian Ministry of Education, we conducted a nationally representative, school-based survey of adolescents aged 12-17 years ( N = 2,349). One fourth of the adolescents reported they would not seek professional help for depression, and those respondents had higher average depression scores. Among those adolescents willing to seek help, the most likely sources included family member (57%), school counselor (46%), psychiatrist (43%), religious leader (39%), and general health practitioner (28%). Lower stigma scores were associated with greater likelihood to seek psychotherapy or visit a psychiatrist, while higher stigma scores were associated with increased likelihood to seek help from a school counselor or a family member. Jordanian adolescents experience significant barriers to seeking professional help for depression. However, even among adolescents with greater depression severity and depression stigma, school counselors were identified as a key resource for help. These findings suggest that school-based interventions may fill a critical service need for adolescents with depression and other mental health problems. School nurses should be leveraged along with counselors to address mental health issues in this vulnerable population.

Depression in Arab Adolescents: A Qualitative Study.

Depression rates among Arab adolescents are expected to rapidly increase necessitating research-based data to aid in planning effective strategies to implement primary prevention and treatment interventions. The current study aimed to capture Jordanian adolescents' experience of depression, identify perceived contributing factors, and assess their attitudes toward depression interventions. An exploratory, qualitative design was used to collect data from 92 participants (age range = 14 to 17) through 12 focus groups. Two main analytical themes and related subthemes were identified. The first theme focused on participants' perceived mental health status, Being a Depressed Adolescent, with two related subthemes: Symptom Profiles and Feelings of Uncertainty and Perceived Roots of Depression. The second theme focused on the experience of Living With Depression and encapsulated two subthemes: Seeking Supportive Resources and Escaping From Labeling. The study revealed gender differences in the recognition of depression symptoms, willingness to seek care, the ability to communicate symptoms, expectations of care, and views on the best sources of help. For girls and boys, the fear of being labeled as mentally ill contributes to poor engagement in, adherence to, and use of mental health services. A comprehensive approach that considers Arab adolescents' beliefs, attitudes, and experiences in conjunction with the family and social context is needed to address the burden of adolescent depression in Arab nations. [Journal of Psychosocial Nursing and Mental Health Services, 57(10), 34-43.].

The prevalence of depressive symptoms among Arab adolescents: Findings from Jordan.

BACKGROUND: The lack of research regarding the current profile of adolescent depression in the Arab countries in general, and Jordan in particular, makes it difficult to design, implement, and disseminate effective interventions to improve the prevention, diagnosis, and treatment of adolescent depression in the region. The purpose of this study was to estimate a national prevalence of depressive symptoms among adolescents in Jordan, and to identify characteristics associated with severity of depression. METHODS: A descriptive, cross-sectional, nationally representative school survey was utilized. A total of 2,349 Jordanian adolescents aged 12-17 completed and returned the survey packets, which included the Beck Depression Inventory-II and measures of sociodemographics and health history. Participants represented all three regions in the country, with 34% from the northern (suburban) region, 43% from the central (urban) region, and 23% from the southern (rural) region. RESULTS: The majority of the adolescents were females (59%) and 15-17 years old (67%). Almost 14% reported having at least one chronic health problem, 15% reported having a mental health problem, 25% reported having academic difficulties, 8% reported that they had received a psychiatric diagnosis, and 22% reported that they had sought psychological help at some point in the past. The mean total depression score was 16.3 (SD = 11.2, 95% CI = 15.8-16.7), with 34% of the sample reporting moderate to severe depression. Depression was significantly higher among respondents who were female, ages 14-15 years, and living in families with low monthly incomes; and who reported having a chronic health problem, mental health problem, learning difficulty, a psychiatric diagnosis and/or seeking previous psychological help. CONCLUSIONS: Our findings should serve as an alarm, particularly given that rates of depression in the Arab countries are expected to increase rapidly in the context of the Arab Spring. Healthcare providers, researchers, and educators should focus attention on developing effective and culturally appropriate screening, prevention, and intervention approaches using evidence-based guidelines to promote Jordanian adolescent mental health, particularly for depression.

Adolescent Depression in Jordan: Symptoms Profile, Gender Differences, and the Role of Social Context.

The influence of gender and other individual and context characteristics on the prevalence and severity of depressive symptoms among Jordanian adolescents remains unclear. The aims of the current study were to: (a) characterize depressive symptoms profiles for Jordanian adolescents; and (b) examine gender differences in the type, severity, and correlates of depressive symptoms. Cross-sectional data were collected from 2,349 Jordanian adolescents ages 12 to 17 using a nationally representative school survey. The Beck Depression Inventory-II was used to assess the presence and severity of depressive symptoms. Female adolescents had significantly higher mean depression scores (17.9 [SD = 11.6], 95% confidence interval [CI] [17.3, 18.5]) than their male counterparts (13.8 [SD = 10.2], 95% CI [13.2, 14.5]). Approximately 41% of girls and 26% of boys reported scores indicating moderate to severe depression. Sex differences and socially constructed gender differences need to be adequately considered in the planning and delivery of mental health care for adolescent depression. If the risk for depression is gender-specific, prevention strategies cannot be gender-neutral. [Journal of Psychosocial Nursing and Mental Health Services, 56(2), 44-55.].

Personal and Perceived Depression Stigma among Arab Adolescents: Associations with Depression Severity and Personal Characteristics.

BACKGROUND: In Arab communities, the selection, utilization, and attitudes towards mental health services are substantially affected by existing mental illness stigma. However, little is known about how the stigma of depression manifests among Arab adolescents, which makes it difficult to design, implement, and disseminate effective anti-stigma interventions for this vulnerable population. Therefore, the purpose of this study was to determine levels of depression stigma among Arab adolescents. The specific aims were to (1) describe the severity of personal and perceived depression stigma among Arab adolescents and its relationship to severity of depression, and (2) determine characteristics associated with severity of depression stigma among Arab adolescents. METHODS: This study was conducted in Jordan, a Middle Eastern Arab country. A nationally representative, school-based survey was utilized. A total of 2349 Jordanian adolescents aged 12-17 completed and returned the survey packets, which included measures on individual characteristics, depression severity, and depression stigma. RESULTS: The majority of the adolescents (88%) reported scores indicating moderate to high depression stigma. Adolescents reported higher rates of perceived stigma than personal stigma. Depression stigma was not significantly associated with severity of depression, but with adolescent's sex, age, region of residence, parents' education, and history of mental health problem. CONCLUSIONS: This is the first Arab study to isolate the influence of adolescent depression and personal characteristics on personal and perceived depression stigmas, and highlight the presence of these distinctions early in adolescence. Such distinction can inform the design and implementation of policies and interventions to reduce both personal and perceived stigma. The study provides important recommendations on when, how, and why to utilize school settings for anti-depression stigma interventions.